Paediatric respiratory isolation: A challenge for a secondary care hospital! A service innovation project.

OBJECTIVE: The aim of this project was to broaden the secondary care hospital's scope of services and provide safe, effective and quality care for the patient presenting with measles. METHODS: Six Sigma DMAIC [define measure, analyze, improve, and control (DMAIC)] methodology was used in this quality improvement project. The quality project was started in October 2015 using a Gantt chart quality tool. RESULTS: The paediatric team with the support of administration of the hospital has established isolation rooms and devised a policy for the care and management of patient with airborne infection to avoid cross transmission. During six months period after establishment of isolation room there were sixty two suspected or confirmed measles cases who were admitted in our hospital, out of them only 4(6.4%) of patients were referred because of their sick condition and need of ventilator support. Further, the percentage of patient's satisfaction level also improved from 60 to 80%. CONCLUSIONS: After this clinical service innovation, there was significant reduction in referrals of measles patients to another hospital and consequently there was an increase in the patient's satisfaction.

[General Practice: continuously developing]. / Huisartsgeneeskunde: continu in ontwikkeling.

Over the past 10 years there have been significant developments in general practice regarding diagnostics, differentiation of competences of general practitioners, cooperation within primary care and with secondary care, task delegation and patient information provision. Less progress has been made in other areas: E-health applications are rarely used, and there is no clear guideline for an integrated policy in patients with multimorbidity. General practitioners also continue to suffer from excessive regulatory pressure, excessive protocols and standardization. In the coming decade, GPs will continue to work in accordance with the core values ​​of their profession: 'person-oriented', 'medical-generalist', 'continuous' and 'jointly'. Their function to provide guidance is becoming increasingly important. In addition, more diagnostics and treatment will take place at the interface between general practice and secondary care. Chronic care will focus more on the needs and wishes of the individual patient. GPs retain their important role in terminal palliative care and emergency care.

The association between believing staying active is beneficial and achieving a clinically relevant functional improvement after 52 weeks: a prospective cohort study of patients with chronic low back pain in secondary care.

BACKGROUND: According to clinical guidelines, advice to stay active despite experiencing pain is recommended to patients with non-specific low back pain (LBP). However, not all patients receive guideline-concordant information and advice, and some patients still believe that activity avoidance will help them recover. The purpose was to study whether guideline-concordant beliefs among patients and other explanatory variables were associated with recovery. The main aim was to investigate whether believing staying active despite having pain is associated with a better functional outcome. METHODS: This was a prospective cohort study involving adults with non-specific LBP referred from general practices to the Spine Centre at Silkeborg Regional Hospital, Denmark. Patients reported on their beliefs about the importance of finding the cause, the importance of diagnostic imaging, perceiving to have received advice to stay active, pain duration, pain intensity, and STarT Back Tool. Agreeing to: 'An increase in pain is an indication that I should stop what I'm doing until the pain decreases' adjusted for age, gender, and education level was the primary explanatory analysis. A 30% improvement in the Roland Morris Disability Questionnaire (RMDQ) score after 52 weeks was the outcome. RESULTS: 816 patients were included and 596 (73.0%) agreed that pain is a warning signal to stop being active. Among patients not considering pain as a warning signal, 80 (43.2%) had a favourable functional improvement of ≥30% on the RMDQ compared to 201 (41.2%) among patients considering pain a warning signal. No difference was found between the two groups (adjusted P = 0.542 and unadjusted P = 0.629). However, STarT Back Tool high-risk patients had a less favourable functional outcome (adjusted P = 0.003 and unadjusted P = 0.002). Chronic pain was associated with less favourable functional outcome (adjusted P < 0.001 and unadjusted P < 0.001), whereas beliefs about finding the cause, diagnostic imaging, perceiving to have received advice to stay active, or pain intensity were not significantly associated with outcome. CONCLUSIONS: Holding the single belief that pain is a warning signal to stop being active was not associated with functional outcome. However, patients characterised by having multiple psychological barriers (high-risk according to the STarT Back Tool) had a less favourable functional outcome. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (registration number: NCT03058315), 20 February 2017.

