Humanización en los servicios de urgencia: Revisión narrativa / Humanization in emergency services: Narrative review

INTRODUCCIÓN: En Colombia, el tema de la humanización de los servicios de salud se encuentra estrechamente ligado a los aspectos normativos, los cuales datan de la conceptualización de la Constitución Política del país y otras normas anteriores que reglamentan la conducta médica y del personal que presta servicios de salud. OBJETIVO: Describir los aspectos relacionados con la humanización en los servicios de urgencia, en publicaciones científicas, mediante una revisión narrativa. MÉTODO: Se realizó una búsqueda bibliográfica, de artículos originales de acceso abierto publicados entre 2010 y 2020 en inglés, español y portugués. La búsqueda se concentró en los meses de marzo a julio de 2020 en cinco bases de datos disponibles en el servicio de biblioteca de la Universidad de Cartagena. RESULTADOS: Se recuperaron 17 artículos que aportaron significativamente al análisis y comprensión de la situación; el 100% en idioma inglés, de estudios desarrollados en cuatro continentes (América, Europa, Asia y Oceanía); los profesionales de enfermería cuentan con mayor número de publicaciones orientadas al conocimiento de la humanización de los servicios de salud. CONCLUSIÓN: Los resultados demuestran un necesario cambio de actitudes frente a la humanización, capacitación y reconocimiento del otro como ser humano. Es frecuente que se normalice la violencia en los servicios de urgencia, situación que es contraria a los criterios de humanización de los servicios de salud.

INTRODUCTION: In Colombia, the issue of the humanization of health services is closely linked to the normative aspects, which date from the conceptualization of the Political Constitution of the country and other previous norms that regulate the medical conduct and of the personnel who provide health services. OBJECTIVE: To describe the aspects related to humanization in emergency services, in scientific publications, through a narrative review. METHOD: A bibliographic search was carried out for original open access articles published between 2010 and 2020 in English, Spanish and Portuguese. The search was concentrated in the months of March to July 2020 in five databases available in the library service of the University of Cartagena. RESULTS: 17 articles were retrieved that contributed significantly to the analysis and understanding of the situation; 100% in English, from studies carried out on four continents (America, Europe, Asia and Oceania); Nursing professionals have a greater number of publications aimed at understanding the humanization of health services. CONCLUSION: The results show a necessary change in attitudes towards the humanization, training and recognition of the other as a human being. Violence in emergency services is often normalized, a situation that is contrary to the criteria of humanization of health services.

Depression, anxiety and associated factors among people with epilepsy and attending outpatient treatment at primary public hospitals in northwest Ethiopia: A multicenter cross-sectional study.

OBJECTIVE: To assess the magnitude and factors associated with depression and anxiety among people with epilepsy and attending out-patient treatment at central Gondar zone primary public hospitals, northwest, Ethiopia. METHOD: An institutional based cross-sectional study was conducted from May-June, 2020 at central Gondar zone primary public hospitals. A total of 589 participants were chosen by systematic sampling technique. Data was collected by utilizing Amharic version interviewer-administered structured and semi-structured questioners. Depression and anxiety were assessed by using hospital anxiety and depression scale. Bivariate and multivariate logistic regression analysis was done to recognize variables related to both depression and anxiety. Association was described by using "adjusted odds ratio" (AOR) along with 95% full Confidence interval (CI). Finally, P-values < 0.05 in adjusted analysis were taken as a cut off for significant association. RESULT: Out of 556 participants included in the study, 30.9%, 33.1% had depression and anxiety respectively. Being divorced/widowed (AOR = 2.43, 95% CI, 1.18-4.99), using two and above number of antiepileptic medications (AOR = 1.77,95% CI,1.02-3.09), very frequent seizure frequency (AOR = 2.68, 95% CI,1.30-5.51), current substance use (AOR = 1.82, 95% CI, 1.03-3.22), perceived stigma (AOR = 5.67,95% CI,3.14-8.18), and hazardous alcohol use (AOR = 2.84, 95% CI,1.32-6.09) were statistically associated with depression. While, being a single (AOR = 1.65, 95% CI, 1.04-2.63), using two and above number of antiepileptic medications (AOR = 2.27, 95% CI, 1.42-3.62), duration of illness ≥16 years (AOR = 2.82, 95% CI, 1.26-6.31), and perceived stigma (AOR = 2.49, 95% CI, 1.63-3.82) were statistically associated with anxiety at a p-value < 0.05. CONCLUSION: This study showed that the magnitude of depression and anxiety were relatively high among people with epilepsy. Using two and above number of antiepileptic medications and perceived stigma were statistically associated with both depression and anxiety. Screening, early identification and providing appropriate intervention of depression and anxiety among people with epilepsy should be great concern for the health care providers.

