- From Treatment to Containment to Enterprise: An Ethno-history of Therapeutic Communities in Puerto Rico, 1961-1993. [Journal Article]
- CMCult Med Psychiatry 2019 Jul 11
- Unpaid work is now a central therapy in Puerto Rican therapeutic communities, where substance users reside and seek to rehabilitate each other, often for years at a time. Once a leading treatment for…
Unpaid work is now a central therapy in Puerto Rican therapeutic communities, where substance users reside and seek to rehabilitate each other, often for years at a time. Once a leading treatment for addiction in mainland United States, therapeutic communities were scaled back in the 1970s after they lost federal endorsement. They continue to flourish in Puerto Rico for reasons that have less to do with their curative powers than with their malleability as multi-purpose social enterprises and their historical co-option by state, market and family actors who have deployed them for a variety of purposes. Their endurance from the 1960s to the neoliberal present obliges us to recognize their capacities as what Mizruchi calls abeyance mechanisms whereby 'surplus' populations, otherwise excluded from labor and home, are absorbed into substitute livelihoods. Having initially emerged as a low-cost treatment, in a context of mass unemployment and prison-overcrowding they now thrive as institutions of containment and informal enterprise.
- The struggle for clinical ethics in Jordanian Hospitals. [Journal Article]
- JBJ Bioeth Inq 2019 Jul 11
- The Arab and Islamic world is in cultural, political and ethical flux. Pressures of globalisation contend with ancient ideas and concepts that permeate cultural frameworks. Health professionals are a…
The Arab and Islamic world is in cultural, political and ethical flux. Pressures of globalisation contend with ancient ideas and concepts that permeate cultural frameworks. Health professionals are among the many groups battling to accommodate the rapidly changing conditions. In many predominantly Muslim countries intense debates are underway among clinicians about the impact of the forces of change on their practices. To help understand these forces we conducted a study of the experiences of clinicians in the Hashemite Kingdom of Jordan, a Middle Eastern nation state where the overwhelming majority of the population is Muslim. The sample contained 508 doctors and doctors-in-training, of whom 63% were male and 80% were younger than 40 years of age. It included both a quantitative survey, covering a wide range of issues, and qualitative, free-text written responses. Our results demonstrated high levels of disquiet related to the overall organisation and administration of the health care system, the specific content of ethical decisionmaking, and the impact of changing social, cultural and religious factors. Concerns included overcrowding, widespread corruption and hierarchical, non- democratic, management practices, and tensions relating to traditional and modern approaches to ethics, especially in relation to consent, organ donation, confidentiality, privacy, abortion, and the role of women. The roles of religion and religious authorities, the relative importance of the family, and community and tribal obligations were also areas of contention. The study exposes profound divisions and widely differing perspectives among Jordanian doctors and an abiding sense of uncertainty and instability within the profession. Many doctors express ambivalence in relation to both modern trends and traditional precepts. Three main axes of ethical contention were demonstrated, relating to the tensions between: "conservative" and "pragmatic" styles of decision-making; "traditional" approaches and internationalised standards of ethics; and the role of Islam and pressures to disengage ethical decision- making from religious authority. We speculate that these issues and divisions, and the deep sense of disquiet revealed by our data reflect large-scale forces to which Jordanian society is exposed and to a substantial degree may provide a way to understand the ethical predicament of many other countries in the contemporary Arab world.
- Evaluation of using pediatric emergency rooms. [Journal Article]
- NCNorth Clin Istanb 2019; 6(2):134-140
- CONCLUSIONS: Proper understanding of the scope of emergency services is very important in order to provide fast and effective healthcare to the patients who get admitted to emergency rooms and maintain appropriate and judicious use of the resources of emergency rooms.
- Emergency department and hospital crowding: causes, consequences, and cures. [Journal Article]
- CEClin Exp Emerg Med 2019 Jul 12
- Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughpu…
Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughput due to staffing, ancillary service performance, and flow processes. As such, the problem may be addressed by process improvements within the ED. A broad body of literature demonstrates that ED overcrowding can be a function of hospital capacity rather than an ED specific issue. Lack of institutional capacity leads to boarding in the ED with resultant ED crowding. This is a problem not solvable by the ED and must be addressed as an institution-wide problem. This paper discusses the causes of ED overcrowding, provides a brief overview of the drastic consequences, and discusses possible cures that have been successfully implemented.
- Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review. [Journal Article]
- BGBMC Geriatr 2019 Jul 05; 19(1):185
- CONCLUSIONS: Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty.
