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2.
Public Health ; 167: 16-20, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30610957

RESUMO

OBJECTIVES: The effects of the Greek economic crisis on the emergency departments (EDs) of public hospitals have not been evaluated. The study aims to evaluate the burden of the financial crisis on public hospital's EDs. STUDY DESIGN: The present study is a retrospective two-center comparative study. METHODS: ED visits, related admissions per year, and the admissions/visits ratio at two public Greek hospitals, the Sismanogleio of Athens (SHA) and the University Hospital of Crete (UHC), from 2008 to 2016 were retrospectively studied. A linear model was fitted for each variable, and the slope values of the linear equations were calculated and compared between the two institutions. RESULTS: ED visits of the UHC exhibited 8.9% increase during the study period, whereas related admissions and admissions/visits ratio increased by 23.4% and 12.5%, respectively. ED visits at the SHA exhibited 5.4% increase, whereas related admissions showed 6% decrease and the admissions/visits ratio was decreased by 8%. Significant differences between the rates of admissions (P < 0.001) and admissions/visits ratio (P = 0.001) among the two hospitals were observed. CONCLUSIONS: Both institutions showed similarly increased ED visits. However, the UHC serving mainly rural, but also suburban and urban population, exhibited different changes regarding admissions and admissions/visits ratio compared with the SHA serving mainly an urban and suburban one, reflecting the way the crisis affected each social group. Depression has amplified the Greek National Health System structural problems and exposed the problematic urban primary health care. Improvement of primary urban health care, autonomy of EDs, and establishment of emergency medicine as independent specialty in Greece could serve better patients seeking care in public hospitals' EDs.


Assuntos
Recessão Econômica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Grécia , Hospitalização/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/organização & administração , Estudos Retrospectivos , População Urbana/estatística & dados numéricos
3.
G Chir ; 34(5): 323-325, 2018 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30444483

RESUMO

Mesothelial cyst of the round ligament is a rare finding in females, with only a few cases reported so far. A case of a 25 year old female patient presenting with a palpable mass in her right inguinal region is presented. The preoperative investigation through ultrasound (U/S), computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an intraabdominal cystic lobular mass in the inguinal canal, in contact with the femoral vessels. The mass was excised and the diagnosis of a benign mesothelial cyst was made through pathological examination. Even though it is a rare condition, it is advisable that clinicians consider in the differential diagnosis when evaluating a non-reducible mass in the inguinal region of a female patient.

4.
G Chir ; 39(5): 323-325, 2018 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30368273

RESUMO

Mesothelial cyst of the round ligament is a rare finding in females, with only a few cases reported so far. A case of a 25 year old female patient presenting with a palpable mass in her right inguinal region is presented. The preoperative investigation through ultrasound (U/S), computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an intraabdominal cystic lobular mass in the inguinal canal, in contact with the femoral vessels. The mass was excised and the diagnosis of a benign mesothelial cyst was made through pathological examination. Even though it is a rare condition, it is advisable that clinicians consider in the differential diagnosis when evaluating a non-reducible mass in the inguinal region of a female patient.

5.
G Chir ; 39(3): 177-180, 2018 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29923488

RESUMO

Littre hernia is defined as the herniation of a Meckel's diverticulum, while Richter's hernia is the herniation of a portion of the bowel wall. An extremely rare case of a combined Littre and Richter's femoral hernia is reported. An 82-year-old male presented at the emergency department with a painful golf ball-like mass at the right inguinofemoral region. With the diagnosis of incarcerated femoral hernia, he was urgently taken to the operating room. Intraoperatively, an incarcerated Littre, as well as a Richter's hernia were revealed. Enterectomy and side-to-side small bowel anastomosis were performed. The patient made an uneventful recovery. To the best of our knowledge, the present is the first report of a combined Littre and Richter's femoral hernia. Such findings should be reported to raise the awareness of surgeons for complicated cases. It is of utmost importance to have a high suspicion index for strangulated hernias, to minimize the time between admission and surgery.

