Nursing care in the anesthetic procedure: an integrative review

Abstract OBJECTIVE To search for the scientific evidence available on nursing professional actions during the anesthetic procedure. METHOD An integrative review of articles in Portuguese, English and Spanish, indexed in MEDLINE/PubMed, CINAHL, LILACS, National Cochrane, SciELO databases and the VHL portal. RESULTS Seven studies were analyzed, showing nurse anesthetists' work in countries such as the United States and parts of Europe, with the formulation of a plan for anesthesia and patient care regarding the verification of materials and intraoperative controls. The barriers to their performance involved working in conjunction with or supervised by anesthesiologists, the lack of government guidelines and policies for the legal exercise of the profession, and the conflict between nursing and the health system for maintenance of the performance in places with legislation and defined protocols for the specialty. Conclusion Despite the methodological weaknesses found, the studies indicated a wide diversity of nursing work. Furthermore, in countries absent of the specialty, like Brazil, the need to develop guidelines for care during the anesthetic procedure was observed.

Financiación capitativa, articulación entre niveles asistenciales y descentralización de las organizaciones sanitarias

Public organisations are subjected to weak incentivesfor competition. Therefore, institutional Darwinismcannot apply. Regulation and performance monitoring isrequired to protect the public interest. This isparticularly the case of organisations in the healthcare arena, since strong incentives may risk the wholesupply of public health services. Regarding to the pathdependence of the Spanish public health institutionswith respect to the international experience and theobserved health technological changes, this paper triesto ground some theoretical bases for the organisationalchange in our health system. We do this by building ourargument from the very basic public goal: the improvementof the health status of the Spanish population. Thisrequires a better integration of health care services.To this regard, capitation in finance shows somecomparative advantages: it takes an integral view forthe care of the population, it allows for a betterdecentralisation ('deconcentration') of risks to healthproviders and favours managed care under a globalperspective, replacing partial payment to differentproviders. However, the paper shows some potentiallimitations for this purpose and the need of a gradualstrategy for its implementation.

Trends in prevalence, awareness, treatment and control of hypertension in the Republic of Seychelles (African region) between 1989 and 2013 [Poster]

Background: Few data exist on secular trends of high blood pressure (HBP) detection and control in low and middle income countries, particularly in the African region. This study examines trends of HBP over 25 years based on 4 independent population surveys. In the Seychelles, heath care is free to all inhabitants within a national health system, inclusive all HBP medications. Previous studies have shown a transition from traditional to cardiometabolic cardiovascular risk factors in Seychelles. Age adjusted cardiovascular disease mortality rates is high but decreasing over the last two decades.

Las deducciones en el IRPF por gasto sanitario privado: situación actual y posibilidades de reforma

The paper provides information about the tax treatment given to personalhealth expenditures in the Personal Income Tax in Spain, and analyseswhat we know about it and how the tax credit or other forms ofpreferential tax treatment can contribute to the financement of privatehealth expenditures, of special relevance in view of the recent PersonalIncome Tax modification proposals . It also points out some of the mainredistributive results coming out from this type of public financement,differentiating between types of expenditures (mainly those on healthservices which are not provided by the public health system, from thosewhich are).

El impacto de los servicios sanitarios sobre la salud

This paper reviews what has increased medical-care spending bought in terms of health benefitswith longitudinal data from the U.S and, more limited, from Spain. Health services contributionto health has been positive in average, especially during the last 50 years for the U.S andthe last 30 years for Spain. This contribution differs among countries and is much greater forsome diseases (cardiovascular) than for others (cancer). Benefits from health care interventionscan be valued on basis on the social willin gness to pay, observed or declared on the process ofestablishing health policy priorities. 30.000 euros per Quality Adjusted Life Year could providean efficiency threshold for financing publicly health services in Spain: Consensus andlegitimacy of the political process of establishing health priorities becomes, however, moreimportant than any approximate number. Attention is paid finally to bridging the gap betweenefficacy (the possibilities given by innovation and resources devoted to health care) andeffectiveness (the distance to the frontier) of the everyday working of a health system with itsinappropriate care and limited application of the existing knowledge.

