RESUMEN
Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings-medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings by exploring the reasons for integration and identifying target patients/conditions, barriers, and recommendations for clinical translation. The foremost reason for integrating SDH in clinical settings was to identify unmet social needs and link patients to community resources, particularly for vulnerable and complex care populations. This was mainly carried out through SDH screening during patient intake to collect individual-level SDH data within the context of chronic medical, mental health, or behavioral conditions. Challenges and opportunities for integration occurred at the educational, practice, and administrative/institutional levels. Gaps remain in incorporating SDH in patient workflows and EHRs for making clinical decisions and predicting health outcomes. Current strategies are largely directed at moderating individual-level social needs versus addressing community-level root causes of health inequities. Obtaining policy, funding, administrative and staff support for integration, applying a systems approach through interprofessional/intersectoral partnerships, and delivering SDH-centered medical school curricula and training are vital in helping individuals and communities achieve their best possible health.
Asunto(s)
Atención a la Salud , Determinantes Sociales de la Salud , Humanos , Políticas , Instituciones de Salud , Apoyo SocialRESUMEN
Hearing impairment following many types of neuraxial anesthetic techniques has alreadly been reported previously. However, postoperative sudden hearing loss after general anesthesia (excluding cardiopulmonary bypass cases) for nonotologic surgery is rarely reported. We present a 42-year-old female patient, who underwent ophthalmologic surgery under general anesthesia because of diabetic retinopathy and developed postoperative hearing loss of the left ear. Sensorineural hearing loss was diagnosed and it has persisted without improvement for 2 years following surgery.
Asunto(s)
Anestesia General/efectos adversos , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Súbita/etiología , Complicaciones Posoperatorias/etiología , Adulto , Puente Cardiopulmonar/efectos adversos , Retinopatía Diabética/complicaciones , Retinopatía Diabética/cirugía , Femenino , HumanosRESUMEN
We report a case of delayed hypoxemia in an aged healthy male patient, which developed 2 hours after cementation of the prosthesis in total hip replacement (THR) under spinal anesthesia. The patient was doing well throughout the operation but unfortunately, progressive tachypnea was noted 1 h after he was transferred to the recovery room (i.e. 2 h after the application of bone cement into the femur). An hour further, distinct wheeze was heard bilaterally on auscultation, which signified bronchospasm. Arterial blood gases analysis revealed a low PaO2 of 71 mmHg and a decrease of oxygen saturation to 91% with supplement of fractional oxygen of 35%. Aerosolization of bronchodilator with terbutaline was administered and supplemental fractional oxygen was increased to 50%. Although wheezing soon subsided, tachypnea and desaturation persisted. He was then transferred to the surgical intensive care unit for further management. Ventilation-perfusion lung scan was performed, which was suggestive of multiple pulmonary embolism.