6.
G Chir ; 39(2): 97-100, 2018 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29694309

RESUMO

Malakoplakia is a rare inflammatory disease, most commonly found in the urinary tract. It appears be related to a functional deficiency of macrophages, resulting in an inability to destroy digested bacteria and it is associated with various conditions that cause immunodeficiency. A rare case of malakoplakia of the colon in a healthy 68-year old male is presented. The patient underwent emergency surgery with colon resection and an end stoma with closure of the distal bowel (Hartmann's procedure), due to incarcerated ventral hernia and sigmoid-colon rupture. He underwent reversal of the Hartmann's procedure four months after the initial operation. The histological examination from the anastomotic rings revealed Michaelis-Gutmann bodies that are pathognomonic of malakoplakia. He received per os ciprofloxacin, bethanecol and ascorbic acid for 12 months. Follow-up endoscopy did not exhibit any signs of the disease. A case of a healthy patient presenting with malakoplakia without any underlying disease that causes immunodeficiency is extremely rare. Treatment of malakoplakia involves the eradication of microorganisms. Cholinergic agonists, such as bethanechol and ascorbic acid, as well as antimicrobial treatment with trimpethoprim/sulphamethoxazol and rifampicin are most commonly being used. Long-term antimicrobial treatment has been reported (6 months to 3 years).

7.
Food Microbiol ; 70: 232-244, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29173632

RESUMO

During fish spoilage, microbial metabolism leads to the production of volatile organic compounds (VOCs), characteristic off-odors and eventual consumer rejection. The aim of the present study was to contribute to the development of intelligent packaging technologies by identifying and quantifying VOCs that indicate spoilage of raw Atlantic cod (Gadus morhua) under atmospheres (%v/v CO2/O2/N2) 60/40/0, 60/5/35 and air. Spoilage was examined by microbiological, chemical and sensory analyses over storage time at 4 or 8 °C. Selected-ion flow-tube mass spectrometry (SIFT-MS) was used for quantifying selected VOCs and amplicon sequencing of the 16S rRNA gene was used for the characterization of the cod microbiota. OTUs classified within the Photobacterium genus increased in relative abundance over time under all storage conditions, suggesting that Photobacterium contributed to spoilage and VOC production. The onset of exponential VOC concentration increase and sensory rejection occurred at high total plate counts (7-7.5 log). Monitoring of early spoilage thus calls for sensitivity for low VOC concentrations.


Assuntos
Embalagem de Alimentos/métodos , Gadus morhua/microbiologia , Carne/microbiologia , Alimentos Marinhos/microbiologia , Animais , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Bactérias/metabolismo , Armazenamento de Alimentos , Humanos , Carne/análise , Alimentos Marinhos/análise , Paladar , Compostos Orgânicos Voláteis/análise , Compostos Orgânicos Voláteis/metabolismo
8.
Front Immunol ; 7: 217, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27375617

RESUMO

BACKGROUND: To extract more information, the properties of infectious disease data, including hidden relationships, could be considered. Here, blood leukocyte data were explored to elucidate whether hidden information, if uncovered, could forecast mortality. METHODS: Three sets of individuals (n = 132) were investigated, from whom blood leukocyte profiles and microbial tests were conducted (i) cross-sectional analyses performed at admission (before bacteriological tests were completed) from two groups of hospital patients, randomly selected at different time periods, who met septic criteria [confirmed infection and at least three systemic inflammatory response syndrome (SIRS) criteria] but lacked chronic conditions (study I, n = 36; and study II, n = 69); (ii) a similar group, tested over 3 days (n = 7); and (iii) non-infected, SIRS-negative individuals, tested once (n = 20). The data were analyzed by (i) a method that creates complex data combinations, which, based on graphic patterns, partitions the data into subsets and (ii) an approach that does not partition the data. Admission data from SIRS+/infection+ patients were related to 30-day, in-hospital mortality. RESULTS: The non-partitioning approach was not informative: in both study I and study II, the leukocyte data intervals of non-survivors and survivors overlapped. In contrast, the combinatorial method distinguished two subsets that, later, showed twofold (or larger) differences in mortality. While the two subsets did not differ in gender, age, microbial species, or antimicrobial resistance, they revealed different immune profiles. Non-infected, SIRS-negative individuals did not express the high-mortality profile. Longitudinal data from septic patients displayed the pattern associated with the highest mortality within the first 24 h post-admission. Suggesting inflammation coexisted with immunosuppression, one high-mortality sub-subset displayed high neutrophil/lymphocyte ratio values and low lymphocyte percents. A second high-mortality subset showed monocyte-mediated deficiencies. Numerous within- and between-subset comparisons revealed statistically significantly different immune profiles. CONCLUSION: While the analysis of non-partitioned data can result in information loss, complex (combinatorial) data structures can uncover hidden patterns, which guide data partitioning into subsets that differ in mortality rates and immune profiles. Such information can facilitate diagnostics, monitoring of disease dynamics, and evaluation of subset-specific, patient-specific therapies.

