ABSTRACT
BACKGROUND: Diabetes care is often sub-optimal. Quality improvement (QI) initiatives are intended to improve care processes and thereby improve patient outcomes. There is a need to assess the degree of implementation of QI strategies, as a prerequisite to managing implementation. AIMS: Our study aims to describe the level of implementation of six QI strategies for improving primary care of diabetes (self-management support, team changes, case management, patient education, electronic patient registers and patient reminders). METHODS: A survey and focus groups were conducted between October 2018 and January 2019. We invited eleven general practices in South Auckland, New Zealand. We constructed a questionnaire assessing six QI initiatives, adapting questionnaire items from published instruments. A summary score was calculated by QI strategy and by practice. RESULTS: Five practices participated. All were simultaneously implementing clinical team changes, patient education, electronic patient registers and patient reminders, but type and level of implementations varied between the practices. The scoring system discriminated between practices with respect to both individual strategies and the practice summary score. Practices engaged well with the assessment. Results were reported back to practices who confirmed that the scoring was plausible. The study describes key features and challenges during the implementation process. CONCLUSIONS: It is important to measure implementation of QI strategies. In this study of five practices, the instrument developed, and the associated measurement processes, were acceptable to practices and the results appear discriminatory and plausible.
Subject(s)
Diabetes Mellitus/therapy , Patient Care Team/organization & administration , Primary Health Care/methods , Quality Improvement/organization & administration , Humans , New Zealand , Surveys and QuestionnairesABSTRACT
RESUMEN Objetivo. Evaluar las características cuantitativas de la canal y composición química de la carne de corderos puros Santa Inés (SI) y cruces con Dorper (DO-SI) o Texel (TX-SI), terminados en confinamiento o semiconfinamiento, mediante un meta-análisis. Materiales y métodos. Bases de datos virtuales como Google Scholar, Science Direct y Scielo fueron utilizados para seleccionar los artículos científicos publicados desde el año 2000 a 2019. Palabras clave como genotipo, corderos, características de la canal y calidad de la carne, tanto en idioma español, portugués e inglés fueron utilizadas como criterios de inclusión de los artículos. De cada grupo genético, fueron evaluados: desempeño animal, características cuantitativas de la canal, cortes de la canal y composición química de la carne. Todos fueron incluidos en el análisis proveniente de 37 artículos científicos. Resultados. Peso corporal final, peso de la canal caliente, rendimiento de la canal fría y porcentaje de músculo no difieren entre los diferentes genotipos evaluados. Corderos DO-SI presentaron mayor consumo de materia seca, ganancia diaria de peso, área de ojo de lomo y porcentaje de lomo. Composición química no fue influenciada por los genotipos. Conclusiones. En ambiente tropical y subtropical, corderos puros SI terminados en confinamiento o semiconfinamiento presentan características cuantitativas de la canal y composición química similar a los corderos de cruces DO-SI y TX-SI.
ABSTRACT Objective. To evaluate the quantitative characteristics of the carcass and chemical composition of the meat of purebred Santa Inês (SI) lambs and crosses with Dorper (DO-SI) or Texel (TX-SI), finished in feedlot or semi-feedlot, through a meta-analysis. Materials and methods. Virtual databases such as Google Scholar, Science Direct and Scielo were used to select scientific articles published from 2000 to 2019. Keywords such as genotype, lambs, carcass characteristics and meat quality, both in Spanish, Portuguese and English were used as criteria for the inclusion of articles. From each genetic group were evaluated: animal performance, quantitative characteristics of the carcass, carcass cuts and chemical composition of the meat. These variables were included in the analysis from 37 scientific articles. Results. Final body weight, hot carcass weight, cold carcass yield and muscle percentage do not differ between the different genetic groups evaluated. DO-SI lambs showed higher dry matter intake, daily weight gain, loin eye area and loin percentage. Chemical composition was not influenced by the genetic groups. Conclusions. In a tropical and subtropical environment, purebred lambs SI finished in feedlot or semi-feedlot have quantitative characteristics of the carcass and chemical composition similar to DO-SI and TX-SI lambs.
Subject(s)
Animals , Sheep , Racial Groups , Red MeatABSTRACT
BACKGROUND: Scholars have recently started to pay more attention in the potential of the inter-professional relationship between general practitioners and specialists to improve outcomes, through consideration given to the effect on prescribing practices. However, more empirical research is needed. OBJECTIVE: To explore inter-professional network factors that may explain effects on General Practitioners prescription behaviours. METHODS: A qualitative study was conducted in an integrated diabetes care program. Data was collected through semi-structured interviews from 16 health practices and a hospital diabetes clinic, using a convenience sample of general practitioners, practices nurses, diabetes nurse specialists and endocrinologists. A conceptual mapping was performed to identify factors underlying networks and effects on patient outcomes. RESULTS: Four themes with their concepts emerged from the conceptual map. These demonstrated the need for building effective channels of communication to share experience and knowledge timely in diabetes care. Communication, collaboration and coordination are critical factors to influence prescription behaviours within primary and secondary care. CONCLUSIONS: conceptual mapping allowed understanding factors that might explain how links between health professionals can improve patient outcomes at the primary and secondary care interface.
