Práticas psicológicas nos Creas do interior do RS: o olhar de trabalhadoras(es) / Psychological practices on CREAS in the countryside of the state of Rio Grande do Sul: perspectives of workers / Prácticas psicológicas en CREAS en el interior de Rio Grande do Sul: perspectiva de trabajadoras/es

O presente texto tem o objetivo de explanar ações desempenhadas por psicólogas(os) trabalhadoras(es) dos Centros de Referência Especializados de Assistência Social (Creas), em situações de violência intrafamiliar, identificadas a partir do estude empírico realizado por mim, psicóloga pesquisadora, também trabalhadora de um Creas. Participaram da pesquisa doze psicólogas(os), trabalhadoras(es) destes centros, em sete municípios do interior do Rio Grande do Sul, onde foram realizadas, presencialmente, as entrevistas. A análise dos dados apontou para uma compreensão metodológica a partir de três dimensões já apontadas na bibliografia, sendo elas: a) Acolhida Inicial, que demonstra que esses profissionais geralmente iniciam suas práticas com uma família ou indivíduo indo ao encontro destes, buscando a vinculação dos mesmos com o serviço; b) Acompanhamento Especializado, onde essas(es) trabalhadoras(es) desenvolvem suas práticas com diversidade e criatividade, a partir de visitas domiciliares, trabalhos com grupos, indivíduos ou famílias, geralmente em conjunto com outros profissionais, principalmente assistentes sociais; c) Articulação com a Rede, onde se identificou um importante movimento para o trabalho em conjunto com outros serviços disponíveis no território. Por fim, as considerações finais indicam que ainda há um caminho a ser trilhado com relação à definição das práticas dos psicólogos no Creas. Porém, há muito que se falar a respeito de práticas que já estão ocorrendo. Assim, tornam-se relevantes as pesquisas acadêmicas nesse contexto, pois ao inserir os profissionais psicólogos trabalhadores da política, eles podem promover uma articulação entre a produção do fazer cotidiano e a reflexão teórica e acadêmica sustentada pelas pesquisas.(AU)

This study aims to explore the activities developed by psychologists from the Centros de Referência de Atenção Especializada (CREAS - Brazilian Specialized Social Assistance Reference Centers), regarding situations of intrafamily violence identified by me, the author, a research psychologist and, CREAS worker. Participants include 12 psychologists who work on such centers from 7 cities in the countryside of Rio Grande do Sul, Brazil, where the interviews were conducted in person. The data analysis pointed toward a methodological comprehension based on 3 dimensions that have already been mentioned in the literature: the Initial Approach, which shows that these workers usually initiate their practices with a family or an individual by going after them, seeking bond development with the service. The Specialized Follow-up, in which these workers develop their practices with diversity and creativity, through home visits and activities with group, family or individual, often with other workers, such as social assistance workers. And the Network Articulation, in which a significant movement toward working with the public services available on each territory is identified. Finally, there is still a path to be taken regarding the definition of psychological practices on CREAS, however, there is much to be noticed of what has already been occurring. Thus, academic research on such context is relevant since the inclusion of psychologists who work in this policy may promote an articulation between daily activity and the theoretical and academic reflection, supported by the research.(AU)

Este texto tuvo por objetivo explicar las acciones desarrolladas por psicólogas/os trabajadoras/es en los "Centros de Referência Especializados de Assistência Social" (CREAS) (Centros de Referencia Especializados en Asistencia Social), respecto a las situaciones de violencia intrafamiliar, identificadas por un estudio empírico hecho por una psicóloga-investigadora que actúa en un CREAS. Participaron 12 psicólogas/os que trabajan en estos centros, en siete ciudades del interior de Rio Grande do Sul (Brasil), donde se llevó a cabo las entrevistas en persona. El análisis de datos apuntó a una comprensión metodológica de tres dimensiones ya destacadas en la bibliografía: la Acogida Inicial, que enseña que estos profesionales generalmente empiezan sus prácticas con una familia o individuo buscando el encuentro para la promoción de la vinculación con el servicio; El Seguimiento Especializado, en el que desarrollan sus prácticas con diversidad y creatividad desde visitas domiciliarias, trabajos con grupos, individuos o familias, generalmente junto a otros profesionales, sobre todo con trabajadores sociales; y Articulación con la Red de Servicios, en la cual se identificó un importante movimiento para el trabajo con otros servicios disponibles en el territorio. Por fin, se observa que todavía hay un camino por recorrer en relación a la definición de las prácticas de psicólogos en CREAS, aunque hay mucho que decir respecto a las prácticas que ya están ocurriendo. Así, se vuelven relevantes las investigaciones académicas en ese contexto por introducir a los profesionales psicólogos trabajadores de la política, las cuales pueden promover una articulación entre la producción del hacer cotidiano y la reflexión teórica y académica sustentada por las investigaciones.(AU)

