scholarly journals Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level

2021 ◽  
Vol 18 (21) ◽  
pp. 11573
Author(s):  
Tamara Rodríguez Quintana ◽  
Viviana Dávalos-Batallas ◽  
Ana-Magdalena Vargas-Martínez ◽  
Lucelly López ◽  
Patricia Bonilla-Sierra ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
National Level ◽  
National Health System ◽  
Health Centers ◽  
Cross Sectional ◽  
Care Level ◽  
Primary Care Level ◽  
Practice Guide ◽  
First Choice

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

scholarly journals Preferences on Vital and Nonvital Tooth Bleaching: A Survey Among Dentists from a City of Southern Brazil

2013 ◽  
Vol 24 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Flávio Fernando Demarco ◽  
Marcus Cristian Muniz Conde ◽  
Caroline Ely ◽  
Eliana Nascimento Torre ◽  
José Ricardo Souza Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Graduate Training ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Tooth Bleaching ◽  
Southern Brazil ◽  
Chi Square ◽  
Cross Sectional ◽  
First Choice ◽  
At Home

This study evaluated the preferences of general dentists regarding vital and nonvital tooth bleaching therapies and investigated whether the time of clinical practice and post-graduate training influence these options. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil (Pelotas, RS). Information was collected regarding sociodemographic variables, level of specialization and time since graduation. In addition, options regarding bleaching therapies including the first choice of material, technique and clinical practice for vital and nonvital tooth bleaching therapies were included. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher exact tests (α=0.05). The response rate was 68% (n=187). At-home bleaching therapy was broadly preferred (78.1%) over in-office (21.9%) bleaching. For at-home bleaching, most dentists answered to use 10% carbamide peroxide (CP) (40.2%) and >30% hydrogen peroxide (HP) (31.7%) for nonvital therapies. The majority of dentists with post-graduation training preferred at-home bleaching techniques (p=0.003). At-home bleaching therapy was also more indicated by younger dentists. No association was found between the choice for nonvital bleaching therapies and time since graduation (p=0.532) or continuous education (p=0.083). In conclusion, at-home bleaching was preferred over in-office therapies; 10% CP and >30% HP were chosen as first option agents to treat discolored vital and nonvital teeth, respectively. The time in clinical practice and the level of specialization affected dentists' choices only for vital tooth bleaching treatment.

scholarly journals Examining Governing Board Functions and Health Center Performances During Health System Reform: A Cross-sectional Study in 4 Regional States of Ethiopia

2020 ◽  
Author(s):  
Mesele Damte Argaw ◽  
Binyam Fekadu Desta
Keyword(s):  
Health System ◽  
Health Center ◽  
National Health System ◽  
Health Centers ◽  
Governing Boards ◽  
Primary Data ◽  
Governing Board ◽  
Cross Sectional ◽  
Parametric Test ◽  
Roles And Responsibilities

Background: Since 1995, the Ethiopian health system has been managed through decentralizing functions, resources, and authorities to local levels. As a result, health centers are led and managed by governing boards. In addition, the national health system strives to transform the performance of health centers through the implementation of reforms. Therefore, this study aims to examine the relationship between governing board functions and health center performances within a health reform context in 4 agrarian regions of Ethiopia. Methods: A cross-sectional survey was conducted from August 28, 2018 to September 30, 2018. Primary data were collected from governing board chairpersons or their designees using interviewer-administered structured questionnaires. The performance of each health center was rated out of 100 percentage points against the Ethiopian Health Center Reform Guideline (EHCRIG) standards. Secondary data were abstracted from a routine health information database using customized tools to capture achievements on 69 EHCRIG standards and its 174 validation criteria. Since the data violate the assumptions of the parametric test, the Spearman’s rank (rho) correlation test, (a non-parametric test) was employed to see if any correlation exists among 4 parameters; namely: structure, roles and responsibilities, training and development of governing boards, and performance of health centers against EHCRIGs standards. A statistically significant relationship was claimed at P<.050. Results: All 83 health center governing boards or designees who were approached for this study, participated. The mean health center governing board function score with standard deviation was 56.0% (SD ± 14.5%). The overall performance of health centers against EHCRIGs was 70.4% (SD ± 15.0%). There was a statistically significant and strong correlation (Spearman rho correlation coefficient) between health center performance scores measured against reform standards with governing board scores of (rho=0.866, P<.001) and overall governance scores (rho=0.828, P<.001). Conclusion: Based on the results of this study, we can conclude that well-functioning health center governing boards can improve the performance of health centers against clinical, and management reform standards. Therefore, continuous strengthening of the capacity of governing boards, focusing on improving implementation of their roles and responsibilities, and continuing training on business management is recommended.

