The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review.

BACKGROUND: People with palliative care needs and their carers often rely on out-of-hours services to remain at home. Policymakers have recommended implementing telephone advice lines to ensure 24/7 access to support. However, the impact of these services on patient and carer outcomes, as well as the health care system, remains poorly understood. AIM: To evaluate the clinical- and cost-effectiveness of out-of-hours palliative care telephone advice lines, and to identify service characteristics associated with effectiveness. DESIGN: Rapid systematic review (PROSPERO ID: CRD42023400370) with narrative synthesis. DATA SOURCES: Three databases (Medline, EMBASE and CINAHL) were searched in February 2023 for studies of any design reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool, and quantitative and qualitative data were synthesised narratively. RESULTS: Twenty-one studies, published 2000-2022, were included. Most studies were observational, none were experimental. While some evidence suggested that telephone advice lines offer guidance and reassurance, supporting care at home and potentially reducing avoidable emergency care use in the last months of life, variability in reporting and poor methodological quality across studies limit our understanding of patient/carer and health care system outcomes. CONCLUSION: Despite their increasing use, evidence for the clinical- and cost-effectiveness of palliative care telephone advice lines remains limited, primarily due to the lack of robust comparative studies. There is a need for more rigorous evaluations incorporating experimental or quasi-experimental methods and longer follow-up, and standardised reporting of telephone advice line models and outcomes, to guide policy and practice.

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations.

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

Evaluation of healthcare professionals' experiences of taking telephone calls from parents of children with congenital heart disease. A risky business.

The Congenital Heart Disease Standards for England indicate that parents and children should have access to a 24-h telephone advice service, however, little is known about existing services. This paper presents phase two of a mixed-methods service evaluation, which aimed to evaluate staff experiences of telephone communication with these parents. All nursing and support staff in a single specialist children's cardiac surgical centre were invited to participate in an online survey during July-November 2019. Data were descriptively and thematically analysed. Participants (N = 39) were predominantly nurses (n = 32, 82%) with 64.1% (n = 25) working in the speciality >10 years. Positive experiences included: signposting and preventing further deterioration; supporting families to get expert advice quickly; providing reassurance. Challenging experiences included: offering advice without being able to see the child, dealing with telephone calls alongside busy workload; and parents running out of medications and telephoning out of hours. In conclusion, taking telephone calls were perceived to be time consuming and are potentially high risk. A standardised approach to assessment, intervention and documentation was deemed necessary. Implementation of an updated parental early warning tool was recommended, along with staff and parental education.

Retrospective multi-center study of robotic-assisted cholecystectomy: after-hours surgery and business-hours surgery outcomes.

The effect of robotic-assisted cholecystectomy (RAC), when performed after hours, on perioperative outcomes has not been evaluated against outcomes achieved during normal business hours. Subjects 18-80 years old who underwent da Vinci robotic-assisted cholecystectomy from August 2018 to February 2021 were included. Baseline and 30-day perioperative outcomes were retrospectively and consecutively collected and analyzed. Inverse probability treatment weighting (IPTW) was performed to balance patient characteristics between groups. A weighted comparative analysis was followed. Outcomes from 505 patients (after hours, n = 169; business hours, n = 336) undergoing RAC across 5 U.S. medical institutions were analyzed. The higher rates of acute cholecystitis and gallbladder inflammation, gangrene, and intraoperative abnormalities in the after-hours group were associated with higher rates of urgent cases and longer operative times-but not increased complication rates-compared to the business-hours group. There were no significant differences in rates of intraoperative or postoperative complications, readmissions, or reoperations. Integrated da Vinci Firefly fluorescence imaging system was used extensively, and the critical view of safety was achieved in > 96% of cases in both groups. No conversions occurred in the after-hours group compared to four conversions in the business-hours group (p = 0.0266). After-hours patients had shorter outpatient lengths of stay. No mortalities were reported for either group (p = 0.0139). After-hours RAC with integrated da Vinci Firefly imaging performed by surgeons experienced in RAC is associated with similar or improved outcomes than the same procedures during business hours in terms of complications, conversions, readmissions, reoperations, and length of stay. ClinicalTrials.gov identifier: NCT04551820; August 5, 2020.

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours.

Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing "after-hours" cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.

Use of Video in Telephone Triage in Out-of-Hours Primary Care: Register-Based Study.

