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1.
BMC Public Health ; 19(1): 1366, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651288

RESUMO

BACKGROUND: Many studies have reported the impact of air pollution on cardiovascular disease (CVD), but few of these studies were conducted in severe haze-fog areas. The present study focuses on the impact of different air pollutant concentrations on daily CVD outpatient visits in a severe haze-fog city. METHODS: Data regarding daily air pollutants and outpatient visits for CVD in 2013 were collected, and the association between six pollutants and CVD outpatient visits was explored using the least squares mean (LSmeans) and logistic regression. Adjustments were made for days of the week, months, air temperature and relative humidity. RESULTS: The daily CVD outpatient visits for particulate matter (PM10 and PM2.5), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) in the 90th-quantile group were increased by 30.01, 29.42, 17.68, 14.98, 29.34%, and - 19.87%, respectively, compared to those in the <10th-quantile group. Odds ratios (ORs) and 95% confidence intervals (CIs) for the increase in daily CVD outpatient visits in PM10 300- and 500-µg/m3, PM2.5 100- and 300-µg/m3 and CO 3-mg/m3 groups were 2.538 (1.070-6.020), 7.781 (1.681-36.024), 3.298 (1.559-6.976), 8.72 (1.523-49.934), and 5.808 (1.016-33.217), respectively, and their corresponding attributable risk percentages (AR%) were 60.6, 87.15, 69.68, 88.53 and 82.78%, respectively. The strongest associations for PM10, PM2.5 and CO were found only in lag 0 and lag 1. The ORs for the increase in CVD outpatient visits per increase in different units of the six pollutants were also analysed. CONCLUSIONS: All five air pollutants except O3 were positively associated with the increase in daily CVD outpatient visits in lag 0. The high concentrations of PM10, PM2.5 and CO heightened not only the percentage but also the risk of increased daily CVD outpatient visits. PM10, PM2.5 and CO may be the main factors of CVD outpatient visits.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Doenças Cardiovasculares/terapia , Ambulatório Hospitalar/estatística & dados numéricos , Adulto , Idoso , Monóxido de Carbono/efeitos adversos , Monóxido de Carbono/análise , Doenças Cardiovasculares/epidemiologia , China/epidemiologia , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dióxido de Nitrogênio/efeitos adversos , Dióxido de Nitrogênio/análise , Ozônio/efeitos adversos , Ozônio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Dióxido de Enxofre/efeitos adversos , Dióxido de Enxofre/análise , Adulto Jovem
2.
West Afr J Med ; 36(3): 246-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622487

RESUMO

BACKGROUND AND OBJECTIVE: Disclosure of human immuno-deficiency virus (HIV) sero-status is a difficult process that involves communication of information about a potentially stigmatizing and transmissible illness. Despite this, it is important for preventing HIV infection and mitigating its impacts. This study aimed to assess the rate and determinants of self-disclosure of HIV sero-status among people living with HIV/AIDS (PLHIV) attending an Antiretroviral Therapy (ART) Clinic in North Central Nigeria with a view to promoting self- disclosure as an intervention for secondary prevention of HIV/AIDS. METHODS: It was a cross-sectional study involving 325 consenting adults aged 18 to 65 years PLHIV attending ART clinic who were recruited using systematic random sampling method. Data collected from the participants include socio-demographic data and medical history. The rate and factors affecting self-disclosure of HIV sero-status were obtained by using a structured interviewer-administered questionnaire. Data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 Results: Most of the participants (66.2%) were females. 96% of the participants had disclosed their HIV sero-status. Self-disclosure of HIV sero-status had statistically significant association with age (c2 = 12.614; p = 0.027) and gender (c2 = 4.638; p = 0.031). CONCLUSION: Self-disclosure of HIV sero-status was high among the participants. Being female and within 15-44 year age group were statistically significant factors associated with disclosure of HIV sero-status. Multiple counselling sessions are needed to improve disclosure particularly in males and older PLHIV as self-disclosure of HIV sero-status is a process that requires ongoing support and encouragement.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Revelação da Verdade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Idoso , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Parceiros Sexuais , Centros de Atenção Terciária , Adulto Jovem
3.
Am J Health Syst Pharm ; 76(16): 1248-1253, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369117