Defining clinical decision making in the provision of audio-visual outpatient care for acute upper limb trauma services: A review of practice.

The Covid-19 pandemic has accelerated the widespread adoption of technology-enabled care in the NHS.1 Moving into phase two of the response, the continuing use of audio-visual technology is expected, where appropriate, to be integral in the provision of safe, quality patient care.2 A clinical need therefore exists to identify when care can be safely delivered remotely using audio-visual technology and when there is a need for in-person contact.  At Salisbury Foundation Trust (SFT), during phase one of the NHS response to Covid-19, the decision to treat upper limb trauma patients in-person or remotely was made using clinical screening criteria. For many patients, audio-visual appointments offered a practical, time efficient way of accessing their reconstructive team for assessment, advice and post-operative care. However, a subset of patients was identified by the team as requiring at least one in-person consultation to minimize perceived clinical risk and to optimize quality outcomes.  In order to understand more fully the challenges and successes of technology-enabled care to date, a national survey of practice across hand units in the UK was conducted. We present here some of our key findings and propose the need to develop nationally agreed screening criteria to determine how and when technology enabled outpatient care can be used in the management of acute upper limb trauma. The results of this survey forms part of a series of projects currently underway looking at the efficacy of audio-visual care in upper limb trauma, including a multicentre observational study.

Psychiatrists' opinion about involuntary outpatient reatment.

INTRODUCTION: Involuntary outpatient treatment (IOT) is a kind of compulsory outpatient treatment, whose aim is to improve the adherence to the treatment in people with severe mental illness and with no awareness of disease. In these cases, therapeutic abandonment involves a high risk of relapse, with appearance of disruptive and/or self-aggressive or hetero-aggressive behavior, repeated hospitalizations and frequent emergencies. The application of IOT is not an issue without contention. Therefore, the need of legislative regulation in Spain has been a controversial subject for several years, and there are both advocates and opponents. OBJECTIVE: The objective of this study is to bring together the opinion of clinical psychiatrists and resident doctors in psychiatry on the involuntary outpatient treatment and its legislative regulation. MATERIAL AND METHOD: This study is descriptive in nature. The study population consists of 42 clinical professionals in mental health (32 psychiatrists and 10 resident doctors in psychiatry). At the beginning of this study (March 2018), some of these professionals were working in the Psychiatry Department's facilities of the University Hospital Complex of Huelva. A personal survey in paper form consisting of ten questions about IOT was carried out to each member of this study. RESULTS: 85.7% of clinicians know the current initiative that tries to carry out the legislative regulation of IOT, and 92.8% of them agree to such regulation. In this sense, 83.3% of them are against the fact that more coercive measures for the psychiatric patients such as the involuntary commitment or the civil incapacitation are regulated and IOT is not. On the one hand, 78.6% of the professionals in mental health believe that IOT is beneficial for the patients. Moreover, 95.2% of them think that is beneficial for their relatives, too. On the other hand, 78.6% of clinicians do not consider that the application of IOT to mentallyill patients is stigmatizing. CONCLUSION: The vast majority of clinicians think that the legislative regulation of involuntary outpatient treatment is necessary in Spain, and they think this treatment is beneficial not only for the patient but also for their family.

Treating the SARS-CoV-2-positive patient with cancer: A proposal for a pragmatic and transparent ethical process.

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision-making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS-CoV-2-positive patients with cancer.

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations.

Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.

[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. / Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB : Interdisziplinäre Task-Force der DGPPN.

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

"Restricted Community Members": Research Protections and Opportunities for Individuals Committed to Assisted Outpatient Treatment.

Several forms of mandated community treatment exist in the United States. One mechanism, assisted outpatient treatment (AOT), has become both more common and more controversial in recent years. The status of individuals committed to AOT remains unclear within regulatory guidelines aimed at protecting research participants. Should individuals on AOT be considered psychiatric inpatients, prisoners, community members, or something else? The authors argue that persons on AOT inhabit a gray area wherein they should be given some of the ethical protections afforded to involuntary inpatients and prisoners, but they should also enjoy freedoms as members of the community. The authors' term for this population is "restricted community members." The need to protect individuals in this population from potentially coercive forces of AOT while also offering them the opportunity to participate in research is especially acute in areas of research where the need is great: serious mental illness and substance use disorders.

[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]. / Entscheidungshilfe zur Therapieplanung bei jugendlichen Flüchtlingen und Asylbewerbern mit Traumafolgestörungen in der ambulanten Praxis.

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.

