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Ferrer R, Báguena M, Balcells J, Bañeras J, Biarnes A, de Nadal M, Gracia RM, Martinez J, Nuvials X, Riera J, Roca O, Ruiz-Rodriguez JC. Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:71-77. [PMID: 34872890 DOI: 10.1016/j.eimce.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d'Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources. METHODS We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona. In this manuscript, we report our previsions, strategies implemented, and the outcomes obtained. RESULTS Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units. Throughout the study period, the proportion of patients on IMV or IMV and ECMO remained above 78%. Most patients were men (65%); the most common age group was 60-70 years. Twenty-three patients received ECMO, and eighteen were cannulated at another center and transferred to HUVH. At the end of the study, fourteen patients were successfully decannulated, three patients died, and the rest of the patients were still on ECMO. Eight pregnant women have been treated in the ICU, with a survival rate of 100%. The ICU mortality of patients younger than 60 years was 3.2%. The mean ICU stay of both survivors and nonsurvivors was 14 days. CONCLUSION The adequate preparation for resource expansion for critically ill patients care, main challenges, and overall positive results can serve as a precedent for similar future scenarios.
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Affiliation(s)
- Ricard Ferrer
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Marcelino Báguena
- Servicio de Medicina Intensiva, Hospital Universitario de Traumatología, Rehabilitación y Quemados Vall d'Hebron, Barcelona, Spain
| | - Joan Balcells
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alfons Biarnes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Miriam de Nadal
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rosa María Gracia
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jesús Martinez
- Coordinador de Críticos, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Nuvials
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Riera
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Oriol Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Juan Carlos Ruiz-Rodriguez
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Iáñez-Domínguez A, Luque-Ribelles V, Palacios-Gálvez MS, Morales-Marente E. [Health professionals' perception about the socio-educational group intervention with women who present somatic symptoms without organic cause]. Aten Primaria 2021; 53:102060. [PMID: 33906094 PMCID: PMC8099602 DOI: 10.1016/j.aprim.2021.102060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/10/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objetivo Conocer la percepción y opinión de profesionales de la salud de Atención Primaria sobre el impacto de la intervención grupal socioeducativa (GRUSE) no medicalizadora con mujeres que presentan síntomas somáticos sin causa orgánica. Diseño Estudio cualitativo fenomenológico. Emplazamiento Centros de salud de atención primaria de la Comunidad Autónoma de Andalucía, durante los años 2017 y 2018. Participantes o contextos Se incluyó a 24 profesionales del ámbito de la salud, seleccionados según su nivel de implicación en la estrategia GRUSE (grupos socioeducativos). Método Se aplicó una metodología cualitativa, a través del método fenomenológico. La técnica empleada para recopilar la información es el grupo de discusión, sobre el que se realizó un análisis de contenido. El software Atlas.ti 8.0 se empleó como recurso de apoyo al análisis. Resultados Los profesionales ponen en valor el trabajo de grupo como medio para provocar cambios y refieren la importancia de la intervención como estrategia no medicalizadora. Perciben que las participantes obtienen una serie de beneficios: mejora de su bienestar personal, aumento de su autoestima y autodeterminación y la generación de redes sociales, beneficios que repercuten igualmente en su entorno más inmediato. Conclusiones En opinión de los profesionales, la estrategia tiene efectos positivos en las mujeres y no supone un incremento de los recursos para el sistema sanitario. Además, manifiestan la importancia de dotar a las mujeres de herramientas para el afrontamiento de problemas de la vida cotidiana, que derivan, en muchas de las ocasiones, de los mandatos de género predominantes en la sociedad patriarcal.