Adult cardiac surgery during COVID-19 lockdown: Impact on activity and outcomes in a high-volume centre.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak had a direct impact on adult cardiac surgery activity, which systematically necessitates a postoperative stay in intensive care. AIM: To study the effect of the COVID-19 lockdown on cardiac surgery activity and outcomes, by making a comparison with the corresponding period in 2019. METHODS: This prospective observational cohort study compared adult cardiac surgery activity in our high-volume referral university hospital from 9 March to 10 May 2020 versus 9 March to 10 May 2019. Data were collected in our local certified database and a national database sponsored by the French society of thoracic and cardiovascular surgery. The primary study endpoints were operative mortality and postoperative complications. RESULTS: With 105 interventions in 2020, our activity dropped by 57% compared with the same period in 2019. Patients were at higher risk, with a significantly higher EuroSCORE II score (3.8±4.5% vs. 2.0±1.8%; P<0.001) and higher rates of active endocarditis (7.6% vs. 2.9%; P=0.047) and recent myocardial infarction (9.5% vs. 0%; P<0.001). The weight and priority of the interventions were significantly different in 2020 (P=0.019 and P<0.001, respectively). The rate of acute aortic syndromes was also significantly higher in 2020 (P<0.001). Operative mortality was higher during the lockdown period (5.7% vs. 1.7%; P=0.038). The postoperative course was more complicated in 2020, with more postoperative bleeding (P=0.003), mechanical circulatory support (P=0.032) and prolonged mechanical ventilation (P=0.005). Only two patients (1.8%) developed a positive status for severe acute respiratory syndrome coronavirus 2 after discharge. CONCLUSIONS: Adult cardiac surgery was heavily affected by the COVID-19 lockdown. A further modulation plan is necessary to improve outcomes and reduce postponed operations to decrease operative mortality and morbidity.

Experiencia de reconversión de un servicio clínico anestésico-quirúrgico en unidad de pacientes críticos COVID-19 en un hospital universitario / Experience of transforming a clinical surgical-anesthetic unit into a COVID-19 critical patient one in a teaching hospital

INTRODUCTION: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical- anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. OBJECTIVES: Describe the unit's restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. MATHERIAL AND METHODS: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an insti- tutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. RESULTS: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. DISCUSSION: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health.

INTRODUCCIÓN: Se presenta la experiencia de reconversión de una unidad de cuidados posanestésicos a una unidad de cuidados intensivos a cargo de personal anestésico-quirúrgico entre mayo y julio de 2020, en contexto de pandemia por SARS-CoV-2. OBJETIVOS: Describir el proceso de reconversión considerando aspectos técnicos, pertinentes al recurso humano, resultados clínicos, indicadores de calidad e impacto psicológico en el equipo de salud. MATERIALES Y MÉTODOS: Se describen las estrategias implementadas por los expertos responsables. Se obtienen datos clínicos desde base de datos institucional y ficha clínica electrónica. Se describe la gestión del recurso humano utilizando registros administrativos de los servicios involucrados. El impacto psicológico en el personal fue evaluado aplicando el cuestionario de Maslach. La calidad de la gestión clínica se obtiene a partir de indicadores de calidad estandarizados para las unidades de pacientes críticos de nuestro establecimiento. RESULTADOS: Se atendieron 25 pacientes en la unidad. La edad promedio fue 62 ± 12 años. El 52% presentó tromboembolismo pulmonar, 36% injuria renal aguda como complicación. Un paciente falleció. La prevalencia de síndrome de Burnout fue de 73,6%. La ocurrencia de eventos adversos fue baja. CONCLUSIONESConclusiones: La reconversión de una unidad anestésico-quirúrgica a una unidad crítica COVID-19, demanda un complejo entramado de estrategias coordinadas que permiten responder a la demanda de atención con resultados clínicos positivos, a expensas del costo de la salud mental del equipo de salud involucrado.