scholarly journals Patients’ perceptions of continuity of care across primary care level and emergency departments in Belgium: cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033188
Author(s):  
Marlene Karam ◽  
Anne-Sophie Lambert ◽  
Jean Macq
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Emergency Departments ◽  
Structural Factors ◽  
Fee For Service ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Level ◽  
Primary Care Level ◽  
Individual Level

ObjectivesTo assess patients’ perceptions of continuity of care (COC) across primary care level and emergency departments (EDs) and to identify contextual and individual factors that influence this perception.DesignCross-sectional multicentre survey.SettingFive EDs in Brussels and Wallonia.Participants501 adult patients referred to the ED by their primary care physician (PCP). Patients with cognitive impairment or in critical condition were excluded.ResultsPatients perceived high levels of the three types of COC. On an individual level, older patients showed a perception of higher levels of continuity. Lower levels of informational and management continuity were observed among patients suffering from chronic diseases and patients with a high level of education. Patients also perceived a redundancy of medical exams, in parallel to a high degree of accessibility between care levels. On an organisational level, three structural factors were identified as barriers to COC, namely, ED workload, suboptimal sharing information system and the current fee-for-service payment system that encourages competition and hinders coordination between actors.ConclusionBelgian healthcare services seem satisfying for patients and easily accessible. However, efforts need to be directed towards improving their efficiency. A stronger primary care level is also needed to benefit the healthcare system by reducing overuse of emergency services. On the individual level, a more enhanced patient-centred approach could be beneficial in improving patients experience of care.

AWARENESS REGARDING PAP SMEAR AMONG WOMEN IN BAGHDAD CITY, IRAQ

2021 ◽  
Vol 74 (9) ◽  
pp. 2287-2292
Author(s):  
Tiba Nezar Hasan ◽  
Taqi Mohammed Jwad Taher ◽  
Hasanain Faisal Ghazi
Keyword(s):  
Cervical Cancer ◽  
Family History ◽  
Pap Smear ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Level ◽  
Primary Care Level ◽  
History Of ◽  
Awareness Level

The aim: The aim of this study was to determine the awareness level regarding pap smear in women living in Baghdad city, Iraq. Materials and methods: A cross-sectional study was done in 265 women living in Baghdad city using internet-based survey. Questionnaire was adopted from a previous study to measure the awareness level among women. Results: the results showed that only 8(3%) of the respondent had a family history of cervical cancer. Almost (94%) have heard about cervical cancer, while only (38%) knew that HPV virus is the cause of cervical cancer. Majority of the respondents (87%) heard about pap smear while only 67 (25.0 %) had performed pap smear before. A total of 86% agreed that early diagnosis is important in treating of the cervical cancer. Conclusions: Majority of women heard of cervical cancer and pap smear, but the level of its practice is still low with only 25% of respondents had performed it before. More health promotion is needed especially, at the primary care level regarding the importance of performing regular pap smear especially for women with family history of the cervical cancer.

scholarly journals The Changing Nature of Palliative Care: Implications for Allied Health Professionals’ Educational and Training Needs

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 112 ◽  
Author(s):  
Deidre D. Morgan ◽  
Deb Rawlings ◽  
Carly J. Moores ◽  
Lizzie Button ◽  
Jennifer J. Tieman
Keyword(s):  
Professional Development ◽  
Palliative Care ◽  
Clinical Practice ◽  
Health Professionals ◽  
Online Survey ◽  
Allied Health ◽  
Further Education ◽  
Allied Health Professionals ◽  
Cross Sectional ◽  
Education Access

CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education. Access to postgraduate professional development was limited by available backfill and funding. Study findings support the importance of free, accessible, relevant educational and professional development resources to support clinical practice. This is particularly relevant for allied health professionals who have limited opportunities to attend formal professional development sessions.

scholarly journals Palliative care integration indicators: an European regional analysis

2021 ◽  
pp. bmjspcare-2021-003181
Author(s):  
Miguel Antonio Sánchez-Cárdenas ◽  
Eduardo Garralda ◽  
Natalia Sofia Arias-Casais ◽  
Edgar Ricardo Benitez Sastoque ◽  
Danny Van Steijn ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Health Systems ◽  
Long Term Care ◽  
European Countries ◽  
Term Care ◽  
Care Level ◽  
Primary Care Level ◽  
Care Facilities

