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[PMID]:28469050
[Au] Autor:Olgers TJ; Dijkstra RS; Drost-de Klerck AM; Ter Maaten JC
[Ad] Endereço:Department of Internal Medicine, Emergency Department, University Medical Centre Groningen, UMCG, Groningen, the Netherlands.
[Ti] Título:The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study.
[So] Source:Neth J Med;75(3):106-111, 2017 Apr.
[Is] ISSN:1872-9061
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Competency in the Airway Breathing Circulation Disability Exposure (ABCDE) approach is required for working in the emergency department. There is limited knowledge on how often and how completely the ABCDE approach is applied to medical patients. The objectives of this study were to assess the frequency with which the ABCDE approach was used in potentially unstable patients and to determine factors influencing the choice of whether or not to use the ABCDE approach. METHODS: This observational pilot study included 270 medical patients admitted to the emergency department and it was observed if and how completely the ABCDE approach was performed. We registered several factors possibly determining its use. RESULTS: Of the 270 patients included, 206 were identified as possibly unstable patients based on their triage code. The ABCDE approach was used in a minority of these patients (33%). When the ABCDE approach was used, it was done rapidly (generally within 10 minutes) and highly completely (> 80% of needed items). The choice not to use the ABCDE approach was frequently based on a first clinical impression and/or vital signs obtained during triage. The ABCDE approach was used more often with a higher triage code. CONCLUSIONS: We show that the emergency department staff are capable of performing the ABCDE approach rather completely (83%), but it was only used in the minority of potentially unstable patients. Important factors determining this choice were the vital signs on triage and a quick first impression. Whether this adequately selects patients in need for an ABCDE approach is not clear yet.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Triagem/métodos
[Mh] Termos MeSH secundário: Diagnóstico
Seres Humanos
Projetos Piloto
Avaliação de Processos (Cuidados de Saúde)
Triagem/utilização
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29195577
[Au] Autor:Wu G; Consunji M; Nelson RA; Yeung K; Sun C; Kim JY; Raz DJ
[Ad] Endereço:Division of Thoracic Surgery, City of Hope, Duarte, California. Electronic address: geena.wu@mihs.org.
[Ti] Título:Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):391-405, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians. Responders and nonresponders did not differ by demographic characteristics. A total of 137 (55.5%) PCPs reported feeling confident in managing the workup of imaging-detected SPN. However, only 53 PCPs (21.3%) were inclined to manage the evaluation and follow-up of SPN. There was no significant difference between family practice and internal medicine physicians with regard to years in practice, size of practice, or referral to specialists. Family practitioners and internists similarly disagreed or were neutral to self-managing SPN (P = 0.60). Internists were twice as likely to express confidence as family practitioners (odds ratio 1.95, 95% confidence interval 1.09-3.48). Among all PCPs, 75.4% would refer management of these patients to a pulmonologist, 28.9% to a surgeon, and 24.2% to an oncologist. Confidence did not predict lung cancer screening practices. Although more than half of PCPs expressed confidence in the workup of SPN, most preferred referral to specialists. Additional research is needed to understand barriers to PCP management of incidental SPN in the effort to facilitate lung cancer screening.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/terapia
Médicos de Atenção Primária
Padrões de Prática Médica
Avaliação de Processos (Cuidados de Saúde)
Nódulo Pulmonar Solitário/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Competência Clínica
Feminino
Pesquisas sobre Serviços de Saúde
Conhecimentos, Atitudes e Prática em Saúde
Disparidades em Assistência à Saúde
Seres Humanos
Modelos Logísticos
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Razão de Chances
Médicos de Atenção Primária/psicologia
Encaminhamento e Consulta
Nódulo Pulmonar Solitário/diagnóstico por imagem
Nódulo Pulmonar Solitário/patologia
Especialização
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:29195570
[Au] Autor:Schwann TA; Tatoulis J; Puskas J; Bonnell M; Taggart D; Kurlansky P; Jacobs JP; Thourani VH; O'Brien S; Wallace A; Engoren MC; Tranbaugh RF; Habib RH
[Ad] Endereço:Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio; Department of Surgery, Mercy Saint Vincent Medical Center, Toledo, Ohio. Electronic address: thomas.schwann@utoledo.edu.
