Effectiveness of a On-site Medicalization Program for Nursing Homes With COVID-19 Outbreaks.

BACKGROUND: Nursing homes are highly vulnerable to the occurrence of COVID-19 outbreaks, which result in high lethality rates. Most of them are not prepared to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHOD: A coordinated on-site medicalization program (MP) in response to a sizeable COVID-19 outbreak in 4 nursing homes was organized, with the objectives of improving survival, offering humanistic palliative care to residents in their natural environment, and reducing hospital referrals. Ten key processes and interventions were established (provision of informatics infrastructure, medical equipment, and human resources, universal testing, separation of "clean" and "contaminated" areas, epidemiological surveys, and unified protocols stratifying for active or palliative care approach, among others). Main outcomes were a composite endpoint of survival or optimal palliative care (SOPC), survival, and referral to hospital. RESULTS: Two hundred and seventy-two of 457 (59.5%) residents and 85 of 320 (26.5%) staff members were affected. The SOPC, survival, and referrals to hospital occurred in 77%, 72.5%, and 29% of patients diagnosed before the start of MP, with respect to 97%, 83.7%, and 17% of those diagnosed during the program, respectively. The SOPC was independently associated to MP (OR = 15 [3-81]); and survival in patients stratified to active approach, to the use of any antiviral treatment (OR = 28 [5-160]). All outbreaks were controlled in 39 [37-42] days. CONCLUSIONS: A coordinated on-site MP of nursing homes with COVID-19 outbreaks achieved a higher SOPC rate, and a reduction in referrals to hospital, thus ensuring rigorous but also humanistic and gentle care to residents.

Medicalización de la vida y daño poblacional: revisión bibliográfica no sistematizada / Medicalization of life and population damage: non-systematic bibliographic review

La práctica de la medicina se encuentra atravesando una crisis, en la cual muchas de las prácticas médicas que se realizan son de poco valor y con frecuencia generan daño a las personas. Se presenta una revisión bibliográfica no sistematizada en la que se analizan en conjunto los diversos factores que contribuyen al desarrollo de excesos médicos y a los daños que estos generan. Consideramos que su conocimiento puede contribuir a mejorar la calidad de los cuidados que se ofrecen a nuestros pacientes. (AU)

The practice of medicine is going through a crisis, in which many of the medical practices that are carried out are of little value and often cause harm to people. An unsystematic bibliographic review is presented in which various factors that contribute to the development of medical excesses are analyzed. Their knowledge can contribute to improving the quality of medical care offered to our patients. (AU)

[Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic.] / La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19.

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. METODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud.

La medicalización de residencias como alternativa real a la hospitalización durante la pandemia de COVID-19 / Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic

OBJETIVO: Las residencias de ancianos son entornos de alto riesgo para la transmisión del coronavirus SARS-CoV-2, por tratarse de ambientes cerrados, con personas que muestran manifestaciones atípicas de la enfermedad, con altas posibilidades de evolucionar desfavorablemente y con personal que frecuentemente presenta una elevada movilidad en relación a los puestos de trabajo. Por otro lado, en una situación de pandemia, numerosos centros hospitalarios han soportado periodos de gran presión asistencial. El objetivo de este trabajo fue presentar una experiencia de medicalización de una residencia donde casi el 50% de los residentes contrajo la enfermedad. MÉTODOS: Se llevó a cabo una intervención multidisciplinar en una residencia de ancianos de titularidad pública con 99 residentes. Trabajaron de forma conjunta especialistas de Medicina Interna, Atención Primaria y técnicos de salud, en estrecha colaboración con los trabajadores de la residencia. Se habilitó la presencia de personal de Enfermería las 24 horas y personal médico con visita diaria. Se dotó al centro de los medios necesarios para la administración de la medicación (oral e intravenosa) y la oxigenoterapia necesaria para atender a los pacientes con la enfermedad. Los resultados analíticos estaban disponibles en 24 horas. Para el análisis de los datos se calcularon los porcentajes y se empleó la media como medida de tendencia central. RESULTADOS: Cuarenta y ocho residentes (48,5%) y quince trabajadores contrajeron la enfermedad. El número total de fallecimientos durante ese periodo fue de trece (13,1%), siete de ellos con diagnóstico de COVID-19 (edad media de 84,4 años), siendo la tasa de letalidad del 14,6%. Once pacientes (22%) con diagnóstico de COVID-19 fueron hospitalizados, falleciendo dos durante el ingreso. CONCLUSIONES: La medicalización de las residencias puede contribuir a disminuir la presión asistencial en los centros hospitalarios, así como a optimizar los cuidados a estas personas vulnerables con una asistencia más humanizada, lo que puede redundar, finalmente, en mejores resultados en salud

OBJECTIVE: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease. METHODS: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency. RESULTS: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission. CONCLUSIONS: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes

How has Advanced Practice Nursing Influenced the Nursing Profession in Canada?

The Special Focus on Advanced Practice Nursing in Canada, published in the Canadian Journal of Nursing Leadership (http://www.longwoods.com/publications/nursing-leadership/24885), highlights the unique contributions that advanced practice nurses (APNs) have added to meet the demands of the evolving Canadian healthcare system. Drs. Martin-Misener and Bryant-Lukosius should be commended for their vision as editors of this Special Issue of CJNL, and profiling some excellent work that has occurred across the country in this field of research. In light of this Special Issue, this commentary is written to offer some reflections upon how APNs (i.e., nurse practitioners, clinical nurse specialists) have influenced the nursing profession more broadly within the Canadian context.

Slaughtering sacred cows: six institutional obstacles to advances in family planning.

In order to capitalise on new opportunities to advance contraceptive and reproductive health choices globally, organisations working in these fields will need to overcome six institutional obstacles. These are: (i) committee management; (ii) over-medicalisation; (iii) fear of risk and controversy; (iv) conferences, meetings, and symposia; (v) obsession with coordination; and (vi) fear of sex. The reproductive health community will require energy, innovative approaches, and a sharp focus on service delivery to address these hurdles that will otherwise slow down and misdirect programmatic momentum.

Integration of mental health into primary healthcare in low-income countries: avoiding medicalization.

Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.

Female genital mutilation in Sierra Leone: who are the decision makers?

The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals' associations need to consider how to prevent further medicalization of the practice.