Base de dados : MEDLINE
Pesquisa : N04.452.095.738 [Categoria DeCS]
Referências encontradas : 10263 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 1027 ir para página                         

  1 / 10263 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29297077
[Au] Autor:Purnell TS; Luo X; Cooper LA; Massie AB; Kucirka LM; Henderson ML; Gordon EJ; Crews DC; Boulware LE; Segev DL
[Ad] Endereço:Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
[Ti] Título:Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014.
[So] Source:JAMA;319(1):49-61, 2018 01 02.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. Objective: To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation. Design, Setting, and Participants: A secondary analysis of a prospectively maintained cohort study conducted in the United States of 453 162 adult first-time kidney transplantation candidates included in the Scientific Registry of Transplant Recipients between January 1, 1995, and December 31, 2014, with follow-up through December 31, 2016. Exposures: Race/ethnicity. Main Outcomes and Measures: The primary study outcome was time to LDKT. Multivariable Cox proportional hazards and competing risk models were constructed to assess changes in racial/ethnic disparities in LDKT among adults on the deceased donor kidney transplantation waiting list and interaction terms were used to test the statistical significance of temporal changes in racial/ethnic differences in receipt of LDKT. The adjusted subhazard ratios are estimates derived from the multivariable competing risk models. Data were categorized into 5-year increments (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size in each analytical cell. Results: Among 453 162 adult kidney transplantation candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white; 30%, black; 16%, Hispanic; and 6%, Asian), 59 516 (13.1%) received LDKT. Overall, there were 39 509 LDKTs among white patients, 8926 among black patients, 8357 among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1% among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6% among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in the receipt of LDKT increased (P < .001 for all statistical interaction terms in adjusted models comparing white patients vs black, Hispanic, and Asian patients). In 1995-1999, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian patients. In 2010-2014, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among Asian patients. Conclusions and Relevance: Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014. These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/etnologia
Falência Renal Crônica/etnologia
Transplante de Rim/tendências
Doadores Vivos
[Mh] Termos MeSH secundário: Adulto
Afroamericanos
Americanos Asiáticos
Estudos de Coortes
Grupo com Ancestrais do Continente Europeu
Feminino
Disparidades em Assistência à Saúde/tendências
Hispano-Americanos
Seres Humanos
Estimativa de Kaplan-Meier
Falência Renal Crônica/cirurgia
Transplante de Rim/mortalidade
Masculino
Meia-Idade
Estados Unidos/epidemiologia
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19152


