The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding dec...The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding decade.Twenty-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be performed.This policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and workforce.Additionally,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.展开更多
<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpart...<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.展开更多
文摘The Balanced Budget Act of 1997 created a designation for critical access hospitals(CAHs)to sustain care for people living in rural communities who lacked access to care due to hospital closures over the preceding decade.Twenty-five years later,1350 CAHs serve approximately 18% of the US population and a systematic policy evaluation has yet to be performed.This policy analysis serves to define challenges faced by CAHs through a literature review addressing the four major categories of payment,quality,access to capital,and workforce.Additionally,this analysis describes how current challenges to maintain sustainability of CAHs over time are accentuated by gaps in public health infrastructure and variability in individual health care plans exhibited during the COVID-19 pandemic.
文摘<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.
