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BMC Pregnancy Childbirth ; 21(1): 848, 2021 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-34965869

RESUMEN

INTRODUCTION: Despite the important increase in in-facility births, perinatal mortality rates have remained high and slow to decrease in many developing countries. This situation is attributed to poor childbirth care quality. The reason why women delivering in health facilities do not always receive care of an adequate standard is unclear. We assessed the determinants of childbirth care quality along the care continuum by means of different approaches. METHODS: A health facility-based cross-sectional study with a direct observation of health care workers' practices while caring for mother-newborn pairs was carried out in Burkina Faso and Côte d'Ivoire. The performance of a set of essential best practices (EBPs) was assessed in each birth event at the admission, prepushing and immediate postpartum stages. A quality score, in the form of the additive sum of EBPs effectively delivered, was computed for each stage. We used negative binomial regression models and a structural equation modeling analysis to assess the determinants of care quality at each stage and the relationships of the quality delivered at the different stages, respectively. RESULTS: A total of 532 and 627 mother-newborn pairs were evaluated in Burkina Faso and Côte d'Ivoire, respectively. In both countries, delivery care quality varied significantly at all stages between health districts. Predelivery care quality was consistently higher in referral hospitals than in primary health care facilities (incident rate ratio (IRR) = 1.02, p < 0.05, and IRR = 1.10, p < 0.05, respectively, for Burkina Faso and Côte d'Ivoire). Quality at admission was poorer among nurses than among midwives in Burkina Faso (IRR = 0.81, p < 0.001). Quality at the admission and predelivery stages was positively correlated with immediate postpartum care quality (ß = 0.48, p < 0.001, and ß = 0.29, p < 0.001, respectively). CONCLUSION: Quality improvement strategies must target both providers and health facilities, and different inputs are needed depending on the stage in the care continuum.


Asunto(s)
Continuidad de la Atención al Paciente , Instituciones de Salud/normas , Personal de Salud/normas , Parto , Calidad de la Atención de Salud/normas , Adulto , Burkina Faso , Costa de Marfil , Estudios Transversales , Femenino , Instituciones de Salud/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Humanos , Análisis de Clases Latentes , Embarazo , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/estadística & datos numéricos
4.
Pan Afr Med J ; 40: 49, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34795829

RESUMEN

Introduction: despite the adoption of mental disorders act in 1972, the use of required mental health care act (MHCA) forms during admission of patients with mental illnesses remained below the legal expectation in the Maun District Hospital. This study audited Letsholathebe II Memorial Hospital (LIIMH) professionals´ usage of MHCA forms. Methods: this was a quasi-experimental study that audited files of patients admitted with mental illnesses, before, three and six months after a continuing medical education (CME). Cochran Q, McNemar symmetry Chi-square were used for comparison of performance. Results: of the 239 eligible files, we accessed 235 (98.3%). About two in ten (n=36/235, 15.3%) MHCA forms were not used in combination with required forms. The quasi-majority of MHCA forms set used, aligned with involuntary admission (n=134/137, 97.8%). Required admission MHCA forms significantly increased from nil before continuing medical education (CME-0), to 64.6% (n=51/79) at CME-3 and 77% (n=59/77) at CME-6 (p<0.001). However, there was no statistical difference between the last two periods (64.6% vs 77%, p=0.164). Voluntary admission remained below 13% (n=10/79). Only six types of MHCA forms were used during this study. Conclusion: there was no adequate use of required MHCA forms at LIIMH before CME. Thereafter, the proportion of adequate use increased from period CME-0 to the periods CME-3 and CME-6. However, there was no difference in proportion between the last two periods. We recommend an effective and regular CME twice a year for health professionals on selected MHCA forms.


Asunto(s)
Educación Continua/métodos , Trastornos Mentales/terapia , Admisión del Paciente/normas , Atención Primaria de Salud/métodos , Adolescente , Adulto , Botswana , Femenino , Formularios como Asunto , Personal de Salud/educación , Personal de Salud/normas , Hospitales/normas , Humanos , Masculino , Auditoría Médica , Admisión del Paciente/legislación & jurisprudencia , Atención Primaria de Salud/legislación & jurisprudencia , Adulto Joven
5.
Infect Dis Clin North Am ; 35(4): 1055-1075, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34752220

RESUMEN

Health care-acquired viral respiratory infections are common and cause increased patient morbidity and mortality. Although the threat of viral respiratory infection has been underscored by the coronavirus disease 2019 (COVID-19) pandemic, respiratory viruses have a significant impact in health care settings even under normal circumstances. Studies report decreased nosocomial transmission when aggressive infection control measures are implemented, with more success noted when using a multicomponent approach. Influenza vaccination of health care personnel furthers decrease rates of transmission; thus, mandatory vaccination is becoming more common. This article discusses the epidemiology, transmission, and control of health care-associated respiratory viral infections.


