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3.
Zhonghua Er Ke Za Zhi ; 57(12): 913-916, 2019 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-31795556

RESUMO

Objective: To investigate general condition of children's rheumatic disease associated medical resources in Fujian Province. Methods: This questionnaire-based survey was conducted in 19 hospitals in Fujian province from December 2, 2018 to May 1, 2019. The questionnaire was designed to survey the general condition of the medical resources and the hospitalization of patients with rheumatic diseases from January 1, 2014 to December 1, 2018. Results: In the 19 hospitals, there were 15 general hospitals and 4 children's hospitals, and only 5 hospitals had children's rheumatic specialist clinic. There were only 53-62 beds for rheumatic disease patients in the 19 hospitals, accounting for 1.7%-2.0% of the total inpatient beds (3 137). There are 29 pediatric rheumatologists in total, accounting for 2.6% (29/1 120) of the total pediatricians. In the past five years, 613 patients with rheumatic diseases, accounting for 0.1% (613/625 214) of total hospitalized patients, were treated in these hospitals. Among them, 201 had juvenile idiopathic arthritis, 295 had systemic lupus erythematosus, 39 had dermatomyositis, 7 had scleroderma, and 57 had inflammatory bowel disease, 9 had Sjogren's syndrome, 5 had Behcet's disease, and none had overlap syndrome or mixed connective tissue disease. Conclusion: The medical resources of children rheumatic diseases in Fujian province are insufficient which need to be developed.


Assuntos
Recursos em Saúde/provisão & distribução , Recursos em Saúde/estatística & dados numéricos , Doenças Reumáticas/terapia , Criança , China , Hospitais , Humanos , Inquéritos e Questionários
5.
Glob Health Action ; 12(1): 1666695, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31532350

RESUMO

Background: mHealth applications assist workflow, help move towards equitable access to care, and facilitate care delivery. They have great potential to impact care in low-resource countries, but have significant ethical concerns pertaining to patient autonomy, safety, and justice. Objective: To achieve consensus among stakeholders on how to address concerns pertaining to autonomy, safety, and justice among mHealth developers and users in low-resource settings, in particular for the application of image-based consultation for diagnostic support. Methods: A consensus approach was taken during a three-day workshop using a purposive sample of global mHealth stakeholders (n = 27) professionally and geographically spread. Throughout a series of introductory talks, group brainstorming, plenary reviews, and synthesis by the moderators, lists of actions were generated that address the concerns engendered by mHealth applications on autonomy, justice and safety, taking into account the development, implementation, and scale-up phases of an mHealth application lifecycle. Results: Several types of actions were recommended; key ones among them included building in risk mitigation measures from the development stage, establishing inclusive consultation processes, using open sources platform whenever possible, training all clinical users, and bearing in mind that the gold standard of care is face-to-face consultation with the patient. Recommendations of patient, community and health system participation and of governance were identified as cutting across the mHealth lifecycle. Conclusion: Priorities agreed-upon at the meeting echo those put forward concerning other domains and locations of application of mHealth. Those more forcefully articulated are the need to adopt and maintain participatory processes as well as promoting self-governance. They are expected to cut across the mHealth lifecycle and are prerequisites to the safeguard of autonomy, safety and justice.


Assuntos
Confidencialidade/ética , Diagnóstico por Imagem , Recursos em Saúde/provisão & distribução , Telemedicina , Consenso , Assistência à Saúde , Humanos , Internacionalidade , Segurança do Paciente , Encaminhamento e Consulta
6.
Glob Health Action ; 12(1): 1656452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31512960

RESUMO

In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children. A Chichewa abstract for this paper is available in a supplementary file.


Assuntos
Aconselhamento , Recursos em Saúde/provisão & distribução , Estado Nutricional , Nutricionistas , Criança , Humanos , Lactente , Entrevistas como Assunto , Malaui , Corpo Clínico Hospitalar/psicologia , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
7.
BMC Health Serv Res ; 19(1): 615, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477103

RESUMO

BACKGROUND: Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its' worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a low-resource setting. METHODS: In this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale. RESULTS: Thirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01). CONCLUSIONS: The inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed.