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Affiliation(s)
- Antonio Iáñez-Domínguez
- Departamento de Trabajo Social y Servicios Sociales, Universidad Pablo de Olavide, Sevilla, España.
| | - Violeta Luque-Ribelles
- Instituto Universitario para el Desarrollo Social Sostenible (INDESS), Universidad de Cádiz, España
| | - María Soledad Palacios-Gálvez
- Centro de Investigación en Pensamiento Contemporáneo e Innovación para el Desarrollo Social (COIDESO), Universidad de Huelva, Huelva, España
| | - Elena Morales-Marente
- Centro de Investigación en Pensamiento Contemporáneo e Innovación para el Desarrollo Social (COIDESO), Universidad de Huelva, Huelva, España
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Ferrer R, Báguena M, Balcells J, Bañeras J, Biarnes A, de Nadal M, Gracia RM, Martinez J, Nuvials X, Riera J, Roca O, Ruiz-Rodriguez JC. Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30272-X. [PMID: 33010961 PMCID: PMC7834691 DOI: 10.1016/j.eimc.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d́Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources. METHODS We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona. In this manuscript, we report our previsions, strategies implemented, and the outcomes obtained. RESULTS Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units. Throughout the study period, the proportion of patients on IMV or IMV and ECMO remained above 78%. Most patients were men (65%); the most common age group was 60-70 years. Twenty-three patients received ECMO, and eighteen were cannulated at another center and transferred to HUVH. At the end of the study, fourteen patients were successfully decannulated, three patients died, and the rest of the patients were still on ECMO. Eight pregnant women have been treated in the ICU, with a survival rate of 100%. The ICU mortality of patients younger than 60 years was 3.2%. The mean ICU stay of both survivors and nonsurvivors was 14 days. CONCLUSION The adequate preparation for resource expansion for critically ill patients care, main challenges, and overall positive results can serve as a precedent for similar future scenarios.
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Affiliation(s)
- Ricard Ferrer
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España.
| | - Marcelino Báguena
- Servicio de Medicina Intensiva. Hospital Universitario de Traumatología, Rehabilitación y Quemados Vall d'Hebron, Barcelona, España
| | - Joan Balcells
- Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona , Barcelona, España
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona. CIBERCV, Barcelona, España
| | - Alfons Biarnes
- Servicio de Anestesiología y Reanimación. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Miriam de Nadal
- Servicio de Anestesiología y Reanimación. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Rosa María Gracia
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Jesús Martinez
- Coordinador de críticos. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Xavier Nuvials
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Jordi Riera
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Oriol Roca
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Juan Carlos Ruiz-Rodriguez
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
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Abstract
There has been a significant change in the clinical characteristics of people living with HIV, with new needs arising that must be tackled. The life expectancy of a subject diagnosed early with HIV infection and recei-ving suppressive antiretroviral therapy is currently on a par with the life expectancy of the general popula-tion. HIV is now a chronic treatable disease and requires a multidisciplinary approach that includes both the hospital medicine specialties and primary care physicians. The fragmented model to provide social and medical healthcare hinders the proper management of patients with HIV infection. There is significant clinical and geographical variability in the healthcare provided for HIV infection in Spain and the need to define and implement new models of healthcare delivery for this disease has been identified.
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Affiliation(s)
- Josep M Llibre
- Unidad VIH, Hospital Universitari Germans Trias i Pujol, Fundación Lluita contra la SIDA, Badalona, Barcelona, España.
| | | | - Antonio Rivero
- Servicio de Enfermedades Infecciosas, Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic)/Universidad de Córdoba (UCO), Córdoba, España
| | - Emma Fernández
- Servicio de Infecciones, Hospital Clínic, Barcelona, España
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Coll-Benejam T, Bravo-Toledo R, Marcos-Calvo MP, Astier-Peña MP. [Impact of overdiagnosis and overtreatment on the patient, the health system and society]. Aten Primaria 2018; 50 Suppl 2:86-95. [PMID: 30563626 PMCID: PMC6837148 DOI: 10.1016/j.aprim.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022] Open
Abstract
The medical activity displays a set of skills aimed at improving the health status of people. In this way, diagnoses are made, choices of tests and treatments are made, and decisions are made about what to do and what not to do that affect the lives of patients. In this article, we propose a reflection on overdiagnosis and overtreatment in relation to the factors that promote it and the impact they have on society, on the functioning of the health system and also directly on patients. Finally, we make some proposals on how to address this overuse considering that primary care is a privileged place to adapt and minimize the impact of the actions of the health system on the health of citizens and reduce the incidents of patient safety linked to the overdiagnosis and inappropriate use of tests and treatments that do not add value to the health of patients.
