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Pesquisa : SP1.001.002.008 [Categoria DeCS]
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PMID:28223153
Autor:Gesthalter YB; Koppelman E; Bolton R; Slatore CG; Yoon SH; Cain HC; Tanner NT; Au DH; Clark JA; Wiener RS
Endereço:Pulmonary Center, Boston University School of Medicine, Boston, MA.
Título:Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs: Lessons Learned.
Fonte:Chest; 152(1):70-80, 2017 Jul.
ISSN:1931-3543
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Guidelines recommend lung cancer screening (LCS), and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how LCS has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. METHODS: We performed qualitative evaluations of LCS implementation at three Veterans Administration facilities, conducting semistructured interviews with key staff (n = 29). Guided by the Promoting Action on Research Implementation in Health Services framework, we analyzed transcripts using principals of grounded theory. RESULTS: Programs successfully incorporated most recommended elements of LCS, although varying in approaches to patient selection, tobacco treatment, and quality audits. Barriers to implementation included managing workload to ensure appropriate evaluation of pulmonary nodules detected by screening and difficulty obtaining primary care "buy-in." To manage workload, programs used nurse coordinators to actively maintain screening registries, held multidisciplinary conferences that generated explicit management recommendations, and rolled out implementation in a staged fashion. Successful strategies to engage primary care providers included educational sessions, audit and feedback of local outcomes, and assisting with and assigning clear responsibility for nodule evaluation. Capitalizing on pre-existing relationships and including a designated program champion helped facilitate intradisciplinary communication. CONCLUSIONS: Lung cancer screening implementation is a complex undertaking requiring coordination at many levels. The insight gained from evaluation of these early-adopting programs may inform subsequent design and implementation of LCS programs.
Tipo de publicação: JOURNAL ARTICLE


  2 / 319 MEDLINE  
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PMID:28206808
Autor:Nützi M; Trezzini B; Medici L; Schwegler U
Endereço:Unit for Empowerment, Participation & Social Integration, Swiss Paraplegic Research.
Título:Job matching: An interdisciplinary scoping study with implications for vocational rehabilitation counseling.
Fonte:Rehabil Psychol; 62(1):45-68, 2017 Feb.
ISSN:1939-1544
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: Matching a person's capabilities and characteristics with the demands and characteristics of their job is crucial for sustainable employment, in particular for persons with disabilities. The present study aims to summarize and synthesize conceptual and empirical knowledge on job matching (JM) from industrial and organizational psychology (IOP), vocational psychology (VP), and return to work (RTW) research. RESEARCH METHOD: We conducted a scoping study applying Arksey and O'Malley's (2005) framework and using eight electronic databases from psychology, economics, and medicine. The literature search covered studies in English and German published between 1945 and 2015. RESULTS: A total of 312 studies were selected and analyzed. Of these, 205 were assigned to IOP, 45 to VP, 31 to both IOP and VP, and 17 to RTW research. Fourteen studies were allocated to both RTW and VP research, representing the field of vocational rehabilitation counseling. IOP and VP studies predominantly investigated the effects of JM on work-related outcomes, such as job satisfaction, tenure, or career development. RTW research focused on the development of mainly generic JM tools for job placement of persons with disabilities. Limited cross-fertilization between IOP and VP and the RTW context became evident. CONCLUSIONS: Unlike in IOP and VP, there is a dearth of JM research in the RTW context. Integrating the broad organizational and occupational JM knowledge from IOP and VP with the biopsychosocial framework of RTW could provide a sound basis for developing JM applications in vocational rehabilitation counseling that promote sustainable work reintegration of persons with disabilities. (PsycINFO Database Record
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  3 / 319 MEDLINE  
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PMID:28771418
Autor:Donoghue EA; COUNCIL ON EARLY CHILDHOOD
Título:Quality Early Education and Child Care From Birth to Kindergarten.
Fonte:Pediatrics; 140(2), 2017 Aug.
ISSN:1098-4275
País de publicação:United States
Idioma:eng
Resumo:High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28679640
Autor:Johnson LM; Frader J; Wolfe J; Baker JN; Anghelescu DL; Lantos JD
Endereço:Division of Oncology Hospitalist Medicine, St. Jude's Hospital and Research Center, Memphis, Tennessee.
Título:Palliative Sedation With Propofol for an Adolescent With a DNR Order.
Fonte:Pediatrics; 140(2), 2017 Aug.
ISSN:1098-4275
País de publicação:United States
Idioma:eng
Resumo:Death from cancer is often painful. Usually, the pain can be relieved in ways that allow patients to remain awake and alert until the end. Sometimes, however, the only way to relieve pain is to sedate patients until they are unconscious. This method has been called palliative sedation therapy. Palliative sedation therapy is controversial because it can be misunderstood as euthanasia. We present a case in which an adolescent who is dying of leukemia has intractable pain. Experts in oncology, ethics, pain management, and palliative care discuss the trade-offs associated with different treatment strategies.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância:YI7VU623SF (Propofol)