Background: Out-of-hours primary care (OOH-PC) is challenging due to high workloads, workforce shortages, and long waiting and transportation times for patients. Use of video enables triage professionals to visually assess patients, potentially ending more contacts in a telephone triage contact instead of referring patients to more resource-demanding clinic consultations or home visits. Thus, video use may help reduce use of health care resources in OOH-PC. Objective: This study aimed to investigate video use in telephone triage contacts to OOH-PC in Denmark by studying rate of use and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce use of health care resources in OOH-PC. Methods: This register-based study included all telephone triage contacts to OOH-PC in 4 of the 5 Danish regions from March 15, 2020, to December 1, 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone triage contacts with video use (video contact) and without video use (telephone contact). Calculating crude incidence rate ratios and adjusted incidence rate ratios (aIRRs), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact. Results: Of 2,900,566 identified telephone triage contacts to OOH-PC, 9.5% (n=275,203) were conducted as video contacts. The frequency of video contact was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC more than 4 hours before the opening hours of daytime general practice. Compared to telephone contacts, notably more video contacts ended with advice and self-care (aIRR 1.21, 95% CI 1.21-1.21) and no follow-up contact (aIRR 1.08, 95% CI 1.08-1.09). Conclusions: This study supports our hypothesis that video contacts could reduce use of health care resources in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results could be biased due to confounding by indication, reflecting that triage GPs use video for a specific set of reasons for encounters.

Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting.

BACKGROUND: Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC). OBJECTIVES: To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC. METHODS: Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary. RESULTS: The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive. CONCLUSION: The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.

Task shifting from general practitioners to other health professionals could increase treatment capacity in out-of-hours primary care.Task shifting occurs for care to patients with less urgent and less complex health issues.The long-term implications of task shifting in out-of-hours primary care should be investigated.

Emergency Call versus General Practitioner Requested Ambulances - Patient Mortality, Disease Severity and Pattern.

Introduction: Ambulance requests by general practitioners for primary care patients (GP-requested) are often omitted in studies on increased demand within emergency care but may comprise a substantial patient group. We aimed to assess acute severity, intensive care unit (ICU) admission, and diagnostic pattern, including comorbidity, and mortality among GP-requested ambulance patients, compared to emergency call ambulance patients. Our hypothesis was that emergency call patients had more severe health issues than GP-requested ambulance patients. Methods: Historic population-based cohort study of ambulance patients in the North Denmark Region, 2016-2020. Hospital contact data including diagnoses, ambulance data, vital signs and vital status was linked using each patient's unique identification number. Primary outcome measure was mortality within 1, 7, and 30 days. Secondary outcomes were disease severity expressed as modified National Early Warning Score (NEWS2), and ICU admission. Admission status and hospital diagnostic pattern, including comorbidity were described and compared. Results: We included 255,487 patients. GP-requested patients (N = 119,361, 46.7%) were older (median years [IQR] 73 [58-83] versus 61 [37-76]) and more had moderate/severe comorbidity (11.9%, N = 13,806 versus 4.9%, N = 6145) than the emergency call patients. Prehospital mNEWS2 median scores were lower for GP-requested patients. For both groups, mNEWS2 was highest among patients aged 66+. GP-requested patients had higher 30-day mortality (9.0% (95% CI: 8.8-9.2), N = 8996) than emergency call patients (5.2% (95% CI: 5.1-5.4), N = 6727). Circulatory (12.0%, 11,695/97,112) and respiratory diseases (11.6%, 11,219/97,112) were more frequent among GP-requested patients than emergency call patients ((10.7%, 12,640/118,102) and (5.8%, 6858/118,102)). The highest number of deaths was found for health issues 'circulatory diseases' in the emergency call group and 'other factors' followed by "respiratory diseases" in the GP-requested group. Conclusion: GP-requested patients constituted nearly half of the EMS volume, they were older, with more comorbidity, had serious conditions with substantial acute severity, and a higher 30-day mortality than emergency call patients.

Buffering or boosting? The dynamic curvilinear relationship between work-related use of information and communication technologies after-hours and wok procrastination.