RESUMO

PURPOSE: Results of a study to determine the proportion of anticoagulation clinic workload that could be performed by clinical pharmacy technicians (CPTs) and the potential impact on operational efficiency of pharmacist-managed anticoagulation clinics (ACCs) are reported. METHODS: In a quality improvement project involving 11 Veterans Affairs (VA) medical centers, investigators conducted a 3-day time study in pharmacist-managed ACCs followed by scoring of task appropriateness for CPTs via the RAND/UCLA appropriateness method by the VA Anticoagulation Subject Matter Expert (SME) Workgroup. The primary outcome was the percentage of tasks deemed appropriate for a CPT to perform. RESULTS: The Anticoagulation SME Workgroup determined that a wide variety of mainly administrative ACC tasks could be completed by a CPT. At the 11 VA ACCs, an average of 53.4% (range, 39.9-76.1%) of tasks being performed by pharmacists were deemed appropriate for CPTs. The average percentage of total clinic time associated with performing tasks appropriate for a CPT equated to an estimated 1,111 hours per year. Shifting that portion of the annual work hours to a CPT could potentially result in cost avoidance of $55,302. CONCLUSION: At the ACCs evaluated, a significant proportion of tasks (53.4% on average) may be appropriate to assign to CPTs to improve the operational efficiency of these clinics. This finding supports development of business plans for the addition of CPTs in ACCs along with elements to inform crafting of an effective template for ACC structure, including clearly defined CPT roles.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/prevenção & controle , Hemorragia/prevenção & controle , Ambulatório Hospitalar/organização & administração , Técnicos em Farmácia/organização & administração , Transtornos da Coagulação Sanguínea/sangue , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Eficiência Organizacional , Hemorragia/sangue , Hemorragia/induzido quimicamente , Hospitais de Veteranos/organização & administração , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Coeficiente Internacional Normatizado , Ambulatório Hospitalar/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Técnicos em Farmácia/estatística & dados numéricos , Papel Profissional , Avaliação de Programas e Projetos de Saúde , Varfarina/uso terapêutico , Carga de Trabalho/estatística & dados numéricos
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 686-691, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238620

RESUMO

Objective: To explore the short-term effects of ambient PM(2.5) on the outpatient visits of chronic obstructive pulmonary disease (COPD) in Ningbo city. Methods: Through the regional health information platform, number of daily COPD outpatients from the four general hospitals in Ningbo was gathered. Related data on meteorological and air pollution from 2014 to 2016 was also collected. Generalized additive model (GAM) of Possion regression was used to estimate the impact of PM(2.5) pollution on COPD outpatients and the lagging effects. Results: In cold (November- April) or warm seasons (May-October), an 10 µg/m(3) increase of PM(2.5) would result in the excessive number of COPD outpatients as 1.87% (95%CI: 0.98%-2.76%), 2.09% (95%CI: 1.11%-3.08%) and 2.56% (95%CI: 0.56%-4.59%), respectively. In terms of the short-term effects of PM(2.5) the strongest was seen in the days of warm season but without delay (P<0.05). The strongest effect appeared at day 4 in cold season and the effect was particularly significant seen in the over 65 year-old group or in the female population. After the introduction of PM(10), SO(2) and NO(2), the concentration of PM(2.5), did not show significant effect on the number of hospital visits due to COPD on the same day (P>0.05). The effect of COPD on the fourth day showed a slight change after the lagging, and the effect was statistically significant (P<0.05). Conclusion: The increase of PM(2.5) concentration in Ningbo was related to the increase of COPD outpatient numbers. Effective prevention measures should be taken to protect the vulnerable population and to reduce the risk of COPD.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Ambulatório Hospitalar/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Material Particulado/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/etiologia , Idoso , Poluição do Ar/estatística & dados numéricos , Assistência Ambulatorial , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/epidemiologia , População Urbana
6.
BMC Health Serv Res ; 19(1): 386, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200720

RESUMO

BACKGROUND: Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases. METHODS: We conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect. RESULTS: During the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate. CONCLUSIONS: Patients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk. TRIAL REGISTRATION: This study was approved by the Danish Data Protection Agency (Project ID 18/35695 ).


