49 research outputs found
Situation of Dominican political thought and activities in France and England
No full textThis thesis investigates the political thought and activities of the French and English Dominicans.
It began historically with a question concerning the nature of the work of John of Paris. Can his De potestate regia et papali be described as a fundamentally theological and philosophical exposition? Such a description would seem to imply a partial separation from the political situation in which he wrote and would see his treatise in relation to the vast mass of the theological literature of the day. In order to test this it would be sensible to undertake a comparative study and to try to see the situation of John of Paris and other Dominicans to discern the effects of this situation on their thought.
To understand the major issues of medieval political thought, the preliminary chapter gives a brief account of the development of this thought. The influence which the Order of Preachers exerted on its members cannot be neglected. The heart of this thesis is found in two rather lengthy chapters dealing with the thought and activities of the members of the Dominican Order in both France and England.
The result of this examination placed the political writings of the Dominicans in France -- of which John of Paris is the major example--in a position apart from that of their other theological and philosophical works. In England, the philosophical and theological productions of the Dominicans are similar to those which were produced by the Dominicans in France except in one major respect, that of treatises dealing with political thought.
The conclusion of this thesis is that the total situation in which these men found themselves must be taken into account in any attempt to understand their thought. In view of this it is evident that Leclercq's view must be modified to the extent that the political situation in which John of Paris wrote explains in part the fact that he wrote a treatise dealing with political affairs. The De potestate regia et papali cannot be regarded merely as a theological and philosophical exposition comme les autres.Arts, Faculty ofHistory, Department ofGraduat
Recommendations for the management of COVID-19 in low- and middle-income countries
Get PDFAt the conclusion of its first year, the dynamics of the COVID-19 pandemic are still fluid. Today’s global and regional numbers on incidence and mortality are outdated just a few weeks later. Effective SARS-CoV-2 vaccines are becoming available, but the exact timeline of their availability, in particular in low- and middle-income countries (LMICs), is still unclear. What has become clear, albeit not completely understood, is that many poorer countries have been hit less by the pandemic than high-income countries (HICs), even when accounting for underreporting related to more limited testing capacity (Figure 1). Many LMICs need to be commended for their generally faster public health responses at much earlier stages in their epidemics than their HIC counterparts. Also, likely because of the relatively younger population in LMICs than HICs, the estimated COVID-19 infection/fatality ratio is typically around two to three deaths per 1,000 infections in LMICs, contrasted to six to 10 deaths per 1,000 infections observed in HICs with older populations
Recommendations on infrastructure and organization of adult ICUs in resource-limited settings
No full textRecommendations on infrastructure and organization of adult ICUs in resource-limited settings
No full textPragmatic recommendations for the management of acute respiratory failure and mechanical ventilation in patients with COVID-19 in low- And middle-income countries
No full textManagement of patients with severe or critical COVID-19 is mainly modeled after care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, and these recommendations are based on evidence that often originates from investigations in resource-rich intensive care units located in high-income countries. Often, it is impractical to apply these recommendations to resource-restricted settings, particularly in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for acute respiratory failure and mechanical ventilation management in patients with severe/critical COVID-19 in LMICs. We suggest starting supplementary oxygen when SpO 2 is persistently lower than 94%. We recommend supplemental oxygen to keep SpO 2 at 88–95% and suggest higher targets in settings where continuous pulse oximetry is not available but intermittent pulse oximetry is. We suggest a trial of awake prone positioning in patients who remain hypoxemic; however, this requires close monitoring, and clear failure and escalation criteria. In places with an adequate number and trained staff, the strategy seems safe. We recommend to intubate based on signs of respiratory distress more than on refractory hypoxemia alone, and we recommend close monitoring for respiratory worsening and early intubation if worsening occurs. We recommend low–tidal volume ventilation combined with FiO 2 and positive end-expiratory pressure (PEEP) management based on a high FiO 2/low PEEP table. We recommend against using routine recruitment maneuvers, unless as a rescue therapy in refractory hypoxemia, and we recommend using prone positioning for 12–16 hours in case of refractory hypoxemia (PaO 2/ FiO 2 < 150 mmHg, FiO 2 3 0.6 and PEEP 3 10 cmH 2O) in intubated patients as standard in ARDS patients. We also recommend against sharing one ventilator for multiple patients. We recommend daily assessments for readiness for weaning by a low-level pressure support and recommend against using a T-piece trial because of aerosolization risk
Pragmatic recommendations for the use of diagnostic testing and prognostic models in hospitalized patients with severe COVID-19 in low- and middle-income countries
Get PDFManagement of patients with severe or critical COVID-19 is mainly based on care for patients with severe pneumonia or acute respiratory distress syndrome (ARDS) from other causes, although some aspects of this new disease may demand a different approach. Recommendations for treatment of severe pneumonia and ARDS management have been gathered mainly from investigations in resource-rich intensive care units (ICUs), mostly located in high-income countries (HICs). It may not be practical to apply these recommendations to resource-restricted settings, particularly in low- and middle-income countries (LMICs). Indeed, high dependency units and ICUs in LMICs are frequently restricted in availability of infrastructure, equipment, medications, skilled nurses, and doctors. An international task force composed of members from LMICs and HICs, all with direct experience in various LMIC settings, critically appraised a list of questions regarding laboratory tests (including microbiology), lung imaging, and the use of diagnostic and prognostic models for patients with severe COVID-19. We provide a list of recommendations and suggestions after pragmatic, experience-based appraisal. A summary of the recommendations is shown in Table 1. Note that although these recommendations are formulated specifically for hospitalized COVID-19 patients with severe or critical disease, as defined by the WHO,1 many are applicable to patients with lower severity of disease
Pragmatic recommendations for the prevention and treatment of acute kidney injury in patients with COVID-19 in low- and middle-income countries
Get PDFCurrent recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable
Global Critical Care: Moving Forward in Resource-Limited Settings
Get PDFCaring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions. This manuscript reviews the field of global critical care, barriers to safe high-quality care, and potential solutions to existing challenges. We also suggest a roadmap for improving the treatment of critically ill patients in resource-limited settings
Assessment of local health worker attitudes toward international medical volunteers in low- And middle-income countries: A global survey
No full text© 2020 The Authors. Background: International Medical Volunteers (IMVs) positively and negatively impact host countries, and the goals of their trips may not always align with the interests of the hosts in Low- and Middle-Income Countries (LMICs). We sought to better understand local physicians’ interest of hosting IMVs and what type of support they desired. Methods: This study was a convenience sample survey-based needs assessment. The surveys were distributed to local physicians by 28 professional society groups in LMICs. Findings: A total of 102 physicians from 51 countries completed the survey. Despite 61.8% participants having no experience with IMVs, 75% were interested in hosting them. Host physicians most desired clinical education (39%), research collaboration (18%), and Systems Development (11%). The most requested specialties were obstetrics and gynecology (25%) and emergency medicine (11%). Respondents considered public hospitals (62%) to be the most helpful clinical setting in which IMVs could work, and 3 months (47%) as the ideal length of stay. Respondents expressed interest in advertising the specific needs of the host country to potential IMVs (80%). Qualitative analyses suggested hosts wanted more training opportunities, inclusion of all stakeholders, culturally competent volunteers, and aid focused on subspecialty education, health policy, public health, and research. Conclusion: Hosts desire more bidirectional clinical education and research capacity building than just direct clinical care. Importantly, cultural competence is key to a successful host partnership, potentially improved through IMV preparation. Finally, respondents want IMVs to ensure that they stay within their scope of practice and training
