RESUMO
INTRODUCTION: Outcomes from diabetic foot infections (DFIs) at the major referral hospital (Hospital Nacional de San Benito) in El Petén, Guatemala have not been analyzed. We hypothesized that poor diabetic control might be associated with a high rate of major lower extremity amputations (mLEAs; above the ankle). METHODS: We performed a retrospective analysis at Hospital Nacional de San Benito between (8/14 and 6/23) in patients presenting with DFIs. Patients receiving mLEAs were compared with all others (AO = [trans-metatarsal amputations, toe amputations, incision and drainage, and antibiotic treatment]). Interviews surgeons were undertaken to ascertain reasons for index operation choice. Univariable and multivariable analyses were undertaken to determine factors associated with mLEAs. RESULTS: Of 110 patients with DFIs, there were 23 mLEAs (above the knee = 21, below the knee = 2). Age, duration with diabetes, and a prior ipsilateral minor amputation were associated with mLEAs. Multivariable analysis identified white blood cell count as significant for mLEA (odds ratio = 1.5 95% confidence interval [1.0 to 2.5]). Cited reasons for a high rate of above the knee amputation (AKAs) versus below the knee amputation were patient related (advanced disease, patient frailty, and poor compliance), systemic (lack of vascular equipment and knee immobilizer), and surgeon related. CONCLUSIONS: This cohort of patients presented with an average of 15 years with diabetes mellitus and poor adherence to diabetic treatment (40%). Many of these diabetic patients developed a DFI requiring mLEAs (21%), most of which were AKAs (91%). Efforts to minimize the number of AKA versus below the knee amputation require immediate attention. Programs to adhere to DM control and foot care in patients with DM are urgently needed.
Assuntos
Amputação Cirúrgica , Pé Diabético , Humanos , Pé Diabético/cirurgia , Amputação Cirúrgica/estatística & dados numéricos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Guatemala/epidemiologia , Idoso , Hospitais de Condado/estatística & dados numéricos , Adulto , Extremidade Inferior/cirurgia , Fatores de RiscoRESUMO
Social determinants of health (SDOHs) are the "conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks" (Healthy People 2030 2021). These conditions include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Ultimately, social determinants affect health status and outcomes to a greater degree than direct clinical care. Although these factors are experienced at a personal level, their impact can be seen on a community level. Also, while SDOHs vary, they tend to be more negatively impactful in rural communities-which then experience more harmful effects on health outcomes than their urban or suburban counterparts (National Advisory Committee on Rural Health and Human Services 2017). The unique experiences and challenges of rural communities require unique solutions. Guadalupe County Hospital in Santa Rosa, New Mexico, collaborates with community partners to address SDOHs. These efforts have a positive impact on their communities and can be replicated in other rural settings.
Assuntos
Hospitais de Condado , Hospitais , Humanos , New Mexico , População Rural , Acessibilidade aos Serviços de SaúdeRESUMO
Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.
Assuntos
Apendicite/terapia , Hospitais de Condado , Hospitais de Ensino , Doença Aguda , Adulto , Feminino , Guatemala , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados UnidosRESUMO
BACKGROUND: The rate of emergent groin hernia repair in developing countries is poorly understood. MATERIALS AND METHODS: A retrospective analysis of groin hernia repairs performed at a county hospital in Guatemala [Hospital Nacional de San Benito (HSNB)] was undertaken and compared to a literature review in developed countries. Patients with incarcerated hernias were interviewed to determine factors related to late presentation. RESULTS: Twenty-five percent of patients with groin hernias in this analysis presented at HNSB emergently (vs. 2.5-7.7% in developed countries). Most patients were male in their fifth decade of life. Ten percent of hernias were femoral. There was no delay in scheduling patients for surgery presenting for elective repair. Most patients lived within 20 miles of the hospital, but only 50% of patients returned for their follow-up appointment. Most patients with an incarcerated inguinal hernia (56%) did not seek medical attention because of family obligations, but when they did, this decision was influence by their children (66%). None of the patients presenting with an incarcerated hernia had education past secondary school. In fact, most (56%) did not have any form formal education. Nearly 90% of patients who had an incarcerated hernia repaired thought that the hospital provided good-to-excellent care. CONCLUSION: A high number of patients present emergently for groin hernia repair at a county hospital in Guatemala compared to developed countries. Our data suggest that emergent hernias are likely the result of patient-related issues rather than health care system limitations.