Assuntos
Reabilitação Cardíaca , Países em Desenvolvimento , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde , Administradores Hospitalares/psicologia , Idoso , Brasil , Doenças Cardiovasculares , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Inquéritos e Questionários
8.
BMC Womens Health ; 19(1): 108, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399092

RESUMO

BACKGROUND: Uganda has one of the highest age-standardized incidence rates of cervical cancer in the world. The proportion of Ugandan women screened for cervical cancer is low. To evaluate barriers and facilitators to accessing cervical cancer screening, we performed a systematic review of reported views of Ugandan women and healthcare workers. The aim of this review is to inform development of cervical cancer screening promotional and educational programs to increase screening uptake and improve timely diagnosis for women with symptoms of cervical cancer. METHODS: Fourteen studies that included the views of 4386 women and 350 healthcare workers published between 2006 and 2019 were included. Data were abstracted by two reviewers and findings collated by study characteristics, study quality, and barriers and facilitators. RESULTS: Nineteen barriers and twenty-one facilitators were identified. Study settings included all districts of Uganda, and the quality of included studies was variable. The most frequently reported barriers were embarrassment, fear of the screening procedure or outcome, residing in a remote or rural area, and limited resources / health infrastructure. The most frequent facilitator was having a recommendation to attend screening. CONCLUSION: Understanding the barriers and facilitators to cervical cancer screening encountered by Ugandan women can guide efforts to increase screening rates in this population. Additional studies with improved validity and reliability are needed to produce reliable data so that efforts to remove barriers and enhance facilitators are well informed.


Assuntos
Detecção Precoce de Câncer , Promoção da Saúde , Neoplasias do Colo do Útero/diagnóstico , Constrangimento , Medo , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Serviços de Saúde Rural/provisão & distribução , Uganda
9.
J Grad Med Educ ; 11(4 Suppl): 91-99, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428264

RESUMO

Background: While resident participation in global health (GH) rotations has grown, little is known about trainee perceptions of the personal value of these international clinical experiences and their importance to the objectives of GH training. Objective: We sought to better understand the clinical scenarios experienced during international rotations that residents perceived as most meaningful and the frequency of these experiences across scenarios and participating residents. Methods: Using the conceptual framework of Schön's reflection on action, we asked University of Minnesota GH track pediatric and internal medicine-pediatric residents to describe 10 clinical scenarios they found interesting or impactful during their 2016-2017 GH elective. We conducted a qualitative analysis of the deidentified resident narratives and mapped themes to the Accreditation Council for Graduate Medical Education (ACGME) competencies. Results: All eligible residents (n = 13) participated, yielding 129 unique clinical scenarios from 7 countries. We identified 5 thematic groups: (1) addressing challenges in making diagnoses in resource-limited settings; (2) dealing with patient outcomes different from those expected in the United States; (3) encountering and managing diseases in a different clinical context; (4) encountering and managing diseases in a different cultural context; and (5) reflecting on learning and self-growth. Of the 129 unique clinical scenarios, 30% (n = 39) had not been previously experienced by participants. Across the 5 themes, all ACGME core competencies were addressed. Conclusions: Residents identified meaningful scenarios of their GH experiences that are relevant to the educational and clinical objectives of GH training.


Assuntos
Competência Clínica/normas , Saúde Global , Medicina Interna/educação , Internacionalidade , Internato e Residência , Aprendizagem , Pediatria/educação , Acreditação/normas , Adulto , Competência Cultural , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Masculino , Narração , Estados Unidos
10.
Arch. Clin. Psychiatry (Impr.) ; 46(4): 107-112, July-Aug. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1019343

