Rural and Urban patients' Requirements and Experiences of Out-of-hours medical care after cancer (RUREO): a questionnaire study.

OBJECTIVE: To investigate how individuals diagnosed with cancer use out-of-hours (OOH) medical services, describe the behavioural determinants of OOH service use and explore whether there are differences between urban and rural dwellers. DESIGN AND SETTING: A cross-sectional questionnaire study conducted in Northeast Scotland. PARTICIPANTS: The questionnaire was sent to 2549 individuals diagnosed with cancer in the preceding 12 months identified through the National Health Service Grampian Cancer Care Pathway database. 490 individuals returned the questionnaire (19.2% response rate), 61.8% were urban and 34.9% were rural. OUTCOMES: Outcomes were differences in frequency of medical service use and attitudes towards OOH services between urban and rural participants. Patient experience (qualitative data) was compared. RESULTS: Daytime services were used much more frequently than OOH services-83.3% of participants had never contacted an OOH primary care service in the preceding 12 months but 44.2% had used their daytime general practitioner at least four times. There were no significant differences between urban and rural dwellers in the patterns of OOH or daytime service use, the behavioural determinants of service use or the experiences of OOH services. Rural dwellers were significantly less likely to agree that OOH services were close by and more likely to agree that where they lived made it difficult to access these services. Rural dwellers were no more likely to agree or disagree that distance would affect their decision to contact OOH services. Qualitative results highlighted barriers to accessing OOH services exist for all patients but that long travel distances can be offset by service configuration, travel infrastructure and access to a car. CONCLUSIONS: Urban and rural dwellers have similar beliefs, attitudes towards and patterns of OOH service use. In Northeast Scotland, place of residence is unlikely to be the most important factor in influencing decisions about whether to access OOH medical care.

How is community based 'out-of-hours' care provided to patients with advanced illness near the end of life: A systematic review of care provision.

BACKGROUND: Deaths in the community are increasing. However, community palliative care out-of-hours is variable. We lack detailed understanding of how care is provided out-of-hours and the associated outcomes. AIM: To review systematically the components, outcomes and economic evaluation of community-based 'out-of-hours' care for patients near the end of life and their families. DESIGN: Mixed method systematic narrative review. Narrative synthesis, development and application of a typology to categorise out-of-hours provision. Qualitative data were synthesised thematically and integrated at the level of interpretation and reporting. DATA SOURCES: Systematic review searching; MEDLINE, EMBASE, PsycINFO, CINAHL from January 1990 to 1st August 2022. RESULTS: About 64 publications from 54 studies were synthesised (from 9259 retrieved). Two main themes were identified: (1) importance of being known to a service and (2) high-quality coordination of care. A typology of out-of-hours service provision was constructed using three overarching dimensions (service times, focus of team delivering the care and type of care delivered) resulting in 15 categories of care. Only nine papers were randomised control trials or controlled cohorts reporting outcomes. Evidence on effectiveness was apparent for providing 24/7 specialist palliative care with both hands-on clinical care and advisory care. Only nine publications reported economic evaluation. CONCLUSIONS: The typological framework allows models of out-of-hours care to be systematically defined and compared. We highlight the models of out-of-hours care which are linked with improvement of patient outcomes. There is a need for effectiveness and cost effectiveness studies which define and categorise out-of-hours care to allow thorough evaluation of services.

Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services.

OBJECTIVES: This study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services. METHODS: Cross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020. Prescriptions were assessed based on the national guidelines. RESULTS: Considering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-of-hours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern. CONCLUSION: Substantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.

