179 research outputs found
Evaluating emergency physiciansâ knowledge, attitudes, and experiences of FARC ex-combatants : a pilot study of Colombiaâs emergency medicine teaching hospitals
Objectives: In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex-combatants into the healthcare system. However, FARC ex-combatants have faced significant challenges in receiving healthcare, and little is known about physicians' abilities to address this population's healthcare needs.
Methods: An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians' knowledge, attitudes, and experiences with the FARC ex-combatant reincorporation process.
Results: Among 53 participants, most were male (60.4%), and âź25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two-thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex-combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty-two participants (41.5%) had identified a patient as an ex-combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex-combatants (r = 0.356, n = 47, P = 0.014).
Conclusion: Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex-combatants, and cared for these patients when they self-identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex-combatant healthcare reintegration.Revista Internacional - Indexad
Incidence of confusional syndrome (delirium) in a Latin American university hospital
IntroducciĂłn:
Poco se conoce acerca de la incidencia del delirio en pacientes hospitalizados en diferentes servicios de hospitales universitarios en LatinoamĂŠrica y de los subtipos que se presentan.
Objetivo:
Determinar la incidencia del delirio, la frecuencia de los subtipos motores y los factores asociados en pacientes hospitalizados en diferentes servicios de un hospital universitario en BogotĂĄ, Colombia.
MĂŠtodos:
Se dio seguimiento a una cohorte de pacientes mayores de 18 aĂąos hospitalizados en los servicios de Medicina Interna, GeriatrĂa, Cuidado Intensivo, CirugĂa General y Ortopedia de un hospital universitario entre enero y junio de 2018. Para identificar la presencia de delirio, se utilizĂł la escala CAM (Confusion Assessment Method) y la CAM-ICU si el paciente presentaba disminuciĂłn de las capacidades de comunicaciĂłn. El subtipo de delirio se caracterizĂł utilizando la escala RASS (Richmond Agitation and Sedation Scale). Los pacientes fueron valorados el dĂa de ingreso y luego cada 2 dĂas hasta su alta hospitalaria. Se derivĂł a los pacientes en quienes se identificĂł delirio para tratamiento especializado interdisciplinario intrainstitucional.
Resultados:
Se evaluĂł a 531 pacientes que ingresaron durante ese periodo a los servicios mencionados. La incidencia global del delirio fue del 12% (IC95%, 0,3-14,8). En orden descendiente, el 31,8% de los pacientes hospitalizados en el servicio de GeriatrĂa, el 15,6% en Cuidado Intensivo, el 8,7% en Medicina Interna, el 5,1% en Ortopedia y el 3,9% en CirugĂa. El subtipo motor mĂĄs frecuente fue el mixto (60,9%), seguido por el normoactivo (34,4%) y el hipoactivo (4,7%). Los factores asociados con la incidencia del delirio fueron la edad (RR ajustada = 1,07; IC95%, 1,05-1,09), la presencia de 4 o mĂĄs comorbilidades (RR ajustada = 2,04; IC95%, 1,31-3,20) y la hospitalizaciĂłn en Cuidado Intensivo (RR ajustada = 2,02; IC95%, 1,22-3,35).
Conclusiones:
La incidencia del delirio es heterogĂŠnea en los diferentes servicios del hospital universitario. La mayor incidencia se presentĂł en pacientes ingresados en el servicio de GeriatrĂa; el subtipo mĂĄs frecuente fue el mixto y los principales factores asociados fueron la edad, la presencia de 4 o mĂĄs comorbilidades y la hospitalizaciĂłn en Cuidado Intensivo.Q3Pacientes con delirioBackground:
Little is known about the incidence of delirium and its subtypes in patients admitted to different departments of university hospitals in Latin America.
Objective:
To determine the incidence of delirium and the frequency of its subtypes, as well as its associated factors, in patients admitted to different departments of a university hospital in BogotĂĄ, Colombia.
Methods:
A cohort of patients over 18 years of age admitted to the internal medicine (IM), geriatrics (GU), general surgery (GSU), orthopaedics (OU) and intensive care unit (ICU) services of a university hospital was followed up between January and June 2018. To detect the presence of delirium, we used the CAM (Confusion Assessment Method) and the CAM-ICU if the patient had decreased communication skills. The delirium subtype was characterised using the RASS (Richmond Agitation and Sedation Scale). Patients were assessed on their admission date and then every two days until discharged from the hospital. Those in whom delirium was identified were referred for specialised intra-institutional interdisciplinary management.
Results:
A total of 531 patients admitted during the period were assessed. The overall incidence of delirium was 12% (95% CI, 0.3-14.8). They represented 31.8% of patients in the GU, 15.6% in the ICU, 8.7% in IM, 5.1% in the OU, and 3.9% in the GSU. The most frequent clinical display was the mixed subtype, at 60.9%, followed by the normoactive subtype (34.4%) and the hypoactive subtype (4.7%). The factors most associated with delirium were age (adjusted RR = 1.07; 95% CI, 1.05-1.09), the presence of four or more comorbidities (adjusted RR = 2.04; 95% CI, 1.31-3.20), and being a patient in the ICU (adjusted RR = 2.02; 95% CI, 1.22-3.35).
