Thyssenrichmond1438
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. Selleck ON123300 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 as control of task difficulty and goal setting, were considered to be very effective in increasing patient motivation.