Work-related use of information and communication technologies after-hours (W_ICTs) blurs the boundaries between work and non-work domains, representing a typical boundary-crossing behavior that affects employees' lives and organizational development. Drawing on the Job Demands-Resources theory, this study develops a dynamic curvilinear model of the impact of W_ICTs on work procrastination, considering intrinsic motivation (self-efficacy and enjoyment) and regulatory focus (prevention focus). Empirical testing of the research hypotheses is conducted through a survey involving 817 employees with standard working hours (e.g. 9 a.m. to 5 p.m.). The results indicate that W_ICTs can be regarded as both inhibitors and promoters, with a U-shaped impact on work procrastination and an inverted U-shaped effect on self-efficacy and enjoyment. The mediating roles of self-efficacy and enjoyment are significant. Moreover, prevention focus moderates the relationship between W_ICTs and enjoyment, whereas the moderating effect between W_ICTs and self-efficacy is insignificant. This dynamic curvilinear relationship may explain the inconsistent results of prior studies regarding the relationship between W_ICTs and employees' negative behaviors. It contributes to expanding research on the outcomes of W_ICTs and the antecedents of work procrastination. Moreover, the proposed influence mechanism between W_ICTs and work procrastination has not been established from the perspective of intrinsic motivation and prevention focus. Hence, this study responds to scholars' calls and adds to the existing research on how W_ICTs affect work procrastination. These research findings enhance the current understanding of the effects of W_ICTs and offer valuable insights for organizations to effectively manage W_ICTs and address work procrastination behavior in practice.

"Always online": How and when task interdependence and dispositional workplace anxiety affect workplace telepressure after hours.

Information and communication technology (ICT) provides employees with convenience in communication. However, it also creates a preoccupation with and urges to respond quickly to work-related ICT messages during nonworking time, which is defined as workplace telepressure after hours (WTA). Drawing on the job demand-resource model, conservation of resource theory, and workplace anxiety theory, this study explores how and when task interdependence and dispositional workplace anxiety affect WTA and how individuals cope with WTA. A total of 269 full-time workers from an online survey panel completed questionnaires at three time-points. We found that both task interdependence and dispositional workplace anxiety are positively related to WTA. The perception of pay-for-responsiveness moderates the relationship between task interdependence and WTA, such that the relationship is significant only for employees with a strong perception of pay-for-responsiveness. Others' approval contingency of self-worth moderates the relationship between dispositional workplace anxiety and WTA, and the relationship is significant only for employees with high degrees of others' approval contingency of self-worth. Finally, WTA arising from external work requirements or the internal pursuit of achieving work goals prompts employees to generate responsiveness coping strategies. Overall, these findings suggest that task interdependence and dispositional workplace anxiety are important factors affecting employees' WTA and highlight the importance of being responsive to WTA.

Adoption and Use of Telemedicine and Digital Health Services Among Older Adults in Light of the COVID-19 Pandemic: Repeated Cross-Sectional Analysis.

BACKGROUND: As the population ages and the prevalence of long-term diseases rises, the use of telecare is becoming increasingly frequent to aid older people. OBJECTIVE: This study aims to explore the use and adoption of 3 types of telehealth services among the older population in Israel before, during, and after the COVID-19 pandemic. METHODS: We explored the use characteristics of older adults (aged ≥65 years) belonging to Clalit Health Services in several aspects in the use of 3 types of telehealth services: the use of digital services for administrative tasks; the use of synchronous working-hours telehealth visits with the patient's personal physician during clinic business hours; and the use of after-hours consultations during evenings, nights, and weekends when the clinics are closed. The data were collected and analyzed throughout 3 distinct periods in Israel: before the COVID-19 pandemic, during the onset of the COVID-19 pandemic, and following the COVID-19 peak. RESULTS: Data of 618,850 patients who met the inclusion criteria were extracted. Telehealth services used for administrative purposes were the most popular. The most intriguing finding was that the older population significantly increased their use of all types of telehealth services during the COVID-19 pandemic, and in most types, this use decreased after the COVID-19 peak, but to a level that was higher than the baseline level before the COVID-19 pandemic. Before the COVID-19 pandemic, 23.1% (142,936/618,850) of the study population used working-hours telehealth visits, and 2.2% (13,837/618,850) used after-hours consultations at least once. The percentage of use for these services increased during the COVID-19 pandemic to 59.2% (366,566/618,850) and 5% (30,777/618,850) and then decreased during the third period to 39.5% (244,572/618,850) and 2.4% (14,584/618,850), respectively (P<.001). Multiple patient variables have been found to be associated with the use of the different telehealth services in each period. CONCLUSIONS: Despite the limitations and obstacles, the older population uses telehealth services and can increase their use when they are needed. These people can learn how to use digital health services effectively, and they should be given the opportunity to do so by creating suitable and straightforward telehealth solutions tailored to this population and enhancing their usability.

Different Results from Varied Angles: The Positive Impact of Work Connectivity Behavior After-Hours on Work Engagement.

With the development of communication technology and the COVID-19 pandemic, it has become increasingly common for employees to maintain work connectivity after-hours, which has a significant impact on their psychological state at work. However, most of the existing studies have not reached a consensus on the impact of work connectivity behavior after-hours on employees' psychological state at work, and the existing studies have led to theoretical and practical disagreements. Based on the Job Demands-Resources model, we built a two-path model of work autonomy and emotional exhaustion to explore the impact of work connectivity behavior after-hours on work engagement. In addition, we compared the differences between different workplace statuses (managers and ordinary employees). Through surveys and analyses of 257 employees, the results show that work connectivity behavior after-hours positively impacts employees' work engagement by increasing managers' work autonomy and reducing ordinary employees' emotional exhaustion. This study not only reveals that work connectivity behavior after-hours positively affects work engagement but also illustrates the differences in impact between managers and ordinary employees; these findings contribute to the development of a consensus on the influence of work connectivity behavior after-hours on employees' psychological state at work, which provides insights for organizations seeking to manage work connectivity behavior after-hours, for example, by adopting different connectivity management strategies for employees with different workplace statuses.

Tit for tat? A study on the relationship between work connectivity behavior after-hours and employees' time banditry behavior.

Based on Conservation of Resources Theory, this study tries to reveal the mechanism of action of work connectivity behavior after-hours triggering employees' time banditry behavior. By using Mplus7.4 software the analysis of 429 leader-employee paired data collected in three stages reveals that work connectivity behavior after-hours has a positive effect on work alienation and psychological distress. Work alienation and psychological distress mediates the relationship between work connectivity behavior after-hours and employees' time banditry behavior, respectively. In addition, organization-based self-esteem mitigates the positive effects of work connectivity behavior after-hours on work alienation and psychological distress, which in turn also moderates the indirect effects of work connectivity behavior after-hours on employees' time banditry behavior through work alienation and psychological distress, respectively. This study provides practical guidance for organizations to reduce employee time banditry behavior and human resource management practices in the new technological environment.

Human body constitution care medicine under the intervention of sports science / Os cuidados médicos com a constituição do corpo humano sob a intervenção da ciência do esporte / Los cuidados médicos con la constitución del cuerpo humano bajo la intervención de la ciencia del deporte

ABSTRACT Introduction: The shape, physiological function, and physical fitness (exercise ability) of the human body are the main parts of physical fitness. Different sports kinesiology methods have different effects on the human physique. System science-related theories can be applied to the research of the human health system under medical theory. Objective: We researched the human body's physique and formulate relevant sports kinesiology programs for the human body. We could analyze the influence of human body shape and physiological condition on human body constitution. Methods: We conducted research on the human body's physical health and nutrition through methods such as physical tests, anthropometric measurements, diet surveys, and laboratory examinations of the human body. Analyzing the correlation between sports and human body conditioning medicine had a favorable outcome in the study. Results: The sports kinesiology program has apparent effects on improving and enhancing human body shape, physiological functions, and physical fitness. Conclusion: The sports kinesiology program has a significant effect on improving the physical fitness of the human body. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A forma, a função fisiológica e o preparo físico (habilidade da prática de exercícios) do corpo humano são os principais componentes do preparo físico. Diferentes métodos de cinesiologia dos esportes êm diferentes efeitos no físico humano. Teorias cientificas sistemáticas podem ser aplicadas à pesquisa do sistema de saúde humana sob a teoria médica. Objetivo: Pesquisamos o físico do corpo humano e formulamos programas de cinesiologia dos esportes relevantes para o corpo humano. Pudemos analisar a forma corporal e a condição fisiológica na constituição do corpo humano. Métodos: Conduzimos uma pesquisa sobre a saúde e nutrição física do corpo humano com métodos como testes físicos, medidas antropométricas, estudos sobre dietas e exames laboratoriais do corpo humano. A análise da correlação entre esportes a medicina do condicionamento do corpo humano teve resultados positivos neste estudo. Resultados: O programa de cinesiologia do esporte tem efeitos visíveis em melhorar e aprimorar a forma do corpo humano, suas funções fisiológicas e o preparo físico. Conclusão: O programa de cinesiologia do esporte tem um efeito significativo em melhorar o preparo físico do corpo humano. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

Resumen Introducción: La forma, la función fisiológica y la preparación física (habilidad de la práctica de ejercicios) del cuerpo humano son los principales componentes de la preparación física. Diferentes métodos de kinesiología de los deportes pueden aplicarse a la investigación del sistema de salud humana bajo la teoría médica. Objetivo: Investigamos el físico del cuerpo humano y formulamos programas de kinesiología de los deportes relevantes para el cuerpo humano. Pudimos analizar la forma corporal y la condición fisiológica en la constitución del cuerpo humano. Métodos: Conducimos una investigación sobre la salud y nutrición física del cuerpo humano a través de métodos como pruebas físicas, medidas antropométricas, estudios sobre dietas y exámenes laboratoriales del cuerpo humano. El análisis de la correlación entre deportes y la medicina del condicionamiento del cuerpo humano tuvo resultados positivos en este estudio. Resultados: El programa de kinesiología del deporte tiene efectos visibles en mejorar y primorear la forma del cuerpo humano, sus funciones fisiológicas y la preparación física. Conclusión: El programa de kinesiología del deporte tiene un efecto significativo en mejorar la preparación física del cuerpo humano. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

As tutelas de urgência com pedidos de saúde em sede de plantão judiciário noturno / The emergency relief with health requests in the night court

RESUMO Este ensaio aborda o tratamento dado pelo judiciário fluminense às demandas de saúde que ingressaram, em sede de plantão judicial noturno, nos meses de janeiro e julho, do ano de 2017, considerando que a judicialização da saúde se trata de um fenômeno que tem aumentado estatisticamente e que o plantão judiciário se tronou uma porta de acesso facilitado aos que buscam tutelas de urgência. No âmbito processual civil, abordam-se os prazos e as multas impostas, bem como os pedidos requeridos. Em especial, analisam-se as tutelas de urgência, trazendo informações sobre a tutela antecipada em caráter antecedente, assim como a necessidade de fundamentação precisa por parte do magistrado e o papel da autonomia mé-dica. A metodologia utilizada foi hipotético-dedutiva, em análise qualitativa, por meio da re-visão doutrinária, jurisprudencial e legislativa. Os resultados evidenciam índices elevados de judicialização em questões de saúde pública e privada.

ABSTRACT This essay addresses the treatment given by the Rio de Janeiro Judiciary to the health demands that were filed at the judicial nocturnal duty, in January and July, 2017, con-sidering that the judicialization of health is a phenomenon that has increased statistically, and that the judicial duty has become a way of easy access for those seeking emergency relief. In civil procedural matters, the deadlines and fines imposed, as well as the requests requested are addressed. In particular, we analyze the urgency decisions, bringing information about the anticipated protection in advance, as well as the need for precise justification on the part of the magistrates and the role of medical autonomy. The methodology used was hypothetical-deductive, in qualitative analysis, through doctrinal, jurisprudential and legislative review. The results show high levels of judicialization in public and private health demands.

Funcionamento 24 horas para Unidades de Saúde da Família: uma solução para ampliação de acesso? Um ensaio sobre as "Upinhas" do Recife / 24-hour operation for Family Health Units: a solution for access expansion? An essay on the "Upinhas" of Recife / Funcionamiento 24 horas para las Unidades de Salud de la Familia: ¿Una solución para la ampliación del acceso? Un ensayo sobre las "Upinhas" de Recife

A Atenção Primária à Saúde é via preferencial de acesso ao sistema de saúde, tendo em vista seu papel ordenador, os benefícios da continuidade do cuidado e resolutividade deste nível de atenção. Diversas barreiras de acesso, dentre eles o horário restrito de funcionamento, fazem com que esse primeiro contato não seja facilitado. No Recife, novos equipamentos de Atenção Primária à Saúde vêm sendo implantados desde o ano de 2013: as "Upinhas 24 horas". O objetivo deste trabalho é analisar o modelo "Upinha" apresentado como uma solução para ampliação de acesso. Foi realizada uma revisão da literatura sobre diversas estratégias existentes de ampliação do acesso, a partir das quais se analisou criticamente o modelo "Upinha 24 horas" às lentes dos modelos vigentes. Horário estendido, acesso avançado e acolhimento à demanda espontânea foram os modelos de ampliação de acesso revisados para embasar a discussão. O impacto do horário estendido na ampliação do acesso pode ser minimizado se outras medidas, como mudanças no modelo de agendamento, priorizando o acesso avançado, não forem concomitantemente implantadas. O modelo "Upinha 24 horas", da forma como se apresenta, parece ser baseado na concepção de uma Atenção Primária à Saúde que funciona como complemento para "desafogar" os serviços de atendimento às urgências já existentes e não como ordenadora do serviço de atenção às urgências. Apesar de apontar numa direção inicialmente acertada, a implantação das "Upinhas 24 horas" parece ainda ser uma proposta incipiente na garantia de acesso.

