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1.
Matern Child Health J ; 26(3): 556-564, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35039975

RESUMO

OBJECTIVES: In recent years, catastrophic hurricanes have devastated numerous areas, prompting a need to build resilience particularly in at-risk populations that rely on health care and social services. The Maternal and Child Health (MCH) workforce covers a wide breadth of services to pregnant women, families, and children with special health care needs. Research has noted the need to strengthen this workforce with training and skills to help their patients and clients prepare, respond, and recover from disasters. METHODS: Focus groups and interviews with 35 Florida parents and professionals impacted by Hurricanes Irma, Maria, and Michael were conducted to evaluate the stressors placed on systems of care serving mothers and infants in Florida. Journey mapping was used to explore opportunities for improving MCH training and services. RESULTS: Results highlight the importance of increased communication and collaboration between families and providers, coordination among health care and social services providers, effective public messaging, tailored preparedness materials and processes, and the need for post-disaster mental health services and employment resources. CONCLUSION: Ultimately, hurricane preparation and mitigation are key for improving community resilience and these efforts should be tailored to MCH populations as well as delivered by the providers who know their needs best.


Assuntos
Tempestades Ciclônicas , Desastres , Criança , Feminino , Florida , Mão de Obra em Saúde , Humanos , Lactente , Gravidez , Recursos Humanos
2.
Am Surg ; 86(8): 996-1000, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762467

RESUMO

BACKGROUND: Pulmonary function tests (PFTs) are currently recommended for liver transplant candidates. We hypothesized that PFTs may not provide added clinical value to the evaluation of liver transplant patients. METHODS: We conducted a retrospective cohort study of adult cadaveric liver transplants from 2012 to 2018. Abnormal PFTs were defined as restrictive disease of diffusing capacity of the lungs for carbon monoxide (DLCO) <80% or obstructive disease of ratio of forced expiratory volume in the first 1 second to the first vital capacity of the lungs (FEV1/FVC) <70%. RESULTS: We analyzed data on 415 liver transplant patients (358 abnormal PFT results and 57 normal results). The liver transplant patients with abnormal PFTs had no difference in number of intensive care unit (ICU) days (P = .68), length of stay (P = .24), or intubation days (P = .33). There were no differences in pulmonary complications including pleural effusion (P = .30), hemo/pneumothorax (P = .74), pneumonia (P = .66), acute respiratory distress syndrome (P = .57), or pulmonary edema (P = .73). The significant finding between groups was a higher rate of reintubation in liver transplant patients with normal PFTs (P = .02). There was no difference in graft survival (P = .53) or patient survival (P = .42). DISCUSSION: Abnormal PFTs, found in 86% of liver transplant patients, did not correlate with complications, graft failure, or mortality. PFTs contribute to the high cost of liver transplants but do not help predict which patients are at risk of postoperative complications.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Transplante de Fígado/economia , Cuidados Pré-Operatórios/economia , Testes de Função Respiratória/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Florida , Sobrevivência de Enxerto , Humanos , Transplante de Fígado/mortalidade , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/estatística & dados numéricos , Testes de Função Respiratória/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
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