7,671 research outputs found

    TeamSTEPPS and Organizational Culture

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    Patient safety issues remain despite several strategies developed for their deterrence. While many safety initiatives bring about improvement, they are repeatedly unsustainable and short-lived. The index hospital’s goal was to build an organizational culture within a groundwork that improves teamwork and continuing healthcare team engagement. Teamwork influences the efficiency of patient care, patient safety, and clinical outcomes, as it has been identified as an approach for enhancing collaboration, decreasing medical errors, and building a culture of safety in healthcare. The facility implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to produce valuable and needed changes, facilitating modification of organizational culture, increasing patient safety compliance, or solving particular issues. This study aimed to identify the correlation between TeamSTEPPS enactment and improved organizational culture in the ambulatory care nursing department of a New York City public hospital

    Improving diagnostic procedures for epilepsy through automated recording and analysis of patients’ history

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    Transient loss of consciousness (TLOC) is a time-limited state of profound cognitive impairment characterised by amnesia, abnormal motor control, loss of responsiveness, a short duration and complete recovery. Most instances of TLOC are caused by one of three health conditions: epilepsy, functional (dissociative) seizures (FDS), or syncope. There is often a delay before the correct diagnosis is made and 10-20% of individuals initially receive an incorrect diagnosis. Clinical decision tools based on the endorsement of TLOC symptom lists have been limited to distinguishing between two causes of TLOC. The Initial Paroxysmal Event Profile (iPEP) has shown promise but was demonstrated to have greater accuracy in distinguishing between syncope and epilepsy or FDS than between epilepsy and FDS. The objective of this thesis was to investigate whether interactional, linguistic, and communicative differences in how people with epilepsy and people with FDS describe their experiences of TLOC can improve the predictive performance of the iPEP. An online web application was designed that collected information about TLOC symptoms and medical history from patients and witnesses using a binary questionnaire and verbal interaction with a virtual agent. We explored potential methods of automatically detecting these communicative differences, whether the differences were present during an interaction with a VA, to what extent these automatically detectable communicative differences improve the performance of the iPEP, and the acceptability of the application from the perspective of patients and witnesses. The two feature sets that were applied to previous doctor-patient interactions, features designed to measure formulation effort or detect semantic differences between the two groups, were able to predict the diagnosis with an accuracy of 71% and 81%, respectively. Individuals with epilepsy or FDS provided descriptions of TLOC to the VA that were qualitatively like those observed in previous research. Both feature sets were effective predictors of the diagnosis when applied to the web application recordings (85.7% and 85.7%). Overall, the accuracy of machine learning models trained for the threeway classification between epilepsy, FDS, and syncope using the iPEP responses from patients that were collected through the web application was worse than the performance observed in previous research (65.8% vs 78.3%), but the performance was increased by the inclusion of features extracted from the spoken descriptions on TLOC (85.5%). Finally, most participants who provided feedback reported that the online application was acceptable. These findings suggest that it is feasible to differentiate between people with epilepsy and people with FDS using an automated analysis of spoken seizure descriptions. Furthermore, incorporating these features into a clinical decision tool for TLOC can improve the predictive performance by improving the differential diagnosis between these two health conditions. Future research should use the feedback to improve the design of the application and increase perceived acceptability of the approach

    Anuário científico da Escola Superior de Tecnologia da Saúde de Lisboa - 2021

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    É com grande prazer que apresentamos a mais recente edição (a 11.ª) do Anuário Científico da Escola Superior de Tecnologia da Saúde de Lisboa. Como instituição de ensino superior, temos o compromisso de promover e incentivar a pesquisa científica em todas as áreas do conhecimento que contemplam a nossa missão. Esta publicação tem como objetivo divulgar toda a produção científica desenvolvida pelos Professores, Investigadores, Estudantes e Pessoal não Docente da ESTeSL durante 2021. Este Anuário é, assim, o reflexo do trabalho árduo e dedicado da nossa comunidade, que se empenhou na produção de conteúdo científico de elevada qualidade e partilhada com a Sociedade na forma de livros, capítulos de livros, artigos publicados em revistas nacionais e internacionais, resumos de comunicações orais e pósteres, bem como resultado dos trabalhos de 1º e 2º ciclo. Com isto, o conteúdo desta publicação abrange uma ampla variedade de tópicos, desde temas mais fundamentais até estudos de aplicação prática em contextos específicos de Saúde, refletindo desta forma a pluralidade e diversidade de áreas que definem, e tornam única, a ESTeSL. Acreditamos que a investigação e pesquisa científica é um eixo fundamental para o desenvolvimento da sociedade e é por isso que incentivamos os nossos estudantes a envolverem-se em atividades de pesquisa e prática baseada na evidência desde o início dos seus estudos na ESTeSL. Esta publicação é um exemplo do sucesso desses esforços, sendo a maior de sempre, o que faz com que estejamos muito orgulhosos em partilhar os resultados e descobertas dos nossos investigadores com a comunidade científica e o público em geral. Esperamos que este Anuário inspire e motive outros estudantes, profissionais de saúde, professores e outros colaboradores a continuarem a explorar novas ideias e contribuir para o avanço da ciência e da tecnologia no corpo de conhecimento próprio das áreas que compõe a ESTeSL. Agradecemos a todos os envolvidos na produção deste anuário e desejamos uma leitura inspiradora e agradável.info:eu-repo/semantics/publishedVersio