Primary Health Care is a preferential route of access to the health system, considering its ordering role, the benefits of continuity of care and the effectiveness of this level of care. Several access barriers, including restricted hours of operation, make this first contact difficult. In Recife, new equipment for Primary Health Care has been implemented since 2013: the "Upinhas 24 horas". The objective of this essay is to analyze the "Upinha" model presented as a solution to increase access. A review of the literature on several existing strategies of access expansion was carried out, from which the "Upinha 24 horas" model was analyzed critically through the lenses of the current models. Extended hours, advanced access and welcoming of the spontaneous demand were the models of access expansion revised to support the discussion. The impact of extended hours on increased access can be minimized if other measures, such as changes to the scheduling model prioritizing advanced access, are not implemented concurrently. The "Upinha 24 horas" model, as presented, seems to be based on the conception of a Primary Health Care system that works as a complement to "unload" the services of attendance to emergency services and not as ordering of the system emergency attention. Despite pointing in an initially correct direction, the implementation of the "Upinhas 24 horas" still seems to be an incipient proposal in the guarantee of access.

La Atención Primaria es la vía preferencial de acceso al sistema de salud, teniendo en cuenta su papel ordenador, los beneficios de la continuidad del cuidado y resolución de este nivel de atención. Diversas barreras en el acceso, dentro de ellas, el horario restringido de funcionamiento, hacen que ese primer contacto sea difícil. En Recife, nuevos equipos de Atención Primaria vienen siendo implementados desde el año 2013: las "Upinhas 24 horas". El objetivo de este trabajo es analizar el modelo "Upinha" presentado como una solución que amplía el acceso. Fue realizada una revisión de la literatura sobre diversas estrategias existentes de ampliación del acceso, a partir de las cuales se analizó críticamente el modelo "Upinha 24 horas" a la vista de los modelos vigentes. Horario extendido, acceso avanzado y acogimiento de la demanda espontanea, fueron los modelos de ampliación del acceso revisados para sustentar la discusión. El impacto del horario extendido en cuanto a la ampliación del acceso puede ser minimizado si otras medidas, como cambios en el modelo de turnos priorizando el acceso avanzado, no fueran concomitantemente implementadas. El modelo "Upinha 24 horas" de la forma que se presenta, parece basado en la concepción de una Atención Primaria que funciona como complemento para "desahogar" los servicios de atención de urgencias. A pesar de apuntar en una dirección inicialmente correcta, la implementación de las "Upinhas 24 horas" parece ser todavía una propuesta incipiente en la garantía del acceso.

Use of the complete Rockall score and the Forrest classification to assess outcome in patients with non-variceal upper gastrointestinal bleeding subject to after-hours endoscopy: a retrospective cohort study / El uso de la puntuación de Rockall completa y la clasificación de Forrest para evaluar resultados en pacientes con hemorragia gastrointestinal alta no varicosa sometidos a endoscopía de urgencia: un estudio de cohorte retrospectivo

OBJECTIVES: To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission. METHODS: The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For 'high risk' situations (Forrest stage Ia-IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay > 3 days). RESULTS: During the study period (75 months), 86 cases (85 patients) met the inclusion criteria. Patients' age was 66.36 ± 14.38 years; 60.5% were male. Mean duration of hospital stay was 15.21 ± 19.24 days. Mortality rate was 16.7% (30 days) and 32.9% (one year); 14% of patients re-bled. Univariate analysis of post-endoscopic Rockall score > 2 showed an odds ratio of 6.09 for death within 30 days (p = 0.04). No other significant correlations were found. CONCLUSION: In patients with UGI-B subject to after-hours endoscopy, a 'high-risk'Rockall score permits an estimation of the risk of death within 30 days but not of re-bleeding. A 'high-risk'Forrest score is not significantly associated with the study endpoints.

OBJETIVOS: Evaluar la utilidad de la clasificación de Forrest y la puntuación de Rockall completa con los valores límites habituales a fin de evaluar el riesgo de eventos adversos en los pacientes con hemorragia gastrointestinal alta (HGIA) sometidos a una esofagogastroduodenoscopia (EGD) de urgencia dentro de seis horas después del ingreso. MÉTODOS: Se analizaron las historias clínicas de pacientes con HGIA de origen no varicoso comprobada por endoscopia de urgencia. Para las situaciones de 'alto riesgo' (etapa Forrest Ia- IIb/puntuación de Rockall completa >2), se realizó un análisis univariado para evaluar las probabilidades de riesgo (oddsratio) y llegar a los criterios de valoración del estudio (mortalidad de 30 días y un año, resangrado, estancia hospitalaria > 3 días). RESULTADOS: Durante el periodo de estudio (75 meses), 86 casos (85 pacientes) cumplieron los criterios de inclusión. La edad de los pacientes fue de 66.36 ± 14.38 años; 60.5% eran varones. La duración promedio de estancia hospitalaria fue de 15.21 ± 19.24 días. La tasa de mortalidad fue de 16.7% (30 días) y 32.9% (1 año); el 14% de los pacientes volvió a tener sangramiento. El análisis univariado de la puntuación Rockall postendoscópica > 2 mostró un odds-ratio de 6.09 por muerte en 30 días (p = 0.04). No se encontraron otras correlaciones significativas. CONCLUSIÓN: En pacientes con HGIA sometidos a endoscopía de urgencia, una puntuación Rockall de 'alto riesgo'permite una estimación del riesgo de muerte dentro de 30 días, pero no de resangrado. Una puntuación Forrest de 'alto riesgo' no es significativa con respecto a los criterios de valoración del estudio.

O trabalho do médico recém-formado em serviços de urgência / The work of recently graduated physicians in emergency services

JUSTIFICATIVA E OBJETIVO: A superlotação dos serviços de urgência, causada por vários fatores, associada ao fato de o médico que lá está ser, muitas vezes, um inexperiente recém-formado, transforma essa área numa das mais problemáticas do sistema de saúde brasileiro. Este estudo teve por objetivo quantificar e avaliar a inserção do médico recém-formado nos serviços de urgência em uma parcela de formandos em 2011 de uma escola privada. MÉTODOS: Foi utilizado um questionário estruturado e perguntado ao egresso se ele estava ou não cursando residência médica, se estava trabalhando em serviço de urgência (não vinculado à residência médica cursada), especificando-o (unidades de pronto atendimento, de emergência ou pré-hospitalar móvel), e se era público ou privado. RESULTADOS: Da turma de 101 ex-alunos, 50 responderam ao questionário. Destes, 31 (62,0%) estavam cursando residência médica e 19 (38,0%) não estavam. Trabalhavam em serviços de urgência 20 (64,5%) estudantes do primeiro grupo e 12 (63,2%) do segundo. Prevaleceu a empregabilidade no setor privado. Não houve diferença significante se o egresso estava cursando ou não residência médica. CONCLUSÃO: O trabalho em serviços de urgência mostrou ser opção relevante para os egressos, independentemente da residência médica. Isso reforça a importância do ensino/aprendizagem de urgências durante a graduação e aponta para a possível sobrecarga de trabalho durante a residência médica...

BACKGROUND AND OBJECTIVE: Emergency services overcrowding, due to a variety of factors, associated with the fact that the physician in charge may often be an inexperienced recently graduated person, has turned this sector into one of the most problematic in Brazilian health system. This study aimed at quantifying and assessing the insertion of recently graduated physicians from a group of graduated students of year 2011 of a private institution in emergency services. METHODS: A structured questionnaire was used; graduates were asked whether they were attending medical residency, and to specify the type of emergency service (not connected to the medical residency attended) they were working at, if any (first care units, emergency units or mobile pre-hospital units), and whether public or private. RESULTS: Out of 101 former students, 50 answered the questionnaire. Out of these, 31 (62.0%) were attending medical residency and 19 (38.0%) were not. Twenty in the former group (64.5%) and 12 in the latter group have been working at emergency units. Jobs in the private sector prevailed. No significant difference was seen between graduates attending/not attending residency. CONCLUSION: Jobs at emergency services have proven to be a relevant option for graduates, regardless of the medical residency. This reinforces the importance of the teaching/learning of emergencies during graduation course and shows possible work overload during medical residency...