[Ti] Título:Worldwide Trends in Multi-arterial Coronary Artery Bypass Grafting Surgery 2004-2014: A Tale of 2 Continents.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):273-280, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recent evidence shows that multi-arterial coronary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left internal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG, if at all, is not well defined. Accordingly, we report 10-year temporal trends of MABG utilization from 2 continents. A study population of 1,683,434 non-emergent, primary, isolated LITA-based coronary artery bypass grafting (CABG) (≥2 grafts) patients was derived from the Society of Thoracic Surgeons (STS) (1,307,528 (79.5%) of 1,644,388 isolated CABG; total 1179 centers) and the Australia New Zealand Cardiothoracic (ANZ) Databases (34,213 (87%) of 39,046 isolated CABG; 24 centers) between 2004 and 2014. Patients were excluded based on the following: (1) no LITA, (2) if arterial grafts were other than RA or ITA, or (3) if grafting data were missing. The 3 MABG groups were LITA + RA, BITA, and BITA + RA, each with or without supplemental vein grafts. Grafting trends and their associated patient demographics were analyzed. SABG (89.3% STS, 51.4% ANZ) was the most common grafting strategy. MABG was most frequently accomplished by LITA + RA: (STS: 6.1%; ANZ: 42.6%), followed by BITA: (STS: 4.1%; ANZ: 4.3%), while ≥3 (BITA + RA) was rare in the STS (0.5%), but more common in ANZ (5.9%). In the STS, between 2004 and 2014, SABG rates systematically increased from 85.2% to 91.7%, BITA grafting was essentially unchanged from 3.6% to 4.3%, while RA use decreased systematically from 10.5% to 3.7%. In the ANZ, SABG rates increased from 17.3% to 51.4%, BITA grafting decreased from 6.3% to 3.6%, while RA grafting decreased from 65.8% to 39.0%. Compared with SABG patients, BITA patients were younger (STS: median age 59 vs 66, P < 0.001; ANZ: mean age 62 vs 68, P < 0.001), predominately male (STS: 84% vs 73%, P < 0.001; ANZ: 86% vs 79%, P < 0.001), less obese (body mass index >30 kg/m ) in STS (37% vs 42%, P < 0.001), more obese in ANZ (33% vs 32%, P = 0.001), and less diabetic (STS: 26% vs 43%, P < 0.001; ANZ: 25% vs 37%, P < 0.001), whereas RA patients were intermediate in age (STS: 61; ANZ: 65), in male sex (STS: 82%; ANZ: 81%), in the prevalence of diabetes (STS: 40%; ANZ: 34%), and were most obese (STS: 47%; ANZ: 34%). A decade-long analysis of STS data reveals a counterintuitive decline in the use (driven by decreasing RA use) of MABG: a potentially superior grafting strategy compared with SABG. In contra distinction, the smaller but growing ANZ data document a distinctly different CABG practice pattern, with a higher MABG utilization rate, but a similarly declining RA use. The reasons for these practice patterns and declining MABG are likely diverse and require further assessment.
[Mh] Termos MeSH primário: Ponte de Artéria Coronária/tendências
Doença da Artéria Coronariana/cirurgia
Padrões de Prática Médica/tendências
Avaliação de Processos (Cuidados de Saúde)/tendências
Cirurgiões/tendências
[Mh] Termos MeSH secundário: Idoso
Austrália
Comorbidade
Ponte de Artéria Coronária/efeitos adversos
Ponte de Artéria Coronária/utilização
Doença da Artéria Coronariana/diagnóstico por imagem
Doença da Artéria Coronariana/epidemiologia
Bases de Dados Factuais
Feminino
Seres Humanos
Masculino
Meia-Idade
Nova Zelândia
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:28876990
[Au] Autor:Chaney KP; Macik ML; Turner JS; Korich JA; Rogers KS; Fowler D; Scallan EM; Keefe LM
[Ti] Título:Curriculum Redesign in Veterinary Medicine: Part I.
[So] Source:J Vet Med Educ;44(3):552-562, 2017.
[Is] ISSN:0748-321X
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:Curricular review is considered a necessary component for growth and enhancement of academic programs and requires time, energy, creativity, and persistence from both faculty and administration. At Texas A&M College of Veterinary Medicine & Biomedical Sciences (TAMU), the faculty and administration partnered with the university's Center for Teaching Excellence to create a faculty-driven, data-enhanced curricular redesign process. The 8-step process begins with the formation of a dedicated faculty curriculum design team to drive the redesign process and to support the college curriculum committee. The next steps include defining graduate outcomes and mapping the current curriculum to identify gaps and redundancies across the curriculum. Data are collected from internal and external stakeholders including veterinary students, faculty, alumni, and employers of graduates. Data collected through curriculum mapping and stakeholder engagement substantiate the curriculum redesign. The guidelines, supporting documents, and 8-step process developed at TAMU are provided to assist other veterinary schools in successful curricular redesign. This is the first of a two-part report that provides the background, context, and description of the process for charting the course for curricular change. The process involves defining expected learning outcomes for new graduates, conducting a curriculum mapping exercise, and collecting stakeholder data for curricular evaluation (steps 1-4). The second part of the report describes the development of rubrics that were applied to the graduate learning outcomes (steps 5-8) and engagement of faculty during the implementation phases of data-driven curriculum change.
[Mh] Termos MeSH primário: Currículo/tendências
Educação em Veterinária/organização & administração
Avaliação de Processos (Cuidados de Saúde)
Faculdades de Medicina Veterinária/organização & administração
[Mh] Termos MeSH secundário: Educação em Veterinária/normas
Seres Humanos
Faculdades de Medicina Veterinária/normas
Texas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171207
[Lr] Data última revisão:
171207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170907
[St] Status:MEDLINE
[do] DOI:10.3138/jvme.0316-065R1


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[PMID]:29049120
[Au] Autor:Abrecht CR; Brovman EY; Greenberg P; Song E; Rathmell JP; Urman RD
[Ad] Endereço:From the *Department of Anesthesia and Perioperative Care, Division of Pain Medicine, University of California San Francisco, San Francisco, California; †Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ‡Controlled Risk Insurance Company (CRICO) Strategies, Boston, Massachusetts; and §Harvard Medical School, Boston, Massachusetts.
[Ti] Título:A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain.
[So] Source:Anesth Analg;125(5):1761-1768, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Opioids are frequently used in chronic pain management but are associated with significant morbidity and mortality in some patient populations. An important avenue for identifying complications-including serious or rare complications-is the study of closed malpractice claims. The present study is intended to complement the existing closed claims literature by drawing on claims from a more recent timeframe through a partnership with a large malpractice carrier, the Controlled Risk Insurance Company (CRICO). The goal of this study was to identify patient medical comorbidities and aberrant drug behaviors, as well as prescriber practices associated with patient injury and malpractice claims. Another objective was to identify claims most likely to result in payments and use this information to propose a strategy for reducing medicolegal risk. METHODS: The CRICO Strategies Comparative Benchmarking System is a database of claims drawing from >350,000 malpractice claims from Harvard-affiliated institutions and >400 other academic and community institutions across the United States. This database was queried for closed claims from January 1, 2009, to December 31, 2013, and identified 37 cases concerning noninterventional, outpatient chronic pain management. Each file consisted of a narrative summary, including expert witness testimony, as well as coded fields for patient demographics, medical comorbidities, the alleged damaging event, the alleged injurious outcome, the total financial amount incurred, and more. We performed an analysis using these claim files. RESULTS: The mean patient age was 43.5 years, with men representing 59.5% of cases. Payments were made in 27% of cases, with a median payment of $72,500 and a range of $7500-$687,500. The majority of cases related to degenerative joint disease of the spine and failed back surgery syndrome; no patients in this series received treatment of malignant pain. Approximately half (49%) of cases involved a patient death. The use of long-acting opioids and medical conditions affecting the cardiac and pulmonary systems were more closely associated with death than with other outcomes. The nonpain medical conditions present in this analysis included obesity, obstructive sleep apnea, chronic obstructive pulmonary disease, hypertension, and coronary artery disease. Other claims ranged from alleged addiction to opioids from improper prescribing to alleged abandonment with withdrawal of care. The CRICO analysis suggested that patient behavior contributed to over half of these claims, whereas deficits in clinical judgment contributed to approximately 40% of the claims filed. CONCLUSIONS: Claims related to outpatient medication management in pain medicine are multifactorial, stemming from deficits in clinical judgment by physicians, noncooperation in care by patients, and poor clinical documentation. Minimization of both legal risk and patient harm can be achieved by carefully selecting patients for chronic opioid therapy and documenting compliance and improvement with the treatment plan. Medical comorbidities such as obstructive sleep apnea and the use of long-acting opioids may be particularly dangerous. Continuing physician education on the safest and most effective approaches to manage these medications in everyday practice will lead to both improved legal security and patient safety.
[Mh] Termos MeSH primário: Assistência Ambulatorial/legislação & jurisprudência
Analgésicos Opioides/efeitos adversos
Dor Crônica/prevenção & controle
Imperícia/legislação & jurisprudência
Erros Médicos/legislação & jurisprudência
Clínicas de Dor/legislação & jurisprudência
Padrões de Prática Médica/legislação & jurisprudência
Avaliação de Processos (Cuidados de Saúde)/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Assistência Ambulatorial/economia
Analgésicos Opioides/administração & dosagem
Causas de Morte
Dor Crônica/diagnóstico
Comorbidade
Compensação e Reparação/legislação & jurisprudência
Bases de Dados Factuais
Feminino
Seres Humanos
Seguro de Responsabilidade Civil/legislação & jurisprudência
Responsabilidade Legal
Masculino
Imperícia/economia
Erros Médicos/economia
Erros Médicos/mortalidade
Meia-Idade
Clínicas de Dor/economia
Medição da Dor
Segurança do Paciente
Padrões de Prática Médica/economia
Avaliação de Processos (Cuidados de Saúde)/economia
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002499


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[PMID]:29049121
[Au] Autor:Ballantyne JC
[Ad] Endereço:From the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
[Ti] Título:Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, and Future Directions.
[So] Source:Anesth Analg;125(5):1769-1778, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:An overreliance on opioids has impacted all types of pain management, making it undoubtedly a root cause of the "epidemic" of prescription opioid abuse in the United States. Yet, an examination of the statistics that led the US Centers for Disease Control and Prevention to declare that prescription opioid abuse had reached epidemic levels shows that the abuse occurrences and deaths are arising outside the hospital or hospice setting, which strongly implicates the outpatient use of opioids to treat chronic pain. Such abuse and related deaths are occurring in chronic pain patients themselves and also through diversion. Overprescribing to outpatients has afforded distressed and vulnerable individuals access to these highly addictive drugs. The focus of this article is on what we have learned since opioid treatment of chronic pain was first popularized at the end of the 20th century and how this new information can guide chronic pain management in the future.
[Mh] Termos MeSH primário: Assistência Ambulatorial/tendências
Analgésicos Opioides/efeitos adversos
Dor Crônica/tratamento farmacológico
Transtornos Relacionados ao Uso de Opioides/prevenção & controle
Padrões de Prática Médica/tendências
Uso Indevido de Medicamentos sob Prescrição/prevenção & controle
Avaliação de Processos (Cuidados de Saúde)/tendências
[Mh] Termos MeSH secundário: Analgésicos Opioides/administração & dosagem
Comportamento Aditivo
Encéfalo/efeitos dos fármacos
Encéfalo/fisiopatologia
Dor Crônica/diagnóstico
Dor Crônica/fisiopatologia
Dor Crônica/psicologia
Prescrições de Medicamentos
Usuários de Drogas/psicologia
Epidemias
Previsões
Seres Humanos
Prescrição Inadequada/prevenção & controle
Transtornos Relacionados ao Uso de Opioides/diagnóstico
Transtornos Relacionados ao Uso de Opioides/epidemiologia
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002500


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[PMID]:29029717
[Au] Autor:Galmer A; Weinberg I; Giri J; Jaff M; Weinberg M
[Ad] Endereço:Department of Cardiology, Vascular Medicine and Peripheral Vascular Intervention Program, Hofstra Northwell School of Medicine, Northwell Health, Manhasset, NY, USA.
[Ti] Título:The Role of the Pulmonary Embolism Response Team: How to Build One, Who to Include, Scenarios, Organization, and Algorithms.
[So] Source:Tech Vasc Interv Radiol;20(3):216-223, 2017 Sep.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pulmonary embolism response teams (PERTs) are multidisciplinary response teams aimed at delivering a range of diagnostic and therapeutic modalities to patients with pulmonary embolism. These teams have gained traction on a national scale. However, despite sharing a common goal, individual PERT programs are quite individualized-varying in their methods of operation, team structures, and practice patterns. The tendency of such response teams is to become intensely structured, algorithmic, and inflexible. However, in their current form, PERT programs are quite the opposite. They are being creatively customized to meet the needs of the individual institution based on available resources, skills, personnel, and institutional goals. After a review of the essential core elements needed to create and operate a PERT team in any form, this article will discuss the more flexible feature development of the nascent PERT team. These include team planning, member composition, operational structure, benchmarking, market analysis, and rudimentary financial operations.
[Mh] Termos MeSH primário: Algoritmos
Prestação Integrada de Cuidados de Saúde/organização & administração
Equipe de Assistência ao Paciente/organização & administração
Avaliação de Processos (Cuidados de Saúde)/organização & administração
Embolia Pulmonar/terapia
[Mh] Termos MeSH secundário: Comportamento Cooperativo
Seres Humanos
Comunicação Interdisciplinar
Modelos Organizacionais
Objetivos Organizacionais
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE


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[PMID]:28963112
[Au] Autor:Johnston EE; Alvarez E; Saynina O; Sanders L; Bhatia S; Chamberlain LJ
[Ad] Endereço:Divisions of Pediatric Hematology/Oncology and emilyj@stanford.edu.
[Ti] Título:Disparities in the Intensity of End-of-Life Care for Children With Cancer.
[So] Source:Pediatrics;140(4), 2017 Oct.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many adult patients with cancer who know they are dying choose less intense care; additionally, high-intensity care is associated with worse caregiver outcomes. Little is known about intensity of end-of-life care in children with cancer. METHODS: By using the California Office of Statewide Health Planning and Development administrative database, we performed a population-based analysis of patients with cancer aged 0 to 21 who died between 2000 and 2011. Rates of and sociodemographic and clinical factors associated with previously-defined end-of-life intensity indicators were determined. The intensity indicators included an intense medical intervention (cardiopulmonary resuscitation, intubation, ICU admission, or hemodialysis) within 30 days of death, intravenous chemotherapy within 14 days of death, and hospital death. RESULTS: The 3732 patients were 34% non-Hispanic white, and 41% had hematologic malignancies. The most prevalent intensity indicators were hospital death (63%) and ICU admission (20%). Sixty-five percent had ≥1 intensity indicator, 23% ≥2, and 22% ≥1 intense medical intervention. There was a bimodal association between age and intensity: ages <5 years and 15 to 21 years was associated with intense care. Patients with hematologic malignancies were more likely to have high-intensity end-of-life care, as were patients from underrepresented minorities, those who lived closer to the hospital, those who received care at a nonspecialty center (neither Children's Oncology Group nor National Cancer Institute Designated Cancer Center), and those receiving care after 2008. CONCLUSIONS: Nearly two-thirds of children who died of cancer experienced intense end-of-life care. Further research needs to determine if these rates and disparities are consistent with patient and/or family goals.
[Mh] Termos MeSH primário: Cuidados Críticos/utilização
Disparidades em Assistência à Saúde/estatística & dados numéricos
Neoplasias/terapia
Padrões de Prática Médica/estatística & dados numéricos
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Adolescente
California
Criança
Pré-Escolar
Cuidados Críticos/métodos
Cuidados Críticos/estatística & dados numéricos
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Avaliação de Processos (Cuidados de Saúde)
Estudos Retrospectivos
Assistência Terminal/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171112
[Lr] Data última revisão:
171112
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171001
[St] Status:MEDLINE


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[PMID]:28945663
[Au] Autor:Parikh ND; Marrero WJ; Sonnenday CJ; Lok AS; Hutton DW; Lavieri MS
[Ad] Endereço:1 Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Industrial and Operational Engineering, University of Michigan, Ann Arbor, MI.3 Department of Surgery, University of Michigan, Ann Arbor, MI.4 School of Public Health, University of Michigan Ann Arbor, MI.
[Ti] Título:Population-Based Analysis and Projections of Liver Supply Under Redistricting.
[So] Source:Transplantation;101(9):2048-2055, 2017 Sep.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To reduce the geographic heterogeneity in liver transplant allocation, the United Network of Organ Sharing has proposed redistricting, which is impacted by both donor supply and liver transplantation demand. We aimed to determine the impact of demographic changes on the redistricting proposal and characterize causes behind geographic heterogeneity in donor supply. METHODS: We analyzed adult donors from 2002 to 2014 from the United Network of Organ Sharing database and calculated regional liver donation and utilization stratified by age, race, and body mass index. We used US population data to make regional projections of available donors from 2016 to 2025, incorporating the proposed 8-region redistricting plan. We used donors/100 000 population age 18 to 84 years (D/100K) as a measure of equity. We calculated a coefficient of variation (standard deviation/mean) for each regional model. We performed an exploratory analysis where we used national rates of donation, utilization and both for each regional model. RESULTS: The overall projected D/100K will decrease from 2.53 to 2.49 from 2016 to 2025. The coefficient of variation in 2016 is expected to be 20.3% in the 11-region model and 13.2% in the 8-region model. We found that standardizing regional donation and utilization rates would reduce geographic heterogeneity to 4.9% in the 8-region model and 4.6% in the 11-region model. CONCLUSIONS: The 8-region allocation model will reduce geographic variation in donor supply to a significant extent; however, we project that geographic disparity will marginally increase over time. Though challenging, interventions to better standardize donation and utilization rates would be impactful in reducing geographic heterogeneity in organ supply.
[Mh] Termos MeSH primário: Área Programática (Saúde)
Prestação Integrada de Cuidados de Saúde/tendências
Acesso aos Serviços de Saúde/tendências
Necessidades e Demandas de Serviços de Saúde/tendências
Disparidades em Assistência à Saúde/tendências
Transplante de Fígado/tendências
Determinação de Necessidades de Cuidados de Saúde/tendências
Avaliação de Processos (Cuidados de Saúde)/tendências
Doadores de Tecidos/provisão & distribuição
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Censos
Bases de Dados Factuais
Feminino
Previsões
Seres Humanos
Masculino
Meia-Idade
Regionalização/tendências
Fatores de Tempo
Obtenção de Tecidos e Órgãos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170926
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001785


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[PMID]:28881247
[Au] Autor:van Dam PA; Tomatis M; Marotti L; Heil J; Mansel RE; Rosselli Del Turco M; van Dam PJ; Casella D; Bassani LG; Danei M; Denk A; Egle D; Emons G; Friedrichs K; Harbeck N; Kiechle M; Kimmig R; Koehler U; Kuemmel S; Maass N; Mayr C; Prové A; Rageth C; Regolo L; Lorenz-Salehi F; Sarlos D; Singer C; Sohn C; Staelens G; Tinterri C; Audisio R; Ponti A; eusomaDB Working Group
[Ad] Endereço:Breast Unit, Antwerp University Hospital, Edegem, Belgium. Electronic address: peter.vandam@telenet.be.
[Ti] Título:Time trends (2006-2015) of quality indicators in EUSOMA-certified breast centres.
[So] Source:Eur J Cancer;85:15-22, 2017 Nov.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM OF THE STUDY: The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast centres to establish minimum standards and ensure specialist multidisciplinary care. Prospectively collected anonymous information on primary breast cancer cases diagnosed and treated in the units is transferred annually to a central EUSOMA data warehouse for continuous monitoring of quality indicators (QIs) to improve quality of care. Units have to comply with the EUSOMA Breast Centre guidelines and are audited by peers. The database was started in 2006 and includes over 110,000 cancers from breast centres located in Germany, Switzerland, Belgium, Austria, The Netherlands, Spain, Portugal and Italy. The aim of the present study is assessing time trends of QIs in EUSOMA-certified breast centres over the decade 2006-2015. MATERIALS AND METHODS: Previously defined QIs were calculated for 22 EUSOMA-certified breast centres (46122 patients) during 2006-2015. RESULTS: On the average of all units, the minimum standard of care was achieved in 8 of 13 main EUSOMA QIs in 2006 and in all in 2015. All QIs, except removal of at least 10 lymph nodes at axillary clearance and oestrogen receptor-negative tumours (T > 1 cm or N+) receiving adjuvant chemotherapy, improved significantly in this period. The desirable target was reached for two QIs in 2006 and for 7 of 13 QIs in 2015. CONCLUSION: The EUSOMA model of audit and monitoring QIs functions well in different European health systems and results in better performance of QIs over the last decade. QIs should be evaluated and adapted on a regular basis, as guidelines change over time.
[Mh] Termos MeSH primário: Neoplasias da Mama/terapia
Prestação Integrada de Cuidados de Saúde/tendências
Avaliação de Processos (Cuidados de Saúde)/tendências
Indicadores de Qualidade em Assistência à Saúde/tendências
[Mh] Termos MeSH secundário: Benchmarking/tendências
Neoplasias da Mama/patologia
Certificação/tendências
Bases de Dados Factuais
Europa (Continente)
Feminino
Fidelidade a Diretrizes/tendências
Seres Humanos
Auditoria Médica
Estadiamento de Neoplasias
Guias de Prática Clínica como Assunto
Padrões de Prática Médica/tendências
Padrão de Cuidado/tendências
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170908
[St] Status:MEDLINE



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