A clínica psicanalítica das urgências subjetivas no hospital universitário: construção de um caso clínico / Psychoanalysis of subjective urgencies at a university hospital: construing a clinical case / La clínica psicoanalítica de urgencias subjetivas en el hospital universitario: construcción de un caso clínico

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)

Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)

El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)

Saúde mental na universidade: atendimento psicológico online na pandemia da covid-19 / Mental health at the university: online psychological care during the covid-19 pandemic / Salud mental en la universidad: atención psicológica en línea en la pandemia de covid-19

Com a pandemia da covid-19, o contexto universitário, que já vinha sendo palco de discussões em relação à saúde mental, tem vivenciado crises mais severas pelos estudantes. Diante deste cenário, foi desenvolvido o projeto Escuta Solidária, voltado à saúde mental dos discentes de graduação e de pós-graduação. Neste artigo, temos como objetivo discutir o atendimento psicológico online com estudantes do curso de psicologia durante o período de isolamento social rígido (maio a junho de 2020). Fizemos, com os psicólogos voluntários, um grupo focal direcionado para a experiência de atendimento psicológico online de curta duração no contexto pandêmico. Trata-se de um estudo qualitativo, realizado com os 11 psicólogos clínicos participantes do referido projeto. A partir de uma análise fenomenológica crítica, os resultados foram divididos em cinco categorias: a) limitações e contribuições do projeto; b) a importância da capacitação e supervisão clínica para a qualidade do projeto; c) atendimento psicológico online; d) ser psicólogo clínico durante a crise da covid-19; e e) demandas emergentes nos atendimentos psicológicos na quarentena. Por fim, discutimos a importância da desmistificação do atendimento psicológico em situações de crise, especialmente na modalidade online, fomentando questionamentos à formação e atuação dos profissionais, no sentido de estarmos atentos às demandas psicológicas que o contexto de crise acarreta na sociedade.(AU)

With the COVID-19 pandemic, the university context, which had already been the stage for discussions regarding mental health, has experienced more severe crises by students. In view of this scenario, the Solidarity Listening project was developed, aimed at the mental health of undergraduate and graduate students. In this article, we aim to discuss online psychological care with psychology students during the period of strict social isolation (May to June 2020). We carried out, with volunteer psychologists, a focus group aimed at the experience of short-termonline psychological care in the pandemic context. This is a qualitative study, carried out with 11 clinical psychologists participating in the aforementioned project. From a critical phenomenological analysis, the results were divided into five categories: a) limitations and contributions of the project; b) the importance of training and clinical supervision for the quality of the project; c) online psychological care; d) being a clinical psychologist during the COVID-19 crisis; and e) emerging demands in psychological care in quarantine. Finally, we discuss the importance of demystifying psychological care in crisis situations, especially in the online modality, promoting questions regarding the training and performance of professionals, to be aware of the psychological demands that the context of crisis entails in society.(AU)

La pandemia del covid-19 provocó que las universidades, que ya habían sido escenario de discusiones sobre la salud mental, experimentaran crisis más severas entre los estudiantes. Ante este escenario, se desarrolló el proyecto Escucha Solidaria, dirigido a la salud mental de estudiantes de grado y posgrado. Este artículo pretende discutir la atención psicológica en línea con estudiantes de Psicología durante el período de aislamiento social más estricto (mayo/junio de 2020). Se conformó un grupo focal con los psicólogos voluntarios orientado a la práctica de la atención psicológica en línea, a corto plazo, en el contexto de una pandemia. Se trata de un estudio cualitativo, realizado con 11 psicólogos clínicos que participaron en el mencionado proyecto. A partir del análisis fenomenológico crítico, los resultados se dividieron en cinco categorías: a) limitaciones y aportes del proyecto; b) importancia de la capacitación y la supervisión clínica para la calidad del proyecto; c) atención psicológica en línea; d) ser psicólogo clínico durante la crisis del covid-19; y e) demandas emergentes en atención psicológica en la cuarentena. Se concluye que es importante desmitificar la atención psicológica en situaciones de crisis, especialmente en la modalidad en línea, al promover principalmente preguntas sobre la formación y el desempeño de los profesionales con el fin de ser conscientes de las demandas psicológicas que el contexto de crisis conlleva la sociedad.(AU)

Serviço-escola de psicologia da Unifesp: campos de estágio, ações e especificidades / UNIFESP's psychology service-school: internship field, actions, and specificities / Serviço-escola de psicologia de la Unifesp: campos de prácticas profesionales, acciones y especificidades

O Serviço-Escola de Psicologia (SEP) da Unifesp foi constituído com o intuito de transcender o tradicional funcionamento das clínicas-escola, superando a atomização da Psicologia em áreas e oferecendo serviços integrados à rede. Isso possibilita uma formação interdisciplinar, pluralista, generalista, não tecnicista, crítica, permitindo a compreensão e atuação do psicólogo em diversos contextos socioculturais. O objetivo do artigo é descrever, avaliar e problematizar as ações do SEP da Unifesp, em relação à oferta de campos de estágio e ações desenvolvidas neles. É um estudo transversal, baseado em metodologia predominantemente quantitativa e descritiva. O levantamento de dados foi realizado por meio de dois questionários online respondidos por todos os supervisores. Os dados quantitativos foram submetidos à análise estatística descritiva. Os resultados evidenciaram maior incidência das ações no município de Santos e, em menor grau, em outros municípios da Baixada Santista e na cidade de São Paulo. A maioria das atividades de estágios não se limita ao espaço físico de atendimento clínico do Serviço-Escola, ocorrendo junto às instituições públicas ou às instituições ligadas ao terceiro setor na região, relacionadas, direta ou indiretamente, com a promoção de políticas públicas. A pluralidade de recursos utilizados (grupos, atendimento individual, acompanhamento terapêutico, oficinas, matriciamento, entre outros) revela uma ampliação do repertório de competências e habilidades. A variedade de oferta de projetos e campos de estágio, públicos-alvo atendidos, assim como a diversidade e flexibilidade de ações e estratégias desenvolvidas, apontam um movimento de congruência em relação às diretrizes curriculares nacionais e ao inovador Projeto Pedagógico do curso.(AU)

UNIFESP's Psychology Service-School (SEP) was founded with the objective of going beyond the traditional functioning of school-clinics, overcoming the atomization of Psychology in areas and offering services integrated to the network. This enables an interdisciplinary, pluralist, generalist, non-technicist, and critical training, allowing psychologists' understanding and action in different sociocultural contexts. This article aims to describe, evaluate, and discuss the actions of UNIFESP's SEP regarding the offer of internship fields and the actions developed in those fields. It is a cross-sectional study, based on a predominantly descriptive and quantitative methodology. The data was surveyed with two online questionnaires answered by all supervisors. Quantitative data were submitted to descriptive statistical analysis. The results showed a higher incidence of actions in the municipality of Santos and, to a lesser extent, in other municipalities of the Baixada Santista and in the city of São Paulo. Most internship activities are not limited to the physical space of the service-school's clinical care and take place alongside public institutions or institutions linked to the third sector in the area, directly or indirectly related to the promotion of public policies. The plurality of resources (groups, personal care, therapeutic monitoring, workshops, matrix support, among others) reveals an expansion of competences and skills repertoire. The variety of projects and internship fields offers, of target audiences served, as well as the diversity and flexibility of the developed actions and strategies point to a congruence movement relating to national curricular guidelines and to the innovative pedagogical project of the course.(AU)

El Serviço-Escola de Psicologia (SEP) de la Unifesp (Universidade Federal de São Paulo, Brasil) buscó trascender el funcionamiento tradicional de las clínicas universitarias, superar la atomización de la Psicología en áreas y ofrecer servicios integrados a la red. Esto permite una formación interdisciplinar, pluralista, generalista, sin tecnicismos, crítica, lo que posibilita a los/las psicólogos/as comprender y actuar en diferentes contextos socioculturales. Este artículo pretendió describir, evaluar y problematizar las acciones del SEP Unifesp respecto a la oferta de campos de prácticas profesionales y acciones desarrolladas. Es un estudio transversal, con metodología predominantemente cuantitativa y descriptiva. Los datos se recolectaron de dos cuestionarios en línea respondidos por los/las supervisores/as. Se les aplicaron un análisis estadístico descriptivo. Hubo más acciones en la ciudad de Santos (Brasil) que en otros municipios de la región metropolitana de la Baixada Santista y en la ciudad de São Paulo. La mayoría de las prácticas profesionales no se limita a la atención clínica del SEP, ocurriendo en instituciones públicas o vinculadas al tercer sector en la región, directa o indirectamente, relacionadas con la promoción de políticas públicas. La pluralidad de recursos (grupos, atención individual, acompañamiento terapéutico, talleres, soporte matricial, entre otros) revela un amplio repertorio de competencias y habilidades. La variada oferta de proyectos y campos para prácticas profesionales, los públicos destinatarios atendidos, así como la diversidad y flexibilidad de acciones y estrategias desarrolladas apuntan a una congruencia respecto a los lineamientos curriculares nacionales y al innovador proyecto pedagógico del curso.(AU)

Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design.

BACKGROUND: Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. AIM: To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. DESIGN: A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. SETTING: Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. RESULTS: People who died in Scotland in 2016 (n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. CONCLUSION: Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.

Policy of free GP care for children under 6 years: The impact on daytime and out-of-hours general practice.

Ireland does not yet have a comprehensive system of universal access to primary care. In 2015, access to general practitioner (GP) care at no charge was introduced for the 70% of children aged under six who previously paid out-of-pocket fees. This study uses data from 16 practices and a regional out-of-hours (OOH) GP service to assess the impact of this policy on attendance. A difference-in-difference (DiD) analysis was applied to visit records of paediatric patients over a period of five years, two years of which were pre-policy, with treatment and control differentiated by age. Attendance at daytime GP by children aged under-six increased by 20%-21% in the three years following the introduction of the policy, largely explained by an increase in the number of patients attending (17.4%-18.6%). Of children aged under-six attending pre-policy, 14.9%-15.8% had >6 visits annually, increasing to 18.5%-20.3% post-policy. OOH GP attendance also increased by 20.5%-29.4% over the same period. Findings are consistent with international literature on the provision of financially accessible healthcare. Prior unmet need, the provision of additional assessments to children aged under six, parental response to a service at no charge, and rerouting of access to the ED through GP, are all possible contributors to this increased demand. A more integrated policy of boosting supply as well as demand is desirable, particularly in the context of future expansion plans, to ensure the health benefits anticipated from the introduction of this policy have every opportunity to be realised.

NHS 111 Clinical Assessment Services: paediatric consultations.

Around the UK, commissioners have different models for delivering NHS 111, General Practice (GP) out-of-hours and urgent care services, focusing on telephony to help deliver urgent and emergency care. During the (early phases of the) COVID-19 pandemic, NHS 111 experienced an unprecedented volume of calls. At any time, 25%-30% of calls relate to children and young people (CYP). In response, the CYP's Transformation and Integrated Urgent Care teams at NHS England and NHS Improvement (NHSE/I) assisted in redeploying volunteer paediatricians into the integrated urgent care NHS 111 Clinical Assessment Services (CAS), taking calls about CYP. From this work, key stakeholders developed a paediatric 111 consultation framework, as well as learning outcomes, key capabilities and illustrations mapped against the Royal College of Paediatrics and Child Health (RCPCH) Progress curriculum domains, to aid paediatricians in training to undertake NHS 111 activities. These learning outcomes and key capabilities have been endorsed by the RCPCH Curriculum Review Group and are recommended to form part of the integrated urgent care service specification and workforce blueprint to improve outcomes for CYP.

Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability.

PURPOSE: Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. METHODS: Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. RESULTS: During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. CONCLUSIONS: Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.

Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study.

BACKGROUND: Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS: We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS: We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION: Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.

Investigating the "Weekend Effect" on Outcomes of Patients Undergoing Endovascular Mechanical Thrombectomy for Ischemic Stroke.

OBJECTIVES: With growing evidence of its efficacy for patients with large-vessel occlusion (LVO) ischemic stroke, the use of endovascular thrombectomy (EVT) has increased. The "weekend effect," whereby patients presenting during weekends/off hours have worse clinical outcomes than those presenting during normal working hours, is a critical area of study in acute ischemic stroke (AIS). Our objective was to evaluate whether a "weekend effect" exists in patients undergoing EVT. METHODS: This retrospective, cross-sectional analysis of the 2016-2018 Nationwide Inpatient Sample data included patients ≥18 years with documented diagnosis of ischemic stroke (ICD-10 codes I63, I64, and H34.1), procedural code for EVT, and National Institutes of Health Stroke Scale (NIHSS) score; the exposure variable was weekend vs. weekday treatment. The primary outcome was in-hospital death; secondary outcomes were favorable discharge, extended hospital stay (LOS), and cost. Logistic regression models were constructed to determine predictors for outcomes. RESULTS: We identified 6052 AIS patients who received EVT (mean age 68.7±14.8 years; 50.8% female; 70.8% White; median (IQR) admission NIHSS 16 (10-21). The primary outcome of in-hospital death occurred in 560 (11.1%); the secondary outcome of favorable discharge occurred in 1039 (20.6%). The mean LOS was 7.8±8.6 days. There were no significant differences in the outcomes or cost based on admission timing. In the mixed-effects models, we found no effect of weekend vs. weekday admission on in-hospital death, favorable discharge, or extended LOS. CONCLUSION: These results demonstrate that the "weekend effect" does not impact outcomes or cost for patients who undergo EVT for LVO.