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doença Crônica/terapia , Pacientes não Comparecentes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Estudos de Coortes , Dinamarca , Feminino , Hospitais/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Fatores de Risco
7.
Med. infant ; 26(2): 130-139, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015635

RESUMO

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)


Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease


Assuntos
Humanos , Adolescente , Ambulatório Hospitalar/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Transferência de Pacientes/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/organização & administração , Cardiopatias Congênitas/terapia , Estudos Retrospectivos , Estudo Observacional
8.
Congenit Heart Dis ; 14(5): 726-734, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31070866

RESUMO

OBJECTIVE: To determine the prevalence and predictors of nonattendance in an ACHD outpatient clinic, and to examine the relationship between nonattendance and emergency department (ED) visits, hospitalizations, and death. METHODS: Patients ≥ 18 years who had scheduled appointments at an ACHD outpatient clinic between August 1, 2014 and December 31, 2014 were included. The primary outcome of interest was nonattendance of the first scheduled appointment of the study period, defined as "no-show" or "same-day cancellation." Secondary outcomes of interest were ED visits, hospitalizations, and death until December 2017. RESULTS: Of 527 scheduled visits, 55 (10.4%) were nonattended. Demographic and socioeconomic characteristics such as race, income, and insurance type were associated with non-attendance (all P values < .05), whereas age, gender, and disease complexity were not. On multivariable analysis, predictors of nonattendance were black race (adjusted odds ratio [AOR] 4.95; P < .001), other race (AOR 3.54; P = .003), and history of no-show in the past (AOR 4.95; P < .001). Compared to patients who attended clinic, patients with a nonattended visit had a threefold increased odds of multiple ED visits and a significantly lower rate of ED-free survival over time. There were no significant differences in hospitalizations or death by attendance. CONCLUSIONS: ACHD clinic nonattendance is associated with race and prior history of no-show, and may serve as a marker of higher ED utilization for patients with ACHD.


Assuntos
Agendamento de Consultas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Cardiopatias Congênitas/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Cardiopatias Congênitas/terapia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Adulto Jovem
9.
J Surg Res ; 242: 193-199, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31085367

RESUMO

BACKGROUND: We sought to understand the challenges in accessing pediatric surgical care in the context of the "three delays" model at the Pediatric Surgery Outpatient Clinic (PSOPC) at a tertiary hospital in Kampala, Uganda. MATERIALS AND METHODS: An outpatient database was established at the weekly PSOPC. A survey regarding prior healthcare visits and barriers to care was additionally administered to clinic patients and inpatients. RESULTS: Patients first sought healthcare a median of 56 d before the current visit to the PSOPC. A majority (52%) of patients first sought care at another health facility, and 17% of those surveyed had presented to the PSOPC three or more times for their current medical issue. Of 240 patients with a new issue or due for their next surgery, 10% were admitted to the ward, with only 54% receiving definitive care. Included in the most commonly needed surgeries for PSOPC patients were herniotomy (16% inguinal; 14.9% umbilical), orchiopexy (6.3%), posterior sagittal anorectoplasty (6.3%), and colostomy closure (4.4%), with the range of patient ages at the time of presentation reflecting delays in care. Patient expenditures associated with travel to the hospital showed inpatients coming from significantly further away, with higher costs of travel and need to borrow or sell assets to cover travel costs, when compared with PSOPC patients. CONCLUSIONS: Patients face significant delays in accessing and receiving definitive surgical care. Associated burdens associated with these delays place patients at risk for catastrophic health expenditures. Infrastructure and capacity development are necessary for improvement in pediatric surgical care.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Ambulatório Hospitalar/organização & administração , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Tempo para o Tratamento/organização & administração , Adolescente , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/economia , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Ambulatório Hospitalar/economia , Ambulatório Hospitalar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Fatores Socioeconômicos , Procedimentos Cirúrgicos Operatórios/economia , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento/economia , Tempo para o Tratamento/estatística & dados numéricos , Uganda
10.
PLoS One ; 14(4): e0215697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022236

RESUMO

BACKGROUND: BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS: This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6-14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians' identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS: A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians' correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians-25% as compared to family medicine physicians-10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category-6% [p = 0.007]. CONCLUSION: Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Obesidade/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Sobrepeso/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Peso Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/organização & administração , Registros Médicos/estatística & dados numéricos , Obesidade/diagnóstico , Ambulatório Hospitalar/organização & administração , Sobrepeso/diagnóstico , Padrões de Prática Médica/organização & administração , Prevalência , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Centros de Atenção Terciária
11.
J Surg Res ; 241: 57-62, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31009886