Conclusions:
The incidence of delirium is heterogeneous in the different departments of the university hospital. The highest incidence occurred in patients that were admitted to the GU. The mixed subtype was the most frequent one, and the main associated factors were age, the presence of four or more comorbidities, and being an ICU patient.https://orcid.org/0000-0001-6119-7060https://orcid.org/0000-0002-1430-1336https://orcid.org/0000-0002-1982-6799https://orcid.org/0000-0002-0477-1908https://orcid.org/0000-0002-3019-0293https://orcid.org/0000-0002-9013-5384Revista Nacional - IndexadaBN
Consensus for the use of flash glucose monitoring in the Colombian adult population with type 1 and 2 diabetes mellitus
IntroducciĂłn: en Colombia las GuĂas de PrĂĄctica ClĂnica para el manejo del paciente con diabetes tipo 1 (DM1) y tipo 2 (DM2) no mencionan el uso del monitoreo de glucosa flash dado que dicho sistema no estaba disponible. El objetivo del presente trabajo fue establecer un grupo de recomendaciones sobre el uso del monitoreo intermitente flash en Colombia. MĂŠtodos: el grupo de expertos estuvo conformado por ocho mĂŠdicos colombianos expertos en el manejo de pacientes con DM1 y DM2 de diversas ciudades de Colombia, una enfermera licen-ciada educadora en diabetes, una paciente con diagnĂłstico de DM1 y un experto metodolĂłgico. A travĂŠs de Zoom Enterprise versiĂłn de la aplicaciĂłn de videoconferencia Zoom (Zoom Video Communications, San Jose, California) el grupo generĂł las preguntas con metodologĂa Metaplan. Posteriormente, se realizĂł una bĂşsqueda sistemĂĄtica de la literatura y anĂĄlisis de la evidencia. Las recomendaciones se generaron mediante grupo nominal segĂşn el grado de evidencia y la formaleza de la recomendaciĂłn siguiendo la metodologĂa GRADE. Resultados: se generaron recomendaciones clĂnicas enfocadas a: a) paciente con diagnĂłstico de DM1 e hipoglucemia; b) paciente con diagnĂłstico de DM1 y mal control metabĂłlico, c) paciente con diagnĂłstico de DM tipo 2 tratado con insulina, d) diabetes pregestacional, e) calidad de vida y f) uso intrahospitalario. Conclusiones: las recomendaciones clĂnicas del presente consenso orientan la toma de decisiones clĂnicas con respecto al uso de monitoreo intermitente flash en el paciente con diagnĂłstico de diabetes en diferentes escenarios clĂnicos.PoblaciĂłn adulta colombiana con diabetes mellitus tipo 1 y 2Introduction: in Colombia, the Clinical Practice Guidelines for the treatment of patients with type 1 (DM1) and type 2 (DM2) diabetes do not mention the use of flash glucose monitoring, as this system was not available. The objective of this study was to establish a set of recommendations for the use of intermittent flash monitoring in Colombia. Methods: the group of experts consisted of eight Colombian physicians from different cities within Colombia, with expertise in the management of patients with DM1 and DM2; a certified diabetes nurse educator; a patient with DM1; and a methodological expert. Using the Zoom En-terprise video conferencing application (Zoom Video Communications, San Jose, California), the group generated questions through the Metaplan method, then carried out a systematic literature search and evidence review. The recommendations were made according to the degree of evidence and strength of the recommendation, following the GRADE method. Results: clinical recommendations were made for: a) patients with DM1 and hypoglycemia; b) patients with DM1 and poor metabolic control; c) patients with insulin-treated DM2; d) pregesta-tional diabetes; e) quality of life; and f) inpatient use. Conclusions: this consensusâs clinical recommendations guide clinical decision making with regard to the use of intermittent flash monitoring in patients with diabetes in various clinical settings.https://orcid.org/0000-0002-8907-3470https://orcid.org/0000-0001-8588-5589https://orcid.org/0000-0002-1982-6799https://orcid.org/0000-0002-1353-148Xhttps://orcid.org/0000-0002-9921-883Xhttps://orcid.org/0000-0003-2267-5431https://orcid.org/0000-0003-4348-9718Revista Nacional - IndexadaCN
Global human footprint on the linkage between biodiversity and ecosystem functioning in reef fishes
Copyright: Š 2011 Mora et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Difficulties in scaling up theoretical and experimental results have raised controversy over the consequences of biodiversity loss for the functioning of natural ecosystems. Using a global survey of reef fish assemblages, we show that in contrast to previous theoretical and experimental studies, ecosystem functioning (as measured by standing biomass) scales in a non-saturating manner with biodiversity (as measured by species and functional richness) in this ecosystem. Our field study also shows a significant and negative interaction between human population density and biodiversity on ecosystem functioning (i.e., for the same human density there were larger reductions in standing biomass at more diverse reefs). Human effects were found to be related to fishing, coastal development, and land use stressors, and currently affect over 75% of the world's coral reefs. Our results indicate that the consequences of biodiversity loss in coral reefs have been considerably underestimated based on existing knowledge and that reef fish assemblages, particularly the most diverse, are greatly vulnerable to the expansion and intensity of anthropogenic stressors in coastal areas
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââĽâII, EF â¤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores
A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do municĂpio de TangarĂĄ da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola nĂŁo vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, nĂŁo entendimento da EA como processo de ensino-aprendizagem, falta de recursos didĂĄticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prĂĄtica, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vĂnculo âEA e ecologia, lixo e hortaâ.Facultad de Humanidades y Ciencias de la EducaciĂł
Healthcare access barriers for FARC ex- combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters
Background: Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC),
Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a
subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de CapacitaciĂłn y
ReincorporaciĂłn (ETCRsâTerritorial Spaces for Training and Reintegration) to facilitate this transition, data has shown
that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.