Asunto(s)
Infección Hospitalaria/prevención & control , Infección Hospitalaria/virología , Infecciones del Sistema Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/virología , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Adhesión a Directriz , Personal de Salud/normas , Humanos , Control de Infecciones/normas , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/transmisión , SARS-CoV-2/patogenicidad , Vacunación , Virus/clasificación , Virus/patogenicidad
6.
Environ Health Prev Med ; 26(1): 100, 2021 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-34610785

RESUMEN

Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.


Asunto(s)
Países en Desarrollo , Transmisión de Enfermedad Infecciosa/prevención & control , Farmacorresistencia Microbiana , Salud Ambiental/normas , Personal de Salud/normas , Inocuidad de los Alimentos , Humanos , Higiene/normas , Rol , Saneamiento/normas , Administración de Residuos/normas
7.
Anesthesiology ; 135(6): 951-962, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34666348

RESUMEN

Respiratory viruses are transmitted via respiratory particles that are emitted when people breath, speak, cough, or sneeze. These particles span the size spectrum from visible droplets to airborne particles of hundreds of nanometers. Barrier face coverings ("cloth masks") and surgical masks are loose-fitting and provide limited protection from airborne particles since air passes around the edges of the mask as well as through the filtering material. Respirators, which fit tightly to the face, provide more effective respiratory protection. Although healthcare workers have relied primarily on disposable filtering facepiece respirators (such as N95) during the COVID-19 pandemic, reusable elastomeric respirators have significant potential advantages for the COVID-19 and future respiratory virus pandemics. However, currently available elastomeric respirators were not designed primarily for healthcare or pandemic use and require further development to improve their suitability for this application. The authors believe that the development, implementation, and stockpiling of improved elastomeric respirators should be an international public health priority.


Asunto(s)
COVID-19/epidemiología , Elastómeros/normas , Diseño de Equipo/normas , Personal de Salud/normas , Exposición Profesional/normas , Ventiladores Mecánicos/normas , COVID-19/prevención & control , COVID-19/transmisión , Diseño de Equipo/métodos , Equipo Reutilizado/normas , Humanos , Exposición Profesional/prevención & control , Pandemias/prevención & control
8.
PLoS One ; 16(10): e0258784, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34710153

RESUMEN

BACKGROUND: Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. METHODS: A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. RESULTS: Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. CONCLUSIONS: In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.


Asunto(s)
Trajes Gravitatorios/estadística & datos numéricos , Instituciones de Salud/normas , Personal de Salud/normas , Complicaciones del Trabajo de Parto/terapia , Hemorragia Posparto/terapia , Ropa de Protección/estadística & datos numéricos , Choque/prevención & control , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Primeros Auxilios , Humanos , Mortalidad Materna/tendencias , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones del Trabajo de Parto/mortalidad , Hemorragia Posparto/epidemiología , Hemorragia Posparto/mortalidad , Embarazo
9.
Best Pract Res Clin Anaesthesiol ; 35(3): 333-349, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511223

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.


Asunto(s)
Manejo de la Vía Aérea/normas , COVID-19/prevención & control , Personal de Salud/normas , Hospitalización , Equipo de Protección Personal/normas , Guías de Práctica Clínica como Asunto/normas , Aerosoles , Manejo de la Vía Aérea/tendencias , COVID-19/epidemiología , Personal de Salud/tendencias , Hospitalización/tendencias , Humanos , Pandemias/prevención & control , Equipo de Protección Personal/tendencias
10.
Best Pract Res Clin Anaesthesiol ; 35(3): 389-404, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511227

RESUMEN

The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.


Asunto(s)
COVID-19/epidemiología , Cuidados Críticos/normas , Personal de Salud/normas , Recursos Humanos/normas , COVID-19/terapia , Cuidados Críticos/tendencias , Personal de Salud/tendencias , Humanos , Liderazgo , Pandemias/prevención & control , Recursos Humanos/tendencias
11.
Best Pract Res Clin Anaesthesiol ; 35(3): 405-414, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511228

RESUMEN

The current COVID-19 pandemic is testing political leaders and healthcare systems worldwide, exposing deficits in crisis communication, leadership, preparedness and flexibility. Extraordinary situations abound, with global supply chains suddenly failing, media communicating contradictory information, and politics playing an increasingly bigger role in shaping each country's response to the crisis. The pandemic threatens not just our health but also our economy, liberty, and privacy. It challenges the speed at which we work, the quality of our research, and the effectiveness of communication within the scientific community. It can impose ethical dilemmas and emotional stress on healthcare workers. Nevertheless, the pandemic also provides an opportunity for healthcare organizations, leaders, and researchers to learn from their mistakes and to place their countries and institutions in a better position to face future challenges.