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PMID:28097634
Autor:Caqueo-Urízar A; Rus-Calafell M; Craig TK; Irarrazaval M; Urzúa A; Boyer L; Williams DR
Endereço:Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile. acaqueo@uta.cl.
Título:Schizophrenia: Impact on Family Dynamics.
Fonte:Curr Psychiatry Rep; 19(1):2, 2017 Jan.
ISSN:1535-1645
País de publicação:United States
Idioma:eng
Resumo:In many societies, family members are now the primary caregivers of mental health patients, taking on responsibilities traditionally under the purview of hospitals and medical professionals. The impact of this shift on the family is high, having both an emotional and economic toll. The aim of this paper is to review the main changes that occur in family dynamics for patients with schizophrenia. The article addresses three central themes: (i) changes in the family at the onset of the disorder, (ii) consequences for family members because of their caregiver role, and (iii) family interventions aimed at improving the complex dynamics within the family. After analyzing and discussing these themes, it is observed that despite advances in the field, the viability of taking care of a patient with schizophrenia by the family remains a challenge. Improving care will require commitments from the family, the mental health service system, and local and national governments for greater investments to improve the quality of life of society in general and individuals with schizophrenia in particular.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


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PMID:28467412
Autor:Filipe A; Renedo A; Marston C
Endereço:London School of Hygiene and Tropical Medicine, London, United Kingdom.
Título:The co-production of what? Knowledge, values, and social relations in health care.
Fonte:PLoS Biol; 15(5):e2001403, 2017 May.
ISSN:1545-7885
País de publicação:United States
Idioma:eng
Resumo:"Co-production" is becoming an increasingly popular term in policymaking, governance, and research. While the shift from engagement and involvement to co-production in health care holds the promise of revolutionising health services and research, it is not always evident what counts as co-production: what is being produced, under what circumstances, and with what implications for participants. We discuss these questions and propose that co-production can be understood as an exploratory space and a generative process that leads to different, and sometimes unexpected, forms of knowledge, values, and social relations. By opening up this discussion, we hope to stimulate future debates on co-production as well as draw out ways of thinking differently about collaboration and participation in health care and research. Part of the title of this article is inspired by the book "The Social Construction of What?" by Ian Hacking (Cambridge, MA: Harvard University Press; 2000).
Tipo de publicação: JOURNAL ARTICLE


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PMID:28628536
Autor:Gill SV; Khetani MA; Yinusa-Nyahkoon L; McManus B; Gardiner PM; Tickle-Degnen L
Endereço:From the Departments of Occupational Therapy (SVG, LY-N), Medicine (SVG), and Psychological & Brain Sciences (SVG), Boston University, Boston, Massachusetts; Departments of Occupational Therapy (MAK), and Disability and Human Development (MAK), University of Illinois at Chicago, Chicago, Illinois; Department of Health Systems, Management and Policy (BM), and Adult and Child Consortium on Health Outcomes Research and Delivery Science (MAK, BM), University of Colorado, Denver, Colorado; Department of Family Medicine, Boston University, Boston, Massachusetts (LY-N, PMG); and Department of Occupational Therapy, Tufts University, Medford, Massachusetts (LT-D).
Título:Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR): A Logic Model.
Fonte:Am J Phys Med Rehabil; 96(7):479-486, 2017 Jul.
ISSN:1537-7385
País de publicação:United States
Idioma:eng
Resumo:In a patient-centered care era, rehabilitation can benefit from researcher-clinician collaboration to effectively and efficiently produce the interdisciplinary science that is needed to improve patient-centered outcomes. The authors propose the use of the Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR) logic model to provide guidance to rehabilitation scientists and clinicians who are committed to growing their involvement in interdisciplinary rehabilitation research. We describe the importance and key characteristics of the FAIRR model for conducting interdisciplinary rehabilitation research.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28679016
Autor:Ciliberti-Vargas MA; Gardener H; Wang K; Dong C; Yi L; Romano JG; Robichaux M; Waddy SP; Nobo U; Diaz-Acosta S; Rundek T; Waters MF; Sacco RL
Endereço:From the University of Miami Miller School of Medicine, Miami, Florida, University of Miami School of Architecture, Coral Gables, Florida, the National Institute for Neurological Diseases and Stroke, Bethesda, Maryland, Hospital HIMA San Pablo, Caguas, Puerto Rico, American Heart Association Greater
Título:Stroke Hospital Characteristics in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study.
Fonte:South Med J; 110(7):466-474, 2017 Jul.
ISSN:1541-8243
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVES: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics within a large quality improvement registry to identify characteristics associated with better outcomes for acute ischemic stroke care. METHODS: Trained personnel from 78 FL-PR CReSD hospitals (69 FL, 9 PR) completed a 50-item survey assessing institutional characteristics across seven domains: acute stroke care resource availability, emergency medical services integration, stroke center certification, data collection and use, quality improvement processes, FL-PR CReSD recruitment incentives, and hospital infrastructure. RESULTS: The rate of survey completion was 100%. Differences were observed both within FL and between FL and PR. Years participating in Get With The Guidelines-Stroke (8.9 ± 2.6 years FL vs 4.8 ± 2.4 years PR, < 0.0001) and proportion of hospitals with any stroke center certification (94.2% FL vs 11.1% PR, < 0.0001) showed the largest variations. Smaller hospital size, fewer years in Get With The Guidelines-Stroke, and lack of stroke center designation and acute stroke care practice implementation may contribute to poorer outcomes. CONCLUSIONS: Results from our survey indicated variability in hospital- and system-level characteristics in stroke care across hospitals in Florida and Puerto Rico. Identification of these variations, which may explain potential disparities, can help clinicians understand gaps in stroke care and outcomes and targeted interventions to reduce identified disparities can be implemented.
Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE


  9 / 319 MEDLINE  
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PMID:28679013
Autor:Varga Z; Sabzwari SAR; Abusaada K
Endereço:From Internal Medicine Residency, Florida Hospital Orlando, Orlando, Florida.
Título:Impact of Consultation on Hospital Outcomes and Resource Utilization for Patients with Acute Congestive Heart Failure.
Fonte:South Med J; 110(7):452-456, 2017 Jul.
ISSN:1541-8243
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVES: Consultation is an important tool for acquiring subspecialty support when managing patients with acute congestive heart failure (CHF). The effect of consultation on hospital outcomes and resource utilization in CHF is unknown. The objectives of our study were to determine the effect of consultation on outcomes in CHF and to evaluate factors affecting the frequency of consultation. METHODS: Our study was a retrospective cohort study of patients admitted to Florida Hospital Orlando for CHF between January 1, 2011 and December 31, 2013. Data on demographics, number of consultations, length of stay (LOS), readmissions within 30 days, cost of care, and mortality were compared according to the number of consultations. For statistical analysis, analysis of variance, the χ test, and multivariate linear regression analysis were used. Risk-adjusted outcomes were reported as observed/expected. RESULTS: A total of 1554 patients were included; 103 (6.6%) patients received no consultation; 482 (31%) received 1; 365 (23.5%) received 2; 229 (14%) received 3; and 375 (24%) received ≥4. Teaching service, age, and African American race were associated with decreased consultation ( < 0.001 for all) and high case-mix index was associated with increased consultation ( < 0.001). Adjusted LOS and costs increased with an increased number of consultations ( < 0.001 for both). There was no difference in adjusted mortality or 30-day readmission rate based on the number of consultations ( = 0.35 and 0.98, respectively). CONCLUSIONS: Increased consultation with patients with CHF is associated with increased costs and LOS without improved mortality or readmission rate. Decreased utilization of consultations by the teaching service suggests that there is an opportunity to decrease utilization of healthcare resources by streamlining the utilization of consultations.
Tipo de publicação: JOURNAL ARTICLE


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PMID:28679012
Autor:Schoenberg NE; Swanson M
Endereço:From the College of Medicine/College of Public Health and the Department of Health Behavior, College of Public Health, University of Kentucky, Lexington.
Título:Rural Religious Leaders' Perspectives on their Communities' Health Priorities and Health.
Fonte:South Med J; 110(7):447-451, 2017 Jul.
ISSN:1541-8243
País de publicação:United States
Idioma:eng
Resumo:OBJECTIVES: In traditionally underserved communities, faith-based interventions have been shown to be effective for health promotion. Religious leaders-generally the major partner in such interventions-however, are seldom are consulted about community health priorities and health promotion preferences. These insights are critical to ensure productive partnerships, effective programming, and sustainability. METHODS: Mixed-methods surveys were administered in one of the nation's most under-resourced regions: rural Appalachia. A sample of 60 religious leaders, representing the main denominations in central Appalachia, participated. Measures included closed- and open-ended survey questions on health priorities and recommendations for health promotion. Descriptive statistics were used for closed-ended survey items and conventional qualitative content analysis was used for open-ended responses. RESULTS: Substance abuse, diabetes mellitus, suboptimal dietary intake and obesity/overweight, and cardiovascular and respiratory illnesses constitute major health concerns. Addressing these challenging conditions requires realistically acknowledging sparse community resources (particularly healthcare provider shortages); building in accountability; and leveraging local assets and traditions such as testimonials, intergenerational support, and witnessing. CONCLUSIONS: With their extensive reach within the community and their accurate understanding of community health threats, practitioners and researchers may find religious leaders to be natural allies in health-promotion and disease-prevention activities.
Tipo de publicação: JOURNAL ARTICLE



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