Methods: Semi-structured interviews were conducted with FARC health promoters and healthcare providers
working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a
qualitative team-based coding method and barriers were categorized according to Julio Frenkâs Domains of
Healthcare Access framework.
Results: Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The
sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health
center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13
Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-
combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were
related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health
insurance program, perceived stigma, and transition process from the FARC health system.
Conclusions: FARC ex-combatants face significant healthcare access barriers, some of which are unique from other
low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider
partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary
healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC
ex-combatants, in order to implement targeted interventions to improve healthcare access.Q2Q1Background: Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC),
Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a
subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de CapacitaciĂłn y
ReincorporaciĂłn (ETCRsâTerritorial Spaces for Training and Reintegration) to facilitate this transition, data has shown
that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.
Methods: Semi-structured interviews were conducted with FARC health promoters and healthcare providers
working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a
qualitative team-based coding method and barriers were categorized according to Julio Frenkâs Domains of
Healthcare Access framework.
Results: Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The
sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health
center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13
Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-
combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were
related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health
insurance program, perceived stigma, and transition process from the FARC health system.
Conclusions: FARC ex-combatants face significant healthcare access barriers, some of which are unique from other
low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider
partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary
healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC
ex-combatants, in order to implement targeted interventions to improve healthcare access.https://orcid.org/ 0000-0001-6634-391XRevista Internacional - IndexadaA1S
Supporting healthcare workers caring for excombatants: incentives among Colombian providers with FARC ex-combatants
Q2Q1Fuerzas Armadas Revolucionarias de Colombia (FARC)With the Peace Agreement between Fuerzas Armadas Revolucionarias de
Colombia (FARC), Colombia promised healthcare to 13,000
âreincorporatingâ FARC ex-combatants. Shortages of healthcare workers
in reincorporation camps means this promise is in danger of going
unfulfilled. More information is needed to determine incentives,
disincentives, and recruitment of healthcare providers to address this
shortage. Semi-structured interviews were conducted with healthcare
providers across FARC reincorporation camps, and a multidisciplinary
team conducted analysis in NVivo12 using a team-based coding
method. Twenty-four healthcare professionals from 15 camps
participated, of which 75% were female. Incentives to work with FARC
included improved clinical skills, professional advancement, increased
comfort with FARC, and contributing to the peace process.
Disincentives included poor living conditions, lack of support, biases,
familial commitments, and sacrificing career opportunities. Threefourths of the sample recommended working with FARC, and 92%
reported a shortage of healthcare workers. Recruitment strategies
included improved resources and specialised career development for
healthcare workers, facilitating interactions between FARC and
healthcare professionals outside clinical scenarios, and integrating
medicine for vulnerable populations into health education. This study
shows the impact that working with FARC ex-combatants can have on
healthcare providers and tangible suggestions for increasing provider
participation to address the healthcare worker shortage.https://orcid.org/0000-0002-1982-6799https://orcid.org/0000-0002-9013-5384https://orcid.org/0000-0002-5372-2459Revista Internacional - IndexadaA2N
Search for narrow resonances using the dijet mass spectrum in pp collisions at sâ=8ââTeV
Results are presented of a search for the production of new particles decaying to pairs of partons (quarks, antiquarks, or gluons), in the dijet mass spectrum in proton-proton collisions at sâ=8ââTeV. The data sample corresponds to an integrated luminosity of 4.0ââfbâ1, collected with the CMS detector at the LHC in 2012. No significant evidence for narrow resonance production is observed. Upper limits are set at the 95% confidence level on the production cross section of hypothetical new particles decaying to quark-quark, quark-gluon, or gluon-gluon final states. These limits are then translated into lower limits on the masses of new resonances in specific scenarios of physics beyond the standard model. The limits reach up to 4.8 TeV, depending on the model, and extend previous exclusions from similar searches performed at lower collision energies. For the first time mass limits are set for the RandallâSundrum graviton model in the dijet channel
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