Decision-making Process by Users and Providers of Health Care Services During the AH1N1 Epidemic Influenza in Mexico: Lessons Learned and Challenges Ahead.

OBJECTIVE: The aim of the study was to analyze, using a decision analysis approach, the probability of severity of illness due to delayed utilization of health services and inappropriate hospital medical treatment during the 2009 AH1N1 influenza epidemic in Mexico. METHODS: Patients with influenza AH1N1 confirmed by the polymerase chain reaction (PCR) test from two hospitals in Mexico City, were included. Path methodology based upon literature and validated by clinical experts was followed. The probability for severe illness originated from delayed utilization of health services, delayed prescription of neuraminidase inhibitors (NAIs) and inappropriate use of antibiotics was assessed. FINDINGS: Ninety-nine patients were analyzed, and 16% developed severe illness. Most patients received NAIs and 85.9% received antibiotics. Inappropriate use of antibiotics was observed in 70.7% of cases. Early utilization of services increased the likelihood of non-severe illness (cumulative probability CP = 0.56). The major cumulative probability for severe illness was observed when prescription of NAIs was delayed (CP = 0.19). CONCLUSION: Delayed prescription of NAIs and irrational use of antibiotics are critical decisions for unfavorable outcomes in patients suffering influenza AH1N1.

Shared decision making in Brazil: Concrete efforts to empower the patients' voice.

Patient involvement in healthcare decisions has grown in Brazil at three different levels: 1) the macro level, which includes the patient actively influencing legislation and regulation of medical care as well as political changes in the process of care itself; 2) the meso level, which includes institutions that aim to improve information, empowerment and counseling to patients, and 3) the micro level, which focuses on the actual decision-making process that takes place within patient-physician encounter. In Brazil, the macro and meso levels are stronger than the micro one. In this paper, the practical efforts to engage patients in the center of their own care are presented. In order to do that, an overview on the National Humanization Policy and the Brazilian patient's movement is provided.

ICU Telemedicine Comanagement Methods and Length of Stay.

BACKGROUND: Studies have identified processes that are associated with more favorable length of stay (LOS) outcomes when an ICU telemedicine program is implemented. Despite these studies, the relation of the acceptance of ICU telemedicine management services by individual ICUs to LOS outcomes is unknown. METHODS: This is a single ICU telemedicine center study that compares LOS outcomes among three groups of intensivist-staffed mixed medical-surgical ICUs that used alternative comanagement strategies. The proportion of provider orders recorded by an ICU telemedicine provider to all recorded orders was compared among ICUs that used a monitor and notify comanagement approach, a direct intervention with timely notification process, and ICUs that used a mix of these two approaches. The primary outcome was acuity-adjusted hospital LOS. RESULTS: ICUs that used the direct intervention with timely notification strategy had a significantly larger proportion of provider orders recorded by ICU telemedicine physicians than the mixed methods of comanagement group, which had a larger proportion than ICUs that used the monitor and notify method (P < .001). Acuity-adjusted hospital LOS was significantly lower for the direct intervention with timely notification comanagement strategy (0.68; 0.65-0.70) compared with the mixed methods group (0.70 [0.69-0.72]; P = .01), which was significantly lower than the monitor and notify group (0.83 [0.80-0.86]; P < .001). CONCLUSIONS: Direct intervention with timely notification strategies of ICU telemedicine comanagement were associated with shorter LOS outcomes than monitor and notify comanagement strategies.

Reflexiones interacadémicas sobre el proceso de atención de enfermería / Inter-academical reflexions on the nursing process

El desarrollo de actividades interacadémicas en espacios de investigación sin lugar a dudas reporta la posibilidad de un intercambio de visiones sobre la disciplina y una experiencia en pro de la cultura de la Inter-multidisciplina. En el marco de la Unidad de Investigación la ENEO-UNAM, ha instituido los jueves académicos, escenario donde se diserta sobre temas relevantes para el cuidado a la salud, tal fue el caso del Proceso de Atención de Enfermería (PAE). En una jornada de cuatro sesiones se abordó por representantes de las diversas Academias de Enfermería e Investigadores en el tema, los diferentes escenarios en los que se evidencia el proceso, así como la problemática y forma de aproximarse al PAE. De dicha actividad se reconocieron tres aspectos nodales en torno al PAE a saber: Aspectos semánticos-nominales, los Teóricos conceptuales y los Instrumentales; todos de gran trascendencia e impostergable abordaje. Lo anterior inserto en una visión filosófica sobre el cuidado a partir de la aprehensión de persona y naturaleza, que lleven a considerar el verdadero humanismo con que se ha investido a la profesión de enfermería.

The development of interacademic activities in investigation spaces without doubt reports the possibility of an interchange of visions on the discipline and a experience for the culture of the Inter-discipline. Within the framework of the Unit of Investigation the ENEO-UNAM, has instituted academic thursdays, scene where dissert on excellent subjects for the care to the health, so was the case of the Nursing Process Attention (PAE by abbreviations in for Spanish) . In cycle of four sessions one approached by representatives of the diverse Academies of Nursing and Investigators in the subject, the different scenes in which the process is demonstrated, as well at the problematic and forms to come near to the PAE. We´re acknowledge of this activity, three aspects around the PAE : Aspects semantic-nominal, the conceptual theoreticians and Instrumentation; all of great importance and urgent boarding. All inserted in a philosophical vision on the care from the apprehension of person and the nature, who take to consider the true humanist whereupon she has been invested to the Nursing profession.