A national healthcare response to intensive care bed requirements during the COVID-19 outbreak in France.

BACKGROUND: Whereas 5415 Intensive Care Unit (ICU) beds were initially available, 7148 COVID-19 patients were hospitalised in the ICU at the peak of the outbreak. The present study reports how the French Health Care system created temporary ICU beds to avoid being overwhelmed. METHODS: All French ICUs were contacted for answering a questionnaire focusing on the available beds and health care providers before and during the outbreak. RESULTS: Among 336 institutions with ICUs before the outbreak, 315 (94%) participated, covering 5054/5531 (91%) ICU beds. During the outbreak, 4806 new ICU beds (+95% increase) were created from Acute Care Unit (ACU, 2283), Post Anaesthetic Care Unit and Operating Theatre (PACU & OT, 1522), other units (374) or real build-up of new ICU beds (627), respectively. At the peak of the outbreak, 9860, 1982 and 3089 ICU, ACU and PACU beds were made available. Before the outbreak, 3548 physicians (2224 critical care anaesthesiologists, 898 intensivists and 275 from other specialties, 151 paediatrics), 1785 residents, 11,023 nurses and 6763 nursing auxiliaries worked in established ICUs. During the outbreak, 2524 physicians, 715 residents, 7722 nurses and 3043 nursing auxiliaries supplemented the usual staff in all ICUs. A total number of 3212 new ventilators were added to the 5997 initially available in ICU. CONCLUSION: During the COVID-19 outbreak, the French Health Care system created 4806 ICU beds (+95% increase from baseline), essentially by transforming beds from ACUs and PACUs. Collaboration between intensivists, critical care anaesthesiologists, emergency physicians as well as the mobilisation of nursing staff were primordial in this context.

Desafío hospitalario: experiencia de un equipo de ginecología en el manejo integral de pacientes COVID 19 / A hospital challenge: experience of a gynecology team in the comprehensive management of patients COVID 19

INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 (COVID 19), causal de la pandemia actual, ha significado a nivel mundial la hospitalización simultánea de múltiples pacientes poniendo a prueba la infraestructura hospitalaria y la capacidad de reacción del personal de salud. Una de las estrategias para el manejo es la reconversión de camas y servicios clínicos. OBJETIVOS: presentar experiencia de un equipo ginecológico en el manejo integral de pacientes no gineco-obstétricas con COVID 19, durante el mes de junio de 2020 en un hospital público de la Región Metropolitana. MÉTODOS: Estudio de corte transversal observacional, descriptivo. Se consideró el total de pacientes adultos hombres y mujeres sin patología gineco-obstétrica con COVID 19 ingresados al puerperio del Hospital Santiago Oriente, obteniéndose datos clínicos y demográficos a través del registro interno de la unidad y del sistema de información de red asistencial. RESULTADOS: Ingresaron 82 pacientes, 32 mujeres y 50 hombres, promedio de edad 64. El promedio de días de hospitalización fue 5, con diagnóstico de ingreso principal neumonía viral por COVID-19. Las comorbilidades frecuentes fueron hipertensión arterial sistémica y diabetes mellitus. La complicación más frecuente fue el tromboembolismo pulmonar agudo. Hubo una alta cobertura de entrega de información vía telefónica a familiares. De los 82 ingresos, 54 pacientes egresaron a su domicilio. El resto a otras unidades dentro de la institución, centros de menor complejidad o residencias sanitarias. Una paciente sexo femenino de 75 años fallece a causa de descompensación de patologias de base secundario a neumonia por Staphylococus aereus. En ella, se descarta la infección por COVID 19 dado tres exámenes por reacción de polimerasa en cadena negativos realizado antes y durante su hospitalización. CONCLUSIONES: Esta experiencia constituyó un desafío para todo el equipo de salud gineco-obstétrico, considerando que nos enfrentamos a otro tipo de pacientes y a una patología nueva. Los resultados médicos son promisorios, la experiencia humana y sentido de trabajo en equipo fue extraordinario.

