OBJETIVO: Avaliar o cumprimento dos Passos 4 a 10 dentre os Dez Passos para o Sucesso do Aleitamento Materno, preconizados pela Iniciativa Hospital Amigo da Criança (IHAC), criada pela Organização Mundial da Saúde (OMS). MÉTODOS: Estudo descritivo de corte transversal. Foram realizadas entrevistas com 100 puérperas nos dois hospitais credenciados pela IHAC em Salvador. Não foram incluídas mães ou recém-nascidos que não poderiam oferecer ou receber aleitamento materno exclusivo, respectivamente.Questionou-se sobre história obstétrica, aleitamento materno anterior, atendimento pré-natal e aspectos relacionados aos Passos Para o Sucesso do Aleitamento Materno. As questões foram elaboradas de acordo com os Critérios Globais para a IHAC. No mínimo 80% das mães deveriam responder de forma satisfatória às perguntas correspondentes a cada passo para que ele fosse considerado como cumprido. Foi feita descrição de frequências para avaliar as respostas. RESULTADOS: O cumprimento foi insatisfatório para o Passo 4 (suporte ao aleitamento materno após o parto - 58%), Passo 5 (aleitamento exclusivo durante a internação - 77%) e Passo 10 (encaminhamento para grupo de suporte ao aleitamento materno - 5%). Outros passos demonstraram bons resultados: Passo 6 (oferta de substitutos do leite materno - 19%), Passo 7 (prática do alojamento conjunto - 91%) e Passo 9 (não uso de chupetas e mamadeiras - 100%). CONCLUSÕES: Houve boa aderência a alguns aspectos dos Critérios Globais da IHAC. Evidencia-se, no entanto, a necessidade de se ampliarem as discussões sobre os critérios para manter o título de "Hospital Amigo da Criança", uma vez que os resultados foram insatisfatórios em relação aos Passos 4, 5 e 10.
OBJECTIVES: to compare compliance with Steps 4 to 10 of "The Steps to Successful Breastfeeding" in two hospitals accredited by the Baby-Friendly Hospital Initiative (BFHI group) with two not yet accredited hospitals in Salvador. METHODS: a cross-sectional study was conducted with 100 women in BFHI-accredited hospitals and 103 women in non-BFHI-accredited hospitals by collecting data on their obstetric history, any breast feeding counseling received during antenatal care, and data on delivery and hospitalization. Data were obtained by applying questionnaires and reviewing patients' medical charts. The chi-square test was used for bivariate variables and Student's t test for continuous variables. RESULTS: statistically significant differences (p<0.05) were found between the BFHI-accredited group and the non-BFHI group with respect to steps 5 (77% vs 35.9%), 6 (81% vs 31%), 8 (77% vs 52.4%), and 9 (100% vs 94.2%). No differences were found between the two groups with respect to steps 4, 7 or 10. Satisfactory compliance with the requirements of the Baby-Friendly Hospital Initiative in BFHIaccredited hospitals was found only with respect to steps 6, 7 and 9. CONCLUSIONS: these results highlight the benefits of BFHI accreditation but emphasize the need for continuous and systematic evaluation in order to promote breastfeeding and provide support in BFHIaccredited maternity hospitals.
OBJECTIVES: Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS: This was a cross-sectional study at a quaternary care children’s hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS: Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported “sometimes” or “usually” communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07–0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13–0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30–0.69). CONCLUSIONS: Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.
OBJECTIVE: Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart. METHODS: Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider’s note. Outcomes were tracked using statistical process control charts. RESULTS: All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%. CONCLUSION: Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.
OBJECTIVES: Individuals who prefer to communicate about health care in a language other than English (LOE) experience poorer quality medical care and challenges when communicating with health care providers. The objective of this study was to elucidate how caregivers who prefer an LOE perceive communication with their physicians on an inpatient general pediatrics service. METHODS: Caregivers of patients admitted to the general pediatrics service at our urban freestanding children’s hospital whose preferred language for medical care was Spanish, Arabic, Brazilian Portuguese, or Mandarin were eligible for this qualitative study. Semistructured interviews using video interpreter services were conducted to explore the participants’ experiences communicating with their physicians. Interview transcripts were analyzed using conventional content analysis. RESULTS: We interviewed 15 participants representing 7 countries of origin and 4 non-English languages: Spanish, Arabic, Brazilian Portuguese, and Mandarin. Three main domains emerged, including: (1) use of interpreter services, (2) overall communication experience with physician providers, and (3) suggestions for improvement in physician communication. Salient themes included early identification of the need for an interpreter is essential and physicians’ use of body language in combination with an interpreter enhances successful communication. CONCLUSIONS: This project fills a gap in existing literature by describing the perspectives of caregivers who prefer an LOE, including those speaking languages other than Spanish, because they communicate with inpatient pediatricians. In addition to ensuring appropriate use of interpreter services, physicians can focus on using plain language and gestures during encounters, helping to facilitate communication and provide culturally competent care for this population.
Background The source of multipotent stromal cells (MSC) can have a significant influence on the health and expansion capacity of the cells. As the applications for allogeneic MSCs in the treatment of feline diseases increase, the location of the initial donor tissue must be analyzed. To date, comparisons have only been made between feline MSCs collected from bone marrow or abdominal fat. This is the first report to compare cells obtained from different adipose depots in the cat with a focus on clinically relevant donor tissues. The tissue was collected from 34 healthy cats undergoing spaying (fat around the ovaries and uterine horn) or subcutaneous fat collected during surgical procedures. Results The amount of starting material is essential to isolate sufficient MSCs. The total tissue yield from the subcutaneous fat was significantly greater than could be obtained from around the reproductive organs, leading to 3 times more MSCs per donor. However, the concentration of MSCs obtained from reproductive fat was higher than from subcutaneous fat. In addition, the viability of the MSCs from the reproductive fat was significantly higher than the subcutaneous fat. Since most spaying occurs in young cats (under 18 months) reproductive fat was collected from adult cats during spaying, illustrating that age did not alter the yield or viability of the MSCs. When sufficient tissue was collected, it was digested either mechanically or enzymatically. Mechanical digestion further decreased the viability and yield of MSCs from subcutaneous fat compared to enzymatic digestion. Biomarkers of stem cell characterization, expansion capacity and function were detected using qPCR. CD70, CD90 and CD105 were all expressed in high levels in the 3 groups. However, the reproductive fat had higher levels of CD73 with the mechanically digested subcutaneous fat having the least. Gata6 was detected in all samples while Sox2 and Sox17 were also detected with higher quantities found in the enzymatically digested subcutaneous fat. Negative control genes of Gata4 and Pdx1 showed no detection prior to 50 cycles. During the first three passages, age of the donor, location of the donor tissue, or digestion protocol had no effect on cell culture doubling times or cell viability. Conclusions While MSCs from reproductive fat had superior cells/tissue weight and initial viability, there were still dramatically fewer cells obtained compared to subcutaneous fat due to the limited amount of tissue surrounding the reproductive organs. Further, in P1-P3 cultures there were no differences noted in doubling time or cell viability between tissue obtained from reproductive or subcutaneous fat depots.
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