RESUMO

Abstract Background Mental health disorders are common in China. There is a lack of knowledge and resources of mental health in China. Objectives To assess the levels of psychiatric resources and services in general hospitals in China. Methods Data regarding psychiatric departments, wards and staff were collected from 57 general hospitals in four provinces of China (Hubei, Zhejiang, Heilongjiang and Yunnan) between April 2014 and June 2014. Questionnaires were distributed to 1,200 non-psychiatric clinicians. Results Among the 57 hospitals, 50 provided mental health services, 36 had mental health wards, and seven had neither mental health clinics nor wards. The median number of mental health clinicians was six per hospital. The median number of specialized nurses was 42 per hospital. A total of 1,152 non-psychiatric clinicians with a career duration of 9.4 ± 8.9 years returned completed questionnaires. Only 6.9% reported a good understanding of the manifestation of anxiety and depressive disorders, 4.5% reported a good understanding of the diagnostic criteria, and 3.8% reported a good understanding of the treatment protocols. Discussion There is inadequate awareness of anxiety and depressive disorders among non-psychiatric clinicians in general hospitals in China. This awareness/understanding increased with increasing hospital level.


Assuntos
Humanos , Hospitais Gerais , Transtornos Mentais , Serviços de Saúde Mental/provisão & distribução , Transtornos de Ansiedade , China , Conhecimentos, Atitudes e Prática em Saúde , Saúde Mental/educação , Estudos Transversais , Pessoal de Saúde/educação , Transtorno Depressivo , Recursos em Saúde/provisão & distribução
11.
Int Health ; 11(6): 613-615, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31329890

RESUMO

BACKGROUND: Validation of trachoma elimination requires monitoring after discontinuation of trachoma program activities, though such evaluations are not commonly done. METHODS: Conjunctival examinations and smartphone photography were performed on a random sample of pre-school children from 15 villages in a region of Burkina Faso thought to have eliminated trachoma. RESULTS: No clinically active trachoma was detected by in-field or photographic evaluation. Smartphone images demonstrated high agreement with field grading (>99% concordance). CONCLUSIONS: Trachoma appears to have been eliminated from this area of Burkina Faso. Smartphone cameras may be a useful aid for monitoring in resource-limited settings.


Assuntos
Fotografação , Vigilância da População/métodos , Smartphone , Tracoma/epidemiologia , Burkina Faso/epidemiologia , Pré-Escolar , Erradicação de Doenças , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Masculino , Reprodutibilidade dos Testes , Tracoma/prevenção & controle
12.
BMC Health Serv Res ; 19(1): 511, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337413

RESUMO

BACKGROUND: Learning Clubs is a multi-component intervention to address the eight common risk factors for women's health, and infant's health and development in resource-constrained settings. We are testing in a cluster randomized controlled trial in rural Vietnam whether this intervention improves cognitive development in children when they are aged two. There are few comprehensive process evaluations of complex interventions to optimise early childhood development. The aim is to conduct a planned process evaluation of the Learning Clubs intervention in Vietnam. METHODS: The evaluation will be conducted alongside the Learning Clubs trial using both qualitative and quantitative methods. Four domains will be included in the evaluation: [1] Context - how contextual factors affect the implementation and outcomes; [2] Implementation - what aspects of the Learning Clubs intervention are actually delivered and how well the intervention is delivered; [3] Mechanism of impact - how the intervention produces changes in the primary and secondary outcomes; and [4] National integration - how the intervention can be scaled up for application nationally. Purposive sampling will be used to recruit project stakeholders from commune, provincial and national levels. Results of the process evaluation will be integrated with those of the outcome and economic evaluations to provide a comprehensive picture of the effectiveness of the Learning Clubs intervention for early childhood development in rural Vietnam. DISCUSSION: Results of the evaluation will provide evidence about the implementation of the intervention and explanations for any differences in the outcomes between participants in intervention and control conditions. The evaluation will be integrated into each stage of the outcome assessments, but will be implemented by a bilingual team independent of the team implementing the intervention. It will therefore provide evidence which will not be influenced by or influence the intervention and will inform both generalisation to other settings and scalability in Vietnam. TRIAL REGISTRATION: Trial registration number ACTRN12617000442303 on the Australian New Zealand Clinical Trials Registry. Registered 27/03/2017. Prospectively registered.