INTRODUCTION: The infection by the SARS-CoV2 coronavirus (COVID 19), the cause of the current pandemic we are experiencing, has meant the simultaneous hospitalization of many patients worldwide, putting the hospital infrastructure and the reaction capacity of health personnel to the test. One of the management strategies is the reconversion of clinical services. OBJECTIVES: present the experience of a gynecological team in the comprehensive management of non-gyneco-obstetric patients with COVID 19, during the month of June 2020 in a public hospital in the Metropolitan Region. METHODS: descriptive, observational cross-sectional study. The total number of patients admitted to the ex-puerperium of the Santiago Oriente Hospital was considered, obtaining clinical and demographic data through the unit's internal registry and the healthcare network information system. RESULTS: 82 patients were admitted, 32 women and 50 men, average age 64. The average number of days of hospitalization was 5, with the main admission diagnosis being viral pneumonia due to COVID-19. Frequent comorbidities were systemic arterial hypertension and diabetes mellitus. The most frequent complication was acute pulmonary thromboembolism. There was a high coverage of the delivery of information via telephone to relatives. Of the 82 admissions, 54 patients were discharged home and the rest to other units within the institution, less complex centers or health residences. One 75 years old female patient dies from concomitant pathologies, and she wasn't positive for COVID-19. CONCLUSIONS: This experience was a challenge for the entire gynecological-obstetric health team, considering that we are facing other types of patients and a new pathology. The medical results are promising, the human experience and sense of teamwork was extraordinary.

Principled decisions and virtuous care: an ethical assessment of the SIAARTI Guidelines for allocating intensive care resources.

This article sets forth ethical principles for responding to extraordinary circumstances in which the demand for medical care threatens to overwhelm available resources, as in the COVID-19 pandemic. In light of these principles, the author then assesses the ethics of the SIAARTI guidelines for rationing ICU beds and ventilators under such circumstances.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

Repercussões da implantação de um núcleo interno de regulação de leitos no processo de trabalho de enfermeiros / Repercussions of Implementation of an Internal Regulation Core in the Nursing Work Process

Introdução: Na efetivação do Sistema Único de Saúde observamse propostas e regulamentações que visam normalizar o acesso aos serviços de saúde e o processo de trabalho dos profissionais. Entre essas propostas, encontram-se a descentralização das funções e a regulação do sistema de saúde, entendida como alternativa assistencial que estabelece a relação entre a gestão e a atenção à saúde. Nesse contexto, a regulação de leitos compreende uma estratégia capaz de adequar os fluxos e os processos de trabalho nos serviços de saúde. Objetivo: Este estudo buscou compreender as repercussões da regulação de leitos no processo de trabalho de enfermeiros. Método: Foram realizadas 13 entrevistas com enfermeiros que vivenciaram a implantação de um núcleo interno de regulação de leitos em um complexo assistencial do interior de São Paulo. Resultado e Discussão: A análise do material possibilitou a extração de duas temáticas: "o contexto histórico de inserção do enfermeiro na regulação de leitos hospitalares" e "as repercussões da implementação da regulação de leitos no processo de trabalho dos enfermeiros". Conclusão: Na compreensão dos participantes a implantação do núcleo propiciou a desconstrução da distribuição de leitos como uma ação técnica e operacional exclusiva do enfermeiro, impactando positivamente no seu processo de trabalho, na macro e na microgestão dos leitos hospitalares.

Introduction: Upon the implantation of the Sistema Único de Saúde (Brazilian Unified Health System), it is possible to observe proposals and regulations which aim to normalize the access to health services and their professional's work process. Among these proposals, there is the decentralization of the functions and regulations of the health system, which is viewed as an alternative that establishes a relation between management and health care. Thus, the hospital beds regulation is a strategy capable of regulating the influx and work processes in the healthcare. Objective: This study aimed to understand the repercussion of the regulation of hospital beds on the nurses' work process. Methods: We interviewed 13 nurses that experienced the implantation of an inner core of hospital beds regulation in the countryside of São Paulo. Results and Discussion: Two themes arose from the analysis of the material: "the historical context of the nurse among the bed regulation in hospitals" and "the repercussion of the regulation of hospital beds on the nurses' work process". Conclusion: The participants reported the implantation of the core allowed a deconstruction of the bed distribution as a technical and operational activity that was exclusive to the nurse, positively impacting on their work process and on the macro and micromanagement of the hospital beds.