Doctors' opinions on clinical coordination between primary and secondary care in the Catalan healthcare system / Opinión de los médicos sobre coordinación entre atención primaria y especializada en el sistema de salud catalán

Objective: To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. Methods: A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. Results: In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. Conclusions: Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination

Objetivo: Analizar la opinión de los médicos sobre la coordinación entre la atención primaria (AP) y la atención especializada (AE) en diferentes redes de servicios de salud, e identificar los factores relacionados. Método: Estudio cualitativo descriptivo-interpretativo basado en entrevistas semiestructuradas. Se diseñó una muestra teórica en dos etapas: 1) redes de servicios de salud con diferentes modelos de gestión; 2) en cada red, médicos de AP y AE. El tamaño muestral se alcanzó por saturación (n = 50). Se realizó un análisis temático de contenido. Resultados: En las tres redes, los médicos expresaron que la atención está coordinada en términos de intercambio de información, consistencia y accesibilidad de AE tras derivación urgente. Sin embargo, emergieron problemas relacionados con el acceso no urgente y cambios en prescripciones, y en dos redes la inadecuación clínica de las derivaciones entre ambos niveles. Se identificaron los siguientes factores relacionados: 1) organizativos: facilitan la coordinación, la existencia de mecanismos de transferencia de información, de comunicación y de acceso rápido, y la proximidad física que promueve actitudes positivas a la colaboración; la obstaculizan el tiempo insuficiente para el uso de mecanismos, incentivos no compartidos en la prescripción y, en dos redes, un cambio del modelo organizativo; 2) relacionados con los profesionales: habilidades clínicas y actitudes frente a la coordinación. Conclusiones: Aunque los médicos perciben que la atención entre niveles está coordinada, también señalan problemas. Los factores identificados muestran hacia dónde dirigir los esfuerzos organizativos para su mejora

Risk classification of patients referred to secondary care for low back pain.

BACKGROUND: Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories. METHODS: An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen's Kappa coefficient, Pearson's r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool. RESULTS: A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ. CONCLUSION: The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.

Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking.

BACKGROUND: Temperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients. METHODS: We screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model. RESULTS: Poorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model. CONCLUSIONS: Possibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled.

Poor predictive value of lower gastrointestinal alarm features in the diagnosis of colorectal cancer in 1981 patients in secondary care.

BACKGROUND: Clinicians are advised to refer patients with lower gastrointestinal (GI) alarm features for urgent colonoscopy to exclude colorectal cancer (CRC). However, the utility of alarm features is debated. AIM: To assess whether performance of alarm features is improved by using a symptom frequency threshold to trigger referral, or by combining them into composite variables, including minimum age thresholds, as recommended by the National Institute for Health and Care Excellence (NICE). METHODS: We collected data prospectively from 1981 consecutive adults with lower GI symptoms. Assessors were blinded to symptom status. The reference standard to define CRC was histopathological confirmation of adenocarcinoma in biopsy specimens from a malignant-looking colorectal lesion. Controls were patients without CRC. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values were calculated for individual alarm features, as well as combinations of these. RESULTS: In identifying 47 (2.4%) patients with CRC, individual alarm features had sensitivities ranging from 11.1% (family history of CRC) to 66.0% (loose stools), and specificities from 30.5% (loose stools) to 75.6% (family history of CRC). Using higher symptom frequency thresholds improved specificity, but to the detriment of sensitivity. NICE referral criteria also had higher specificities and lower sensitivity, with PPVs above 4.8%. More than 80% of those with CRC met at least one of the NICE referral criteria. CONCLUSIONS: Using higher symptom frequency thresholds for alarm features improved specificity, but sensitivity was low. NICE referral criteria had PPVs above 4.8%, but sensitivities ranged from 2.2% to 32.6%, meaning many cancers would be missed.