10.
Mol Diagn Ther ; 18(3): 309-14, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24403168

RESUMO

BACKGROUND AND OBJECTIVES: The ability of Yersinia species to produce biofilms has not been hitherto systematically studied, although there is evidence, that Y. enterocolitica is able to form biofilms on inanimate surfaces. The present study aimed to detect the production of biofilms by 60 clinical strains of Y. enterocolitica and to compare the antimicrobial susceptibility of planktonic versus biofilm-forming bacteria. METHODS: Y. enterocolitica strains were collected from stool and blood cultures collected from ß-thalassaemic children, with gastroenteritis and/or septicemia. The isolated bacterial strains were grouped by biotyping and serotyping and the antimicrobial susceptibility of the planktonic forms was investigated by MIC determination. Biofilm formation was detected by the use of silicone disks and for the biofilm forming strains the minimum inhibitory concentration for bacterial regrowth (MICBR) of 11 clinically important antimicrobials was determined. The presence of the waaE, a gene reported to be related with biofilm formation was investigated in all the strains. RESULTS: All of 60 strains were positive for biofilm production by the use of silicone disks. The great majority of the biofilm forms were resistant to all the antimicrobials. In antimicrobial concentrations far higher than the CLSI breakpoints, bacterial regrowth from the biofilms was still possible. None of the strains bore the waaE gene. CONCLUSIONS: These results, indicate that biofilm formation by Y. enterocolitica might be an inherent feature. The presence of biofilms increased dramatically the MICBR in all antimicrobials. The way in which biofilms could contribute to Y. enterocolitica pathogenicity in humans is a matter needing further investigation.


Assuntos
Antibacterianos/farmacologia , Gastroenterite/microbiologia , Sepse/microbiologia , Yersiniose/microbiologia , Yersinia enterocolitica/efeitos dos fármacos , Yersinia enterocolitica/isolamento & purificação , Talassemia beta/sangue , Proteínas de Bactérias/genética , Biofilmes/efeitos dos fármacos , Pré-Escolar , Farmacorresistência Bacteriana , Humanos , Lactente , Testes de Sensibilidade Microbiana , Plâncton/efeitos dos fármacos , Sorotipagem , Yersinia enterocolitica/classificação , Talassemia beta/complicações
13.
Mol Diagn Ther ; 17(5): 311-7, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23733519

RESUMO

PURPOSE: Salmonella enterica enterica encodes a variety of virulence factors. Among them, the type III secretion system (TTSS) encoded in the Salmonella pathogenicity islands (SPIs) is required for induction of proinflammatory responses, invasion of intestinal epithelial cells, induction of cell death in macrophages, and elicitation of diarrhea. The presence of the effector protein genes sopB, sopD, sopE, sopE2, avrA, and sptP of the SPIs was analyzed in 194 S. enterica enterica strains belonging to 19 serovars. METHODS: S. enterica enterica strains were collected from children with gastroenteritis, either hospitalized or attending the outpatient clinic, aged 1-14 years. Nineteen different serotypes were included in the study. Serotyping, biofilm formation determination, and antimicrobial resistance of the planktonic as well as the biofilm forms of the strains have been reported previously. RESULTS: At least one virulence gene was present in all Salmonella isolates. Biofilm formation was statistically independent of any of the six genes. Strains lacking sopE and sopE2 were more resistant to all the antimicrobials. CONCLUSIONS: The association of the virulence genes with the antimicrobial resistance of Salmonella in general has been previously reported and is a matter of further investigation. For the clinical expression of pathogenicity in humans, the contribution of these genes is questionable, as some strains bearing only a single gene (either sptP or avrA) were still capable of causing gastroenteritis.