  2 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
[PMID]:29394480
[Au] Autor:McBeth CL; Durbin-Johnson B; Siegel EO
[Ti] Título:Interprofessional Huddle: One Children's Hospital's Approach to Improving Patient Flow.
[So] Source:Pediatr Nurs;43(2):71-76, 2017 Mar-Apr.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Admitting pediatric patients promptly to the appropriate unit where they can receive specialty care is of critical importance to safe, quality care. A daily morning huddle was implemented at one children's hospital as a quality improvement project. The aim of this project was to improve patient flow throughout the children's hospital by improving interprofessional and interdepartmental communication and collaboration. This article reports on changes in patient flow before and after implementation of the daily huddle, as measured by pediatric emergency department (ED) boarding times. This retrospective, descriptive study was conducted at a regional children's hospital within an academic hospital. Data were collected from the electronic medical record over two separate time periods coinciding with pre/post-huddle implementation. Non-random, purposive sampling was used, resulting in a prehuddle sample (n = 450) and post-huddle sample (n = 329). Times were significantly shorter after huddle implementation compared to pre-huddle (p < 0.001) from admission orders in the ED to transfer to the PICU or pediatric ward. The median time decreased from 3.0 to 2.6 hours post-huddle implementation. These findings suggest huddles as one potential factor in the formula to improve patient flow from the ED by enhancing interprofessional and interdepartmental collaboration and communication. Findings from this study are of vital importance to pediatric patients, nurses, and physicians. Promptly admitting patients from the ED to the appropriate unit where they can receive needed specialty care that potentially improves the quality and safety of patient care is paramount. Further research is needed to determine what format and contexts the huddle can be utilized to facilitate efficient patient flow and improve patient outcomes.
[Mh] Termos MeSH primário: Eficiência Organizacional
Enfermagem em Emergência/normas
Serviço Hospitalar de Emergência/organização & administração
Hospitais Pediátricos/organização & administração
Admissão do Paciente/normas
Enfermagem Pediátrica/normas
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Registros Eletrônicos de Saúde
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Listas de Espera
[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:N
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  3 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo SciELO Brasil
[PMID]:29340526
[Au] Autor:Yousefi M; Yousefi M; Fogliatto FS; Ferreira RPM; Kim JH
[Ad] Endereço:Departamento de Engenharia de Produção e Transportes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
[Ti] Título:Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework.
[So] Source:Braz J Med Biol Res;51(3):e6961, 2018 Jan 11.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.
[Mh] Termos MeSH primário: Comportamento
Serviço Hospitalar de Emergência/organização & administração
Pacientes Desistentes do Tratamento/estatística & dados numéricos
Triagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Brasil
Simulação por Computador
Aglomeração
Tomada de Decisões
Técnicas de Apoio para a Decisão
Serviço Hospitalar de Emergência/estatística & dados numéricos
Hospitais Públicos
Seres Humanos
Tempo de Internação
Modelos Teóricos
Pacientes Desistentes do Tratamento/psicologia
Modelagem Computacional Específica para o Paciente
Treinamento por Simulação
Listas de Espera
[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:180118
[St] Status:MEDLINE


  4 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27773453
[Au] Autor:Liu Y; Vela M; Rudakevych T; Wigfield C; Garrity E; Saunders MR
[Ad] Endereço:Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
[Ti] Título:Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis.
[So] Source:J Heart Lung Transplant;36(3):264-271, 2017 Mar.
[Is] ISSN:1557-3117
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patient's transplant-eligible diagnosis and waitlist registration. METHODS: We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV ] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests. RESULTS: Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist. CONCLUSIONS: Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.
[Mh] Termos MeSH primário: Fibrose Cística/cirurgia
Transplante de Pulmão/métodos
Fibrose Pulmonar/cirurgia
Encaminhamento e Consulta/estatística & dados numéricos
Listas de Espera
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Adulto
Estudos de Coortes
Comorbidade
Fibrose Cística/diagnóstico
Fibrose Cística/mortalidade
Feminino
Rejeição de Enxerto
Sobrevivência de Enxerto
Seres Humanos
Cobertura do Seguro
Estimativa de Kaplan-Meier
Transplante de Pulmão/mortalidade
Masculino
Meia-Idade
Seleção de Pacientes
Fibrose Pulmonar/diagnóstico
Fibrose Pulmonar/mortalidade
Testes de Função Respiratória
Estudos Retrospectivos
Medição de Risco
Índice de Gravidade de Doença
Estatísticas não Paramétricas
Análise de Sobrevida
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; 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:161025
[St] Status:MEDLINE


