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关键词： Emergency medical dispatch   emergency medical services   telemedicine   conflict (psychology)   patient satisfaction   professional-patient relations   triage  

摘要： Introduction This substudy examined whether video-assisted emergency calls affected perceived conflict, call pleasantness, and help received among callers and *** The study was nested within the cluster-randomized CAM-VISION trial at the Emergency Medical Dispatch Center (EMDC) in the Central Denmark Region. Between April 17 and May 1, 2023, dispatchers were assigned to either video-enabled or telephone-only communication. After each call, dispatchers and callers rated conflict, pleasantness, and help on 7-point Likert scales. Outcomes were analyzed using proportional-odds logistic regression (video vs telephone) with 95% confidence intervals (CIs) and supporting sensitivity *** During the 14-day period, 26 dispatchers completed 1522 questionnaires from 2600 emergency calls (response rate 58.5%), including 711 (47%) in the video group and 811 (53%) in the telephone group. Video calls were associated with significantly lower dispatcher-reported conflict (OR 0.39, 95% CI 0.16-0.94;mean difference -0.2, 95% CI -0.5 to 0.0) and fewer severe conflicts (1.4% vs 0.3%;RD -1.1 pp, 95% CI -2.1 to -0.03). Among 322 linked caller-dispatcher pairs, callers rated conflict slightly higher compared with dispatchers (+0.5 points). Caller-reported conflict was similar between groups (OR 0.92, 95% CI 0.55-1.54). Ratings of pleasantness (OR 1.18, 95% CI 0.77-1.80) and perceived help (OR 1.42, 95% CI 0.90-2.24) were uniformly high and did not differ significantly between *** Video during emergency calls reduced dispatcher-perceived conflict but did not significantly affect caller-perceived conflict or satisfaction, though results consistently trended towards favoring *** Registration *** Identifier: NCT05742412

关键词： coronary artery disease   quality improvement program   quality indicators   STEMI  

摘要： Background The American Heart Association's GWTG (Get With The Guidelines) program has demonstrated effectiveness in standardizing and improving cardiovascular care in the United States. This study describes the implementation of the GWTG-CAD (GWTG-Coronary Artery Disease) program in Mexico and evaluates its impact on adherence to guideline-directed medical therapy and key clinical processes. Methods Patients presenting with acute coronary syndrome from 10 hospitals in Mexico were included in the GWTG-CAD registry. Clinical processes and guideline-directed medical therapy use were assessed over the program's first 18 months, grouped into preprogram, 0 to 6 months, 6 to 12 months, and 12 to 18 months. Results A total of 2363 patients were analyzed. Mean age was 62.7 +/- 12.4 years, and 73.4% were male. ST-segment-elevation myocardial infarction was the initial presentation in 65.4% (n=1546). Substantial improvements were achieved in time-sensitive care. The proportion of patients receiving an ECG within 10 minutes of arrival increased from 61% preprogram to 93% at 12to 18 months (P<0.001), and mean time to first ECG decreased from 23.3 +/- 38.7 minutes to 8.5 +/- 19 minutes (P<0.001). Guideline-directed medical therapy at discharge (aspirin, beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and antiplatelet agents) remained consistently >85%. Significant improvements were observed on health processes, including ECG documentation (89%-97.3%), symptom onset recording (79.7%-90.1%), left ventricular ejection fraction assessment (73.4%-87.5%), and lipid profile measurement (42.7%-72%) (all P<0.001). Conclusions Implementation of the GWTG-CAD program in Mexico enabled the identification of critical barriers in cardiac care and supported targeted quality-improvement strategies, resulting in measurable improvements in clinical processes over 18 months.

关键词： CAM   spirituality   health   science  

摘要： This article investigates the dynamic interplay between spirituality, complementary and alternative medicine (CAM), and health systems within diverse sociocultural contexts, focusing on Argentina and Spain. Through empirical analysis of contemporary forms of spirituality and health, the study examines how CAM therapies are integrated and negotiated within healthcare institutions and how their spiritual dimensions are addressed. The comparative analysis of Argentina and Spain, countries with shared cultural, religious, and linguistic ties yet distinct socioeconomic developments and healthcare systems, uncovers notable similarities. Specifically, two concurrent processes are identified: first, the trend towards 'scientifying' CAM practices to align them with mainstream health systems, and second, the increasing spiritualisation of healthcare environments, especially in palliative care. In both contexts, the concept of scientific evidence emerges as a pivotal 'symbolic marker', influencing the acceptance or rejection of CAM therapies among healthcare professionals. This dual process underscores significant tensions in the perception and integration of spirituality within healthcare settings, highlighting broader implications for the articulation of spiritual practices and conventional medical paradigms. The comparative approach provides valuable insights into attitudes towards spirituality and CAM in similar yet distinct contexts.