La gestión sanitaria: orientaciones a futuro para el cambio organizativo, del control y la financiación

This paper offers a general view of changes in health care management in theSpanish Health System. We focus on the organisational, financing andaccountability aspects of health care provision. We do this by encompassingmanagerial changes and social change and well-grounded in theory health economicsliterature. In this way we try to link applied economics and management issues,as we did in a former paper, ten years ago on the same basis(López-Casasnovas, 2002). We emphasise mistakes and milestones in the wayforward to improve health systems by better understanding the public natureof health policies. Key aspects of this are to achieve a better allocation ofresponsibilities to providers on patients health, to incentive the organisationof medical self-managed health care institutions and to build global budgets onrisk-adjusting capitation and better integrated health care providers on acommunity basis.

Between Cultures: The Dyadic and Triadic Therapeutic Alliance in Multicultural Setting

Many researchers have identified the therapeutic alliance (TA) as the main factor that predicts psychotherapeutic success regardless the type of approach or treatment. In a multicultural setting, the construction of the therapeutic alliance is accompanied by elements that specially influence the flow of the interaction. Some examples of these elements are language, cultural beliefs, and traditions. For Hispanic-American clients in Lausanne (Switzerland), this encounter could take place in a dyadic setting, in the presence of a therapist who speaks Spanish and shares or not the client's culture of origin. On the other hand, it can take place in a triadic setting, in the presence of a therapist who does not speak Spanish and an interpreter that serves as a communication bridge. This present project has the purpose of studying the TA between different health professionals and the Hispanic- American clients who are assisted with and without an interpreter in Lausanne's health system. My goal is to study this relationship in the clients' context (many of them are clandestine) and based on their perception and subjective experience through a quantitative and qualitative complementary methodology. Because this project is in progress, this communication will focus on presenting the population's socio-demographic characteristics, the research questionings, methodology, and preliminary results.This project can enhance our knowledge about relationships between two cultures in a therapeutic encounter (psychological/psychiatric or medical). At the same time, it can bring us a better understanding about the migration movements of Hispanic-Americans in Switzerland.

Burnout levels among Portuguese family doctors: a nationwide survey

AIM: To characterise the prevalence of burnout syndrome in a sample of family doctors (FDs) working in the Portuguese National Health System. DESIGN: Cross-sectional survey. SETTING: Primary healthcare centres from the 18 continental districts and two archipelagos of Portugal. METHOD: The Portuguese version of the Maslach Burnout Inventory-Human Services Survey was sent to 40 randomly selected healthcare centres and distributed to the FDs employed. Socio-demographic and work-related data were also collected. Participants were classified as having high, average or low levels of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) dimensions of burnout. RESULTS: 371 questionnaires were sent, of which 153 (83 women, age range 29-64 years; response rate 41%) returned. One-quarter (25.3%, 95% CI 18.6% to 33.1%) of FDs scored high for EE, 16.2% (10.7% to 23.2%) for DP and 16.7% (11.1% to 23.6%) for lack of PA. On multivariate analysis, being married, of older age, having many years of practice or working in a personalised healthcare unit tended to be associated with increased burnout components. Men tended to present higher EE and DP but lower lack of PA than women. Finally, the prevalence (95% CI) of burnout ranged between 4.1% (1.5% to 8.6%) and 32.4% (25.0% to 40.6%), depending on the definition used. CONCLUSIONS: High burnout is relatively common among Portuguese FDs. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among Portuguese FDs.

Rôle du médecin interniste ou du généraliste dans le diagnostic et le suivi d'une collagénose [Family physician and connective tissue disorders].

The exact place of the family physician in the diagnosis and management of connective tissue disease is poorly studied moreover will essentially depend on the health system and the organization of medical network of each country. Connective tissue diseases are rare and complex diseases that require in all cases referral to specialists for their diagnosis as well as monitoring. All patients must still keep a family doctor whose importance increases more and more as our specialized treatments prolong survival of patients who become chronically ill with multi-organic sequelae. A closely interaction between the various specialists and family physicians is necessary to ensure a good long-term follow-up.

Prévention quaternaire: agir est-il toujours justifié en médecine de famille [Quaternary prevention: is acting always justified in family medicine?].

Quaternary prevention aims to protect the patient or population against overmedicalisation. Quaternary prevention influences all the activities of family medicine by questioning the utility of primary prevention and early diagnosis, identifying the risks of creating new pathological entities and practicing a maximalist medicine. Family doctors can support quaternary prevention by focusing on their patients' priorities and the local resources of an efficient health system.