Asunto(s)
COVID-19/epidemiología , Gestión de Recursos de Personal en Salud/normas , Personal de Salud/normas , Liderazgo , COVID-19/terapia , Comunicación , Gestión de Recursos de Personal en Salud/métodos , Atención a la Salud/métodos , Atención a la Salud/normas , Humanos , Pandemias
12.
Best Pract Res Clin Anaesthesiol ; 35(3): 425-435, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511230

RESUMEN

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.


Asunto(s)
Centros Médicos Académicos/tendencias , Anestesiología/tendencias , COVID-19/epidemiología , Cuidados Críticos/tendencias , Reestructuración Hospitalaria/tendencias , Admisión y Programación de Personal/tendencias , Centros Médicos Académicos/normas , Anestesiología/normas , COVID-19/terapia , Cuidados Críticos/normas , Personal de Salud/normas , Personal de Salud/tendencias , Reestructuración Hospitalaria/normas , Humanos , Ciudad de Nueva York , Pandemias , Admisión y Programación de Personal/normas
14.
Pan Afr Med J ; 39: 148, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34527164

RESUMEN

This paper aims to highlight the challenges in managing liver diseases in Ghana and the efforts needed to improve services to help curb the high rate of liver mortality in the young adults. Ghana is a rising, middle-income West African country with well-established administrative systems for healthcare, albeit with hospitals lacking modern equipment and being devoid of infrastructure for sophisticated interventional procedures. Although liver disease is common, due to the high prevalence of chronic viral hepatitis B and C infection, antiviral drugs are commonly unavailable, even in the rare instances where they can be afforded. Hospital wards and outpatient clinics are usually over-crowded with long waiting times and limited doctor-patient time interaction. Treatment for end-stage liver disease can be a challenge, with limited endoscopic services, which are centered in the big cities and with expertise which is not widespread. The training program in endoscopic therapies by the Mayo Clinic (Rochester, Minnesota, USA), with faculty coming to Ghana to disseminate practical skills during a "training of trainers" program has gone a long way spreading the knowledge of managing life-threatening complications, such as variceal hemorrhage, albeit on a small scale in national terms. Collaboration between institutions from well-resourced and poorly-resourced countries exemplifies how such partnerships can go a long way in helping to support local training needs and the development of transferrable skills. Such partnerships may effectively provide healthcare workers with adequate training, with hepatology treatment protocols that are adapted to the local environment and thus allowing contextualisation of generic guidelines from the developed world and making them applicable to local settings.


Asunto(s)
Atención a la Salud/organización & administración , Personal de Salud/organización & administración , Hepatopatías/terapia , Competencia Clínica , Conducta Cooperativa , Ghana , Personal de Salud/educación , Personal de Salud/normas , Humanos , Hepatopatías/mortalidad , Hepatopatías/fisiopatología , Listas de Espera
19.
Pan Afr Med J ; 39: 41, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34422164

RESUMEN

Introduction: regular in-service training of healthcare workers within the immunization program is critical to address the program needs created by the introduction of new vaccines and technologies, as well as the expanding scope of immunisation programmes beyond infant immunization and towards a life-course approach. National immunization programs conduct in-service training of health workers depending on program needs and particularly when new program elements are introduced. Methods: we conducted a survey of national and provincial level immunization program staff in 9 countries in the World Health Organization (WHO) African Region to determine the perceived needs and preferred training methods for capacity building in immunisation. Results: nearly all of the respondents (98.3%) stated that there are skill gaps at their respective levels in the immunization program which require training, with 88% indicating that mid-level program management (MLM) training was needed to train new program staff, while 78% indicated program performance gaps and 60% of the respondents stated that refresher training is needed. Program areas identified as top priorities for training included immunisation monitoring and data quality, sustainable immunization financing, adverse events monitoring and community mobilization. More than three quarters of the respondents (78%) think that online MLM training is adequate to address program gaps. Only four of the 9 immunization program managers indicated that they regularly monitor the number of MLM trained staff within their national program. Conclusion: there is a strong need for in-service training of immunization program officers in the countries surveyed, especially at the subnational levels. Program managers should conduct regular monitoring of the training status of staff, as well as conduct detailed training needs assessments in order to tailor the training approaches and topics. Online training provides an acceptable approach for capacity building of immunization program staff.


Asunto(s)
Personal de Salud/educación , Programas de Inmunización/organización & administración , Capacitación en Servicio/métodos , África , Creación de Capacidad , Competencia Clínica , Personal de Salud/normas , Humanos , Inmunización/métodos , Inmunización/normas , Encuestas y Cuestionarios , Vacunas/administración & dosificación
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