Academic literature on the topic 'Readjusting health care'

During the COVID-19 pandemic, concerns about the impact of the aerosol generated in dental procedures on the spread of disease led to additional infection control measures that will remain as part of the biosafety routine after the end of the pandemic. This article addresses a little discussed topic that concerns the need to adapt the physical space and operational-technological choices for post-COVID dental care19. The current architecture of spaces for dental care in teaching and public health service units allows the care of several patients simultaneously. However, aerosols are produced routinely during dental procedures, with a real possibility of contamination between different patients. In this way, we present perspectives and suggestions for readjusting these spaces for teaching units and public health services in the short, medium and long term and also for using the resources of Information and Communication Technologies and minimally invasive dentistry.

Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

Abstract This paper is a translation of three early critiques of the responses of the Covid-19 pandemic in Italy, each addressing a unique facet and different perspective of Europe’s first lockdown. Through bringing together these memorial traces, the article captures the heterogeneity of discussions taking place on the left at the very beginning of the pandemic, destabilizing a totalizing framing of Covid responses through simple binaries such as health vs economics or individual rights vs the collective good. Crisitina Morini addresses the ambivalences around the term ‘care’ (in Italian meaning both ‘attention’ and ‘cure’). Grounded in feminist economics, she argues for the establishment of a self-determination income envisioned as an unconditional and universal income, not linked to working positions. Sara Gandini ponders the possibility of turning anger into a political force and questions what forms this could take. Highlighting the problems related to turning a public health issue into one of national security, Gandini probes the politics of acceptability around Covid-related deaths against non-Covid related deaths, particularly deaths precisely exacerbated by confinement strategies. She speaks also of the silencing and policing of dissent when one tries to raise such issues in the public space. Lastly, Andrea Fumagalli uses the idea of crisis as an opportunity to rethink social and economic issues. These include readjusting the balance between private and public healthcare, (especially as Covid treatments are not very profitable), the implementation of a major European investment plan relating to social infrastructure and the environment, which will relaunch the European economy. Though these critiques were formulated at the start of the pandemic. many of the arguments and questions the authors asked themselves at the time remain highly topical: the role of welfare and income, the regulatory devices (including gender) that risk passing using the fight against the pandemic; all of which are central to maintaining a lucidity of analysis and to be resistant witnesses, politicizing anger to turn it into an agency that takes advantage of this difficult experience to build a slightly better world.

Abstract Background Patients with type 2 diabetes mellitus (T2DM) receiving primary care regularly visit their practice nurses (PNs). By actively participating during medical consultations, patients can better manage their disease, improving clinical outcomes and their quality of life. However, many patients with T2DM do not actively participate during medical consultations. To understand the factors affecting engagement of patients with T2DM, this study aimed to identify factors that help or hinder them from actively participating in consultations with their primary care PNs. Methods Two semi-structured focus groups and 12 semi-structured individual interviews were conducted with patients with T2DM (n = 20) who were undergoing treatment by primary care PNs. All interviews were transcribed verbatim and analyzed using a two-step approach derived from the context-mapping framework. Results Four factors were found to help encourage patients to actively participate in their consultation: developing trusting relationships with their PNs, having enough time in the appointment, deliberately preparing for consultations, and allowing for the presence of a spouse. Conversely, four factors were found to hinder patients from participating during consultations: lacking the need or motivation to participate, readjusting to a new PN, forgetting to ask questions, and ineffectively expressing their thoughts. Conclusion Patients lacked the skills necessary to adequately prepare for a consultation and achieve an active role. In addition, patients’ keen involvement appeared to benefit from a trusting relationship with their PNs. When active participation is impeded by barriers such as a lack of patient’s skills, facilitators should be introduced at an early stage. Trial registration Current Controlled Trials NTR4693 (July 16, 2014).

Abstract Background and Aims The coronavirus disease 2019 (COVID-19) pandemic, has required a rapid and drastic transformation of health systems worldwide, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain was a urgent need. During this period is worth noting that outpatient nephrology consultations were carried out largely virtually. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments including ours at Virgen de las Nieves University hospital (Granada), reducing elective activity. Method At the beginning of the pandemic, we quickly adapted by designing an outpatient healthcare model adapted to the situation. With a virtual model we established direct communication via online almost in "real time" between primary care and our Nephrology Service consultation, avoiding unnecessary travel of patients and relatives, risk exposures to interpersonal and reducing the cost and the public crowds in the hospital. Based on inter-consultation criteria adapted to the guidelines and consensus documents of different societies, we established a new intercommunication system between Primary Care Physicians and external nephrology consultations, to FILTER consultations that did not require unnecessary exposures and reducing the cost of healthcare and the waiting time among others. Between June 2020 and December 2021, we received 372 cases referred from Primary Care for a first virtual assessment in the high-resolution nephrology clinic, clinical recommendations were effectively issued regarding complementary tests, treatment … and the need to refer to our Nephrology outpatient clinic for study and follow-up or not. Results Of the 372 patients evaluated VIRTUALLY, 38 were referred by Acute Kidney Injury (AKI) of which 35 were discharged with follow-up by their Primary Care Physician, 37 patients were referred by eGFR <30 ml / min / 1.73m2 being discharged 29, 66 patients were referred by eGFR between 30-60 ml / min / 1.73m2, being discharged 51 , 15 had Albumin / creatinine ratio (ACR ) between 30-300 mg / gr discharging 100%, 22 cases were consulted for ultrasound renal abnormalities and 18 of them were discharged, 5 were referred for apparently non-urological hematuria, not requiring nephrological follow-up in any case, the reason for referral "other causes" had n = 102 of which the main reason was "loss of an appointment in consultation during the pandemic", nephrectomy, kidney transplants with decompensation, family history of hereditary kidney disease (PKD, Alport …) without follow up need in n=95 of cases In Spain the activity of presential care in outpatient Nephrology consultations was suspended in 47% of the services, carrying out activity through telephone calls in 98.9%, that is, in the majority of Spanish hospitals. In 16.5% of the centers, telemedicine was the only form of external clinical visits. In 57% of the centers, outpatient follow-up tests were stopped during the pandemic. Conclusion The actual COVID-19 pandemic has demonstrated that a transformation and adaptation plan based on the optimization of resources, the implementation of telemedicine and the reorganization of our healthcare activity is necessary. The activity of presential care in outpatient Nephrology consultations was suspended in 47% of the Spanish Nephrology services(1). Humanity has demonstrated once again that it is capable of overcoming adversity, readjusting to change. In our virtual consultation, we attended 372 cases of which 288 (66.6%) were discharged with recommendations to their Primary Care Physician. Avoiding costs, unnecessary exposure of patients, relatives and healthcare personnel, giving an almost "real time” response to the patient and avoiding unnecessary travels. A model of care in external consultations that has come to stay in the future.

This chapter examines the findings on which populations of military veterans are known to be at risk of suicide. The impact of military culture on veterans as well as the impact of deployment, combat trauma, and sexual trauma are discussed, as well as the difficulties of readjusting to civilian life, particularly when the veteran has served in a combat zone. The chapter reviews some of the barriers that veterans must deal with when in need of mental health care. The limits of suicide prediction are discussed and a model for assessing suicide risk using risk factors within high risk diagnoses, including risk in combat-related posttraumatic stress disorder, is presented. Finally, suggestions for managing suicide risk in veterans are discussed. Since veterans are more likely to own firearms and commit suicide with a firearm than nonveterans, an emphasis is placed on employing means restriction counseling for veterans at risk.