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Affiliation(s)
- Txema Coll-Benejam
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Dirección de Atención Primaria de Menorca, Servicio Balear de Salud
| | - Rafael Bravo-Toledo
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Linneo, Servicio Madrileño de Salud, Madrid, España
| | - María Pilar Marcos-Calvo
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Casetas, Servicio Aragonés de Salud, Zaragoza, España
| | - María Pilar Astier-Peña
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Tauste, Servicio Aragonés de Salud, Zaragoza, España; Wonca World Working Party On Quality and Safety (WWPQS); Wonca Europe Working Party on Quality and Safety (EquiP).
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Tejada-Ortigosa EM, Flores-Rojas K, Moreno-Quintana L, Muñoz-Villanueva MC, Pérez-Navero JL, Gil-Campos M. [Health and socio-educational needs of the families and children with rare metabolic diseases: Qualitative study in a tertiary hospital]. An Pediatr (Barc) 2018; 90:42-50. [PMID: 29853433 DOI: 10.1016/j.anpedi.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/10/2018] [Accepted: 03/01/2018] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Rare diseases are a challenge for public health due to the lack of information on their magnitude. These include inborn errors of metabolism. The objective of this study was to assess the quality of life and social, health, economic, and educational needs of a group of paediatric patients with inborn errors of metabolism attended to in a hospital. MATERIAL AND METHOD A questionnaire was developed based on the needs and expectations, based mainly on the Andalusian Plan for Rare Diseases. An analysis was performed on the variables of health, socioeconomic, and educational needs of 65 paediatric patients with inborn errors of metabolism. RESULTS The respondents showed few possibilities to cope with medication (61%), special diet (86%), and other health benefits (79%). Just under half of them (43%) believed that the quality of family life had been greatly reduced since the onset of the disease. The main caregiver was the mother in 61.5% of cases, compared to 1.5% of cases in which it was the father. The primary caregivers had to reduce their working hours or give up their job in 77% of cases. CONCLUSIONS The multidisciplinary treatment is affected by the inability of families to cope with a high cost, as well as with difficult access to these resources. In addition, there is great impact on the quality of life of patients, and their caregivers. Therefore, there is a need to evaluate the results of government health and socio-economic support plans for patients with rare diseases, and make a real response to their needs.
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Affiliation(s)
- Eva María Tejada-Ortigosa
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - Katherine Flores-Rojas
- Unidad de Metabolismo Infantil, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Córdoba, España
| | - Laura Moreno-Quintana
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - María Carmen Muñoz-Villanueva
- Unidad de Metodología de la Investigación, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - Juan Luis Pérez-Navero
- Servicio de Pediatría, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - Mercedes Gil-Campos
- Unidad de Metabolismo Infantil, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Córdoba, España.
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Abstract
OBJECTIVE To identify good practices in order to develop and implement indicators of health outcomes for clinical and healthcare management, as well as the characteristics for an indicator to be considered adequate. METHODOLOGY A scoping review was performed, with the following phases: 1) Search and identification of bibliography. 2) Selection of relevant documents. Including those studies that discussed issues related to good practices for the use of health indicators in the management field. Those published in a language other than English or Spanish or before 2006 were excluded. 3) Analysis and extraction of information. 4) Consultation with stakeholders, using a qualitative methodology through Concept Mapping, with the participation of 40 experts (decision-makers, scientific societies, and health professionals). The data collection process included an inductive and structured procedure, with prioritisation of ideas grouped into clusters, according to feasibility and importance criteria (0-10 scale). RESULTS Good practices identified 2 levels: 1) macro-management: Define a framework for the evaluation of indicators and establish a benchmark of indicators. 2) meso-management: Establish indicators according to evidence and expert consensus, taking into account priority areas and topics, testing before final use, and communicate results adequately. The characteristics of a suitable indicator are: 1) Approach of an important issue, 2) Scientific validity, 3) Possibility of measurement with reliable data, 4) Meaning of useful and applicable measurement, and 5) Wide scope. CONCLUSIONS The best practices for the use of indicators in clinical and healthcare management can make it easier to monitor performance and accountability, as well as to support the decision-making addressed at the development of initiatives for quality improvement.
