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INTRODUCTION: Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has bee
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n given to which treatments are appropriate for less advantaged countries.
EVIDENCE ACQUISITION: The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries.
EVIDENCE SYNTHESIS: Pharmacotherapy for intermittent claudication was found to be expensive and improve walking distance by a modest amount. Exercise and endovascular therapies were more effective and exercise the most cost-effective. For critical limb ischemia, bypass surgery and endovascular therapy, which are both resource intensive, resulted in similar rates of amputation-free survival. Substantial reductions in cardiovascular events occurred with use of low cost drugs (statins, ACE inhibitors, anti-platelets) and smoking cessation.
CONCLUSIONS: The panel concluded that, in low- and middle-income countries, cardiovascular prevention is a top priority, whereas a lower priority should be given to pharmacotherapy for leg symptoms and revascularisation, except in countries with established vascular units.
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This is an e-learning module with the objective of providing education for health professionals and pregnant women using published results and studies based on COVID-19 surveillance data, which have indicated an increased risk among pregnant women of presenting with severe forms of COVID-19 and, the
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refore, of being hospitalized and admitted to intensive care units.
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Development finance institutions owned by European governments and the World Bank Group are spending hundreds of millions of dollars on expensive for-profit hospitals in the Global South that block patients from getting care, or bankrupt them, with
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some even imprisoning patients who cannot afford their bills. At the height of the COVID-19 pandemic, some of these same hospitals denied entry to patients suffering from the virus or sold intensive care beds at eyewatering prices to the highest bidder. These development institutions have woefully inadequate safeguards, invest via a complex web of tax-avoiding financial intermediaries, and offer little to zero evidence on the impacts their investments are having. Oxfam is calling on rich-country governments and the World Bank Group to immediately halt their spending on for-profit private healthcare, and for an urgent independent investigation to be conducted into all active and historic investments.
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COVID-19 Vaccines: 1 Safety Surveillance 2 Manual
While there is no indication that pregnant women have an increased susceptibility to infection with SARS-CoV-2, there is evidence that pregnancy may increase the risk of severe illness and mortality from COVID-19 disease in comparison with non-pregn
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ant women of reproductive age. As seen with non-pregnant women, a high proportion of pregnant women have asymptomatic SARS-CoV-2 infection and severe disease is associated with recognized medical (e.g., high body-mass index (BMI), diabetes, pre-existing pulmonary or cardiac conditions) and social (e.g., social deprivation, ethnicity) risk factors. Pregnant women with symptomatic COVID-19 appear to have an increased risk of intensive care unit admission, mechanical ventilation and death in comparison with non-pregnant women of reproductive age, although the absolute risks remain low. COVID-19 may increase the risk of preterm birth, compared with pregnant women without COVID-19, although the evidence is inconclusive.
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The survey, conducted between March 1–10, 2018, assessed the performance of 104 public and 33 private hospitals in Venezuela. According to the figures, most laboratory services and hospital nutrition services are only available intermittently or are completely inoperative. Shortages of items such
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as basic medicines, catheters, surgical supplies, and infant formula are highlighted in the survey; 14% of intensive care units have been shut down because they are unable to operate and 79% of the facilities analysed have no water at all.
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Healthcare-associated infections (HAI) are a significant burden globally, with millions of patients affected each year. These infections affect both high- and limited-resource healthcare settings, but in limited-resource settings, rates are approximately twice as high as high-resource settings (15 o
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ut of every 100 patients versus 7 out of every 100 patients). Furthermore, rates of infections within certain patient populations are significantly higher in limited-resource settings, including surgical patients, patients in intensive-care units (ICU) and neonatal units. It is well documented that environmental contamination plays a role in the transmission of HAIs in healthcare settings. Therefore, environmental cleaning is a fundamental intervention for infection prevention and control (IPC).It is a multifaceted intervention that involves cleaning and disinfection (when indicated) of the environment alongside other key program elements to support successful implementation (e.g., leadership support, training, monitoring, and feedback mechanisms). To be effective, environmental cleaning activities must be implemented within the framework of the facility IPC program, and not as a standalone intervention. It is also essential that IPC programs advocate for and work with facility administration and government officials to budget, operate and maintain adequate water, sanitation and hygiene (WASH) infrastructure to ensure that environmental cleaning can be performed according to best practices.
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Key messages for professionals working at hospitals and other healthcare settings: managers/administrators, infectious disease specialists, infection prevention and control professionals, epidemiologists, prescribers, junior doctors and students, pharmacists, nurses, clinical microbiologists, and pr
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ofessionals in emergency departments, in intensive care units, and in long-term care facilities.
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The semi-structured guided interviewing on ICU nurses in a medical center of southern Taiwan wasapproved by the IRB at the research department of the hospital and data collection was carried out from January toJune 2012. The investigator repeatedly read the transcribed text, and found statements rel
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evant to the themes in thetranscriptions to form significant statements as the basis of data analysis. To ensure the rigor of this study, theinvestigator adopted the approach of trustworthiness of qualitative research proposed by Lincoln and Gu.
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Key questions
What is already known?
Critical illness is common throughout the world and COVID-19 has caused a global surge of critically ill patients.
There are large gaps in the quality of care for critically ill patients, especially in
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low-staffed and low-resourced settings, and mortality rates are high.
Essential Emergency and Critical Care (EECC) is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all wards in all hospitals in the world.
What are the new findings?
The clinical processes that comprise EECC and the essential care of critically ill patients with COVID-19 have been specified in a large consensus among clinical experts worldwide.
The resource requirements for hospitals to be ready to provide this care has been described.
What do the new findings imply?
The findings can be used across medical specialties in hospitals worldwide to prioritise and implement essential care for reducing preventable deaths.
Inclusion of the EEEC processes could increase the impact of pandemic preparedness and response programmes and policies for health systems strengthening.
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Nursing Times [online]; 117: 11, 18-21.
A Joint Position Statement of the Indian Society of Critical Care Medicine (ISCCM) and the Indian
Association of Palliative Care (IAPC)
Indian Journal of Critical
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Care Medicine September 2014 Vol 18 Issue 9
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Clincial Practice Guidelines
Guidelines for essential trauma care
recommended
The Guidelines for essential trauma care seek to set achievable standards for trauma treatment services which could realistically be made available to almost every injured person in the world. They then seek to define the resources that would be nec
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essary to assure such care. These include human resources (staffing and training) and physical resources (infrastructure, equipment and supplies).
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Accessed 24 June 104
4th edition. A manual for clinics, community health centers and district hospitals
Operational Guidelines for Programme Managers & Service Providers
The National Guideline for Neonatal Care and Establishment of Neonatal Care Unit aims to provide health workers with all basics and necessary knowledge and skills to provide appropriate
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care at the most vulnerable period in a newborn’s life. This guideline will be available to all health facilities as a reference book for health workers. The book contains up-to-date evidence-based information and management of newborns with a range of needs in the initial newborn period
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The standards for the care of small and sick newborns in health facilities define, standardize and mainstream inpatient care of small and sick newborns, building on essential newborn
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care and ensuring consistency with the WHO quality of care framework. The standards will guide countries in caring for this vulnerable population and support the quality of care of newborns in the context of universal health coverage. They will provide a resource for policy-makers, health care professionals, health service planners, programme managers, regulators, professional bodies and technical partners involved in care
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