Atenção secundária em saúde bucal em municípios de pequeno porte: uma avaliação transversal da demanda X acesso / Secondary attention to oral health in small municipalities: a cross-sectional evaluation of the demand X access

A Política Nacional de Saúde Bucal almeja garantir o direito ao acesso e a integralidade do cuidado em saúde bucal se organizando por meio de rede de atenção. Porém, a despeito da melhoria do acesso aos procedimentos de Atenção Primária, a implantação dos Centros de Especialidades Odontológicas (CEO) é lenta, desigual e os vazios assistenciais encontrados ainda definem a falta ou dificuldade de acesso aos procedimentos especializados em saúde bucal limitando a integralidade do cuidado. O presente estudo tem como objetivo conhecer a demanda e o acesso aos procedimentos especializados em Saúde Bucal em 10 municípios da região de Guanhães, Minas Gerais, que não possuem Centro de Especialidades Odontológicas. Com desenho transversal, a pesquisa foi realizada com 30 cirurgiões-cirurgião-dentistas (CD) da Atenção Primária que registraram todos os pacientes que foram atendidos no período de julho a novembro de 2016 que apresentaram necessidade de indicação para procedimentos especializados em saúde bucal. A análise descritiva foi desenvolvida no programa SPSS for Windows versão 18.0.A população nessa região é de 99.245 habitantes; a média do Índice de Desenvolvimento Humano Municipal é 0,618, a renda per capta mediana é de R$ 346,96 e a taxa de analfabetismo para indivíduos acima de 15 anos é de 19%. A média de cobertura da Estratégia de Saúde da Família é de 98,75% e a de Saúde Bucal, 94%. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (parecer1.615.701). Foram identificados 1085pacientes que apresentaram necessidade de indicação para procedimentos especializados em Saúde Bucal. A maioria era do sexo feminino (56,6%), com idade entre 13 e 34 anos (52,6%). Das especialidades avaliadas, 61% dos pacientes apresentaram necessidade de tratamento endodôntico, sendo que o dente mais acometido foi o primeiro molar permanente (26,4%) em pacientes entre 13 e 34 anos. A necessidade de prótese foi observada em 22,9% dos pacientes. Dos 836 pacientes efetivamente encaminhados, 96,6% foram encaminhados para a rede privada. Os desfechos foram registrados para 435 pacientes, sendo que 19,8% dos pacientes tiveram o procedimento especializado realizado na própria unidade de saúde e 45,5% dos pacientes foram submetidos à exodontia. Os dados encontrados mostram uma demanda alta para a especialidade de endodontia. Sem a opção de acesso ao tratamento especializado na rede pública (falta do CEO), muitos pacientes tiveram os dentes com essa indicação extraídos. A falta de registro do desfecho para a maioria dos pacientes aponta que a atenção primária em saúde bucal da região é limitada em seu papel de coordenar o cuidado e ordenar a rede. Para que a Política Nacional de Saúde Bucal possa contemplar especificidades de regiões como essa, sugere-se a ampliação do escopo de ação das equipes de saúde bucal na atenção primária ou da criação de serviços especializados de menor monta, a fim de garantir acesso a este nível em saúde bucal

The oral Health National Policy aims at ensuring the right to access and integrality to the oral health care organizing its self thrrought the care network. Howerer, despite the improvement to the access to procedures of Promary Care, the implementation of the Dental Specialties Centers is slow, unequal and the attendance voids seen still define the lack or difficulty in accessing specialized procedures in oral health limiting the care integrality...

Drug utilization review of cephalosporins in a secondary care hospital in United Arab Emirates.

