A major challenge for hospitals in low-income and middle-income countries is to improve management of patients diagnosed with sepsis. The objective of the present study was to evaluate the Institute ...for Healthcare Improvement (IHI) Model as a strategy to implement a managed sepsis protocol aimed at reducing sepsis mortality. We performed a longitudinal, prospective, non-randomised study using PDSA cycles for translating and implementing improvement actions and tools. Baseline case mortality/case fatality data were collected, and compliance rates were evaluated according to the Surviving Sepsis Campaign guidelines (3-hour care-bundle). Sepsis multidisciplinary work teams were designated and were responsible to develop Driver Diagrams and implement process changes in the intensive care unit, wards and emergency department. Satisfaction levels of healthcare professionals were assessed (balance variables). The study was carried out in a public quaternary hospital, in São Paulo city, Brazil (Hospital Municipal da Vila Santa Catarina). The number of patients with sepsis studied was 416 who were followed over a 15-month period. The data analyses were carried out by statistical process control. Case fatality rates were kept below a prespecified target of 25% (15.9%) during the period. Satisfaction level of the participating staff was high (95.2%) and 71% of participants reported no work overload. The IHI model was found to be a feasible and useful strategy for implementing a sepsis management clinical protocol.
Background: Prostate cancer remains a major health concern worldwide, and postoperative recurrences are a significant challenge in its treatment. Various treatment modalities have been studied, but ...consensus on optimal strategies has not yet been established. This case report examines the feasibility and toxicity of stereotactic body radiation therapy (SBRT) as a therapeutic option for postoperative recurrences of prostate cancer. Case presentation: A 68-year-old man with a history of prostate cancer, initially treated with radical prostatectomy, who presented biochemical recurrence. Diagnostic imaging revealed a 9 mm nodule in the prostate bed, which was treated by SBRT guided by ultrasound visualization. The patient tolerated the treatment well, experiencing minimal genitourinary and gastrointestinal discomfort. Discussion: Multiple treatment alternatives exist for post-prostatectomy recurrence. Retrospective studies have suggested the efficacy of SBRT, although they lack robust empirical evidence. Recent investigations have highlighted the safety profile of SBRT, emphasizing the need for further exploration, particularly in image-guided radiotherapy. Conclusion: SBRT guided by ultrasound visualization emerges as a promising option for ablative treatment of postprostatectomy recurrence, offering a favorable safety profile and encouraging oncologic outcomes. Further research is needed to further clarify its role in salvage radiotherapy for localized recurrences.
La participación de los padres hombres en el cuidado, la crianza y las tareas domésticas es un asunto clave para la igualdad de género y el desarrollo infantil. En Latinoamérica las mujeres destinan ...más tiempo que los hombres al cuidado en el hogar. Por otra parte las políticas han reforzado el papel de cuidadoras en las madres y de proveedores económicos en los padres. En las últimas décadas las mujeres salieron a trabajar remuneradamente sin embargo todavía dedican más tiempo al cuidado y sus trabajos son más precarios. A pesar de todos los avances en legislación y políticas, al parecer, el orden de género se resiste a cambiar o lo hace muy lentamente.
Chilean education is highly segregated, making it difficult to construct cohesive and democratic societies. Through a mixed-method sequential design we explored the relationship between segregation ...(selection and socioeconomic level) and quality of school climate, taking as example the 200 Chilean schools who participated in the PISA 2009 test. The results evidence worst school environments in public, non-selective and low socioeconomic status schools, where students feel stigmatized and discriminated by academic, social, family and political variables. We discuss the need to revise the education policy that encourages competition among schools for academic performance and training in civics to move towards more integrated schools and more democratic societies. Keywords segregation; selectivity; school life; students; school climate La educacion chilena es altamente segregadora, lo que dificulta la construccion de sociedades cohesionadas y democraticas. La investigacion corresponde a un diseno mixto, secuencial y bietapico que indago la relacion entre segregacion (seleccion y nivel socioeconomico) y calidad de la convivencia escolar, tomando como muestra las 200 escuelas PISA 2009. Los resultados evidencian peores ambientes escolares en las escuelas municipales, de niveles socioeconomicos bajos y no selectivos, donde los estudiantes se sienten estigmatizados y discriminados por variables academicas, familiares y politicas. Se discute la necesidad de revisar la politica educativa que incentiva la competencia entre escuelas por rendimiento academico y formar en educacion civica para avanzar hacia escuelas mas integradas y con ello a sociedades mas justas y democraticas. Palabras clave segregacion; selectividad; convivencia escolar; estudiantes; ambiente escolar; clima escolar
Extremely poor people have more problems to have access to social networks and health care.
To evaluate the access to health services and the perception about these services of adults living in ...conditions of extreme poverty.
A survey was applied to 361 people living in slums aged 15 to 77 years (83% females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty.
Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32% were not registered in primary health clinics. Among children of less than 6 years of age, 22% were delayed in their vaccination schedule and 32% were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems.
People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system.
Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a ...paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.
Cardiovascular diseases (CVD), mainly ischemic heart disease and stroke, is the main cause of death worldwide and each year more people die from CVD than from any other cause. These data call for a ...paradigm shift, where health promotion and cardiovascular prevention will acquire a central role in health policies. From this perspective, dedicating time during the consultation to promoting the acquisition of heart-healthy habits would be indicated in all individuals, regardless of cardiovascular risk classification, the role of the internist being fundamental. This position document from the International Forum of Internal Medicine (FIMI) presents the main indications regarding changes in lifestyle and acquisition of healthy habits to prevent CVD. The different sections will address topics including: nutrition, physical activity, sedentary lifestyle, obesity, smoking, alcohol consumption, sleep, stress, environmental problems related to CVD and specific conditions in women. A section is included about starting CVD promotion and prevention measures at an early age, childhood and adolescence, also mentioning epigenetic aspects related to CVD. Social determinants in CVD are also taken into account, since some of these aspects, such as low socioeconomic level, modify cardiovascular risk and should be taken into account.
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