ANTECEDENTES: Recientemente, académicos están dedicando más atención al potencial de las relaciones inter-profesionales entre médicos generales y especialistas, para mejorar los resultados en los pacientes a través de mejores prácticas de formulación. Sin embargo, es necesaria más investigación empírica. OBJETIVO: Explorar los mecanismos asociados en la colaboración entre profesionales de salud en la interface entre el primero y segundo nivel de salud, y sus efectos los comportamientos de prescripción de los médicos. MÉTODOS: Fue conducido un estudio cualitativo en el contexto de un programa integrado de atención de pacientes diabéticos. Fueron utilizadas entrevistas semi-estructuradas para la recolección de datos, en 16 centros de atención en salud y un programa de diabetes en el hospital de referencia, usando muestreo por conveniencia de médicos generales, enfermeras generales, enfermeras especialistas en diabetes y endocrinólogos. RESULTS: Cuatro temas con sus respectivos conceptos emergieron del mapa conceptual, identificando de manera general factores asociados a la red de profesionales y sus efectos en los pacientes. Lo que demuestra la necesidad de crear efectivos canales de comunicación para compartir experiencias y conocimientos en el cuidado de los pacientes diabéticos de una forma oportuna. Comunicación, colaboración y coordinación son factores críticos que influencian los comportamiento de prescripción de los médicos generales en la interface entre el nivel de atención primario y secundario. CONCLUSIONES: El mapeo conceptual permitió un mejor entendimiento en como las interacciones entre profesionales de salud entre el primero y segundo nivel de salud puede mejorar la condición clínica de los pacientes.
Subject(s)
Cooperative Behavior , General Practitioners/organization & administration , Health Personnel/organization & administration , Interprofessional Relations , Adult , Communication , Delivery of Health Care, Integrated/organization & administration , Diabetes Mellitus/therapy , Female , Humans , Interviews as Topic , Male , Middle Aged , Practice Patterns, Physicians'/standards , SpecializationABSTRACT
Background: Scholars have recently started to pay more attention in the potential of the inter-professional relationship between general practitioners and specialists to improve outcomes, through consideration given to the effect on prescribing practices. However, more empirical research is needed. Objective: To explore inter-professional network factors that may explain effects on General Practitioners' prescription behaviours. Methods: A qualitative study was conducted in an integrated diabetes care program. Data was collected through semi-structured interviews from 16 health practices and a hospital diabetes clinic, using a convenience sample of general practitioners, practices nurses, diabetes nurse specialists and endocrinologists. A conceptual mapping was performed to identify factors underlying networks and effects on patient outcomes. Results: Four themes with their concepts emerged from the conceptual map. These demonstrated the need for building effective channels of communication to share experience and knowledge timely in diabetes care. Communication, collaboration and coordination are critical factors to influence prescription behaviours within primary and secondary care. Conclusion: conceptual mapping allowed understanding factors that might explain how links between health professionals can improve patient outcomes at the primary and secondary care interface.
Antecedentes: Recientemente, académicos están dedicando más atención al potencial de las relaciones inter-profesionales entre médicos generales y especialistas, para mejorar los resultados en los pacientes a través de mejores prácticas de formulación. Sin embargo, es necesaria más investigación empírica. Objetivo: Explorar los mecanismos asociados en la colaboración entre profesionales de salud en la interface entre el primero y segundo nivel de salud, y sus efectos los comportamientos de prescripción de los médicos. Métodos: Fue conducido un estudio cualitativo en el contexto de un programa integrado de atención de pacientes diabéticos. Fueron utilizadas entrevistas semi-estructuradas para la recolección de datos, en 16 centros de atención en salud y un programa de diabetes en el hospital de referencia, usando muestreo por conveniencia de médicos generales, enfermeras generales, enfermeras especialistas en diabetes y endocrinólogos. Resultados: Cuatro temas con sus respectivos conceptos emergieron del mapa conceptual, identificando de manera general factores asociados a la red de profesionales y sus efectos en los pacientes. Lo que demuestra la necesidad de crear efectivos canales de comunicación para compartir experiencias y conocimientos en el cuidado de los pacientes diabéticos de una forma oportuna. Comunicación, colaboración y coordinación son factores críticos que influencian los comportamiento de prescripción de los médicos generales en la interface entre el nivel de atención primario y secundario. Conclusión: El mapeo conceptual permitió un mejor entendimiento en como las interacciones entre profesionales de salud entre el primero y segundo nivel de salud puede mejorar la condición clínica de los pacientes.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cooperative Behavior , General Practitioners/organization & administration , Health Personnel/organization & administration , Interprofessional Relations , Communication , Delivery of Health Care, Integrated/organization & administration , Diabetes Mellitus/therapy , Interviews as Topic , Practice Patterns, Physicians'/standards , SpecializationABSTRACT
AIM: The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. METHODS: An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. RESULTS: The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⻹ vs. -1.3 ± 0.28 s⻹, p=0.02) and SRE (1.8 ± 0.4 s⻹ vs. 2.2 ± 0.4 s⻹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. CONCLUSION: In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury.