- Reasons for longer LOS at the emergency departments: Practical, patient-centred, medical, or cultural? [Journal Article]
- IJInt J Health Plann Manage 2019 Jul 04
- Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physic…
Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient-centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient-centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.
- Health inequalities in the Great Depression: a case study of Stockton on Tees, North-East England in the 1930s. [Journal Article]
- JPJ Public Health (Oxf) 2019 Jul 04
- CONCLUSIONS: There were geographical inequalities in health in the 1930s and the most deprived areas had the worst overall mortality rates. The areas with the worst housing conditions and health outcomes in the 1930s remain so today - health inequality is extant over time across different periods of austerity.
- Investigating client satisfaction with antiretroviral treatment services in South-South Nigeria. [Journal Article]
- SJSAHARA J 2019; 16(1):70-76
- Client satisfaction is a key method of evaluating the quality of healthcare services. This research investigated client satisfaction with anti-retroviral treatment services in selected outpatient fac…
Client satisfaction is a key method of evaluating the quality of healthcare services. This research investigated client satisfaction with anti-retroviral treatment services in selected outpatient facilities in Rivers State. This study was a qualitative study carried out in four antiretroviral treatment (ART) facilities in Rivers State, Nigeria. Researchers conducted nine Key Informant Interviews (KIIs), 25 In-depth interviews (IDIs) and eight Focus Group Discussion (FGDs) among 73 Persons Living with HIVs (PLHIVS) consisting of 31 males and 42 females, using a topic guide. Interviews were recorded, transcribed and analysed using thematic content analysis. Majority of study participants interviewed reported being very satisfied with confidentiality, health worker attitude, interpersonal communication, counselling, and availability of drugs. The major sources of dissatisfaction included overcrowding, long waiting time and inadequate/expensive laboratory services. Suggestions proffered for improving the quality of care at the centres included increasing staff strength at the treatment centres, improving the quality and cost of laboratory services, and infrastructure upgrade. This study demonstrates the role health workers and facility processes play in satisfaction with services at HIV treatment centres. Health workers, programme officers, and managers in HIV prevention, care and treatment need to pay attention to these issues if they would be successful in improving the quality of care for PLHIVs.
- Deep Learning Algorithm to Predict Need for Critical Care in Pediatric Emergency Departments. [Journal Article]
- PEPediatr Emerg Care 2019 Jul 01
- CONCLUSIONS: The deep learning algorithm predicted the critical care and hospitalization of pediatric ED patients more accurately than the conventional early warning score, triage tool, and machine learning methods.
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- Breed Group Effects on Complaints about Canine Welfare Made to the Royal Society for the Prevention of Cruelty to Animals (RSPCA) Queensland, Australia. [Journal Article]
- AAnimals (Basel) 2019 Jun 26; 9(7)
- Cruelty- and neglect-related canine welfare concerns are important welfare and social issues. Dog breed has been identified as a risk factor for bad welfare, and yet its role in different types of ca…
Cruelty- and neglect-related canine welfare concerns are important welfare and social issues. Dog breed has been identified as a risk factor for bad welfare, and yet its role in different types of canine welfare concerns has not been fully investigated. We conducted a retrospective study of 107,597 dog welfare complaints received by RSPCA Queensland from July 2008 to June 2018. The breed of the dog involved in the incident was either recorded as stated by the complainant or by the inspector attending the case. Dog breed was divided into groups following the Australian National Kennel Club nomenclature. Dogs of a non-recognised breed were more likely to be reported in welfare complaints than recognised breed dogs. Recognised breed dogs had a greater risk of being reported with poisoning, lack of veterinary support, abuse and being left unattended in a hot vehicle; while non-recognised breed dogs had greater risk of being reported with insufficient shelter, exercise and food/water, as well as overcrowding and abandonment. Utility breeds, terriers and working dogs were most likely to be reported, while toy, non-sporting breeds and gundogs were least likely to be reported. Common complaint types for utility dogs were: insufficient food/water, shelter and exercise, and poor living conditions; for terriers: abandonment, intentional abuses and killing or injuring another animal; for working dogs: insufficient food/water, shelter and exercise; for toy dogs: lack of veterinary care, overcrowding and staying in a hot vehicle alone; for non-sporting dogs: lack of veterinary care, being left in a hot vehicle unattended and poor body conditions; and for hounds: killing or injuring another animal, intentional abuses and poor body conditions. Breed groups rather than breeds may be the best method of breed identification in a public reporting system as they group similar breeds together, and as our research shows, they relate to types of animal welfare complaints. Understanding the relationship between breed group and canine welfare complaints may help authorities improve public education programs and inform decision-making around which breed a new owner should choose.