Assuntos
Saúde do Lactente , População Rural , Saúde da Mulher , Criança , Análise Custo-Benefício , Assistência à Saúde/normas , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Lactente , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Vietnã
13.
BMC Health Serv Res ; 19(1): 501, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319824

RESUMO

BACKGROUND: Cardiovascular disease remains the most common cause of death. However, effective and timely secondary care contributes to improved quality of life, decreased morbidity and mortality. This study analyzed the medical care of patients in a resource limiting country with a first presentation of acute myocardial infarction (AMI). METHODS: A cross-sectional retrospective study was conducted on first time AMI patients admitted between March 1st 2011 and March 31st 2015 to the only tertiary public hospital in a resource limiting country, Trinidad. Relevant data were obtained from all confirmed AMI patients. RESULTS: Data were obtained from 1106 AMI patients who were predominantly male and of Indo Trinidadian descent. Emergency treatment included aspirin (97.2%), clopidogrel (97.2%), heparin (81.3%) and thrombolysis (70.5% of 505 patients with ST elevation MI), but none of the patients had primary angioplasty. Thrombolysis was higher among younger patients and in men. There were no differences in age, sex, and ethnicity in all other treatments. Of the 360 patients with recorded times, 41.1% arrived at the hospital within 4 h. The proportion of patients receiving thrombolysis (door to needle time) within 30 min was 57.5%. In-patient treatment medication included: aspirin (87.1%), clopidogrel (87.2%), beta blockers (76.5%), ACEI (72.9%), heparin (80.6%), and simvastatin (82.5%). Documentation of risk stratification, use of angiogram and surgical intervention, initiation of cardiac rehabilitation (CR), and information on behavioral changes were rare. Electrocardiogram (ECG) and cardiac enzyme tests were universally performed, while echocardiogram was performed in 57.1% of patients and exercise stress test was performed occasionally. Discharge treatment was limited to medication and referrals for investigations. Few patients were given lifestyle and activity advice and referred for CR. The in-hospital death rate was 6.5%. There was a significantly higher relative risk of in-hospital death for non-use of aspirin, clopidogrel, simvastatin, beta blockers, and heparin, but not ACE inhibitors and nitrates. CONCLUSIONS: Medication usage was high among AMI patients. However, there was very minimal use of non-pharmacological measures. No differences were found in prescribed medication by age, sex, or ethnicity, with the exception of thrombolysis.


Assuntos
Recursos em Saúde/provisão & distribução , Infarto do Miocárdio/terapia , Adulto , Idoso , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Hospitalização , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Centros de Atenção Terciária , Trinidad e Tobago
14.
Curationis ; 42(1): e1-e8, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-31038326

RESUMO

BACKGROUND:  Providing optimal care to critically ill patients poses challenges in resource-poor settings because of the lack of equipment, inadequately trained personnel and limited infrastructure. OBJECTIVES:  This study explored challenges experienced by health care professionals working in resource-poor intensive care units. METHOD:  A qualitative, explorative, descriptive design was used. The population comprised nurses and doctors working in an intensive care unit of one hospital in the Limpopo province of South Africa. A purposive sample was selected and 17 semi-structured interviews were conducted. Data were analysed using Tesch's method. Ethical considerations were adhered to. RESULTS:  Participants experienced challenges related to provision of suboptimal patient care, the challenge of non-adherence to protocols and/or instructions and the challenge of practising beyond the scope of practice. CONCLUSION:  Lack of resources resulted in providing suboptimal intensive patient care. Patients were prone to infections and their safety might be compromised.