  5 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29248826
[Au] Autor:Tai D; Dhar A; Yusuf A; Marshall A; O'Beirne J; Patch D; Tsochatzis E; Alexander G; Portal J; Thalheimer U; Thorburn D; Kallis Y; Westbrook RH
[Ad] Endereço:Royal Free Hospital, United Kingdom.
[Ti] Título:The Royal Free Hospital 'hub-and-spoke network model' delivers effective care and increased access to liver transplantation.
[So] Source:Public Health;154:164-171, 2018 Jan.
[Is] ISSN:1476-5616
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: 'Hub-and-spoke' networks may be one solution to reduce the geographical inequality in access to liver transplantation (LT) and the growing demands on, and saturation of, LT centres. It is not clear if such networks improve equity of access, deliver comparable patient outcomes or effect patient satisfaction. STUDY DESIGN: Retrospective evaluation of outcomes and patient satisfaction within the Royal Free liver transplant 'hub-and-spoke' network. METHODS: Patient outcomes in those assessed for LT between September 2011 and 2014 at spoke centres (n = 4) were compared retrospectively with those assessed at the LT hub centre. Patient satisfaction questionnaires were completed and changes in LT referral patterns were explored with data obtained directly from NHS Blood and Transplant (NHSBT). RESULTS: A total of 655 patients (180 spoke; 475 hub) were assessed for LT. Patients referred from spoke centres were more likely to have viral hepatitis as an underlying aetiology (72/180 vs 110/475; P < 0.001), or hepatocellular carcinoma (48/180 vs 60/475; P < 0.001) as an indication for LT and were more likely to be listed for LT when compared with hub patients (139/180 vs 312/475, P = 0.005). Mortality on the waiting list (9/123 vs 25/269, P = 0.57), waiting time to LT (64-days vs 78-days, P = 0.91) and Model for End-Stage liver disease (MELD)/United Kingdom End-Stage Liver Disease (UKELD) score (P = 0.24/0.26) in listed patients were equivalent as were 1- and 3-year patient and graft survival rates. Patient satisfaction rates were high at both types of centre, with significantly more patients preferring 'locally delivered care' at spoke vs hub (11/50 vs 70/73, P≤0.0001). Since the development of formal hub-and-spoke networks data from NHSBT based on postcode confirmed a significant increase in patients undergoing LT (153%) from spoke centres, whereas numbers assessed and transplanted from the hub centre have remained static. CONCLUSION: Hub-and-spoke LT networks are effective in offering equivalent clinical outcomes, high patient satisfaction and alleviate clinical pressure on the hub centre. They have to potential to help eliminate the geographical disparity in mortality rates from chronic liver disease.
[Mh] Termos MeSH primário: Assistência à Saúde/organização & administração
Acesso aos Serviços de Saúde/estatística & dados numéricos
Hospitais
Transplante de Fígado/estatística & dados numéricos
Modelos Organizacionais
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Hepatopatias/mortalidade
Hepatopatias/cirurgia
Masculino
Meia-Idade
Encaminhamento e Consulta
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Reino Unido/epidemiologia
Listas de Espera/mortalidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171218
[St] Status:MEDLINE


  6 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29180439
[Au] Autor:Crawford SM
[Ad] Endereço:Airedale NHS Foundation Trust, Keighley BD20 6TD, UK.
[Ti] Título:Goodhart's law: when waiting times became a target, they stopped being a good measure.
[So] Source:BMJ;359:j5425, 2017 11 27.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Listas de Espera
[Mh] Termos MeSH secundário: Seres Humanos
Fatores de Tempo
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5425