    ADVANCING THE QUADRUPLE AIM IN MEDI-CAL MANAGED CARE: PROVIDER AND HEALTH PLAN LEADER PERSPECTIVES REGARDING THE INCLUSION OF PARAPROFESSIONALS ON CARE TEAMS FOR DEVELOPMENTAL SCREENING AND CARE COORDINATION

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    Problem Approximately 25% of Medi-Cal enrollees receive a developmental screening in the first three years of life, a rate below the 33% national benchmark (DHCS 2020). Medi-Cal providers cite limited time as a barrier to completing developmental screenings (First 5 LA 2017). Literature supports inclusion of unlicensed paraprofessionals on teams to increase developmental screening and service referral rates (Minkovitz 2003, Warmels 2017). An understanding of facilitators and barriers to adding paraprofessionals such as community health workers (CHWs) and care coordinators to teams can inform pediatric transformation initiatives. Research regarding workforce transformation strategies is pivotal as California advances a CHW Medi-Cal benefit in 2022 and prepares for a physician shortage (Chapman 2017, LAO 2021, Spetz 2017). Pediatric paraprofessionals could advance the “quadruple aim”- improving population health, enhancing patient experience, reducing per capita cost of health care, and improving clinician work life (Bodenheimer 2014). As the majority of Medi-Cal enrollees face health disparities, ensuring pediatric members with developmental concerns are routed to services could address the “quintuple aim,” which includes improving health equity (Nundy 2022).Methodology This mixed methods study analyzed 10 Medi-Cal providers’ and 10 Medi-Cal plan clinical leaders’ perceptions of facilitators and barriers impacting timely developmental screening and coordination to services and supports. The study then identified facilitators and barriers to shifting developmental screening and care coordination tasks to paraprofessionals. Results Medi-Cal provider and health plan informants were receptive to incorporating paraprofessionals on teams to perform select developmental screening and care coordination tasks. Facilitators included leaders committed to early identification and intervention (EII), a training and supervisory infrastructure, and software optimized for screenings and referrals. The major barrier was a perception of inadequate reimbursement. Few respondents perceived health plans as drivers of successful EII, suggesting an opportunity for California regulators to enforce screening and coordination requirements, fund pediatric workforce transformation, and route families to care coordination resources.Recommendations The research suggests major reimbursement needs to adequately support of developmental screening and care coordination tasks. Study findings can inform leaders pursuing pediatric workforce transformation initiatives in Medi-Cal. Additional qualitative research with paraprofessionals and families is warranted to refine workforce transformation approaches.Doctor of Public Healt

    COVID-19 Outbreak and Beyond

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    The COVID-19 pandemic drastically changed our lifestyle when, on 30 January 2020, the World Health Organization declared the coronavirus disease outbreak a public health emergency of international concern. Since then, many governments have introduced unprecedented containment measures, hoping to slow the spread of the virus. International research suggests that both the pandemic and the related protective measures, such as lockdown, curfews, and social distancing, are having a profound impact on the mental health of the population. Among the most commonly observed psychological effects, there are high levels of stress, anxiety, depression, and post-traumatic symptoms, along with boredom and frustration. At the same time, the behavioral response of the population is of paramount importance to successfully contain the outbreak, creating a vicious circle in which the psychological distress impacts the willingness to comply with the protective measures, which, in turn, if prolonged, could exacerbate the population’s distress. This book includes: i) original studies on the worldwide psychological and behavioral impact of COVID-19 on targeted individuals (e.g., parents, social workers, patients affected by physical and mental disorders); ii) studies exploring the effect of COVID-19 using advanced statistical and methodological techniques (e.g., machine learning technologies); iii) research on practical applications that could help identify persons at risk, mitigate the negative effects of this situation, and offer insights to policymakers to manage the pandemic are also highly welcomed

    Covid-19 and Capitalism

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    This open access book provides a comprehensive analysis of the socioeconomic determinants of Covid-19. From the end of 2019 until presently, the world has been ravaged by the Covid-19 pandemic. Although the cause of this is (obviously) a virus, the extent to which this virus spread, and therefore the number of infections and deaths, was largely determined by socio-economic factors. From this, it follows that the course of the pandemic varies greatly from one country to another. This observation applies both to countries’ resilience to such a pandemic (which is mainly rooted in the period preceding the outbreak of the virus) and to the way in which countries have reacted to the virus (including the political choices on how to respond). Meanwhile, research has made it clear that the nature of this response (e.g., elimination policy, mitigation policy, and proceeding herd immunity) was, on the one hand, strongly determined by political and ideological factors and, on the other hand, was highly influential in the factors of success or failure in combating the pandemic. The book focuses on the situation in a number of Western regions (notably the USA, the UK, and the EU and its Member States). The author addresses the reasons why in many Western countries both pandemic prevention and response policies to Covid-19 have failed. The book concludes with recommendations concerning the rearrangement of the socio-economic order that could increase the resilience of (Western) societies against such pandemics
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