Assuntos
Pessoal de Saúde/psicologia , Recursos em Saúde/provisão & distribução , Qualidade da Assistência à Saúde/normas , Adulto , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde/tendências , Humanos , Unidades de Terapia Intensiva/organização & administração , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , África do Sul
15.
PLoS One ; 14(5): e0215679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136575

RESUMO

Timely diagnosis of tuberculosis (TB) is limited in Ethiopia. We evaluated the performance of a low technology, thin layer agar, Mycobacterium tuberculosis (M.tb) culture color plate (TB-CX) test with concurrent drug susceptibility testing (DST) to isoniazid (INH), rifampin (RIF), and pyrazinamide (PZA) directly from sputum specimens. Patients undergoing examination for TB and multidrug-resistant (MDR)-TB were enrolled in Addis Ababa, Ethiopia from March 2016 to February 2017. All subjects received a GeneXpert MTB/RIF PCR test. TB-CX test results were compared to reference Löwenstein-Jensen (LJ) culture for M.tb detection and DST for susceptibility to INH and RIF. Kappa statistic was applied to test agreement between results for TB-CX test and the reference methods, a cut-off Kappa value of 0.75 was considered as high level of agreements. A total of 137 participants were analyzed: 88 (64%) were new TB cases, 49 (36%) were re-treatment cases. The TB-CX test detected M.tb and DST in an average of 13 days compared to 50 days for the conventional DST result. The sensitivity and specificity of the TB-CX test for detecting M.tb were 94% and 98%, respectively (concordance, 96%; kappa 0.91). The sensitivity of the TB-CX test to detect drug resistance to INH, RIF, and MDR-TB was 91%, 100%, and 90% respectively. The specificity of the TB-CX test for detecting INH, RIF, and MDR-TB was 94%, 40%, and 94% respectively. Overall agreement between TB-CX test and LJ DST for detection of MDR-TB was 93%. The TB-CX test showed strong agreement with the GeneXpert test for detecting M.tb (89%, kappa 0.76) but low agreement for the detection of RIF resistance (57%, kappa 0.28). The TB-CX test was found to be a good alternative method for screening of TB and selective drug resistant-TB in a timely and cost-efficient manner.


Assuntos
Técnicas de Cultura , Farmacorresistência Bacteriana , Recursos em Saúde/provisão & distribução , Testes de Sensibilidade Microbiana/economia , Testes de Sensibilidade Microbiana/métodos , Mycobacterium tuberculosis/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/farmacologia , Criança , Cor , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/crescimento & desenvolvimento , Fatores de Tempo , Adulto Jovem
16.
Congenit Heart Dis ; 14(4): 511-516, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30945809

RESUMO

BACKGROUND: Delivery of care to the adult congenital heart disease (ACHD) population has been limited by a shortage in the ACHD physician resources. There is limited data regarding the adequacy of the ACHD physician resources in the United States and our population estimates are extrapolated from Canadian data. Therefore, we proposed to evaluate the adequacy of ACHD physician: patient ratios in the United States at both national and regional levels. METHODS: Data from the Adult Congenital Heart Association (ACHA) website along with metropolitan area and statewide population data from 2016 US Census Bureau estimates were analyzed. Physicians listed on the ACHA website were cross-referenced with ABIM to verify ACHD board certification status. RESULTS: There are 115 self-identified ACHD programs and 418 self-identified ACHD physicians listed in the ACHA website. There are 320 board-certified ACHD cardiologists in the United States today, including 161 not listed in the ACHA website. Regarding ratios of ACHD-certified physicians to patients, the best served metropolitan statistical area (MSA) is Raleigh-Cary, NC, and the worst served MSA is Riverside-San Bernardino-Ontario, CA. The best served State is Washington, DC, and the worst served State is Indiana. CONCLUSIONS: The ACHD population continues to grow, and the looming national physician shortage is likely to greatly affect the ability to meet the complex needs of this growing population. In order to bring the ACHD patient: physician ratio to 1000:1, a minimum of 170 additional ACHD board-certified physicians are needed now.