Assuntos
Biofilmes/crescimento & desenvolvimento , Farmacorresistência Bacteriana/genética , Infecções por Salmonella/microbiologia , Salmonella enterica/isolamento & purificação , Salmonella enterica/patogenicidade , Fatores de Virulência/genética , Fatores de Virulência/metabolismo , Adolescente , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Criança , Pré-Escolar , Gastroenterite/microbiologia , Genes Bacterianos , Humanos , Lactente , Salmonella enterica/genética , Salmonella enterica/fisiologia , Sorotipagem
14.
Tech Coloproctol ; 15 Suppl 1: S25-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21887563

RESUMO

PURPOSE: Rectal prolapse is uncommon; however, the true incidence is unknown because of underreporting, especially in the elderly population. Full-thickness rectal prolapse, mucosal prolapse and internal prolapse are three different clinical entities, which are often combined and constitute rectal prolapse. The aim of the study is to present our experience in the surgical management of rectal prolapse. METHODS: In a 6-year period (2004-2010), 27 patients were surgically treated for rectal prolapse. The majority of patients were women (25 women, two men) and their mean age was 72.36 years. The operations performed were two Delorme's procedures, five STARR (Stapled TransAnal Rectal Resection), 14 Wells procedures, two Wells combined with Thiersch, one Altemeier, one sigmoid resection combined with Wells and two Thiersch. RESULTS: An emergency sigmoidostomy was performed on a patient after Wells operation due to obstructive ileus. One death occurred on the 5th postoperative day due to pulmonary embolism. Two recurrences observed 8 months postoperatively, one in a patient after STARR operation and one in a patient after Thiersch technique. The great majority of patients are completely relieved of symptoms. CONCLUSIONS: The application of different modalities in the treatment of rectal prolapse is attributed to the fact that cause, degree of prolapse and symptoms, vary from one patient to another. Successful approach depends on many factors, including the status of a patient's anal sphincter muscle before surgery, whether the prolapse is internal or external and the overall condition of the patient.


Assuntos
Complicações Pós-Operatórias/etiologia , Prolapso Retal/cirurgia , Reto/cirurgia , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Prolapso Retal/diagnóstico , Recidiva
15.
Tech Coloproctol ; 15 Suppl 1: S101-3, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21887568

RESUMO

INTRODUCTION: Intestinal obstruction in pregnancy is not common. Colonic volvulus occurs in 24% of such cases. Due to the rare incidence and lack of imaging during pregnancy, correct diagnosis is often delayed. CASE PRESENTATION: We present a case of a 33-year-old female with a twin pregnancy gestation, who presented with acute abdominal pain. Physical examination revealed a gravid uterus and tenderness in the lower abdominal quadrants. Due to intense uterine contractions, the patient was urgently submitted to cesarean delivery, giving birth to two healthy infants. Twelve hours after the cesarean section, right lower quadrant abdominal pain was persistently severe. Nausea, vomiting, diarrhea, and abdominal dilatation were also present. Abdominal X-ray and CT scan showed bowel obstruction, possibly secondary to cecal volvulus. The patient was subjected to explorative laparoscopy, cecal volvulus detorsion, and laparoscopic appendectomy. RESULTS: The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. CONCLUSIONS: Cecal volvulus in pregnancy is a rare, difficult to diagnose, clinical entity. It is associated with high morbidity and mortality, both of mother and fetus, because of delayed diagnosis. A high index of clinical suspicion is required in pregnant or puerperant women with signs and symptoms of bowel obstruction and persistent pain at the right low abdominal quadrant. As long as diagnosis is timely set, laparoscopy is a safe and successful means of surgical treatment.