RESUMO

INTRODUCTION: Nonmedical opioid use is a major public health problem. There is little standardization in opioid-prescribing practices for pediatric ambulatory surgery, which can result in patients being prescribed large quantities of opioids. We have evaluated the variability in postoperative pain medication given to pediatric patients following routine ambulatory pediatric surgical procedures. METHODS: Following IRB approval, pediatric patients undergoing umbilical hernia repair, inguinal hernia repair, hydrocelectomy, and orchiopexy from 2/1/2017 to 2/1/2018 at our tertiary care children's hospital were retrospectively reviewed. Data collected include operation, surgeon, resident or fellow involvement, utilization of preoperative analgesia, opioid prescription on discharge, and patient follow-up. RESULTS: Of 329 patients identified, opioids were prescribed on discharge to 37.4% of patients (66.3% of umbilical hernia repairs, 20.6% of laparoscopic inguinal hernia repairs, and 33.3% of open inguinal hernia repairs [including hydrocelectomies and orchiopexies]). For each procedure, there was large intrasurgeon and intersurgeon variability in the number of opioid doses prescribed. Opioid prescription ranged from 0 to 33 doses for umbilical hernia repairs, 0 to 24 doses for laparoscopic inguinal repairs, and 0 to 20 doses prescribed for open inguinal repairs, hydrocelectomies, and orchiopexies. Pediatric surgical fellows were less likely to discharge a patient with an opioid prescription than surgical resident prescribers (P < 0.01). In addition, surgical residents were more likely to prescribe more than twelve doses of opioids than pediatric surgical fellows (P < 0.01). Increasing patient age was associated with an increased likelihood of opioid prescription (P < 0.01). There were two phone calls and two clinic visits for pain control issues with equal numbers for those with and without opioid prescriptions. CONCLUSIONS: There is significant variation in opioid-prescribing practices after pediatric surgical procedures; increased awareness may help minimize this variability and reduce overprescribing. Training level has an impact on the frequency and quantity of opioids prescribed.


Assuntos
Analgésicos Opioides/uso terapêutico , Ambulatório Hospitalar/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Herniorrafia/efeitos adversos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , /prevenção & controle , Orquidopexia/efeitos adversos , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Hidrocele Testicular/cirurgia , Estados Unidos/epidemiologia
12.
BMC Dermatol ; 19(1): 5, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961561

RESUMO

BACKGROUND: Epidemiological studies to determine the pattern of skin diseases among children are important for proper health care planning and management. The purpose of this study was to describe the pattern of skin diseases among pediatric patients seen at a dermatology outpatient clinic of Wolaita Sodo Teaching and Referral Hospital, southern Ethiopia. METHOD: We conducted a retrospective hospital-based, cross-sectional study between January 2016 and December 2017 at a teaching and referral hospital dermatology outpatient department. All children younger than 15 years presenting with newly-diagnosed skin diseases were included. Diagnosis was mainly made clinically, with some laboratory support. RESULTS: A total of 1704 children with 1869 new skin diagnoses were included, of whom 139 (8.2%) had more than one disease. Of the children, 52.4% were males and 44.9% within the age-group 5-10 years. Eczematous dermatitis accounted for the largest group (23.9%, n = 447) of skin conditions followed by bacterial infections (21.3%, n = 398), fungal infections (18.8%, n = 351) and infestations (9.9%, n = 185). Seasonal variation was demonstrated, with eczematous conditions and bacterial infections being higher during autumn and winter. CONCLUSION: Overall, eczema, bacterial and fungal infections were the three major pediatric skin diseases occurring among children attending this hospital's outpatient department. There was seasonal variation in some of the skin diseases. This study gives a snapshot of skin disorders presenting to hospital in children in southern Ethiopia and may help to plan dermatology service expansion, educational programs and preventive measures.


Assuntos
Dermatopatias/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Ambulatório Hospitalar/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos
13.
Int J Dermatol ; 58(11): 1311-1316, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30892698

RESUMO

BACKGROUND: Vulvar complaints are among the most frequent causes for a woman to visit a healthcare provider. The diseases of this area of the body may be a challenge to diagnose. In this study, we assess epidemiologic and clinical data of patients in an outpatient vulvar clinic in the dermatology department of a tertiary hospital. METHODS: We performed an observational retrospective study of patients who attended our consultation service for vulvar diseases at the Dermatology Division at Hospital das Clínicas da Faculdade de Medicina da USP during a 4-year period. Data were obtained by patient medical records and by phone. RESULTS: During the 4-year period under study, a total of 136 patients were treated in the outpatient service specialized in vulvar care. All patients were included in the study. The most frequent diagnoses were lichen sclerosus et atrophicus (64.7%), lichen planus (8.8%), and vitiligo (8%). We registered that 26.7% of the patients showed extravulvar involvement. CONCLUSIONS: Women with vulvar diseases need specific care, considering not only genital aspects but also all skin changes. In this context, the dermatologist is a very well trained professional to take good and complete care of these patients. However, ideally vulvar clinics should have a multidisciplinary team.