Background Cephalosporins are one of the most commonly used antibiotics in United Arab Emirates (UAE). Few studies have been carried out to evaluate the antibiotic utilization pattern in UAE in spite of the obvious increase in cephalosporins resistance during the past decade. Objective To assess the prescriptions pattern of cephalosporins among physicians at a secondary care hospital in Ras Al Khaimah, UAE. Method This observational prospective study was carried out during October 2013 to April 2014. The data of in patients were documented in the predesigned patient profile form and was analyzed for patient's, drug's and drug's therapy related parameters. Results The 3rd generation cephalosporins constituted 83.6 % of the prescriptions, with ceftriaxone being the most commonly used one (81.1 %). They were mainly prescribed for the treatment of the lower respiratory tract infections (60.2 %). Seven (3.5 %) different ADRs linked to cephalosporin use were observed ranging from oral thrush to clostridium difficile infection. A total of 1039 antimicrobial and nonantimicrobial medications were prescribed concomitantly with cephalosporins. Conclusion The 3rd generation cephalosporins were commonly prescribed by parenteral route. Thus, there is a strong need for rationalizing their use to preserve their efficacy and prevent the development of resistance in the region.

Outcome of patients with dual diagnosis in secondary psychiatric care.

BACKGROUND: Dual diagnosis (DD) is a common co-morbidity of mental illness and substance use disorder (SUD) and patients with DD are prone to complications. Better knowledge on the outcome, mortality and management of patients with DD in usual secondary psychiatric care would help to inform improved treatment strategies in the future. AIMS: To explore the functional outcome and mortality of patients with DD receiving psychiatric treatment. To assess the recognition of substance use disorders (SUDs) in terms of diagnosis, and the associations of clinically diagnosed SUDs with treatment-related variables. METHODS: The sample of 330 patients was collected by screening all currently treated patients with the Alcohol Use Disorders Identification Test (AUDIT) and a question about other substances used. The inclusion criteria were AUDIT >7 and/or reported use of other substances during the preceding 12 months. The Global Assessment of Functioning scale was used to assess functional outcomes during a 2-year follow-up. Information concerning treatment and patient characteristics was collected retrospectively. RESULTS: Level of functioning remained stable among all study patients during follow-up. The mortality rate was not increased. Effective medication use was associated with improved functional outcomes. SUDs were underdiagnosed. A clinically diagnosed SUD seemed to have an impact on the regularity of appointments and the doses of prescribed medications. CONCLUSIONS: Given our results suggesting a stable level of functioning, patients with DD appear to be well managed within secondary psychiatric care. Attention should be paid to more precise diagnostics of SUDs and to effective use of medication.

The Impact of Small Spinal Curves in Adolescents Who Have Not Presented to Secondary Care: A Population-Based Cohort Study.

STUDY DESIGN: A prospective, population-based, birth cohort study. OBJECTIVE: The aim of this study was to identify whether there is any hidden burden of disease associated with smaller spinal curves. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis is present in 3% to 5% of the general population. Large curves are associated with increased pain and reduced quality of life. However, no information is available on the impact of smaller curves, many of which do not reach secondary care. METHODS: The Avon Longitudinal Study of Parents and Children (ALSPAC) recruited over 14,000 pregnant women from the Bristol area of South-West England between 1991 and 1992 and has followed up their offspring regularly. At age 15, presence or absence of spinal curvature ≥6 degrees in the offspring was identified using the validated dual-energy X-ray absorptiometry Scoliosis Measure on 5299 participants. At age 18, a structured pain questionnaire was administered to 4083 participants. Logistic regression was used to investigate any association between presence of a spinal curve at age 15 and self-reported outcomes at age 18 years. RESULTS: Full data were available for 3184 participants. Two hundred two (6.3%) had a spinal curve ≥6 degrees and 125 (3.9%) had a curve ≥10 degrees (median curve size of 11 degrees). About 46.3% reported aches and pains that lasted for a day or longer in the previous month. About 16.3% reported back pain. Those with spinal curves were 42% more likely to report back pain than those without (odds ratio 1.42, 95% confidence interval 1.00-2.02, P = 0.047). Those with spinal curves had more days off school and were more likely to avoid activities that caused their pain. CONCLUSION: Our results highlight that small scoliotic curves may be less benign than previously thought. Teenagers with small curves may not present to secondary care, but are nonetheless reporting increased pain, more days off school, and avoidance of activities. These data suggest that we should reconsider current scoliosis screening and treatment practices. LEVEL OF EVIDENCE: 2.