Assuntos
Doenças do Ceco/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Volvo Intestinal/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Gravidez de Gêmeos , Doenças do Ceco/cirurgia , Cesárea , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Volvo Intestinal/complicações , Volvo Intestinal/cirurgia , Laparoscopia , Gravidez , Complicações na Gravidez/cirurgia , Radiografia
16.
Tech Coloproctol ; 15 Suppl 1: S63-6, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21887573

RESUMO

PURPOSE: Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not. METHODS: From 2008 to 2010, ten patients with colorectal injuries were surgically treated by primary repair or by a staged repair. RESULTS: The patients were five men and five women, with median age 40 years (20-55). Two men and two women had rectal injuries, while 6 patients had colon injuries. The mechanism of trauma in two patients was firearm injuries, in two patients was a stab injury, in four patients was a motor vehicle accident, in one woman was iatrogenic injury during vaginal delivery, and one case was the transanal foreign body insertion. Primary repair was possible in six patients, while diversion was necessary in four patients. CONCLUSIONS: Primary repair should be attempted in the initial surgical management of all penetrating colon and intraperitoneal rectal injuries. Diversion of colonic injuries should only be considered if the colon tissue itself is inappropriate for repair due to severe edema or ischemia. The role of diversion in the management of unrepaired extraperitoneal rectal injuries and in cases with anal sphincter injuries is mandatory.


Assuntos
Colo/lesões , Colo/cirurgia , Reto/lesões , Reto/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adulto , Colostomia , Feminino , Corpos Estranhos/complicações , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Tech Coloproctol ; 14 Suppl 1: S21-3, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20683754

RESUMO

BACKGROUND: The aim of this study is to compare the ability of three treatments in patients with anal fissure, sphincterotomy, nitroglycerin ointment and combination of gel xylocaine and lactulose. METHODS: Ninety adults divided in three groups of 30 patients each group, received one of the three treatments in a 3-year interval (2007-2009) and the follow-up was for 2 months. Group A received nitroglycerin ointment, Group B underwent sphincterotomy and Group C received gel xylocaine and lactulose. RESULTS: Concerning pain, after treatment 60% of patients in Group A did not complain of pain, 20% had transient pain, another 10% moderate pain and the remaining 10% had severe pain. In Group B, 95% of the patients had no pain and only 5% had mild, transient pain. In Group C 60% of the patients had moderate pain and the other 40% suffered from severe pain. Concerning fissure healing, in 60% of the patients of Group A, the fissure was healed. In Group B fissure healed in 93.3% and in Group C only in 16.6% of the patients. CONCLUSION: The "gold standard" for anal fissure treatment is the lateral internal sphincterotomy and that each one of the three methods has its advantages and disadvantages.


Assuntos
Fissura Anal/terapia , Administração Oral , Administração Tópica , Adulto , Idoso , Canal Anal/cirurgia , Terapia Combinada , Quimioterapia Combinada , Feminino , Seguimentos , Géis , Humanos , Lactulose/administração & dosagem , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Pomadas , Estudos Prospectivos , Vasodilatadores/administração & dosagem
18.
Eur J Clin Microbiol Infect Dis ; 29(11): 1401-5, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20640867