  7 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29287087
[Au] Autor:Kulkarni S; Hall I; Formica R; Thiessen C; Stewart D; Gan G; Greene E; Deng Y
[Ad] Endereço:Department of Surgery, Section of Organ Transplantation & Immunology, Yale School of Medicine, New Haven, CT, United States of America.
[Ti] Título:Transition probabilities between changing sensitization levels, waitlist activity status and competing-risk kidney transplant outcomes using multi-state modeling.
[So] Source:PLoS One;12(12):e0190277, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Sensitization and activity status are associated with kidney transplant waitlist mortality. Unknown is how changes in these covariates after listing impact transplant outcomes. METHODS: Two cohorts were created from the OPTN (Organ Procurement and Transplantation Network) database, one pre-KAS (new kidney allocation system) (10/01/2009-12/04/2013, n = 97,793) and one post-KAS (12/04/2014-06/17/2015, n = 13,113). Multi-state modeling provides transition probabilities between intermediate states (CPRA category/activity status combinations) and competing-risk outcomes: transplant (living), transplant (deceased), death, or other/well. RESULTS: Transition probabilities show chances of converting between intermediate states prior to a competing-risk outcome. One year transplant probabilities for post-KAS candidates with a CPRA of 0%(P, 0.123[95% CI, 0.117,0.129]), 1-79%(P, 0.125 [95% CI, 0.112,0.139]), 95-98%(P, 0.242[95% CI, 0.188, 0.295]) and 99-100%(P, 0.252 [95% CI, 0.195, 0.308]) were significantly higher than the pre-KAS cohort; they were lower for CPRA 80-89%(P, 0.152 [95% CI, 0.116,0.189]) and not statistically different for CPRA 90-94%(P, 0.180 [95% CI, 0.137,0.223]) candidates. Post-KAS, Whites had a statistically higher transplant probability only at a CPRA of 99-100%. CONCLUSION: Multi-state modeling provides transition probabilities between CPRA/activity status combinations, giving estimates on how changing patient characteristic's after listing impact outcomes. Preliminarily, across most CPRA categories, there was no statistical difference in transplant probabilities between Whites, Blacks and Hispanics following KAS implementation, however, this finding requires longer follow-up for validation.
[Mh] Termos MeSH primário: Transplante de Rim
Listas de Espera
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Seres Humanos
Meia-Idade
Modelos Teóricos
Probabilidade
Fatores de Risco
Doadores de Tecidos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190277


  8 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28464878
[Au] Autor:Kuluski K; Im J; McGeown M
[Ad] Endereço:Centre for Education and Research on Aging and Health, Lakehead University, 1 Bridgepoint Drive, M4M 2B5, Toronto, ON, Canada. Kerry.Kuluski@sinaihealthsystem.ca.
[Ti] Título:"It's a waiting game" a qualitative study of the experience of carers of patients who require an alternate level of care.
[So] Source:BMC Health Serv Res;17(1):318, 2017 05 02.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Delayed hospital discharge (also known as Alternate Level of Care or ALC) is a global health care quality issue with negative implications for people (e.g., functional decline) and the health care system (e.g., costly interruptions in hospital flow and procedures). ALC disproportionately impacts people with cognitive impairment, and insight into the needs and experiences of this specific sub population and their carers is lacking. The purpose of this study was to understand the hospital experience of carers (e.g., family members) of patients with ALC and cognitive impairment who were waiting for long-term care from the hospital. METHODS: This is a qualitative descriptive study entailing 12 semi-structured interviews with 15 carers of patients with ALC from three hospitals in Northwestern Ontario. Interviews were conducted between October 2015 and February 2016. Two reviewers thematically analyzed the interview data. RESULTS: Five core themes were identified from the interview data: patient over person, uncertain and confusing process, inconsistent quality in care delivery, carers addressing gaps in the system, and personalization of long-term care. CONCLUSIONS: Waiting for long-term care from the hospital is a stressful and uncertain time for family carers. ALC is an 'in-between' phase when patients and carers may be at their most vulnerable yet receive the least care from the formal care system. Carers provide critical insight into the needs and behaviors of patients as well as processes that need to be improved to enhance their experience. Such insights will help health systems internationally as they grapple with the issue of ALC whilst trying to optimize engagement with patients and their families.
[Mh] Termos MeSH primário: Cuidadores
Assistência de Longa Duração
Alta do Paciente
[Mh] Termos MeSH secundário: Família
Feminino
Seres Humanos
Entrevistas como Assunto
Tempo de Internação
Masculino
Ontário
Pesquisa Qualitativa
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180117
[Lr] Data última revisão:
180117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2272-6