Análise do sistema de referência e contrarreferência da endodontia em um município da região metropolitana de Belo Horizonte, MG / System analysis and contrarreferência of Endodontics in a municipality of the metropolitan region of Belo Horizonte, MG

A avaliação nos serviços de saúde compreende a utilização de indicadores gerais de monitoramento dos serviços. A pesquisa avaliativa objetiva estudar o desempenho dos serviços e produzir recomendações que orientem soluções para os problemas identificados. As avaliações de serviços em atenção secundária em saúde bucal no Brasil estão em fase incipiente de construção de evidências, sobretudo após a implantação dos Centros de Especialidades Odontológicas. Este estudo teve como objetivo analisar o processo de referência e contrarreferência entre a Atenção Primária e a Atenção Secundária no serviço de Endodontia do CEO do município de Contagem, Minas Gerais e subsidiar o aperfeiçoamento do protocolo de encaminhamento para o serviço. Foram coletados dados secundários, dos sistemas de informação municipais, bem como de prontuários contidos nos arquivos do CEO em estudo, relativos ao universo dos 512 pacientes atendidos entre 2009 e 2014. Falhas nos registros impediram a verificação do tempo médio de espera pela primeira consulta. O tempo médio decorrido entre a primeira consulta e a conclusão do tratamento foi em média de 3,12 meses. Houve maior frequência relativa dos indivíduos oriundos das regiões administrativas municipais onde há maior população e maior número de unidades básicas de saúde. Houve números bastante semelhantes entre dentes uni radiculares e não uni radiculares tratados. Grande número de pacientes chegou ao serviço de endodontia do CEO apresentando dentes já sem possibilidade de tratamento. Foram gerados dados que pudessem subsidiar a renovação do protocolo de funcionamento vigente para o serviço estudado

The evaluation of health services may use both general service monitoring indicators and evaluation research, which aims at studying service performance and its enhancement through problem solving. The evaluation of secondary level oral health services in Brazil is incipient in evidence construction, hence after the creation of the CEO. This study aimed at analyzing the referral system between primary health care and the endodontics secondary level care from the CEO of the city of Contagem, Minas Gerais, searching for the enhancement of the existing referral protocol. Secondary data were collected from the city´s data systems as well as from service´s files, regarding all 512 patients who attended it between 2009 and 2014. Register flaws prevented the determination of mean waiting time before first appointment. Mean time between first appointment and treatment conclusion was 3.12 months. There was higher frequency of individuals from those city´s administrative regions with higher population and more availability of primary health care units. Similar proportions of single and non-single rooted teeth were treated. Great proportions of teeth reached CEO´s endodontics service without possible treatment. Data were generated to supply the renovation of the present service referral protocol

The UK National Health Service: delivering equitable treatment across the spectrum of coronary disease.

BACKGROUND: Social gradients in cardiovascular mortality across the United Kingdom may reflect differences in incidence, disease severity, or treatment. It is unknown whether a universal healthcare system delivers equitable lifesaving medical therapy for coronary heart disease. We therefore examined secular trends in the use of key medical therapies stratified by socioeconomic circumstances across a broad spectrum of coronary disease presentations, including acute coronary syndromes, secondary prevention, and clinical angina. METHODS AND RESULTS: This was a cross-sectional observational analysis of nationally representative primary and secondary care data from the United Kingdom. Data on treatments for all myocardial infarction patients in 2003 and 2007 were derived from the Myocardial Ischemia National Audit Project (n=51 755). Data on treatments for patients with chronic angina (n=33 211) or requiring secondary prevention (n=32 976) in 1999 and 2007 were extracted from the General Practice Research Database. Socioeconomic circumstances were defined using a weighted composite of 7 area-level deprivation domains. Treatment estimates were age-standardized. Use of all therapies increased in all patient groups, both men and women. Improvements were most marked in primary care, where use of ß-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for secondary prevention and treatment of angina doubled, from ≈30% to >60%. Small age gradients persisted for some therapies. No consistent socioeconomic gradients or sex differences were observed for myocardial infarction and postrevascularization (hard diagnoses). However, some sex inequality was apparent in the treatment of younger women with angina. CONCLUSIONS: Cardiovascular treatment is generally equitable and independent of socioeconomic circumstances. Future strategies should aim to further increase overall treatment levels and to eradicate remaining age and sex inequalities.