RESUMO

In the present study, 194 Salmonella enterica strains, isolated from infected children and belonging to various serotypes, were investigated for their ability to form biofilms and the biofilm forms of the isolated strains were compared to their corresponding planktonic forms with respect to the antimicrobial susceptibility. For the biofilm-forming strains, the minimum inhibitory concentration for bacterial regrowth (MICBR) from the biofilm of nine clinically applicable antimicrobial agents was determined, and the results were compared to the respective MIC values of the planktonic forms. One hundred and nine S. enterica strains out of 194 (56%) belonging to 13 serotypes were biofilm-forming. The biofilm forms showed increased antimicrobial resistance compared to the planktonic bacteria. The highest resistance rates of the biofilm bacteria were observed with respect to gentamicin (89.9%) and ampicillin (84.4%), and the lowest rates with respect to ciprofloxacin and moxifloxacin (2.8% for both). A remarkable shift of the MICBR(50) and MICBR(90) toward resistance was observed in the biofilm forms as compared to the respective planktonic forms. The development of new consensus methods for the determination of the antimicrobial susceptibility of biofilm forms seems to be a major research challenge. Further studies are required in order to elucidate the biofilm antimicrobial resistance mechanisms of the bacterial biofilms and their contribution to therapeutic failure in infections with in vitro susceptible bacteria.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Gastroenterite/microbiologia , Infecções por Salmonella/microbiologia , Salmonella enterica/efeitos dos fármacos , Adolescente , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Humanos , Lactente , Testes de Sensibilidade Microbiana , Plâncton/efeitos dos fármacos , Salmonella enterica/isolamento & purificação , Salmonella enteritidis/efeitos dos fármacos , Salmonella enteritidis/isolamento & purificação , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/isolamento & purificação
19.
Int Ophthalmol ; 30(6): 703-7, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20107867

RESUMO

The objective of this study was to compare the light sensitivity and pain experienced by patients undergoing cataract surgery under subtenon and topical with intracameral anaesthesia. Fifty-four patients were randomly assigned to receive either two drops of proxymethacaine 0.5% as topical anaesthesia with 0.5 ml preservative-free 1% intracameral lidocaine or 4 ml 2% lignocaine as subtenon anaesthesia. Light sensitivity and overall pain perception were recorded at the end of surgery. The mean pain score in the subtenon group (0.11; range 0-1) was lower than in the topical group (1.07; range: 0-3, P < 0.001). The mean light-sensitivity score was lower in the subtenon group (0.26; range: 0-4) than in the topical group (1.29; range: 0-4, P = 0.001). Subtenon anaesthesia was more effective in suppressing light sensitivity and pain during cataract surgery than topical with intracameral anaesthesia. This suggests that use of subtenon anaesthesia may lead to a more comfortable operative experience.


Assuntos
Extração de Catarata/efeitos adversos , Extração de Catarata/métodos , Complicações Intraoperatórias , Dor/etiologia , Transtornos de Fotossensibilidade/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Feminino , Humanos , Implante de Lente Intraocular , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Propoxicaína/administração & dosagem
20.
Emerg Med J ; 25(11): 740-4, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18955608

RESUMO

OBJECTIVES: To investigate the appropriateness of patients attending an Accident & Emergency (A&E) department of an eye hospital, identify reasons for inappropriate use and propose recommendations in improving the provision of ophthalmic A&E care. METHODS: A prospective questionnaire-based survey of consecutive patients who presented to the A&E department over a 7-day period was conducted. Patient demographic data, reason for attending from the patients' perspective, diagnosis, duration of symptom and management outcome were recorded. The diagnoses were grouped into acute and non-acute, and into those which were considered suitable to be seen in a primary care setting by specialist trained community general practitioners (GPs) or optometrists. RESULTS: 560 completed questionnaires were evaluated; 171 cases (30.6%) were considered as non-acute and 210 (37.5%) were considered suitable to be seen by specialist trained community GPs or optometrists. 352 patients (62.8%) had symptoms for 1-6 days, 144 (25.7%) had symptoms for 1-4 weeks and 64 (11.5%) had symptoms for >1 month before presentation; in the latter two groups, 52 of the 208 patients (25%) were diagnosed with non-acute conditions. "Great concern" was the most common reason for attending the casualty department. 350 patients (62.5%) were discharged on the day of presentation. CONCLUSIONS: A significant number of patients who attend ophthalmic A&E departments have non-urgent conditions that could be managed satisfactorily in a primary care setting by specialist trained GPs or optometrists outside the hospital casualty department. Improvement in education of patients, the provision of specialist ophthalmic training for GPs and optometrists, and expansion of outpatient services are needed so that casualty remains a genuine emergency service.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmopatias/terapia , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Oftalmologia/normas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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