Stress ulcer prophylaxis in non-critically ill patients: a prospective evaluation of current practice in a general surgery department

Objective: There is little evidence regarding the benefit of stress ulcer prophylaxis (SUP) outside critical care setting. Over-prescription of SUP is not devoid of risks. This prospective study aimed to evaluate the use of proton pump inhibitors (PPIs) for SUP in a general surgery department.Methods: Data collection was performed prospectively during an 8-week period on patients hospitalized in a general surgery department (58 beds) by pharmacists. Patients with a PPI prescription for the treatment of ulcers, gastro-oesophageal reflux disease, oesophagitis or epigastric pain were excluded. Patients admitted twice during the study period were not re-included. The American Society of Health-System Pharmacists guidelines on SUP were used to assess the appropriateness of de novo PPI prescriptions.Results: Among 255 consecutive patients in the study, 138 (54%) received a prophylaxis with PPI, of which 86 (62%) were de novo PPI prescriptions. One-hundred twenty-nine patients (94%) received esomeprazole (according to the hospital drug policy). The most frequent dosage was 40 mg/day. Use of PPI for SUP was evaluated in 67 patients. Fifty-three patients (79%) had no risk factors for SUP. Twelve and 2 patients had one or two risk factors, respectively. At discharge, PPI prophylaxis was continued in 34% of patients with a de novo PPI prescription.Conclusion: This study highlights the overuse of PPIs in non-ICU patients and the inappropriate continuation of PPI prescriptions at discharge.Treatment

Patients âgés admis aux urgences suite à une chute: que faire [Older people admitted to the emergency department after a fall: what to do?].

Falls in older people are frequent. Falls may lead to serious injuries and are associated with greater morbidity, mortality, and reduced overall functioning in the older population. Evidences exist regarding the beneficial effects of fall prevention programs. However, these interventions are rarely implemented in our health system. Older people admitted to the emergency department after a fall should get careful attention in order to initiate specific interventions to prevent new falls. This article provides a clinical assessment strategy to evaluate older persons after a fall and proposes an algorithm for discharge planning decision.

Medicaid Value Management Program SFY 2008 Report Executive Summary, 2007

In June, 2007, the Commonwealth Fund released a report entitled, “Aiming Higher: Results from a State Scorecard on Health System Performance.” The report ranked states’ health care performance based upon four areas: access, quality, potentially avoidable use of hospitals and costs of care, and healthy lives. Iowa was ranked second overall and was the only state to rank in the top 25 percent on each of the four measures.1 Coupling the HEDIS measures and CAHPS survey results with the Commonwealth report outcomes provides additional information for determining how the state performs with regard to the health care system, in general, and the Medicaid program specifically. For the past five years the results of eight outcome measures encompassing children and adults, and preventive, chronic and acute care have been reported by the University of Iowa Public Policy Center (PPC). The PPC is the independent evaluator for the Medicaid managed care programs and assists the state in an effort to understand the process of care within the Medicaid program. Seven of the eight measures are recommended by the Centers for Medicare and Medicaid, while the eighth, annual dental visit, is used in recognition of the challenges found in providing dental care to Medicaid‐enrolled children and adults.

Penser la médecine communautaire s'apprend avec les pairs. [The spirit of community medicine: students learning from students].

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Misleading tacrolimus concentration value in blood taken from a catheter used for tacrolimus administration.

PURPOSE: A misleading blood tacrolimus concentration (BTC) value caused by the contamination of a central venous catheter previously used for tacrolimus administration is described. SUMMARY: A 59-year-old woman with severe chronic obstructive pulmonary disease successfully underwent double lung transplantation. In the intensive care unit, she received a continuous i.v. infusion of tacrolimus from days 1 to 5 after transplantation through the distal lumen of a polyurethane triple-lumen central venous catheter. The catheter lumen was flushed twice a day with 0.9% sodium chloride injection. The proximal lumen was used for blood sampling after being flushed; the first 10 mL of blood was discarded. BTCs determined in whole blood one, four, and five days after transplantation were within the therapeutic range of 5-15 ng/mL. On day five the patient was transferred to the thoracic surgery ward and was switched to oral tacrolimus 1.5 mg twice daily. The BTC on day 6 was unexpectedly high at 134.5 ng/mL. The patient's clinical status was normal, and no signs of tacrolimus toxicity were observed. On day 7, blood samples were drawn from a peripheral vein and simultaneously through the central venous catheter. Although the central venous catheter had not been exposed to tacrolimus during the preceding two days, it yielded blood with a BTC eight times higher than the BTC in blood from the peripheral vein (41.4 ng/mL versus 5.1 ng/mL). CONCLUSION: The collection of blood from a central venous catheter lumen that had been used for tacrolimus administration resulted in a BTC about eight times higher than what was measured in peripheral blood.