ObjectiveTo estimate the capacity of European countries to integrate palliative care (PC) into their health systems through PC service provision for patients of all ages, with different care needs and diseases, in various settings and by a range of providers.MethodsSecondary analysis of survey data from 51 countries with 22 indicators explored the integration of available PC resources for children, for patients of all ages, at the primary care level, for oncology and cardiac patients, and in long-term care facilities. We also measured volunteer participation. Results were quantified, converted into weighted subscores by area and combined into a single ‘Integration Capacity Score (ICS)’ for each country.ResultsThirty-eight countries reported 543 specialised paediatric PC services. One-third of all surveyed countries reported 20% or more of patients with PC needs at the primary care level. Twenty-four countries have a total of 155 designated centres that integrate oncology and PC. Eight countries were pioneering cardiology services that integrate PC. Eight reported a volunteer workforce of over 1000 and 12 had policies regulating PC provision and interventions in long-term care facilities. Across all indicators, 39 countries (76%) score from low to very low integration capacity, 8 (16%) score at an intermediate level, and 4 (8%; the Netherlands, UK, Germany and Switzerland) report a high-level integration of PC into their health systems.ConclusionVariable progress according to these indicators shows that most European countries are still in the process of integrating PC into their health systems.

scholarly journals Precision Oncology in Metastatic Uterine Cancer; Croatian First-Year Experience of the Comprehensive Genomic Profiling in Everyday Clinical Practice

2021 ◽  
Vol 27 ◽  
Author(s):  
Dora Čerina ◽  
Višnja Matković ◽  
Kristina Katić ◽  
Ingrid Belac Lovasić ◽  
Robert Šeparović ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Uterine Cancer ◽  
National Level ◽  
Pik3ca Mutation ◽  
First Year ◽  
Precision Oncology ◽  
Genomic Profiling ◽  
Genomic Alterations ◽  
Cross Sectional ◽  
Comprehensive Genomic Profiling

Comprehensive genomic profiling (CGP) is gradually becoming an inevitable part of the everyday oncology clinical practice. The interpretation and optimal implementation of the results is one of the hot topics of modern-day oncology. According to the recent findings, uterine cancer harbors a high level of gene alterations but is still insufficiently explored. The primary goal of this project was to assess the proportion of patients with targetable mutations. Also, the aim was to define and emphasize potential opportunities as well as the problems we have faced in the first year of testing on the national level. We performed a multicentric, retrospective, nested cross-sectional analysis on the total population of Croatian patients with advanced/metastatic uterine cancer where the tumor CGP was performed during 2020. CGP of the tumor tissue of 32 patients revealed clinically relevant genomic alterations (CRGA) in 27 patients (84%) with a median of 3 (IQR 1-4) CRGA per patient. The most common CRGAs were those of phosphatide-inositol-3 kinases (PIK3) in 22 patients (69%), with 13/22 (59%) of those patients harboring PIK3CA mutation. The next most common CGRAs were ARID1A and PTEN mutations in 13 (41%) and 11 (34%) patients, respectively. Microsatellite status was determined as stable in 21 patients (66%) and highly unstable in 10 patients (31%). A high tumor mutational burden (≥10Muts/Mb) was reported in 12 patients (38%). CGP analysis reported some kind of targeted therapy for 28 patients (88%). CGP determined clinically relevant genomic alterations in the significant majority of patients with metastatic uterine cancer, defining it as a rich ground for further positioning and development of precision oncology.

Association between early treatment hospitals, serum cholesterol level and cardiovascular disease risk in dyslipidemia patients

2020 ◽  
Author(s):  
Kyu-Tae Han ◽  
Seung Ju Kim
Keyword(s):  
Primary Care ◽  
Serum Cholesterol ◽  
Community Health Centers ◽  
Serum Cholesterol Level ◽  
Health Centers ◽  
Cvd Risk ◽  
Care Level ◽  
Primary Care Level ◽  
Cholesterol Levels ◽  
Primary Care Institutions

Abstract Background Studies have shown the importance of managing chronic diseases, such as cardiovascular disease (CVD), at the primary treatment level. Here, we aimed to evaluate the association between medical treatment institutions and health outcomes in patients with dyslipidemia, a major risk of CVD, to provide evidence for increasing chronic disease management at the primary care level in Korea. Methods We used National Health Insurance Sampling cohort data, of which 37 506 patients were newly diagnosed with dyslipidemia during 2009–14. CVD risk and changes in serum cholesterol level after dyslipidemia diagnosis were outcome variable examined. A generalized estimating equation model was used to identify associations between initial medical institution, CVD risk and changes in serum cholesterol levels. The Cox proportional-hazard ratio was used to assess the association between initial medical institutions and detailed CVD risk. Subgroup analyses were conducted to assess CVD risk following treatment with prescription medication. Results Our analyses demonstrate that CVD risk was lower at primary care-level community health centers and clinics compared to tertiary hospitals, with a statistically significant difference observed in clinics. Ischemic heart disease was lower at community health centers and clinics. However, all medical institution types were associated with significantly lower serum cholesterol levels compared to the baseline. Conclusions Management of patients with dyslipidemia at primary care institutions was associated with reduced CVD risk and decreased serum cholesterol levels. Therefore, policymakers should strengthen the quality of healthcare at primary care institutions and educate patients that these institutions are appropriate for managing chronic disease.

Sign in / Sign up

Export Citation Format

Share Document