Zhangbowling9981
Growing health inequities among the increasingly diverse population in Aotearoa New Zealand have prompted responses in the healthcare system. Diversity-related policies and programmes have been developed in some District Health Boards (DHB) to address the issues. The translation of such policy into practice is, however, convoluted by subjective interests and power differentials and thus the outcomes of policies may deviate from their original objectives. In this paper we examine how staff in one DHB translate and implement health equity and diversity initiatives in their everyday practices in hospital settings. In high-level institutional thinking, Māori health equity policy is dictated by the Treaty of Waitangi which sets it apart from the cultural competence focus of programmes for other ethnic groups. Drawing on interviews with clinical staff in the DHB, we reveal how intersecting subject positions, including personal histories and institutional roles, influence the interpretation and enactment of these policies and programmes in ways that blur their distinct agendas. As a result, the paper demonstrates how the politics that underpin agendas that distinctly address equity and diversity, as well as the potential for change in these areas, can be compromised in everyday practice on the hospital floor.
Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists and Neurokinin-1 (NK-1) receptor antagonists, have been used to treat PONV.
To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant.
Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.
Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I-III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included.
All statistical assessments were conducted by a random effect approach and odds ratios and 95% Confidence Intervals were calculated.
Aprepitant 40mg and 80mg significantly reduced the incidence of vomiting 0-24hours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30-0.54]; p < 0.001, and OR = 0.32; 95% CI 0.19-0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0-24h and 0-48hours postoperatively (OR = 0.07; 95% CI 0.02-0.24; p < 0.001 and OR = 0.07; 95% CI 0.02-0.23; p < 0.001).
Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present.
Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses.
CRD42019120188.
CRD42019120188.
Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication.
Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each placebo, low dose (bolus 10mg.kg
), low dose+maintenance (bolus 10mg.kg
+maintenance 1mg.kg
.hr
), high dose (bolus 30mg.kg
) and high dose+maintenance (bolus 30mg.kg
+maintenance 3mg.kg
.hr
). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hours postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period.
The intraoperative blood loss was 440±207.54mL in the placebo group, 412.5±208.21mL in the low dose group, 290±149.6ml in the low dose plus maintenance group, 332.5±162.33mL in the high dose group and 240.7±88.15mL in the high dose maintenance group (p <0.001). The reduction in postoperative blood loss in the drain for the first 24hours was 80±44.44mL in the placebo group, 89.88±44.87mL in the low dose group, 56.7±29.12mL in the low dose plus maintenance group, 77.9±35.74mL in the high dose group and 46.7±19.9mL in the high dose maintenance group (p <0.001). DVT was not encountered in any patient.
Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose+maintenance group.
Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose+maintenance group.
There has been a recent focus on the impact of race on health equity, which has revealed unsettling results. Multiple studies have shown that the underrepresentation of minorities in medical education such as course slides, pre-clinical lecture material, case studies, and textbooks impedes racial equity in the practice of medicine.
In this study, we aimed to survey the landscape of published imaging in modern medicine to understand the degree of racial diversity represented in current biomedical literature.
We performed a photogrammetric analysis of medical images from the New England Journal of Medicine representing various medical fields and geographic regions to examine implicit biases with regards to human skin color.
Overall, 18% of images depicted non-white skin tone but there was considerable heterogeneity in the percentage of non-white medical images published from different geographic regions and specialties (ranging from 0% to 67%).
Unfortunately, these results suggest that there is an understand the multifaceted influence of race and culture on the daily experience of patients in the modern healthcare system. We hope this study will encourage authors to critically evaluate their medical images for implicit bias so that documented photography in scientific literature may better reflect the populations we serve.
The primary objective was to provide a list of effective motivational strategies based on consensus among rehabilitation experts, generated using the Delphi technique. The secondary objective was to identify the types of information that are important when selecting motivational strategies.
Delphi study.
On-site survey at academic conferences and web-based survey.
Rehabilitation experts (N=198) including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists who had worked in stroke rehabilitation for at least 5 years.
Not applicable.