The increasing secondary care burden of idiopathic pulmonary fibrosis: hospital admission trends in England from 1998 to 2010.

BACKGROUND: The lack of mandatory clinical registries for idiopathic pulmonary fibrosis (IPF) has meant a reliance on routine clinical data to provide trends in disease incidence. Death certificate and primary care data suggest that the incidence of IPF has increased in the United Kingdom at a rate of approximately 5% per year, but due to possible concerns about the diagnostic validity of these clinical datasets, it is helpful also to analyze data from secondary care. We used national secondary care data to determine trends in hospital admissions for IPF clinical syndrome (IPF-CS) in England between 1998 and 2010. METHODS: We obtained the annual number of hospital admissions for all National Health Service (NHS) hospital trusts in England for the International Classification of Diseases and Related Health Problems, 10th Revision codes J84.1 and J84.9 between 1998 and 2010. We calculated annual admission-rate ratios, adjusting for age and sex, using Poisson regression. We also investigated changes in age at admission and length of stay, and we estimated hospitalization costs. RESULTS: The number of hospital admissions from IPF-CS increased at an annual rate of approximately 5%, from 5,524 patients in 1998 to 9,525 patients in 2010, and was highest in men and the older population. Mean age at admission increased from 66 to 71 years, while length of stay decreased by 2.1 days during the same period. CONCLUSIONS: Hospital admissions for IPF-CS in England follow a similar trend to other data sources in the United Kingdom . This has resulted in escalating costs of inpatient care, which is a significant financial burden on health-care resources.

Não comparecimentos às primeiras consultas odontológicas na atenção secundária em um município mineiro de grande porte / No-shows to the first scheduled dental appointments for secondary care in a large Minas Gerais city

O não comparecimento de usuários a consultas agendadas, especificamente aquele relativo à atenção secundária odontológica em Belo Horizonte, não é problema recente, representando impactos à saúde, prejuízos à resolutividade e integralidade do cuidado, além de custos desnecessários ao sistema. O presente estudo, por meio do método quantitativo, visou à identificação e análise de possíveis fatores associados aos não comparecimentos, em 2011, às primeiras consultas odontológicas agendadas de usuários residentes em Belo Horizonte, pertencentes a ambos os sexos, com idade igual ou superior a 18 anos referenciados, a partir da atenção primária, para as especialidades odontológicas cirurgia, endodontia, periodontia e disfunção têmporo-mandibular, no Centro de Especialidades Odontológicas (CEO) Centro-Sul. Foi utilizada pesquisa em base de dados secundários do Sistema de Regulação da Secretaria Municipal de Saúde da Prefeitura de Belo Horizonte(SMSA/PBH). A variável dependente foi o "não comparecimento" à primeira consulta agendada e as variáveis independentes analisadas foram: idade, tempo na fila de espera, sexo, distrito sanitário de origem e especialidade para a qual o usuário foi referenciado. Foram utilizados os testes de Mann-Whitney e qui-quadrado de Pearson para análise bivariada e regressão de Poisson com variância robusta para análise multivariada. Os testes foram conduzidos com um nível de significância de 5% e intervalo de confiança de 95%. Entre as 6.428 primeiras consultas odontológicas agendadas para 2011, nas quatro especialidades selecionadas para análise, 32,9% não foram realizadas em função da ausência do usuário...

Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives.

Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.

