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1.
Medicine (Baltimore) ; 98(33): e16818, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415398

RESUMO

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo.We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records.Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients' median age was 3 years (interquartile range, 1-6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 AM and 3 PM, respectively. Approximately 20% of weekday visits occurred after 6 PM, when other pediatricians' offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 PM. The overall median waiting time was 650 seconds (interquartile range, 429-1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%).The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 PM. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.


Assuntos
Plantão Médico/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Plantão Médico/métodos , Criança , