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1.
Oral Dis ; 26(1): 89-95, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31596995

RESUMEN

OBJECTIVES: To investigate the clinical advices pharmacists would give to patients who present with various oral mucosal lesions. SUBJECTS AND METHODS: One hundred and twenty pharmacists in three major cities in the United Arab Emirates (UAE) were approached by senior dental students acting as mystery shoppers. Pharmacists were shown an image of one of four oral mucosal lesions representing candidosis, aphthous ulcer, erosive lichen planus and squamous cell carcinoma (SCC). Pharmacists' referral pattern and choices of medications were recorded and assessed against demographic variables. RESULTS: Eighty-eight per cent (88%) of pharmacists dispensed a non-prescription medication to treat the oral lesions, including SCC, while only 12% recommended that the lesion shown to them be assessed by a clinician. Among all referral recommendations, 32% were for SCC (p = .006). Geographical proximity of a clinic to the pharmacy was a significant factor in determining pharmacists' referral recommendation (p = .036). CONCLUSION: Most pharmacists dispensed a medication for oral mucosal lesions, including potentially malignant and malignant ones, without referring patients to a medical or dental practitioner. Pharmacists should be aware of the serious nature of some oral mucosal lesions and the necessity to refer those cases to a qualified practitioner for proper clinical assessment.


Asunto(s)
Competencia Clínica , Servicios Comunitarios de Farmacia , Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/terapia , Candidiasis/diagnóstico , Candidiasis/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Liquen Plano/diagnóstico , Liquen Plano/terapia , Mucosa Bucal/patología , Farmacéuticos , Derivación y Consulta/estadística & datos numéricos , Estomatitis Aftosa/diagnóstico , Estomatitis Aftosa/terapia , Emiratos Árabes Unidos
2.
Acta Odontol Scand ; 78(1): 38-44, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31385739

RESUMEN

Objectives: This retrospective study investigated requests and indications for cone-beam computed tomography (CBCT) in children and adolescents over a 3-year period at one oral and maxillofacial radiology department. Specific aims were to determine what technical settings were used, which caregivers write the referrals, and how often and for what reasons re-exposure was necessary.Materials and methods: Patients <19 years of age who had been referred to the department and undergone a CBCT scan during 2015-2017 were included in the study.Results: CBCT were made in 617 of the 3847 eligible referrals. The most common referral was from general practice dentists (GPD) (43%). Mean age of the patients was 12.5 years (range: 6-18). Nineteen different types of requests were identified. The most common request was assessment of an ectopic canine with a question about potential resorption of adjacent teeth (38.6%). Forty (6.5%) of the CBCT needed to be re-taken due to patient motion artefacts.Conclusions: The most common request and indication for CBCT examination of children and young adults were to assess an ectopic canine and determine the presence of resorption of adjacent teeth. Referrals from GPDs were the most frequent and the largest age group was the 11- to 15-year olds. The reason for re-exposures was motion artefacts. High scanning speed to reduce motion artefacts and a half rotation (180°) to reduce the radiation dose to the patient should be preferred. The need for continuous work with quality and systematic monitoring of radiographic procedures at any radiology department should be given high priority.


Asunto(s)
Radiografía Dental Digital , Derivación y Consulta/estadística & datos numéricos , Tomografía Computarizada de Haz Cónico Espiral/estadística & datos numéricos , Adolescente , Niño , Servicio Odontológico Hospitalario , Humanos , Estudios Retrospectivos , Tomografía Computarizada de Haz Cónico Espiral/métodos , Encuestas y Cuestionarios , Suecia , Adulto Joven
3.
Rev Saude Publica ; 53: 110, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826176

RESUMEN

OBJECTIVE: To evaluate the influence of the Mais Médicos (More Doctors) Program on the performance of primary health care by quantifying health services access and use in Northeast Brazil, based on the population size of the municipalities, on the financial investment in health, and on the number of physicians in the family health teams. METHOD: Evaluative research of quantitative nature. Access was evaluated by the population coverage ratio of the Family Health Strategy and use of health services, which were measured by medical appointments conducted between April 2013 and September 2015. We defined processes for database selection, adjustment, and validation, including explanatory variables for a sample of 896 municipalities. The analysis was based on the time periods before and after the implementation of the program. The Wilcoxon signed-rank test and non-parametric alternatives constituted statistical tests in the comparative analysis of the data. RESULTS: A 19.2% increase was observed in the number of medical appointments between the first six months and the final six months of the data series. In this period, the median appointments in municipalities with up to 5,000 inhabitants increased from 701.0 to 768.0; while in those with more than 100,000 inhabitants it decreased from 285.5 to 280.0 (p < 0.05). Between April 2013 and September 2015, the median coverage ratio of the family health teams increased from 89.2% to 95.3%, approaching 100% in the municipalities with up to 20,000 inhabitants. CONCLUSIONS: The study highlights the expansion of access and use of primary health care services in the northeast region after the implementation of the Mais Médicos (More Doctors) Program. Between April 2013 and September 2015, the coverage of family health teams and the production of medical appointments increased, constituting important achievements for SUS.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Programas de Gobierno , Médicos/provisión & distribución , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Brasil , Prestación de Atención de Salud/economía , Salud de la Familia , Asignación de Recursos para la Atención de Salud , Humanos , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Recursos Humanos
4.
Rev Saude Publica ; 53: 106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800907

RESUMEN

BACKGROUND: Although the prognosis of differentiated thyroid carcinoma (DTC) therapy is considered excellent over time, some cases have a poorer prognosis and evolve into death. OBJECTIVE: This study aimed to estimate the 5-year specific survival and to identify prognosis factors in a cohort of DTC adult subjects. METHODS: Survival probability was estimated by Kaplan-Meier's method in a retrospective hospital-based cohort study. Comparisons were made by log-rank test. Prognosis factors were identified using Cox risk modeling and crude and adjusted Hazard Ratio measures were obtained. Two models were estimated, considering age grouping of the 7th and 8th editions of TNM. RESULTS: Specific 5-year survival in the cohort was 98.5% (95%CI: 94.2 - 97.5). Considering TNM 7th edition, the risk estimates were 9.88 (95%CI: 1.67 - 58.33) for age group ≥ 55 years, 18.87 (95%CI: 7.38 - 48.29) for individuals with distant metastasis, 6.36 (95%CI: 2.26 - 17.91) for patients who underwent lymphadenectomy and 0.16 (95%CI: 0.06 - 0.43) for those who received radioiodine therapy. For TNM 8th edition, the risk estimates were 10.12 (95%CI: 2.05 - 50.09) for age group ≥ 55 years, 12.43 (95%CI: 4.58 - 33.77) for individuals with distant metastasis, 5.06 (95%CI: 1.82 - 14.05) for patients who underwent lymphadenectomy and 0.19 (95%CI: 0.07 - 0.51) for those who received radioiodine therapy. CONCLUSIONS: This cohort had a very high survival over a 5-year period. The prognosis was negatively influenced by age, distant metastasis and lymphadenectomy, whereas radioiodine therapy was found to be protective.


Asunto(s)
Carcinoma/mortalidad , Derivación y Consulta/estadística & datos numéricos , Neoplasias de la Tiroides/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Brasil/epidemiología , Carcinoma/patología , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias de la Tiroides/patología , Factores de Tiempo , Carga Tumoral , Adulto Joven
5.
Med. infant ; 26(4): 335-345, dic. 2019. Tab
Artículo en Español | LILACS | ID: biblio-1047042

RESUMEN

Mediano Riesgo es un servicio de atención ambulatoria del Hospital Garrahan. Se atienden pacientes con enfermedades prolongadas, que han realizado consultas en otros efectores de salud u otros servicios del Hospital, o que requieren segunda opinión o abordaje multidisciplinario. Objetivos: Mensurar el tiempo profesional invertido en la atención como herramienta para ponderar la complejidad de los pacientes. Identificar variables demográficas y del proceso de atención. Material y métodos: Investigación descriptiva, transversal sobre pacientes encuestados entre julio y diciembre de 2017 en el Sector de Mediano Riesgo. Se registraron: variables demográficas, proceso de atención, diagnósticos previos y finales, interconsultas, exámenes complementarios y tiempos de consulta profesional. Se tomó 65 minutos (mediana del tiempo profesional total) como punto de corte para definir dos grupos: tiempo de consulta corto o largo. Se realizó un análisis comparativo entre ambos. Resultados: se encuestaron 400 pacientes. Mediana de edad fue de 67,2 meses; 80,1% procedían de CABA y del GBA; mediana de duración del síntoma fue 4 meses; 25,8% tenía enfermedad de base; 62,5% fueron pacientes derivados (externos e internos); destino a pediatra zonal: 30%; interconsultas: 48,5%; tiempo total profesional: mediana 65 minutos (rango 12-460); diagnósticos simples: 37,2%. Variables con significación estadística para pertenecer al tiempo largo: número de diagnósticos finales, procedencia, diagnósticos no simples y presencia de enfermedad de base. Variables con tendencia a pertenecer a tiempo largo: duración del síntoma mayor de 1 mes, edad menor a 24 meses, patología tumoral, síndromes polimalformativos, abuso sexual infantil y problemas de lenguaje /aprendizaje. Conclusiones: el tiempo de consulta es un factor concurrente para la evaluación de la complejidad del proceso de atención. La identificación de variables que permitan preverlo es información relevante para la organización del sector, o de otros efectores de salud (AU)


The sector of Intermediate Risk is part of the outpatient clinics of Garrahan Hospital. In the sector patients with chronic diseases are seen, that have have consulted at other centers or other departments of the hospital, or that need a second opinion or a multidisciplinary approach. Objectives: To assess the professional time invested in care as a tool to evaluate the complexity of the patients, and to identify demographic variables and the care process. Material and methods: A cross-sectional, descriptive study on patients surveyed between July and December 2017 in the Sector of Intermediate Risk. The following data were recorded: Demographic features, care process, previous and final diagnoses, consultations, complementary studies, duration of the interview. A time of 65 minutes (median total time of the visit) was defined as the cut-off point to define two groups: Those with a long and a short interview. A comparative analysis was performed comparing both groups. Results: 400 patients were surveyed. Median age was 67.2 months; 80.1% were form the city of Buenos Aires and Greater Buenos Aires. Mean symptom duration was 4 months; 25.8% had an underlying disease; 62.5% of the patients was referred (either external or internally); referred by the local pediatrician: 30%; second opinions: 48,5%; total time of the interview: median 65 minutes (range, 12-460); simple diagnoses: 37.2%. Statistically significant variables for a long interview were: number of final diagnoses, place of origin, complicated diagnoses, and presence of underlying disease. Variables with a trend to a long interview were: symptom duration more than one month, age less than 24 months, a diagnosis of a tumor, polymalformation syndromes, sexual abuse, language/learning difficulties. Conclusions: The time of the interview is a concurrent factor for the assessment of the complexity of the care process. Identification of the variables that allow to anticipate these cases is relevant for the organization of the sector or other health care providers (AU)


Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Derivación y Consulta/estadística & datos numéricos , Factores de Tiempo , Atención Ambulatoria/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Grupo de Atención al Paciente , Estudios Transversales , Encuestas y Cuestionarios
6.
Medicine (Baltimore) ; 98(52): e18399, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876712

RESUMEN

Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.


Asunto(s)
Trastornos Mentales/epidemiología , Adolescente , Adulto , Factores de Edad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Sudáfrica , Adulto Joven
7.
Medicina (B Aires) ; 79(5): 337-344, 2019.
Artículo en Español | MEDLINE | ID: mdl-31671382

RESUMEN

The international recommendations point to the early integration of palliative care (PC) in cancer through simultaneous care and training of primary teams. The PC Unit of the Hospital General de Agudos E. Tornú conducts interconsultations for hospitalized patients in the hospital and provides training to the treatment teams. The profile of the interconsultations carried out could provide important information about the characteristics of the PC intervention within the institution. The objective of this study was to retrospectively analyze the first-time interconsultations of cancer patients carried out over 2 years, focusing on temporality, identification of problems by the treating team and the PC interconsultation team, the promptness of response and the prognostic capacity of the latter. In the period, 168 interconsultations were carried out. Most patients had advanced disease, poor performance status, no possibility of oncological treatment and recent diagnosis. In approximately 25% of the cases, evidence of early intervention and participation of the pc team in decision making was found. The opportunity of PC intervention is discussed and areas needing improvement are indicated, such as the identification of non-physical symptoms and prognosis, to be considered in future care and educational activities.


Asunto(s)
Hospitales Generales/estadística & datos numéricos , Neoplasias/terapia , Cuidados Paliativos/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Hospitalización , Humanos , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/mortalidad , Estudios Retrospectivos , Factores de Tiempo
8.
Pan Afr Med J ; 33: 306, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692846

RESUMEN

Introduction: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods: A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results: Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion: The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.


Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Complicaciones del Embarazo/epidemiología , Derivación y Consulta/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Adhesión a Directriz , Humanos , Trabajo de Parto , Guías de Práctica Clínica como Asunto , Embarazo , Atención Terciaria de Salud , Túnez , Adulto Joven
10.
Int Heart J ; 60(6): 1303-1307, 2019 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-31735770

RESUMEN

In order to prevent ischemic stroke, it is important to identify and treat patients with atrial fibrillation (AF) who do not consult a doctor in a medical institution. The aim of this study was to determine the consultation rate at medical institutions for patients with AF in group medical examinations conducted in a city in western Japan. Of 6101 examinees of group medical examinations (40 years of age or older) conducted in Ibara City, Okayama Prefecture, Japan, from 2012 to 2014, 4338 participants (71.1%) who were evaluated by electrocardiogram (ECG) gave written informed consent and responded to surveys in the form of questionnaires through a personal interview conducted by nurses were included in the Ibara-AF study. A cumulative total of 82 subjects were diagnosed as having AF by ECG (prevalence of AF = 1.89%), and 51 individuals had AF during the three-year period.15 (29.4%) of the 51 patients with AF did not regularly visit medical institutions. Among them, 46.7% (n = 7) and 53.3% (n = 8) of the patients were symptomatic and asymptomatic, respectively, and 73.3% of the patients had a CHADS2 score of more than one point. There were no significant differences in patients' characteristics between regular and non-regular visit groups. In conclusion, about one-third of the patients with AF did not regularly see a doctor in a medical institution and most of them had a CHADS2 score of more than one point in a Japanese rural area. Educating the public about the risks of AF is required.


Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Electrocardiografía , Utilización de Instalaciones y Servicios , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
12.
Spine (Phila Pa 1976) ; 44(22): 1578-1584, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31689253

RESUMEN

STUDY DESIGN: Retrospective review with qualitative phone interview. OBJECTIVE: This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. METHODS: A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. RESULTS: Mean Cobb angle at first specialist review was 49.5°â€Š±â€Š14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. CONCLUSION: In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. LEVEL OF EVIDENCE: 4.


Asunto(s)
Derivación y Consulta/estadística & datos numéricos , Escoliosis , Adolescente , Humanos , Entrevistas como Asunto , Estudios Retrospectivos , Escoliosis/diagnóstico , Escoliosis/epidemiología , Escoliosis/cirugía , Columna Vertebral/cirugía , Tiempo de Tratamiento/estadística & datos numéricos , Resultado del Tratamiento , Australia Occidental
13.
J Surg Oncol ; 120(8): 1365-1370, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31642056

RESUMEN

BACKGROUND: Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown. METHODS: Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. RESULTS: Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001). CONCLUSION: Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.


Asunto(s)
Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/terapia , Manejo de la Enfermedad , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/terapia , Grupo de Atención al Paciente , Carcinoma Hepatocelular/patología , Terapia Combinada , Grupos de Población Continentales/estadística & datos numéricos , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Hepatitis C Crónica/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Proveedores de Redes de Seguridad , Estados Unidos/epidemiología
14.
Einstein (Sao Paulo) ; 18: eAO4620, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31664329

RESUMEN

OBJECTIVE: To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. METHODS: This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. RESULTS: The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. CONCLUSION: This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.


Asunto(s)
Derivación y Consulta/estadística & datos numéricos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Estudios Transversales , Demografía , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Prevalencia , Distribución por Sexo , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Adulto Joven
15.
BMC Med ; 17(1): 184, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31570106

RESUMEN

BACKGROUND: The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). METHODS: Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. RESULTS: The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a "service exporter." Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients' conditions do not demand technologically sophisticated services. The effects of regulation and the agents' preferences reinforce the tendency to refer patients to centrally located hospitals. CONCLUSIONS: Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients' flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.


Asunto(s)
Vías Clínicas/estadística & datos numéricos , Parto Obstétrico/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Adulto , Brasil/epidemiología , Cesárea/estadística & datos numéricos , Ciudades/epidemiología , Ciudades/estadística & datos numéricos , Vías Clínicas/organización & administración , Vías Clínicas/normas , Estudios Transversales , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Parto Obstétrico/métodos , Parto Obstétrico/normas , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Transferencia de Pacientes/organización & administración , Embarazo , Indicadores de Calidad de la Atención de Salud , Derivación y Consulta/estadística & datos numéricos , Análisis de Sistemas , Transporte de Pacientes/estadística & datos numéricos
16.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31515298

RESUMEN

OBJECTIVES: To examine screening practices for autism spectrum disorder (ASD), subsequent referrals, and diagnostic outcomes within a large network of primary pediatric care practices. METHODS: Rates of ASD screening with the Modified Checklist for Autism in Toddlers (M-CHAT) at 18- and 24-month well-child visits were examined among 290 primary care providers within 54 pediatric practices between June 2014 and June 2016. Demographic, referral, and diagnostic data were abstracted from the medical records for all children who failed the M-CHAT (ie, score of ≥3) at either or both visits. RESULTS: Rates of M-CHAT screening were 93% at 18 months and 82% at 24 months. Among 23 514 screens, scores of 648 (3%) were ≥3 (386 at 18 months, 262 at 24 months) among 530 unique children who failed 1 or both screenings. Among screen-failed cases, 18% received a diagnosis of ASD and 59% received ≥1 non-ASD neurodevelopmental disorder diagnosis within the follow-up period. Only 31% of children were referred to a specialist for additional evaluation. CONCLUSIONS: High rates of ASD-specific screening do not necessarily translate to increases in subsequent referrals for ASD evaluation or ASD diagnoses. Low rates of referrals and/or lack of follow-through on referrals appear to contribute to delays in children's receipt of ASD diagnoses. Additional education of primary care providers regarding the referral process after a failed ASD screening is warranted.


Asunto(s)
Trastorno del Espectro Autista/diagnóstico , Lista de Verificación , Pediatría/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Factores de Edad , Trastorno del Espectro Autista/epidemiología , Preescolar , Humanos , Lactante , Perdida de Seguimiento , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/epidemiología
17.
BMC Health Serv Res ; 19(1): 669, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533708

RESUMEN

BACKGROUND: Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services. The aim of this study was to assess the level of patient satisfaction with perioperative anaesthesia care and to determine the factors that influence satisfaction. METHOD: This study is an cross sectional design, conducted on 470 patients who underwent different types of surgeries at two National Referral Hospitals in Asmara, Eritrea between January and March of 2018. Patients were interviewed 24 h after the operation using a Tigrigna translated Leiden Perioperative Care Patient Satisfaction questionnaire (LPPSq). Descriptive and inferential analysis were made using SPSS (version 22). Statistical significance level was set at P < 0.05. RESULTS: The overall satisfaction score was 68.8%. Less fear and concern was observed among patients with satisfaction scores of 87.5%. Staff-patient relationship satisfaction score was 75%. Patients were least satisfied with information provision (45%). Multivariable analysis revealed that satisfaction of patients who did surgery at Halibet hospital is significantly higher (p < 0.001) than those patients who did at Orotta hospital. Moreover, those patients who did elective surgery had higher level of satisfaction that those who did emergency surgery (p < 0.001). CONCLUSION: Moderate level of satisfaction was observed among the patients. Generally, the study emphasized that the information provision about anesthesia and surgery was low. Patients described better staff-patient relationship and low fear and concern related to anesthesia and surgery was observed.


Asunto(s)
Anestesia/normas , Satisfacción del Paciente/estadística & datos numéricos , Atención Perioperativa/normas , Adulto , Anestesia/psicología , Estudios Transversales , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Tratamiento de Urgencia/psicología , Tratamiento de Urgencia/normas , Eritrea , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
18.
Clin Nephrol ; 92(5): 221-225, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31496515

RESUMEN

BACKGROUND: Multiple studies have revealed disparity in renal healthcare access and outcomes in racial/ethnic minorities with the socioeconomic status explaining the majority but not all of the disparity. We wanted to determine if racial/ethnic disparities existed at the first step toward renal transplantation, the renal transplant referral process. MATERIALS AND METHODS: A cohort of 200 adult end-stage renal disease patients was followed retrospectively for 2 years from January 2016 to February 2018. The study exposure was based on self-declared race/ethnicity of the patients, who were categorized as Black, White, and Hispanic. The study outcome was based on medical team patient evaluation and consisted of the patients who refused referral, who were not referred, and who were referred for transplant. Medical and demographic factors collected were age, gender, socioeconomic status, hemoglobin A1c ≥ 7, body mass index ≥ 40, left ventricular ejection fraction ≤ 40%, the presence of coronary or peripheral arterial disease, albumin level, history of smoking, cirrhosis, and cancer. The data were analyzed using univariate analyses and multinomial logistic regression. RESULTS: In the adjusted analysis, there was no difference in the likelihood of transplant referral between Black and White patients (OR = 0.71, 95% CI 0.22 - 2.3, p = 0.56). However, both Black (OR = 16, 95% CI 3.3 - 77, p = 0.0006) and White (OR = 22, 95% CI 3.4 - 150, p = 0.0013) patients were more likely to be referred for transplant when compared with Hispanic patients. Odds of transplant refusal were not different across race/ethnic groups. CONCLUSION: Hispanic patients are disadvantaged in the referral for renal transplant when compared to Black and White patients for reasons unclear at this time.


Asunto(s)
Grupos de Población Continentales/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Trasplante de Riñón/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Estudios Retrospectivos
19.
BMC Health Serv Res ; 19(1): 572, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412858

RESUMEN

BACKGROUND: The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS: Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS: One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS: Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.


Asunto(s)
Artritis Juvenil/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Algoritmos , Artritis Juvenil/epidemiología , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Manitoba/epidemiología , Evaluación de Necesidades , Reumatología
20.
Br J Neurosurg ; 0(0): 1-11, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31407596

RESUMEN

Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. Materials and Methods: A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 months between 1st October 2016 and 31st March 2017. Results: A total of 28 UK spinal units submitted data on 4441 referrals. Over half of referrals were made without any previous imaging (n = 2572, 57.9%). Of all referrals, 695 underwent surgical decompression (15.6%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%). Patient location and pre-referral imaging were not associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced longer time intervals from referral to undergoing the MRI scan. Conclusions: This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Adherence to guidelines would reduce the number of referrals to spinal services by 72% and reduce the number of patient transfers by 79%.


Asunto(s)
Síndrome de Cauda Equina/diagnóstico , Derivación y Consulta/estadística & datos numéricos , Adulto , Síndrome de Cauda Equina/cirugía , Vías Clínicas , Descompresión Quirúrgica/estadística & datos numéricos , Tratamiento de Urgencia , Utilización de Instalaciones y Servicios , Femenino , Humanos , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Utilización de Procedimientos y Técnicas , Estudios Retrospectivos , Columna Vertebral/cirugía , Reino Unido
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