Assuntos
Ambulatório Hospitalar/estatística & dados numéricos , Pele/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Vulva/patologia , Doenças da Vulva/epidemiologia , Adolescente , Adulto , Idoso , Biópsia , Feminino , Humanos , Líquen Plano/diagnóstico , Líquen Plano/epidemiologia , Líquen Plano/patologia , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso e Atrófico/epidemiologia , Líquen Escleroso e Atrófico/patologia , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Vitiligo/diagnóstico , Vitiligo/epidemiologia , Vitiligo/patologia , Doenças da Vulva/diagnóstico , Doenças da Vulva/patologia , Adulto Jovem
14.
Int J Health Plann Manage ; 34(2): e1257-e1271, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30901132

RESUMO

BACKGROUND: Because of increasing demand, hospitals in England are currently under intense pressure resulting in shortages of beds, nurses, clinicians, and equipment. To be able to effectively cope with this demand, the management needs to accurately find out how many patients are expected to use their services in the future. This applies not just to one service but for all hospital services. PURPOSE: A forecasting modelling framework is developed for all hospital's acute services, including all specialties within outpatient and inpatient settings and the accident and emergency (A&E) department. The objective is to support the management to better deal with demand and plan ahead effectively. METHODOLOGY/APPROACH: Having established a theoretical framework, we used the national episodes statistics dataset to systematically capture demand for all specialties. Three popular forecasting methodologies, namely, autoregressive integrated moving average (ARIMA), exponential smoothing, and multiple linear regression were used. A fourth technique known as the seasonal and trend decomposition using loess function (STLF) was applied for the first time within the context of health-care forecasting. RESULTS: According to goodness of fit and forecast accuracy measures, 64 best forecasting models and periods (daily, weekly, or monthly forecasts) were selected out of 760 developed models; ie, demand was forecasted for 38 outpatient specialties (first referrals and follow-ups), 25 inpatient specialties (elective and non-elective admissions), and for A&E. CONCLUSION: This study has confirmed that the best demand estimates arise from different forecasting methods and forecasting periods (ie, one size does not fit all). Despite the fact that the STLF method was applied for the first time, it outperformed traditional time series forecasting methods (ie, ARIMA and exponential smoothing) for a number of specialties. PRACTISE IMPLICATIONS: Knowing the peaks and troughs of demand for an entire hospital will enable the management to (a) effectively plan ahead; (b) ensure necessary resources are in place (eg, beds and staff); (c) better manage budgets, ensuring enough cash is available; and (d) reduce risk.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Previsões/métodos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Modelos Estatísticos , Ambulatório Hospitalar/estatística & dados numéricos , Ambulatório Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Reino Unido
15.
Saudi Med J ; 40(2): 158-167, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30723861

RESUMO

OBJECTIVES: To investigate the period prevalence and risk factors for clinically important prescription and monitoring errors among adults managed in community care in Saudi Arabia (SA). METHODS: This retrospective cohort study used electronic health record (HER) data. A random sample comprising of 2,000 adults (≥18 years old) visiting Family Medicine clinics in King Faisal Specialist Hospital and Research Center (KFSH & RC), Riyadh, SA, was selected. Data collection took 3 months (October December 2017).  Descriptive analyses and logistic regression modeling were performed using STATA (version 14) statistical software. Results: The overall period prevalence of medication errors over 15 months was 8.1% (95% confidence interval [CI] 6.5-9.7). Risk factors that significantly predicted overall risk of patients experiencing one or more medication errors were: age ≥65 years, male gender, Saudi nationality, and polypharmacy (defined as the concurrent use of ≥5 drugs). CONCLUSIONS: Clinically important medication errors were commonly observed in relation to both drug prescription and monitoring.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Prevalência , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Fatores Sexuais , Adulto Jovem
16.
Med J Aust ; 210(7): 321-325, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30773636

