The degree of knowledge of the Guaraní language of the students is lower compared to the general population; those who best understand and express themselves were born or studied in the interior of the country. The majority considers that primary and secondary education contribute little in the learning of Guaraní. Since language is an important communication tool in the patient-doctor relationship and knowing that Guarani is the most spoken language in the country, strategies for its learning should be implemented.
Study Objectives: Literature suggests that radiation causes iatrogenic cancer in 1:1500 to 1:3000 pediatric patients undergoing head computed tomography (CT). While many of these head CTs are clinically necessary, research from the PECARN study suggests that clinicians may over-utilize head CT in pediatric patients with mild head injuries. We sought to determine whether a pediatric mild head injury care path, focused on implementing the PECARN decision rule through physician education, shared decisionmaking, and clinical decision support tools, can reduce head CT utilization.Methods: We conducted a quality improvement project to reduce inappropriate head CT utilization through five interventions: ( 1) Engagement of emergency department (ED) nurse and physician leadership explaining the rationale and proposed interventions; (2) Physician education through on-site presentation, distributed Power Point slides, and face-to-face support; (3) Incorporation of a parent/patient shared decisionmaking model into the ED visit; (4) Clinical decision support tool (CDST) embedded into the electronic medical record (EMR); ( 5) Importation of all data into the clinical note to reduce keystrokes and drive compliance. The study was conducted at two sites, a pediatric ED based in a large community hospital and a freestanding ED. Participants included all pediatric patients with a chief complaint of minor head injury or associated ICD-9 codes, as determined by the care path committee prior to launch. Data was collected for a predetermined 9-week period after implementation. This was compared to baseline data from the preceding year. Targets for care path utilization (60%) and head CT reduction (15% relative reduction) were established a priori. The shared decisionmaking tool was a pink sheet placed in the patient room for parent review prior to the provider entry. It included all questions from the PECARN decision rule, translated into understandable layman's terms. This was then reviewed by the provider with the parent(s) during the interview. Decision support involved a separate care path navigator and best practice alert (BPA) within the EMR (EPIC). A BPA was built to fire when a pediatric head CT was ordered. It would remind the provider to utilize the CDST. The CDST prompted providers to enter exclusion criteria, high risk criteria, and moderate risk criteria and displayed the rate of clinically important
Life story systematization requires a rigorous selection of information from various sources. This brief qualitative study uses the biographical method and its objective is to describe the figure of Bartolomé Coronel. Considered one of the first children doctors and his contribution to Asuncion society at the beginning of the 20th century, who died in the Bubonic plague pandemic, in 1911. Various sources are taken: from the profile made by the distinguished educator Celsa Speratti de Garcete, family letters, details of her biography provided by a familiar, speeches allusive to the subject of study and other texts that allow a collective view of him. In conclusion, the current context of Covid19 and the Bubonic plague in the past present the same risk and scarce biosecurity measures taked despite the advancement of science and medicine in our days. The figure of Dr. Bartolomé Coronel presents a wealth of nuances and deserves to be rescued with the memory of oblivion.
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