Análise dos serviços de atenção secundária na especialidade de endodontia de municípios de Minas Gerais: percepções de usuários e endodontistas / Analysis of the secondary care services in endodontics of Minas Gerais cities: patients and progessional perceptions

O processo de avaliação dos serviços é uma ferramenta importante da gestão, na evolução e construção do SUS, norteando-lhe o planejamento, auxiliando-o na tomada de decisões. Na Endodontia, a introdução dos instrumentos rotatórios de níquel-titãnio facilitou o preparo e a limpeza do sistema de canais radiculares, em menor tempo e com maior eficiência clínica. Possibilitou melhor qualidade nas obturações dos canais radiculares, e menor fadiga tanto para os pacientes quanto para os profissionais, permitindo-lhes assistir a um maior número de indivíduos com alta qualidade técnica...

La actividad quirúrgica urgente en un servicio de cirugía general en un hospital de segundo nivel ¿Hay diferencias cuantitativas entre hospitales de distinto nivel? / Urgent surgical activity in a general surgery department in a second level hospital. There are differences between different level hospitals?

INTRODUCCIÓN. Se muestra la actividad quirúrgica realizada durante la atención continuada en un Servicio de Cirugía General. Los objetivos son conocer la actividad quirúrgica urgente, la efectividad y calidad de la misma y la comparación con un hospital de mayor nivel de la misma comunidad autónoma. MATERIAL Y MÉTODO. Estudio clínico prospectivo de 105 pacientes intervenidos durante la guardia de presencia física (mismo cirujano) en el Servicio de Cirugía General y del Aparato Digestivo del Hospital “Virgen de la Luz”, hospital de 2º nivel, en un periodo de 12 meses (año 2006-2007). RESULTADOS. 80 guardias (51 diarias y 29 festivos). 105 intervenciones (87,62% primeras 24 horas). 102 pacientes (96% hospitalizados).Edad media 48,46 años (± 24,37): 47,06% entre 31 y 70 años. 109 procedimientos: Apendicectomía (27,52%), patología anorrectal (11,93%), hernioplastia inguino-crural (10,09%), colecistectomía (6,42%) y amputación de extremidad (5,50%).Promedio 1,31 (± 0,17) intervenciones/día. Promedio 94,23 ± 61,89 minutos/intervención. Inicio de 10 a 14 horas (34,29%)y de 17 a 21 horas (34,29%). 63,81% anestesia general. 83,81% a reanimación. El 10,55% del tiempo en quirófano. 0% mortalidad. CONCLUSIONES. Las intervenciones intraabdominales, y la apendicectomía en particular, son las más frecuentes, con predominio en personas mayores de 61 años y la mayor actividad los jueves, con unos indicadores de efectividad y calidad excelentes. Al comparar, hay diferencias cuantitativas entre hospitales de distinto nivel (AU)

INTRO. We are showing about surgical activity taking place during on going care activity in a General Surgery Department. Our purposes are to know the activity of urgent surgery, the effectivity and quality and comparison with other high level hospital. MATERIALS AND METHOD. Clinical prospective study of 105 patients having surgery during off-hours activity (same surgeon)performed by General Surgery and Digestive Systems doctors from Hospital “Virgen de la Luz”, Cuenca, a 2nd level hospital, during 12 months (years 2006-2007). RESULTS. 80 shifts (51 daily and 29 holidays). 105 instances (87,62% first24 hours). 102 patients (96% admitted). Average age 48,46 years old (±24,37): 47,06% between 31-70 years. 109 procedures: Appendectomies (27,52%), anorectal pathology (11,93%), wall pathology (10,09%), colecistectomy (6,42%) andextremity amputation (5,50%). Average 1,31 (±0,17) instances/day. Average time 94,23±61,89 minutes/instance. Beginningfrom 10 am to 14 pm (34,29%) and from 17 pm to 21 pm (34,29%). 63,81% under general anaesthesia. 83,81% recovery room. Surgery room time 10,55%. 0% deaths. CONCLUSIONS. Main incidence intra-abdominal surgery, and appendectomy specifically, with prevalence in older than 61 years and biggest activity on thursday. Excellent indicator of efficiency and quality. There are quantitatives differences between different level hospitals to compare (AU)