RESUMO

OBJECTIVES: To compare the outcomes and safety of a rapid access chest pain clinic (RACPC) in Australia with those of a general cardiology clinic. DESIGN: Prospective comparison of the outcomes for patients attending an RACPC and those of historical controls. SETTING: Royal Hobart Hospital cardiology outpatient department. PARTICIPANTS: 1914 patients referred for outpatient evaluation of new onset chest pain (1479 patients seen in the RACPC, 435 patients previously seen in the general cardiology clinic). MAIN OUTCOME MEASURES: Service outcomes (review times, number of clinic reviews); adverse events (unplanned emergency department re-attendances at 30 days and 12 months; major adverse cardiovascular events at 12 months, including unplanned revascularisation, acute coronary syndrome, stroke, cardiac death). RESULTS: Median time to review was shorter for RACPC than for usual care patients (12 days [IQR, 8-15 days] v 45 days [IQR, 27-89 days]). All patients seen in the RACPC received a diagnosis at the first clinic visit, but only 139 patients in the usual care group (32.0%). There were fewer unplanned emergency department re-attendances for patients in the RACPC group at 30 days (1.6% v 4.4%) and 12 months (5.7% v 12.9%) than in the control group. Major adverse cardiovascular events were less frequent among patients evaluated in the RACPC (0.2% v 1.4%). CONCLUSIONS: Patients were evaluated more efficiently in the RACPC than in a traditional cardiology clinic, and their subsequent rates of emergency department re-attendances and adverse cardiovascular events were lower.


Assuntos
Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ambulatório Hospitalar/estatística & dados numéricos , Clínicas de Dor/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Dor no Peito/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta , Fatores de Tempo , Vitória/epidemiologia
17.
Female Pelvic Med Reconstr Surg ; 25(2): 109-112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807410

RESUMO

BACKGROUND: An estimated 4% to 6.6% of women delivering vaginally sustain obstetrical anal sphincter injuries (OASI). Despite this, a gap exists in the provision of postpartum care to women globally. Given the negative impact of OASI, action is needed, and multidisciplinary perineal clinics can help. Consequently, such a clinic was established in 2011 at the Royal Alexandra Hospital (RAH), a tertiary care center in Edmonton, Alberta. OBJECTIVE: This study assesses the state of perineal clinics specializing in OASI internationally and locally by investigating the literature for descriptions of specialized perineal clinics for women with OASI, describing the RAH perineal clinic, and assessing the prevalence of OASI at the RAH in the context of the clinic. METHODS: A search of peer-reviewed literature was conducted on Medline and observations and interviews of RAH perineal clinic staff were conducted, as was a medical chart review. RESULTS: Articles describing only 10 perineal clinics specializing in OASI were found, with varying structures. The multidisciplinary RAH clinic, like one other clinic, has a strong physiotherapy focus, with education and Pilates classes and one-on-one appointments offered by pelvic floor physiotherapists. In 2016, of the 326 (6.9%) vaginal deliveries that resulted in OASI at the RAH, only 66.0% (215) were referred to the clinic. CONCLUSIONS: Multidisciplinary perineal clinics are needed globally. Despite the creation of the perineal clinic at the RAH, women continue to lack specialized care after OASI. It is crucial that healthcare professionals specializing in OASI share their experiences to establish best practices and create new, and improve existing, perineal clinics.


Assuntos
Canal Anal/lesões , Lacerações/reabilitação , Ambulatório Hospitalar/estatística & dados numéricos , Períneo/lesões , Alberta , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Modalidades de Fisioterapia , Cuidado Pós-Natal , Encaminhamento e Consulta/estatística & dados numéricos
18.
BMC Res Notes ; 12(1): 87, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764864

RESUMO

OBJECTIVE: The objective of the research is to measure prevalence of hypertension and associated factors adult outpatient clients in Addis Ababa, Ethiopia. RESULTS: A total of 487 participants were included in the study. The prevalence of hypertension was (34.7%), 95% CI (30.6-38.8), of them 53.8 were Male and 46.2% were female. Among 169 participants identified as having high blood pressure, 131 (66.5%) were aware of their blood pressure, from those 96 (48.7%) of them were receiving antihypertensive medication. Mean elevated systolic blood pressure was 124.7 ± 20 (SD) and diastolic blood pressure was 81.5 ± 9.8 (SD). The multivariable regression analysis showed that having ever been told hypertension (AOR = 15.47, 7.74-30.89); using animal product butter (AOR = 2.66, 1.25-5.67); physical inactivity (AOR = 2.83, 1.34-6.01) and BMI 25.0 to 29.9 and greater than 30 (AOR = 5.02, 1.58-15.94 and AOR = 3.98, 1.04-16.01, respectively) were statistically significant predictors of hypertension. The prevalence of hypertension was considerably high. The health system needs to develop strategies to increase the reach of relevant screening and diagnostic services.