Panelists were asked to rate the effectiveness of motivational strategies and to rate the importance of different types of information using a 5-point Likert scale. Consensus was defined as having been reached for items with an interquartile range of 1 or less.
A total of 116 experts (58.6%) completed the third round of the Delphi survey. Consensus was reached on all of the 26 presented strategies. Seven strategies, such astional strategies. These findings represent a group of consensus-based recommendations for increasing patient adherence to stroke rehabilitation programs, which may be beneficial to many medical professionals working in stroke rehabilitation.This paper focuses on the consensus tracking control of nonlinear multi-agent systems by utilizing the quadratic inner-bounded (QIB) and the one-sided Lipschitz (OSL) conditions in the presence of input saturation constraint under a directed communication topology. A novel sector constraint for the saturation function to formulate consensus control of nonlinear systems under saturating inputs is derived. This sector condition is applied to develop a leader-following consensus of nonlinear agents. A local treatment of the consensus control, ensuring a guaranteed region of stability in the presence of input constraints is provided herein. A computationally simple convex routine-based approach is attained for extraction of the coupling weight and gain of the relative state feedback-based consensus protocol along with the enlargement of the region of stability. Unlike the conventional schemes, the proposed approach can deal with OSL nonlinear agents, effectively employs the information of communication topology in the sector condition, and can be applied to both linear and nonlinear regions of actuators. Moreover, a useful consensus approach for the Lipschitz nonlinear agents is obtained as a particular scenario of the resultant method. Numerical examples to demonstrate the applications and effectiveness of the proposed approach for the input-constrained nonlinear mobile and robotic agents are provided.
Supplemental oxygen therapy is commonly required for respiratory failure requiring mechanical ventilation in the ICU. However, hyperoxaemia may be injurious and may increase mortality. We evaluated the relationship amongst the degree of hyperoxaemia and changes in fraction of inspired oxygen (Fio
) in response to hyperoxaemia, as well as associations with mortality in mechanically ventilated ICU patients.
We retrospectively identified all invasively mechanically ventilated patients admitted to five ICUs, and retrieved all oxygen tension (Pao
) and Fio
data. We assessed the time between arterial blood gas (ABG) samples, proportions of patients with hyperoxaemia, and changes in Fio
when hyperoxaemia was present. The primary outcome was the association between Pao
(assessed by mechanically ventilated exposure-time-divided area under the curve [AUC]) and mortality (in-ICU and post-ICU discharge) using a multistate illness-death model with transition intensities estimated by Cox proportional hazards moeroxaemic. Hyperoxaemia was associated with increased ICU mortality in these patients.Background Community-based outreach programs play an important role in the provision of HIV testing, treatment and health care for men who have sex with men (MSM) in Indonesia. However, qualitative studies of community-based HIV programs have mostly focused on clients rather than on outreach workers (OW). The experiences of MSM peer OW provide insights into how to extend and improve community involvement in HIV programs in Indonesia.
This is a qualitative study based on focus group discussions, which brought together MSM OW (n = 14) and healthcare workers (n = 12). This approach facilitated documentation of the challenges associated with community-based outreach programs in Indonesia through a participatory focus group discussion between OW and healthcare workers.
Findings are reported in relation to challenges experienced in the context of community outreach, and solutions to the challenges faced by OW. Bafilomycin A1 It was found that awareness of a shared commitment to delivering HIV programs can facilitate good relationships between OW and healthcare workers.
Future efforts should consider the role of OW within broader relationships, especially with healthcare workers, when developing community-based responses to HIV testing and treatment. Documenting the role of OW can help contribute to an understanding of ways to adapt HIV programs to reduce barriers to access both for those identified as MSM and others who are ambiguously placed in relation to the programmatic use of such categories.
Future efforts should consider the role of OW within broader relationships, especially with healthcare workers, when developing community-based responses to HIV testing and treatment. Documenting the role of OW can help contribute to an understanding of ways to adapt HIV programs to reduce barriers to access both for those identified as MSM and others who are ambiguously placed in relation to the programmatic use of such categories.