Assuntos
Cardiologistas/provisão & distribução , Cardiologia , Assistência à Saúde/organização & administração , Recursos em Saúde/provisão & distribução , Cardiopatias Congênitas/epidemiologia , Sociedades Médicas , Recursos Humanos/tendências , Adulto , Humanos , Ontário , Estudos Retrospectivos , Estados Unidos
18.
Australas Emerg Care ; 22(1): 8-12, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30998873

RESUMO

BACKGROUND: We aimed to determine the barriers to optimal management of psychiatric patients in the emergency department (ED). METHODS: We undertook an observational study in a tertiary referral ED with a 24h acute psychiatric nursing service (February to April, 2017). Following patient discharge, the attending psychiatric nurse completed a validated questionnaire to determine the barriers they encountered with their patient. RESULTS: Data were collected on 104 patient encounters. The environmental/resource barriers included limited space (30.8% of cases), limited time (25.0%) and ED overcrowding (22.1%). The ED staff barriers included insufficient knowledge and education regarding psychiatric illness (25.0%), negative attitudes (17.3%) and avoidance of psychiatric patients (16.3%). The patient barriers included dual diagnoses (26.0%), difficulty differentiating between psychiatric illness and social disorganisation (25.0%), and presentation issues complicating management (22.1%). The day of presentation, patient diagnosis and place of disposition were associated with the total number of barriers for each patient. Most barriers were reported on weekdays, for patients with substance abuse disorders or psychosis and for those discharged to home or an inpatient psychiatric ward. CONCLUSION: Barriers to optimal psychiatric management are common and vary considerably. These findings will inform workplace reform and education strategies aimed at mitigating the observed barriers.


Assuntos
Transtornos Mentais/terapia , Adulto , Serviço Hospitalar de Emergência/organização & administração , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários
19.
Midwifery ; 75: 33-40, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30986692

RESUMO

OBJECTIVE: To explore women's and healthcare provider's perspectives of what quality of care during childbirth means to them and how this can be improved. DESIGN: 14 Focus Group Discussions (FGD) with women and 27 Key Informant Interviews (KII) with healthcare providers. Thematic framework analysis was used. SETTING: 14 public healthcare facilities across two districts in Malawi. Mothers who had given birth at a healthcare facility within the last 7-42 days and healthcare providers who were directly involved in maternity care. FINDINGS: Perceptions of what constitutes good quality of care differed substantially. For healthcare providers, the most important characteristics of good quality care included structural aspects of care such as availability of materials, and sufficient human resources. For women, patient-centred care including a positive relationship and experience was prioritised. However, both groups had similar views on what constitutes poor quality of care; unwelcoming reception on admission, non-consented care, physical and verbal abuse were described as examples of poor care. Shortage of staff, poor labour room design and a non-functional referral system were key barriers identified. KEY CONCLUSIONS: Women as well as healthcare providers want good quality, professional care at birth and are disappointed if this is not in place. IMPLICATION FOR PRACTICE: There is a need to incorporate women as well as healthcare provider's views when designing, implementing, monitoring and evaluating maternal health programmes. For a positive birth experience, a healthcare facility needs to have an enabling environment and good communication between healthcare providers and women should be actively promoted.


Assuntos
Recursos em Saúde/provisão & distribução , Trabalho de Parto/psicologia , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Feminino , Grupos Focais/métodos , Pessoal de Saúde/psicologia , Humanos , Malaui , Mães/psicologia , Percepção , Gravidez , Pesquisa Qualitativa
20.
J Spec Oper Med ; 19(1): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30859533

RESUMO

The Peshmerga are the official military of the autonomous region of Kurdistan, Iraq. There remains a high level of variability across Peshmerga units in medical equipment and training. Presumably, Peshmerga soldiers are dying from preventable causes of death due to combat-related injuries, just as US troops did before the introduction of Tactical Combat Casualty Care (TCCC) training and supplies. This report outlines the efforts of a small US-based collective to provide TCCC training at the TCCC for all combatants skill level to Peshmerga forces and develop members of the Peshmerga as trainers.


Assuntos
Recursos em Saúde/provisão & distribução , Medicina Militar/educação , Lesões Relacionadas à Guerra/terapia , Medicina Selvagem/educação , Humanos , Iraque
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