Assuntos
Hipertensão/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
19.
Perspect Sex Reprod Health ; 51(1): 35-41, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30645011

RESUMO

CONTEXT: Advancing gestational age can increase the cost of an abortion and is a significant risk factor for complications. While obesity is not associated with increased risks, anecdotal evidence suggests that obese women seeking services at freestanding abortion clinics are often referred for hospital-based care, which can lead to delays. METHODS: In 2016, a cross-sectional survey collected data on the experiences of 201 women who had obtained abortions at a hospital-based clinic in Philadelphia; rates of medical complications were determined from hospital records. Multivariable logistic regression analysis was used to assess if obesity was associated with whether patients had been referred from freestanding abortion clinics or reported other paths to care. Differences in wait time and up-front out-of-pocket costs were examined by women's referral status. RESULTS: No difference in rates of abortion complications was found between patient groups. Women who were severely obese (body mass index of at least 40 kg/m2 ) were more likely than normal-weight individuals to have been referred from a freestanding abortion clinic (odds ratio, 7.5). The median wait time to get an abortion was 28 days for referred patients and 12 days for others. Multivariable analysis confirmed that referred patients waited twice as long as other patients (rate ratio, 2.0) and paid 66% more in up-front costs. CONCLUSIONS: Future research is needed to determine whether obese women seeking abortions are being referred despite evidence that they do not require hospital-based care. If obese women are suffering delays because of referral, strategies to help overcome delay should also be explored.


Assuntos
Aborto Induzido/estatística & dados numéricos , Obesidade/epidemiologia , Ambulatório Hospitalar/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Aborto Induzido/economia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Índice de Massa Corporal , Estudos Transversais , Feminino , Idade Gestacional , Gastos em Saúde , Humanos , Modelos Logísticos , Análise Multivariada , Razão de Chances , Philadelphia/epidemiologia , Gravidez , Salários e Benefícios , Centros de Atenção Terciária , Tempo para o Tratamento/economia , Transportes
20.
Am J Rhinol Allergy ; 33(3): 317-322, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30693801

RESUMO

BACKGROUND: Nonattendance to clinical appointments is a global problem appreciated by clinicians with an ambulatory presence. There are few reports of nonattendance in otolaryngology clinics, and no reports on nonattendance for a single otolaryngology subspecialty. OBJECTIVE: To describe the no-show population in rhinology clinics. METHODS: A retrospective chart review was performed involving rhinology clinics from 2 academic medical centers in the United States. All patients who either attended their clinic appointment(s) or did not attend without previously cancelling from June 2016 to May 2017 were included. Data collected included patient demographics, appointment status, season and time of visit, insurance status, type of visit (new vs established), and provider seen. RESULTS: There were 2791 clinical appointments evaluated over a 12-month period at 2 rhinology clinics involving 4 fellowship-trained rhinologists. Ninety-two percent of patients kept their appointments, while 8% did not. Sex, season of visit, time of visit (am vs pm), type of visit, provider sex, provider location, or provider's experience (<10 years vs ≥10 years) were not associated with patient's attendance status. Univariate analysis showed that patient's age ≤50 ( P = .001) and primary insurance type ( P < .001) were associated with nonattendance. Medicaid as the primary insurance type was associated with clinic nonattendance. Multivariable analysis showed that age ≤ 50 years, odds ratio (OR) 1.62 (95% confidence interval [CI] 1.14-2.30), P = .007, and primary insurance type (Medicaid: OR 3.75 [95% CI 2.58-5.45], P < .001) remained significant predictors of nonattendance. CONCLUSION: Patients younger than 50 years and patients with Medicaid as the primary insurance types are associated with risk of missing rhinology clinic appointments. As a subspecialty, delivery of timely care and clinical efficiency could be improved by interventions directed toward improving attendance among this population.


Assuntos
Agendamento de Consultas , Pacientes não Comparecentes/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Ambulatório Hospitalar , Adulto , Fatores Etários , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Ambulatório Hospitalar/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
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