Assuntos
Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia/estatística & dados numéricos , Acesso à Informação , Adulto , Idoso , Atenção à Saúde/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências/epidemiologia , Feminino , Virilha/cirurgia , Guatemala/epidemiologia , Pesquisas sobre Atenção à Saúde , Hérnia Femoral/complicações , Hérnia Femoral/epidemiologia , Hérnia Femoral/cirurgia , Hérnia Inguinal/complicações , Herniorrafia/efeitos adversos , Hospitais/estatística & dados numéricos , Hospitais de Condado/normas , Hospitais de Condado/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them. METHODS: We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC. RESULTS: Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons. CONCLUSIONS: Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.
Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Hospitais de Condado , Atitude do Pessoal de Saúde , Colecistectomia Laparoscópica/economia , Guatemala/epidemiologia , Recursos em Saúde/economia , Pesquisa sobre Serviços de Saúde , Hospitais de Condado/economia , Hospitais de Condado/normas , Humanos , População Rural , CirurgiõesRESUMO
BACKGROUND: Health care must be provided with strong primary health care models, emphasizing prevention and a continued, integrated and interdisciplinary care. Tools should be used to allow a better planning and more efficient use of resources. AIM: To assess risk adjustment methodologies, such as the Adjusted Clinical Groups (ACG) developed by The Johns Hopkins University, to allow the identification of chronic condition patterns and allocate resources accordingly. MATERIAL AND METHODS: We report the results obtained applying the ACG methodology in primary care systems of 22 counties for three chronic diseases, namely Diabetes Mellitus, Hypertension and Heart Failure. RESULTS: The outcomes show a great variability in the prevalence of these conditions in the different health centers. There is also a great diversity in the use of resources for a given condition in the different health care centers. CONCLUSIONS: This methodology should contribute to a better distribution of health care resources, which should be based on the disease burden of each health care center.
Assuntos
Diabetes Mellitus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/economia , Insuficiência Cardíaca/epidemiologia , Hipertensão/epidemiologia , Risco Ajustado/métodos , Chile/epidemiologia , Doença Crônica , Diabetes Mellitus/diagnóstico , Grupos Diagnósticos Relacionados , Feminino , Insuficiência Cardíaca/diagnóstico , Hospitais de Condado/economia , Humanos , Hipertensão/diagnóstico , Masculino , Morbidade , Atenção Primária à Saúde/economiaRESUMO
Background: Health care must be provided with strong primary health care models, emphasizing prevention and a continued, integrated and interdisciplinary care. Tools should be used to allow a better planning and more efficient use of resources. Aim: To assess risk adjustment methodologies, such as the Adjusted Clinical Groups (ACG) developed by The Johns Hopkins University, to allow the identification of chronic condition patterns and allocate resources accordingly. Material and Methods: We report the results obtained applying the ACG methodology in primary care systems of 22 counties for three chronic diseases, namely Diabetes Mellitus, Hypertension and Heart Failure. Results: The outcomes show a great variability in the prevalence of these conditions in the different health centers. There is also a great diversity in the use of resources for a given condition in the different health care centers. Conclusions: This methodology should contribute to a better distribution of health care resources, which should be based on the disease burden of each health care center.
Assuntos
Humanos , Masculino , Feminino , Alocação de Recursos para a Atenção à Saúde/economia , Risco Ajustado/métodos , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/embriologia , Hipertensão/epidemiologia , Atenção Primária à Saúde/economia , Chile/epidemiologia , Doença Crônica , Morbidade , Grupos Diagnósticos Relacionados , Diabetes Mellitus/diagnóstico , Insuficiência Cardíaca/diagnóstico , Hospitais de Condado/economia , Hipertensão/diagnósticoRESUMO
BACKGROUND: Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. AIM: This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. METHOD: A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. RESULTS AND CONCLUSION: The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.