Ensaio reflexivo sobre o uso da rede de dormir como prevenção da Úlcera por Pressão / Ensayo reflexivo sobre el uso de la hamaca para la prevención de Úlceras por Presión / Reflexive essay on the use of hammocks for preventing pressure ulcers

Introdução: a rede de dormir é um utensílio de origem indígena utilizado para sentar, descansar e dormir. Em Roraima, região norte do Brasil, por questões culturais a rede de dormir também é utilizada como leito hospitalar. Nesse sentido é emergente transcender o pensamento etnográfico e refletir sobre os efeitos que a rede de dormir pode causar sobre o corpo físico daquele que repousa por longo período de tempo sobre ela. Objetivo: realizar um ensaio reflexivo sobre o uso da Rede de dormir como prevenção da Úlcera por Pressão. Métodos: discursivo reflexivo apoiado pelo método de análise de conteúdo clássica, a partir do texto literário de Câmara Cascudo. Conclusão: o texto de Cascudo atendeu parcialmente os objetivos do estudo, ampliou o entendimento da importância da rede de dormir não somente como objeto de decoração, mas também para confortar e dormir, embora seu uso possa estar sob o julgo das preferências de um corpo indissociável a sua cultura(AU)

Introduction: The hammock is an utensil of indigenous origin used to sit down, to rest and to sleep. In Roraima, north area of Brazil, for cultural subjects the hammock is also used as bed hospitalar. In that sense it is emergent to transcend the thought ethnographic and to contemplate on the effects that the hammock can cause on the physical body of that that rests for long period of time on it. Objective: Make a reflective essay on sleeping on hammock by using Cascudo's literary text to provide constitutive elements to subsidize the theoretical framework of a doctoral thesis, which proposes the use of sleeping hammock to prevent pressure ulcers. Method: Reflective discourse provided by classical content analysis method. Conclusion: Cascudo's text answered the study's objectives, expanded the understanding of the importance of hammock not only as a decoration object, but also to provide comfort and sleep, though its use may be under the judgment of the body which is inseparable from cultural preferences(AU)

Introducción: la hamaca es una herramienta de origen indígena utilizado para sentarse, descansar y dormir. En Roraima, norte de Brasil, por cuestiones culturales la hamaca también se utiliza como una cama de hospital. En consecuencia es emergente sobrepasar el pensamiento etnográfico y reflexionar sobre los efectos que puede causar la hamaca en el cuerpo físico de la persona que se encuentra durante un largo periodo de tiempo sobre ella. Objetivo: realizar un ensayo reflexivo sobre el uso de la hamaca como la prevención de la Úlcera por Presión. Método: discursivo reflexivo apoyado por el método de análisis de contenido clásico, a partir del texto literario de Cámara Cascudo. Conclusión: el texto de Cascudo reunió parcialmente los objetivos del estudio, el aumento de la comprensión de la importancia de la hamaca no sólo como un objeto decorativo, sino también para la comodidad y el sueño, aunque su uso puede estar bajo el yugo de las preferencias de un cuerpo inseparable de su cultura(AU)

[Postacute care]. / Cuidados postagudos.

The aging of the population and changes in family and social structures have led to increasing care needs for elderly persons following an acute disease or accident, with consequent concerns regarding costs and sustainability within the public health system. The main objective of postacute care (PAC) is to restore the functional capabilities of the patient after an acute event and contribute to determine the patient's outcome and future healthcare requirements. With this background, we carried out a systematic review of the published literature from 1990 to 2011 focused on the following aspects of PAC: a) objectives; b) estimations of the need and the indicators for access to it, and c) transfer strategies from acute care to PAC. The results of this review indicate that PAC is an efficient approach to improve patients' quality of life and to sustain the public healthcare system. The choice of candidates for PAC should be based on both health and social indicators, and the overall process viewed in a cross-sectional manner in order to avoid increases in total cost.

Community perception of rural hospital conversion/closure: re-conceptualising as a critical incident.