  9 / 10263 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
[PMID]:29211411
[Au] Autor:Guss B; Mishkin D; Sharma R
[Ti] Título:Using Telemedicine to Address Crowding in the ED.
[So] Source:ED Manag;28(11):127-31, 2016 Nov.
[Is] ISSN:1044-9167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Some health systems are piloting telemedicine solutions in the ED to address crowding and decrease patient wait times. One new program, implemented at the Lisa Perry Emergency Center at New York Presbyterian (NYP) Weill Cornell Medical Center in New York, involves offering low-acuity patients the option of visiting an off-site physician via telemedicine hookup. Administrators note that the approach can get patients in and out of the ED within 30 minutes, and patients have thus far been highly satisfied with the approach. However, an earlier telemedicine program piloted at the University of San Diego Health System's (UCSD) Hillcrest Hospital in 2013 got bogged down due to administrative and insurance reimbursement hurdles, although the approach showed enough promise that there is interest in restarting the program. In the NYP program, patients are identified as appropriate candidates for the program at triage. They can opt to be seen remotely or through traditional means in the ED's fast-track section. Administrators note that patients with complex problems requiring extensive workups are not suitable for the telemedicine approach. The most challenging aspect of implementing a successful telemedicine program in the ED is getting the workflows right, according to administrators. An earlier ED-based telemedicine program piloted at UCSD ran into difficulties because the model required the involvement of two physicians, and some insurers did not want to pay for the telemedicine visits. However, patients were receptive.
[Mh] Termos MeSH primário: Aglomeração
Serviço Hospitalar de Emergência/organização & administração
Telemedicina
[Mh] Termos MeSH secundário: Eficiência Organizacional
Seres Humanos
Satisfação do Paciente
Estados Unidos
Listas de Espera
Carga de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


  10 / 10263 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27773831
[Au] Autor:Parsons RF; Locke JE; Redfield RR; Roll GR; Levine MH
[Ad] Endereço:Emory University, Surgery Department, United States.
[Ti] Título:Kidney transplantation of highly sensitized recipients under the new kidney allocation system: A reflection from five different transplant centers across the United States.
[So] Source:Hum Immunol;78(1):30-36, 2017 Jan.
[Is] ISSN:1879-1166
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Deceased donor kidney allocation was reorganized in the United States to address several problems, including the highly sensitized patients disadvantaged with large, diverse repertoires of antibodies. Here, five transplant surgeons review their center's experience with the new allocation changes: highlighting areas of accomplishment, opportunities for improvement and, in some cases, stark differences in practice. Across these five centers the highly sensitized patients (CPRA ⩾98%) range from 5.5 to 9.2% of the 12,364 candidates on their collective waitlist. All centers reported greater rates of kidney transplantations in highly sensitized patients (12.4-27%). Three of the programs (Emory, UCSF, UW) relied upon the virtual crossmatch prior to organ acceptance in a majority of cases (70-86%)-the mere presence of antibody on HLA antibody screen was sufficient to exclude the donor in most cases at Emory and UCSF. Penn and UAB relied upon the physical flow crossmatch in almost all cases prior to proceeding with transplantation. Current or historical donor-specific antibody was occasionally crossed in certain cases at UW and UAB necessitating IVIG/plasmapheresis and/or B cell depletion perioperatively. Some authors raised concerns for cost efficiency given the increased need for organ/specimen transportation, and extensive use of hospital resources and ancillary services. In general, we found that the new allocation system has successfully achieved one of its primary goals-increased kidney transplantation in the disadvantaged, highly sensitized patients; the long-term outcomes in all patients and the cost ramifications of these changes will require continued reassessment and clarification.
[Mh] Termos MeSH primário: Tipagem e Reações Cruzadas Sanguíneas
Transplante de Rim
Obtenção de Tecidos e Órgãos
[Mh] Termos MeSH secundário: Análise Custo-Benefício
Regulamentação Governamental
Antígenos HLA/imunologia
Teste de Histocompatibilidade
Seres Humanos
Imunização
Isoanticorpos/metabolismo
Doadores de Tecidos
Transplantados
Resultado do Tratamento
Estados Unidos
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (HLA Antigens); 0 (Isoantibodies)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE



página 1 de 1027 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde