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[PMID]:29178197
[Au] Autor:MacKenzie RK; van Lettow M; Gondwe C; Nyirongo J; Singano V; Banda V; Thaulo E; Beyene T; Agarwal M; McKenney A; Hrapcak S; Garone D; Sodhi SK; Chan AK
[Ad] Endereço:Dignitas International, Zomba, Malawi.
[Ti] Título:Greater retention in care among adolescents on antiretroviral treatment accessing "Teen Club" an adolescent-centred differentiated care model compared with standard of care: a nested case-control study at a tertiary referral hospital in Malawi.
[So] Source:J Int AIDS Soc;20(3), 2017 Nov.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: There are numerous barriers to the care and support of adolescents living with HIV (ALHIV) that makes this population particularly vulnerable to attrition from care, poor adherence and virological failure. In 2010, a Teen Club was established in Zomba Central Hospital (ZCH), Malawi, a tertiary referral HIV clinic. Teen Club provides ALHIV on antiretroviral treatment (ART) with dedicated clinic time, sexual and reproductive health education, peer mentorship, ART refill and support for positive living and treatment adherence. The purpose of this study was to evaluate whether attending Teen Club improves retention in ART care. METHODS: We conducted a nested case-control study with stratified selection, using programmatic data from 2004 to 2015. Cases (ALHIV not retained in care) and controls (ALHIV retained in care) were matched by ART initiation age group. Patient records were reviewed retrospectively and subjects were followed starting in March 2010, the month in which Teen Club was opened. Follow-up ended at the time patients were no longer considered retained in care or on 31 December 2015. Cases and controls were drawn from a study population of 617 ALHIV. Of those, 302 (48.9%) participated in at least two Teen Club sessions. From the study population, 135 (non-retained) cases and 405 (retained) controls were selected. RESULTS: In multivariable analyses, Teen Club exposure, age at the time of selection and year of ART initiation were independently associated with attrition. ALHIV with no Teen Club exposure were less likely to be retained than those with Teen Club exposure (adjusted odds ratio (aOR) 0.27; 95% CI 0.16, 0.45) when adjusted for sex, ART initiation age, current age, reason for ART initiation and year of ART initiation. ALHIV in the age group 15 to 19 were more likely to have attrition from care than ALHIV in the age group 10 to 14 years of age (aOR 2.14; 95% CI 1.12, 4.11). CONCLUSIONS: This study contributes to the limited evidence evaluating the effectiveness of service delivery interventions to support ALHIV within healthcare settings. Prospective evaluation of the Teen Club package with higher methodological quality is required for programmes and governments in low- and middle-income settings to prioritize interventions for ALHIV and determine their cost-effectiveness.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Infecções por HIV/tratamento farmacológico
Aceitação pelo Paciente de Cuidados de Saúde
Padrão de Cuidado
[Mh] Termos MeSH secundário: Adolescente
Instituições de Assistência Ambulatorial
Estudos de Casos e Controles
Feminino
Seres Humanos
Malaui
Masculino
Estudos Prospectivos
Estudos Retrospectivos
Grupos de Autoajuda
Centros de Atenção Terciária
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25028


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[PMID]:29236628
[Au] Autor:Semrau KEA; Hirschhorn LR; Marx Delaney M; Singh VP; Saurastri R; Sharma N; Tuller DE; Firestone R; Lipsitz S; Dhingra-Kumar N; Kodkany BS; Kumar V; Gawande AA; BetterBirth Trial Group
[Ad] Endereço:From Ariadne Labs-Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health (K.E.A.S., M.M.D., D.E.T., S.L., A.A.G.), the Divisions of Global Health Equity (K.E.A.S.) and General Internal Medicine (S.L.) and the Department of Surgery (A.A.G.), Brigham and Women's Hospital, the Departme
[Ti] Título:Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India.
[So] Source:N Engl J Med;377(24):2313-2324, 2017 12 14.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes. METHODS: We conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention. RESULTS: Of 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P<0.001 for both comparisons). However, there was no significant difference between the trial groups either in the composite primary outcome (15.1% in the intervention group and 15.3% in the control group; relative risk, 0.99; 95% confidence interval, 0.83 to 1.18; P=0.90) or in secondary maternal or perinatal adverse outcomes. CONCLUSIONS: Birth attendants' adherence to essential birth practices was higher in facilities that used the coaching-based WHO Safe Childbirth Checklist program than in those that did not, but maternal and perinatal mortality and maternal morbidity did not differ significantly between the two groups. (Funded by the Bill and Melinda Gates Foundation; Clinical Trials number, NCT02148952 .).
[Mh] Termos MeSH primário: Lista de Checagem
Parto Obstétrico/normas
Tocologia
[Mh] Termos MeSH secundário: Adulto
Lista de Checagem/utilização
Distribuição de Qui-Quadrado
Parto Obstétrico/educação
Feminino
Fidelidade a Diretrizes
Seres Humanos
Índia/epidemiologia
Recém-Nascido
Análise de Intenção de Tratamento
Mortalidade Materna
Tocologia/educação
Avaliação de Resultados (Cuidados de Saúde)
Mortalidade Perinatal
Gravidez
Transtornos Puerperais/epidemiologia
Melhoria de Qualidade
Padrão de Cuidado
Organização Mundial da Saúde
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMoa1701075


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[PMID]:29201147
[Au] Autor:Edwards K; Borthwick A; McCulloch L; Redmond A; Pinedo-Villanueva R; Prieto-Alhambra D; Judge A; Arden N; Bowen C
[Ad] Endereço:Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
[Ti] Título:Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review.
[So] Source:J Foot Ankle Res;10:51, 2017.
[Is] ISSN:1757-1146
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background: Research focusing on management of foot health has become more evident over the past decade, especially related to chronic conditions such as diabetes. The level of methodological rigour across this body of work however is varied and outputs do not appear to have been developed or translated into clinical practice. The aim of this systematic review was to assess the latest guidelines, standards of care and current recommendations relative to people with chronic conditions to ascertain the level of supporting evidence concerning the management of foot health. Methods: A systematic search of electronic databases (Medline, Embase, Cinahl, Web of Science, SCOPUS and The Cochrane Library) for literature on recommendations for foot health management for people with chronic conditions was performed between 2000 and 2016 using predefined criteria. Data from the included publications was synthesised via template analysis, employing a thematic organisation and structure. The methodological quality of all included publications was appraised using the Appraisal for Research and Evaluation (AGREE II) instrument. A more in-depth analysis was carried out that specifically considered the levels of evidence that underpinned the strength of their recommendations concerning management of foot health. Results: The data collected revealed 166 publications in which the majority (102) were guidelines, standards of care or recommendations related to the treatment and management of diabetes. We noted a trend towards a systematic year on year increase in guidelines standards of care or recommendations related to the treatment and management of long term conditions other than diabetes over the past decade. The most common recommendation is for preventive care or assessments (e.g. vascular tests), followed by clinical interventions such as foot orthoses, foot ulcer care and foot health education. Methodological quality was spread across the range of AGREE II scores with 62 publications falling into the category of high quality (scores 6-7). The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166). Conclusions: It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.
[Mh] Termos MeSH primário: Doença Crônica/terapia
Doenças do Pé/terapia
/patologia
Podiatria/normas
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doença Crônica/epidemiologia
Complicações do Diabetes/prevenção & controle
Diabetes Mellitus/terapia
Gerenciamento Clínico
Prática Clínica Baseada em Evidências
Doenças do Pé/epidemiologia
Doenças do Pé/patologia
Órtoses do Pé/provisão & distribuição
Úlcera do Pé/terapia
Seres Humanos
Guias de Prática Clínica como Assunto/normas
Padrão de Cuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.1186/s13047-017-0232-3


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[PMID]:28467331
[Au] Autor:Conti AA
[Ad] Endereço:. andrea.conti@unifi.it.
[Ti] Título:An Analysis of the Changes in Communication Techniques in the Italian Codes of Medical Deontology.
[So] Source:Acta Biomed;88(1):33-38, 2017 Apr 28.
[Is] ISSN:0392-4203
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIM OF THE WORK: The code of deontology of the Italian National Federation of the Colleges of Physicians, Surgeons and Dentists (FNOMCeO) contains the principles and rules to which the professional medical practitioner must adhere. This work identifies and analyzes the medical-linguistic choices and the expressive techniques present in the different editions of the code, and evaluates their purpose and function, focusing on the first appearance and the subsequent frequency of key terms. METHODS: Various aspects of the formal and expressive revisions of the eight editions of the Codes of Medical Deontology published after the Second World War (from 1947/48 to 2014) are here presented, starting from a brief comparison with the first edition of 1903. Formal characteristics, choices of medical terminology and the introduction of new concepts and communicative attitudes are here identified and evaluated. RESULTS: This paper, in presenting a quantitative and epistemological analysis of variations, modifications and confirmations in the different editions of the Italian code of medical deontology over the last century, enucleates and demonstrates the dynamic paradigm of changing attitudes in the medical profession. CONCLUSIONS: This analysis shows the evolution in medical-scientific communication as embodied in the Italian code of medical deontology. This code, in its adoption, changes and adaptations, as evidenced in its successive editions, bears witness to the expressions and attitudes pertinent to and characteristic of the deontological stance of the medical profession during the twentieth century.
[Mh] Termos MeSH primário: Códigos de Ética/tendências
Odontologia/normas
Padrão de Cuidado/tendências
[Mh] Termos MeSH secundário: Códigos de Ética/história
História do Século XX
História do Século XXI
Seres Humanos
Itália
Padrão de Cuidado/história
Terminologia como Assunto
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180125
[Lr] Data última revisão:
180125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.23750/abm.v88i1.5440


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[PMID]:28468890
[Au] Autor:Yeung SE; Hilkewich L; Gillis C; Heine JA; Fenton TR
[Ad] Endereço:Nutrition Services and sophia.yeung@ahs.ca.
[Ti] Título:Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery.
[So] Source:Am J Clin Nutr;106(1):44-51, 2017 Jul.
[Is] ISSN:1938-3207
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. We conducted a prospective cohort study in adult elective colorectal resection patients after conventional ( = 46) and ERAS ( = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg · d ; ERAS group: 0.54 g · kg · d ; < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables ( = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS ( = 0.049) and fewer total infectious complications ( = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; < 0.001). ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665.
[Mh] Termos MeSH primário: Neoplasias Colorretais/cirurgia
Proteínas na Dieta/administração & dosagem
Suplementos Nutricionais
Procedimentos Cirúrgicos do Sistema Digestório
Tempo de Internação
Estado Nutricional
Cuidados Pós-Operatórios/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Cirurgia Colorretal
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Ingestão de Energia
Comportamento Alimentar
Seres Humanos
Intestino Grosso/cirurgia
Masculino
Meia-Idade
Náusea/etiologia
Necessidades Nutricionais
Assistência Perioperatória
Complicações Pós-Operatórias
Estudos Prospectivos
Padrão de Cuidado
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dietary Proteins)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.3945/ajcn.116.148619


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[PMID]:29218967
[Au] Autor:Cusack L; Gebbie K
[Ti] Título:Call for national dialogue: Adapting standards of care in extreme events. We are not ready.
[So] Source:Collegian;24(1):93-100, 2017.
[Is] ISSN:1322-7696
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Clinical practices are based on a common understanding of nursing's professional standards in all aspects of patient care, no matter what the circumstances are. Circumstances can however, change dramatically due to emergencies, disasters, or pandemics and may make it difficult to meet the standard of care in the way nurses are accustomed. The Australian nursing profession has not yet facilitated a broad discussion and debate at the professional and institutional level about adapting standards of care under extreme conditions, a dialogue which goes beyond the content of basic emergency and disaster preparedness. The purpose of this paper is to encourage discussion within the nursing profession on this important ethical and legal issue. A comprehensive review of the literature was undertaken to determine the state of the evidence in relation to adapting standards of care under extreme conditions. Content analysis of the literature identified categories related to adapting standards of care that have been considered by individuals or groups that should be considered in Australia, should a dialogue be undertaken. The categories include ethical expectations of professional practice; legal interpretation of care requirements, resource priority between hospital and public health and informing communities. Literature reviews and commentary may provide the background for a national dialogue on the nursing response in an extreme event. However, it is only with the engagement of a broadly representative segment of the professional nursing community that appropriate guidance on adapting standards of care under extreme conditions can be developed and then integrated into the professional worldview of nursing in Australia.
[Mh] Termos MeSH primário: Planejamento em Desastres/organização & administração
Desastres
Serviços Médicos de Emergência/normas
Padrão de Cuidado
[Mh] Termos MeSH secundário: Tomada de Decisões
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171209
[St] Status:MEDLINE


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[PMID]:29180390
[Au] Autor:Collier R
[Ad] Endereço:CMAJ.
[Ti] Título:Is it ever better not to have health insurance?
[So] Source:CMAJ;189(47):E1466, 2017 11 27.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde
Seguro Saúde
Medicaid
[Mh] Termos MeSH secundário: Seres Humanos
Patient Protection and Affordable Care Act
Padrão de Cuidado
Estados Unidos
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.109-5528


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[PMID]:28937571
[Au] Autor:Committee on Practice Bulletins-Obstetrics
[Ti] Título:Practice Bulletin No. 183: Postpartum Hemorrhage.
[So] Source:Obstet Gynecol;130(4):e168-e186, 2017 10.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2-4).The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician-gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.
[Mh] Termos MeSH primário: Obstetrícia/normas
Hemorragia Pós-Parto
Padrão de Cuidado/normas
[Mh] Termos MeSH secundário: Gerenciamento Clínico
Feminino
Seres Humanos
Morte Materna/prevenção & controle
Gravidez
Fatores de Risco
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002351


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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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[PMID]:28836877
[Au] Autor:Daniel R; Villuri S; Furlong K
[Ad] Endereço:a Farber Hospitalist Service, Vickie and Jack Farber Institute for Neuroscience, Departments of Neurosurgery and Medicine , Thomas Jefferson University , Philadelphia , PA , USA.
[Ti] Título:Management of hyperglycemia in the neurosurgery patient.
[So] Source:Hosp Pract (1995);45(4):150-157, 2017 Oct.
[Is] ISSN:2154-8331
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Hyperglycemia is associated with adverse outcomes in patients who are candidates for or underwent neurosurgical procedures. Specific concerns and settings that relate to these patients are preoperative glycemic control, intraoperative control, management in the neurological intensive care unit (NICU), and postoperative control. In each of these settings, physicians have to ensure appropriate glycemic control to prevent or minimize adverse events. The glycemic control is usually managed by a neurohospitalist in co-management with the neurosurgery team pre- and post-operatively, and by the neurocritical care team in the setting of NICU. In this review article, we outline current standards of care for neurosurgery patients with diabetes mellitus and/or and hyperglycemia and discuss results of most recent clinical trials. We highlight specific concerns with regards to glycemic controls in these patients including enteral tube feeding and parenteral nutrition, the issues of the transition to the outpatient care, and management of steroid-induced hyperglycemia. We also note lack of evidence in some important areas, and the need for more research addressing these gaps. Where possible, we provide suggestions how to manage these patients when there is no underlying guideline.
[Mh] Termos MeSH primário: Glicemia/análise
Complicações do Diabetes/prevenção & controle
Hiperglicemia/prevenção & controle
Hipoglicemia/prevenção & controle
Hipoglicemiantes/administração & dosagem
Insulina/administração & dosagem
Procedimentos Neurocirúrgicos/normas
Assistência Perioperatória/normas
[Mh] Termos MeSH secundário: Glicemia/efeitos dos fármacos
Glicemia/fisiologia
Complicações do Diabetes/complicações
Complicações do Diabetes/tratamento farmacológico
Seres Humanos
Hiperglicemia/complicações
Hiperglicemia/tratamento farmacológico
Hipoglicemiantes/normas
Hipoglicemiantes/uso terapêutico
Insulina/normas
Insulina/uso terapêutico
Unidades de Terapia Intensiva/normas
Monitorização Fisiológica/métodos
Monitorização Fisiológica/normas
Procedimentos Neurocirúrgicos/efeitos adversos
Procedimentos Neurocirúrgicos/métodos
Assistência Perioperatória/métodos
Padrão de Cuidado
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Hypoglycemic Agents); 0 (Insulin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1080/21548331.2017.1370968



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