Assuntos
Atitude do Pessoal de Saúde , Pacientes Internados/classificação , Avaliação das Necessidades/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Sistemas de Informação para Admissão e Escalonamento de Pessoal/organização & administração , Carga de Trabalho , Atividades Cotidianas , Hospitais de Condado , Hospitais de Distrito , Hospitais de Ensino , Humanos , Satisfação no Emprego , Enfermeiros Administradores/organização & administração , Enfermeiros Administradores/psicologia , Pesquisa em Administração de Enfermagem , Avaliação em Enfermagem , Pesquisa Metodológica em Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Qualidade da Assistência à Saúde , Índice de Gravidade de Doença , Inquéritos e Questionários , Suécia , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricosRESUMO
Among women of Mexican descent, increased acculturation in the US has been associated with poorer health behaviors during pregnancy. This study examined a population of low-income women of Mexican descent in an agricultural community to determine: whether social support patterns were associated with age at arrival in the US; whether social support was associated with pregnancy behaviors; and whether increased social support could prevent some of the negative pregnancy behaviors that accompany acculturation. Participants were 568 pregnant women enrolled in prenatal care in the Salinas Valley, California. Participants were predominantly Spanish speaking, born in Mexico, and from farmworker families. Information on social networks, social support, age at arrival in the US, and pregnancy health behaviors was gathered during interviews conducted during pregnancy and immediately after delivery. Poorer health behaviors were observed among women who had come to the US at a younger age. Social support during pregnancy was lowest among women who had come to the US at an older age. High parity, low education, and low income were also associated with low social support. Higher social support was associated with better quality of diet, increased likelihood of using prenatal vitamins, and decreased likelihood of smoking during pregnancy. High social support also appeared to prevent the negative impact of life in the US on diet quality. Women with intermediate or low levels of social support who had spent their childhoods in the US had significantly poorer diet quality than women who had spent their childhoods in Mexico. However, among women with high social support, there was no difference in diet quality according to country of childhood. Thus, in the case of diet quality, increased social support appears to prevent some of the negative pregnancy behaviors that accompany time in the US among women of Mexican descent.
Assuntos
Aculturação , Dieta , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Gestantes/etnologia , Apoio Social , Adulto , California , Centros Comunitários de Saúde , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Hospitais de Condado , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , TempoRESUMO
The paper is an abridgement about the task and activities done by the resident's teamwork, under the guidelines of the chief of the Head and Neck Surgery Department, at Provincial Hospital of Rosario de Santa Fé (Argentina), with regard to epidemiology, clinical, anatomopathological and therapeutics features and follow-up care of laryngeal cancerous patients they treated in the Hospital.
Assuntos
Neoplasias Laríngeas , Adulto , Idoso , Argentina , Feminino , Hospitais de Condado , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-IdadeAssuntos
Resfriado Comum/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Chicago , Criança , Pré-Escolar , Feminino , Hospitais com mais de 500 Leitos , Hospitais de Condado/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Lactente , Masculino , Pais , Classe Social , Inquéritos e QuestionáriosAssuntos
Cocaína , Complicações na Gravidez , Transtornos Relacionados ao Uso de Substâncias/complicações , Morte Súbita do Lactente/epidemiologia , California/epidemiologia , Causalidade , Feminino , Hospitais de Condado , Hospitais Urbanos , Humanos , Incidência , Recém-Nascido , Programas de Rastreamento , Gravidez , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Morte Súbita do Lactente/etiologiaRESUMO
El beneficio de la terapia con trombolisis en el infarto agudo del miocardio ha sido ampliamente documentado en muchos estudios multicéntricos. Aquí se demuestra que la terapia con estreptoquinasa intravenosa en dosis más pequeñas obtiene beneficios similares con complicaciones menores y que este tratamiento se puede practicar en unidades de cuidado intensivo de hospitales de la comunidad, sin equipos de hemodinamia sofisticados. En la unidad de cuidado intensivo del Hospital Bocagrande en Cartagena se estudiaron 19 pacientes con infarto agudo del miocardio, de menos 6 horas de evolución desde el comienzo del dolor. recibieron estreptoquinasa en dosis de 750.000 unidaes en infusión intravenosa siguiendo un protocolo previamente establecido. La evaluación de la respuesta al tratamiento se hizo tomando en consideración parámetros de carácter no invasivo. La tasa de mortalidad en estos pacientes fue de 5 por ciento. La tasa de reperfusión fue de 68.4 por ciento y hubo una alta tasa de angina post-infarto, la cual respondió satisfactoriamente a tratamiento farmacológico