BACKGROUND: In this article, a consideration of the role and meaning of the rural hospital is contextualised within the health reform environment in Saskatchewan (Canada). Individual and community perceptions of the impact of the conversion/closure of a rural hospital are often unheard and more often unheeded. Some researchers suggest hospital conversion/closure is a devastating event in the life of rural communities, yielding long-lasting medical, economic and psychological consequences. METHOD: This article examines the concept of critical incidents with the intent of proposing a working definition of the concept. Lazarus and Folkman's (1984) construct of appraisal provides the framework for discussion and re-conceptualisation of critical incidents. RESULTS AND CONCLUSIONS: The recommendation is to consider the adoption of an alternate definition of critical incident shifting away from professional or external delineation of an event's meaning. The proposed definition states that a critical incident is any external event that alters an individual's or community's life from the perspective of that individual or community. Finally, the conversion/closure of a rural hospital is considered within this re-conceptualised 'critical incident' definition.

Emergency department observation unit: can it be funded through reduced inpatient admission?

STUDY OBJECTIVE: We sought to test the assumption that an emergency department observation unit can be funded through the reallocation of resources made available through the unit's impact in reducing inpatient admissions and facilitating bed closures. METHODS: We conducted our study in a tertiary care center ED with 46,000 visits annually. For a 3-month period, all patients admitted to the hospital through the ED were screened by an emergency physician for suitability for admission to an observation unit. Any patient in the hospital for 3 days or less who did not undergo surgery or other inpatient procedure, and who was admitted through the ED, was considered a candidate for the observation unit. RESULTS: Of 1,840 admissions, 147 patients met the admission criteria. Only 48 (32.2%) could have been treated in an observation unit, and these patients were not admitted to any single unit in high frequency. The potential savings from inpatient bed closures would only have amounted to 1.68 full-time equivalents-not enough to staff a 4-bed observation unit, which would require 5 full-time equivalents. CONCLUSION: Because of the diffuse and inconsistent effect such a unit had on inpatient bed use, funding for an ED observation unit at our institution could not be justified on the basis of the closure of inpatient beds and transfer of resources.

Hospitals. Models of perfection.

Small general hospitals can adapt to changing demands in a number of ways. These include expanding day-case work and increasing outpatient services. Small hospitals could concentrate on elective surgery, or provide a full surgical service for a limited time each week, such as three days. Small ex-general hospitals could be used to provide rehabilitation services and beds for patients who do not need to be looked after in an acute hospital.

La satisfacción del enfermo hospitalizado: empleo de hamacas en un hospital rural del sureste de México / Hospitalized patient satisfaction: Hammocks employed in a rural hospital of southeastern Mexico

Se informa de una investigación experimental encaminada a lograr una adecuación institucional a las características socioculturales de la población y así obtener una mayor satisfacción del usuario, con la consecuente elevación de la calidad de la atención médica. Por primera vez en la historia médica nacional se introdujo en un hospital del sector público -Hospital Rural de Hecelchakán, Campeche- el empleo de hamacas en una sección de mujeres, predominantemente de origen maya. Los resultados fueron excelentes, la totalidad de las enfermedades encuestadas estuvieron de acuerdo con el cambio. Como contraparte existió resistencia del personal médico. Se abre la posibilidad de extender la experiencia a los hospitales del sector salud que se encuentran en la Península de Yucatán, Istmo de Tehuantepec, Tabasco, Chiapas y costas de Oaxaca y Veracruz

La hamaca: historia, etnografía y usos médicos de un mueble americano / Hammocks: history, ethnographic and medical uses of a south American furniture

Con una notable aceptación por parte de los pacientes internados, durante 1995 se sustituyeron algunas camas por hamacas en un hospital rural ubicado en Hecelchakán, Camcpeche. Con la finalidad de elaborar el respectivo proyecto de investigación, efectuamos una revisión histótica y etnográfica que aquí se presenta, sobre el origen, expansión y utilización contemporánea de este singular mueble. Las hamacas son de origen arahuaco, grupo que se ubica en el norte de América del Sur con una expansión cultural hacia las islas caribeñas, donde los europeos pudieron observarse las hamacas por primera vez. En la actualidad son usadas cotidianamente para dormir en toda la Península de Yucatán, en Tabasco y en algunas regiones (sobre todo costeras) de Chiapas, Oaxaca, Guerrero y Veracruz

Reducing intensive care unit length of stay. A stepdown unit for first-day heart surgery patients.

The restructuring of healthcare delivery systems has increased the demand for successful, low-cost, alternative approaches to providing care. The authors detail the design, implementation, and evaluation of one alternative approach for delivery of care to thoracic surgery patients. The authors describe the use of a stepdown unit for the care of patients 24 to 36 hours after cardiothoracic surgery.