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Affiliation(s)
- C Bermúdez Tamayo
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, España; CIBER en Epidemiología y Salud Pública CIBERESP, Madrid, España; Instituto de Investigación Biosanitaria ibs. Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, España.
| | - A Olry de Labry Lima
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, España; CIBER en Epidemiología y Salud Pública CIBERESP, Madrid, España; Instituto de Investigación Biosanitaria ibs. Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, España
| | - L García Mochón
- Escuela Andaluza de Salud Pública (EASP), Campus Universitario de Cartuja, Granada, España; Instituto de Investigación Biosanitaria ibs. Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, España
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Albert S, Nongrum M, Webb EL, Porter JDH, Kharkongor GC. Medical pluralism among indigenous peoples in northeast India - implications for health policy. Trop Med Int Health 2015; 20:952-60. [PMID: 25753562 DOI: 10.1111/tmi.12499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The government of India is promoting and increasing investment in the traditional medicine systems of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) in the northeast region of India. But there are few empirical data that support this policy decision. This study estimates the awareness and use of the different medical systems in rural Meghalaya, a state in north-east India with a predominantly ethnic tribal population. METHOD We conducted a cross-sectional multistage random sample household survey across all districts of Meghalaya. To enable appropriate estimates for the whole of rural Meghalaya, the data were weighted to allow for the probability of selection of households at each stage of the sampling process. RESULTS Both local tribal medicine and biomedicine were widely accepted and used, but the majority (68.7%, 95% CI: 51.9-81.7) had not heard of AYUSH and even fewer had used it. Tribal medicine was used (79.1%, 95% CI 66.3-88.0), thought to be effective (87.5%, 95% CI: 74.2-94.1) and given in a variety of disorders, including both minor and major diseases. In the 3 months prior to the survey, 46.2% (95% CI: 30.5-62.8) had used tribal medicine. Only 10.5% (95% CI: 6.1-17.6) reported ever using any of the AYUSH systems. CONCLUSION Our comparative estimates of the awareness and use of tribal medicine, different systems of AYUSH and of biomedicine among indigenous populations of India question the basis on which AYUSH is promoted in the northeast region of India and in the state of Meghalaya in particular.
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Affiliation(s)
- Sandra Albert
- Indian Institute of Public Health, Shillong, India.,Public Health Foundation of India, New Delhi, India
| | | | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
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Tudela P, Mòdol JM. [On hospital emergency department crowding]. Emergencias 2015; 27:113-120. [PMID: 29077353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recent years have seen a range of measures deployed to curb crowding in hospital emergency departments, but as episodes of overcrowding continue to occur the discussion of causes and possible solutions remains open. The problem is universal, and efforts to revamp health care systems as a result of current socioeconomic circumstances have put emergency services in the spotlight. Consensus was recently achieved on criteria that define emergency department overcrowding. The causes are diverse and include both external factors and internal ones, in the form of attributes specific to a department. The factors that have the most impact, however, involve hospital organization, mainly the availability of beds and the difficulty of assigning them to emergency patients requiring admission. Crowding is associated with decreases in most health care quality indicators, as departments see increases in the number of patients waiting, the time until initial processing, and the time until a physician or nurse intervenes. Crowding is also associated with risk for more unsatisfactory clinical outcomes. This situation leads to dissatisfaction all around-of patients, families, and staff-as aspects such as dignity, comfort, and privacy deteriorate. Proposals to remedy the problem include assuring that the staff and structural resources of a facility meet minimum standards and are all working properly, facilitating access to complementary tests, and providing observation areas and short-stay units. The response of hospitals to the situation in emergency departments should include alternatives to conventional admission, through means for rapid diagnosis, day hospitals, and home hospitalization as well as by offering a clear response in cases where admission is needed, granting easier access to beds that are in fact available. For its part, the health system overall, should improve the care of patients with chronic diseases, so that fewer admissions are required. It is also essential to search for ways to bring the supply of necessary social and health care services more in step with demand.
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Affiliation(s)
- Pere Tudela
- Unidad de Corta Estancia- Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Facultat de Medicina, Universitat Autonònoma de Barcelona, España
| | - Josep Maria Mòdol
- Unidad de Corta Estancia- Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Facultat de Medicina, Universitat Autonònoma de Barcelona, España
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