Conhecimento e Interesse sobre Suporte Básico de Vida entre Leigos / Basic Life Support Knowledge and Interest among Laypeople

Os leigos podem salvar vidas ou reduzir sequelas em determinadas situações de emergência, se tiverem conhecimento adequado do Suporte Básico de Vida. Apesar disso, o conhecimento do leigo sobre este tema ainda foi pouco pesquisado no Brasil. Objetivo: Investigar o conhecimento, as possíveis limitações e o interesse dos leigos sobre o Suporte Básico de Vida. Métodos: O instrumento de coleta de dados foi um questionário composto por 30 questões aplicadas a uma amostra de 377 indivíduos. Os testes qui quadrado e t não pareado foram utilizados para verificar possíveis associações entre o conhecimento sobre Suporte Básico de Vida e variáveis socioeconômicas. Resultados: Cerca de 41% dos entrevistados declararam saber o que é Suporte Básico de Vida, mas apenas 5,8% afirmaram que, de fato, sentiam-se preparados para aplicá-lo. Quase a totalidade da amostra considerou esse conhecimento importante, e 89,9% fariam um treinamento sobre Suporte Básico de Vida. A média de respostas corretas da amostra foi 37,8% ± 18,1%, observando-se maior conhecimento entre aqueles com maior escolaridade (38,6% ± 18,3%; p = 0,014) e que tinham realizado algum treinamento prévio em Suporte Básico de Vida (43,5% ± 17,8%; p = 0,002). Conclusão: Os leigos reconhecem sua relevância no atendimento inicial de vítimas em certas situações de emergência e, embora tenham interesse em aprender o Suporte Básico de Vida, carecem de meios de capacitação.

Laypeople can save lives and reduce sequelae in certain emergency situations if they have enough knowledge on Basic Life Support. Nonetheless, laypeople's knowledge of Basic Life Support has been little investigated in Brazil. Objective: To investigate laypeople's knowledge, possible barriers and interest regarding Basic Life Support. Methods: A questionnaire containing 30 questions was applied to a sample of 377 individuals. Chi-square and unpaired t test were calculated to assess the possible association between socioeconomic variables and the knowledge of Basic Life Support. Results: Approximately 41.1% of the sample affirmed they knew what Basic Life Support was, but only 5.8% felt prepared to perform it, if needed. Nearly the whole sample considered the knowledge of Basic Life Support important and 89.9% would be available to take a Basic Life Support learning course. The average of correct answers was 37.8% ± 18.1%. This value was higher among subjects with higher level of education (38.6% ± 18.3%; p = 0.014) and among those who reported previous training in Basic Life Support (43.5% ± 17.8%; p = 0.002). Conclusions: Laypeople recognize their role in the immediate care given to victims of certain emergency situations. Even though laypeople lack training, they show interest in learning Basic Life Support.

Satisfacción de pacientes con atención médica en emergencias / Patient satisfaction with medical care emergency

Introducción: al acudir a un centro hospitalario, los usuarios de servicios médicos tienen confianza en que su necesidad de salud será atendida y que al final el proceso sea solventado a cabalidad y eficazmente, es por ello importante conocer la satisfacción que tienen con los servicios. Objetivo: identificar el nivel de satisfacción con la atención médica de los usuarios atendidos en el servicio de emergencia. Métodos: estudio descriptivo de corte transversal en el servicio de emergencia del circuito de salud integral Augusto Egas de la ciudad de Santo Domingo de los Tsáchilas, Ecuador, durante el primer trimestre de 2015, en un universo de 382 pacientes a quienes se aplicó una encuesta validad para obtener la información, el análisis de la información, se realizó mediante el sistema SPSS, al hacer uso de la correlación bivariada de Kendall, los resultados se expresan en tablas de manera porcentual. Resultados: el personal de enfermería predominó como primer contacto con el usuario, brindó un trato agradable, de calidad y calidez, expresado en el 44 por ciento de la muestra, el sexo femenino prevaleció en los encuestados 66 por ciento; un 49 por ciento opinó que fue atendido en los primeros treinta minutos de su llegada al servicio, el 75 por ciento expresó haber recibido una atención médica y de enfermería satisfactoria. Conclusión: los pacientes que acuden al servicio de emergencia reciben una atención satisfactoria por parte del personal de salud(AU)

Introduction: Users of medical services to go to hospital they are confident that their health needs will be taken care of and ultimately the process is solved fully and effectively, it is therefore important to know the satisfaction with the services. Objective: Identify the level of satisfaction with the care of users treated in the emergency service. Methods: A descriptive cross-sectional study was conducted in the emergency circuit holistic health Augusto Egas of Santo Domingo de los Tsáchilas, Ecuador, during the first quarter of 2015, in a universe of 382 patients who applied a validate survey to obtain information, analysis of information, was performed using the SPSS system by making use of bivariate correlation Kendall, the results are expressed in percentage terms tables. Results: The nursing staff prevailed as the first contact with the user friendly service provided, quality and warmth expressed in 44 percent of the sample, the female respondents prevailed in 66 percent; 49 percent felt that it was handled in the first thirty minutes of their arrival at the service, 75 percent said they have received a satisfactory medical care and nursing. Conclusion: Patients who come to the emergency service receive satisfactory attention from health personnel(AU)