Possible associations between callers' degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study.

BACKGROUND: Telephone triage within out-of-hours (OOH) services aims to ascertain the urgency of a caller's medical condition in order to determine the correct type of health care needed, ensuring patient safety. To improve the triage process by increasing patient-centred communication, a triage tool has been developed, whereby callers are asked to rate their degree-of-worry (DOW) as a measure of self-evaluated urgency. Studies show that low socioeconomic status (SES), being single and non-Western ethnicity are associated to low self-rated health and high morbidity and these factors may also be associated with high DOW. The aim of this paper was to examine if low SES, being single and non-Western ethnicity were associated to high DOW of callers contacting OOH services. METHODS: A prospective cohort study design, at the OOH services for the Capital Region of Denmark. Over 2 weeks, 6869 of 38,787 callers met the inclusion criteria: ≥18 years, patients themselves or close relative/friend, reported DOW, had a valid personal identification number and gave informed consent. Callers were asked to report their DOW (1 = minimal worry to 5 = maximal worry), which was dichotomized into low (1-3) and high (4, 5) DOW and linked to data from electronical medical records and Statistics Denmark. Socioeconomic factors (education and annual household income), marital status and ethnicity were assessed in relation to DOW by logistic regression. RESULTS: High DOW was reported by 38.2% of the participants. Low SES (low educational level; OR 1.5, 95% CI 1.3-1.7 and low annual household income; 1.5, 1.3-1.6) was associated with high DOW and so too was being single; 1.2, 1.1-1.3 and of non-Western ethnicity; 2.9, 2.5-3.4. CONCLUSIONS: Knowledge of the association of low SES, marital status as single and non-Western ethnicity with high DOW among callers to OOH services may give call handlers a better understanding of callers' DOW. If this does not correspond to the call handler's perception of urgency, this knowledge may further encourage patient-centred communication, aid the triage process and increase patient safety. A better understanding of socioeconomic variables and their relation to callers' DOW gives direction for future research to improve telephone triage of OOH services.

What is the demand for out-of-hours dermatology? A UK-based region-wide survey of dermatology demand and provision during the evenings and at weekends.

BACKGROUND: Little is known about the demand for out-of-hours (OOH) dermatology in the UK, and this can make commissioning of acute services difficult. The East Midlands region has a population of 4.5 million people, with variable access to OOH dermatology services. AIM: We sought to investigate the provision of, and demand for, OOH dermatology services across the region with a view to informing commissioning decisions for the future. METHODS: We contacted all dermatology departments in the East Midlands region to establish what level of service was commissioned at evenings and weekends. At the sites providing any form of OOH service, we recorded all requests for advice received after 17.00 h on weekdays, or at any time during weekends and bank holidays over a 3-month period from October to December 2019. RESULTS: The OOH services provided ranged from 24 h/day cover 7 days/week at one site, to no formal provision across much of the rest of the region. In total, 125 calls were received during the study period, averaging 1 call per day on weekday evenings, and 2 calls per day at weekends and on bank holidays. Of these 125 calls, 11 patients (9%) were prioritized and seen by the on-call dermatologist on the day of referral, and 9 of these had potentially life-threatening skin conditions. A further 39 (31%) were deemed to need review within 24 h and 22 (18%) within 48 h. The remaining 42% were given appointments within 7 days or dealt with by telephone advice. CONCLUSION: The demand for OOH dermatology across the East Midlands is low, but access to timely dermatology advice is essential in some situations. Commissioning of a regional dermatology OOH service incorporating digital technology may help to improve the equity of access for all patients across the region.

Emergency department use following incentives to provide after-hours primary care: a retrospective cohort study.

BACKGROUND: Access to primary care outside of regular working hours is limited in many countries. This study investigates the relation between the after-hours premium, an incentive for primary care physicians to provide services after hours, and less-urgent visits to the emergency department in Ontario, Canada. METHODS: We analyzed a retrospective cohort of a random sample of Ontario residents from April 2002 to March 2006, and a subcohort of patients followed from April 2005 to March 2016. We linked patient and primary care physician data with emergency department visit data. We used fixed-effects regression models to analyze the association between the introduction of the after-hours premium, as well as subsequent increases in the value of the premium, and the number of monthly emergency department visits. RESULTS: The sample consisted of 586 534 patients between 2002 and 2006, and 201 594 patients from 2005 to 2016. After controlling for patient and physician characteristics, seasonality and time-invariant patient confounding factors, introduction of the after-hours premium was associated with a reduction of 1.26 less-urgent visits to the emergency department per 1000 patients per month (95% confidence interval -1.48 to -1.04). Most of this reduction was observed in after-hours visits. Sensitivity analysis showed that the monthly reduction in less-urgent visits to the emergency department was in the range of -1.24 to -1.16 per 1000 patients. Subsequent increases in the after-hours premium were associated with a small reduction in less-urgent visits to the emergency department. INTERPRETATION: Ontario's experience suggests that incentivizing physicians to improve access to after-hours primary care reduces some less-urgent visits to the emergency department. Other jurisdictions may consider incentives to limit less-urgent visits to the emergency department.

Socioeconomic inequality in telephone triage on triage response, hospitalization and 30-day mortality.

We investigated socioeconomic inequality (measured by the indicators highest attained education level and household income) in telephone triage on triage response (face-to-face contact), hospitalization and 30-day mortality among Danish citizens calling the medical helpline 1813 between 23 January and 9 February 2017. The analysis included 6869 adult callers from a larger prospective cohort study and showed that callers with low socioeconomic status (SES) were less often triaged to a face-to-face contact and had higher 30-day mortality than callers with high SES.

After-hours emergency department care: Does time or day of arrival affect survival?

OBJECTIVE: To determine whether after-hours presentation to EDs is associated with differences in 7-day and 30-day mortality. The influence of patient case-mix and workforce staffing differences are also explored. METHODS: We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013-September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after-hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. RESULTS: Weekend presentation was slightly more associated (7-day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01-1.10) or no more associated (30-day mortality odds ratio 1.01, 95% CI 0.98-1.03) with death than weekday presentation. When weeknights are included in the 'after-hours' period, odds ratios are smaller, so that after-hours presentation is no more associated (7-day mortality odds ratio 1.03, 95% CI 0.99-1.08) or less associated (30-day mortality odds ratio 0.95, 95% CI 0.93-0.97) with death. No significant after-hours patient case-mix differences were observed between weekday and weekend presentations for 7-day mortality. In other combinations of outcome and after-hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after-hours differences in ED mortality. CONCLUSIONS: After-hours presentation on the weekend to an ED is associated with higher 7-day mortality even after controlling for case-mix.

Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective.

PURPOSE: The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. METHODS: An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. RESULTS: Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). CONCLUSION: The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.

Escuta clínica, triagem e plantão psicológico em um serviço-escola Pernambucano / Clinical listening, screening and psychological support on a school clinic in Pernambuco / Escucha clínica en clasificación y turno psicológico en un servicio escuela Pernambucano

Resumo Esta pesquisa teve como objetivo geral compreender experiências de escuta clínica nas modalidades de triagem e plantão psicológico entre estudantes lotados em um serviço-escola de Pernambuco. Os objetivos específicos foram descrever sentidos dessas experiências, investigar como eles percebiam a formação recebida para ofertarem esses serviços, como também identificar dificuldades enfrentadas nos processos e estratégias utilizadas para dirimi-las. Utilizou-se o método da hermenêutica colaborativa, e 18 colaboradores, subdivididos em quatro grupos de discussão, responderam a uma entrevista aberta com pergunta disparadora. Os resultados foram analisados em uma perspectiva fenomenológica, revelando que os estudantes enfrentavam dificuldades como desarticulação entre teoria e prática, manejo do tempo, angústia e insegurança inicial, além de falta de suporte estrutural recebido pelo serviço-escola para ofertar tais serviços. No entanto era possível a eles desenvolver a escuta, deixando-a fluir na condução dos processos em direção às demandas dos clientes. Diante de estratégias como capacitação ofertada pelo serviço-escola, suporte emocional recebido pelas equipes de supervisão e seus próprios processos pessoais, conseguiam enfrentar as dificuldades encontradas durante a formação, sentindo-se, apesar de tudo, valorizados e reconhecidos pelo serviço prestado. Concluiu-se, principalmente, a importância de inserir estudantes em serviços-escola em práticas anteriormente ao estágio obrigatório e em diversas modalidades de porta de entrada, desde que tais estratégias estejam integradas ao projeto pedagógico do curso, cabendo à instituição oferecer uma formação que, efetivamente, articule teoria e prática nas experiências cotidianas do estudante no processo de vivenciar e aprimorar sua escuta clínica ao tornar-se psicólogo.(AU)

Abstract This research aims to understand experiences of clinical listening in the modalities of screening and psychological support among students at a school clinic in the state of Pernambuco, Brazil. With that, the study sought to describe the feelings arising from these experiences, investigating how students perceived the adequacy of the academic education to offer these services and identifying hardships faced in the processes, as well as strategies adopted for solving them. Using the collaborative hermeneutics method, 18 collaborators were subdivided into four discussion groups and submitted to an open interview with a triggering question. The results wereanalyzedin a phenomenologicalperspective, revealing that students experienced difficulties regarding disarticulation between theory and practice, time management, anguish, insecurity, and lack of structural support received from the school to offer such services. Despite these factors, the students managed to develop clinical listening skills, letting it flow according to patients' demands. The training offered by the school service, the emotional support received by supervisory teams, and their own personal processes enabled students to face the problems encountered during their formation, feeling valued and recognized for the service provided. The results denote the importance of promoting practices of clinical listening among students at school clinics before they attend the mandatory internship, provided that such strategies are integrated to the pedagogical project. Thus, the institution must offer a formation that effectively integrate theory and practice, improving students' process of clinical listening.(AU)

Resumen Esta investigación tuvo como objetivo general comprender experiencias de escucha clínica en las modalidades de clasificación y turno psicológico entre estudiantes de un servicio escolar en Pernambuco. Los objetivos específicos fueron desde exponer el sentido de estas experiencias, investigar cómo percibían la formación para ofrecer esos servicios, así como identificar las dificultades encontradas y estrategias para solucionarlas. Utilizándose el método de la hermenéutica colaborativa y 18 colaboradores, subdivididos en cuatro grupos de discusión, contestaron a una entrevista abierta con una pregunta desencadenante. Se analizaron los resultados de una perspectiva fenomenológica, revelando que enfrentaron dificultades como desarticulación entre teoría y práctica, manejo del tiempo, angustia e inseguridad inicial, además de la falta de soporte estructural recibido por la escuela. Sin embargo, les fue posible desarrollar la escucha, dejándola fluir en los procesos clínicos según la demanda del cliente. Se utilizó estrategias como capacitación ofrecida por la escuela, soporte emocional por la supervisión y sus procesos personales propios, lograron enfrentar las dificultades encontradas durante la formación; sintiéndose, a pesar de todo, valorados y reconocidos por el servicio realizado. Se concluyó, principalmente, en la importancia de añadir a los estudiantes en los servicios escolares con prácticas anteriores a las obligatorias y en varias modalidades de integración, siempre que esas estrategias se incorporen en el proyecto pedagógico del curso, correspondiendo a la institución ofrecer una formación que articule efectivamente la teoría y práctica en las experiencias diarias del alumno en el proceso de experimentar y mejorar su escucha clínica al convertirse en psicólogo.(AU)