Satisfacción de pacientes con atención médica en emergencias / Patient satisfaction with medical care emergency

Introducción: al acudir a un centro hospitalario, los usuarios de servicios médicos tienen confianza en que su necesidad de salud será atendida y que al final el proceso sea solventado a cabalidad y eficazmente, es por ello importante conocer la satisfacción que tienen con los servicios. Objetivo: identificar el nivel de satisfacción con la atención médica de los usuarios atendidos en el servicio de emergencia. Métodos: estudio descriptivo de corte transversal en el servicio de emergencia del circuito de salud integral Augusto Egas de la ciudad de Santo Domingo de los Tsáchilas, Ecuador, durante el primer trimestre de 2015, en un universo de 382 pacientes a quienes se aplicó una encuesta validad para obtener la información, el análisis de la información, se realizó mediante el sistema SPSS, al hacer uso de la correlación bivariada de Kendall, los resultados se expresan en tablas de manera porcentual. Resultados: el personal de enfermería predominó como primer contacto con el usuario, brindó un trato agradable, de calidad y calidez, expresado en el 44 por ciento de la muestra, el sexo femenino prevaleció en los encuestados 66 por ciento; un 49 por ciento opinó que fue atendido en los primeros treinta minutos de su llegada al servicio, el 75 por ciento expresó haber recibido una atención médica y de enfermería satisfactoria. Conclusión: los pacientes que acuden al servicio de emergencia reciben una atención satisfactoria por parte del personal de salud(AU)

Introduction: Users of medical services to go to hospital they are confident that their health needs will be taken care of and ultimately the process is solved fully and effectively, it is therefore important to know the satisfaction with the services. Objective: Identify the level of satisfaction with the care of users treated in the emergency service. Methods: A descriptive cross-sectional study was conducted in the emergency circuit holistic health Augusto Egas of Santo Domingo de los Tsáchilas, Ecuador, during the first quarter of 2015, in a universe of 382 patients who applied a validate survey to obtain information, analysis of information, was performed using the SPSS system by making use of bivariate correlation Kendall, the results are expressed in percentage terms tables. Results: The nursing staff prevailed as the first contact with the user friendly service provided, quality and warmth expressed in 44 percent of the sample, the female respondents prevailed in 66 percent; 49 percent felt that it was handled in the first thirty minutes of their arrival at the service, 75 percent said they have received a satisfactory medical care and nursing. Conclusion: Patients who come to the emergency service receive satisfactory attention from health personnel(AU)

The Ethical Imperative to Move to a Seven-Day Care Model.

Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.

Observation Care: Ethical and Legal Considerations for the Emergency Physician.

BACKGROUND: The Medicare observation rules remain controversial despite Centers for Medicare and Medicaid Services revisions and the new 2-midnight rule. The increased financial risks for patients and heightened awareness of the rule have placed emergency physicians (EPs) at the center of the controversy. DISCUSSION: This article reviews the primary ethical and legal (particularly with respect to the Emergency Medical Treatment and Active Labor Act) implications of the existing observation rule for EPs and offers practical solutions for EPs faced with counseling patients on the meaning and ramifications of the observation rule. CONCLUSIONS: We conclude that while we believe it does not violate the intent of the Emergency Medical Treatment and Active Labor Act to respond to patient questions about their admission status, the observation rules challenge the ethical principles of transparency related to the physician-patient relationship and justice as fairness. Guidance for physicians is offered to improve transparency and patient fairness.

[Organisational challenges of community information offices for the elderly in Switzerland : A qualitative study with ethical reflections]. / Strukturelle Herausforderungen kommunaler Altersstellen in der Schweiz : Eine qualitative Studie mit ethischer Reflexion.

BACKGROUND: Current Swiss politics concerning age and ageing are orientated towards the principle "out-patient before in-patient". As part of new regulations, in 2011 all communities were required to set up information offices to answer questions about out-patient and in-patient care. OBJECTIVES: The aim of this qualitative study was to analyse in which form and under which conditions such information offices are run. METHODS: A qualitative study was conducted which consisted of semistructured interviews with managers of information offices. They were analysed using qualitative content analysis. RESULTS: The analysis shows that on the one hand the information offices have the potential to serve an important role in the communities and that they have a highly complex, demanding and responsible function. On the other hand the results illustrate that in organisational respects the situation is highly heterogeneous and unregulated. CONCLUSION: For the running of the information offices, there is need for action such as the definition of general framework, quality standards, qualifications and values profiles, objectives, mission, responsibility and legitimation, instruments for networking and cooperations.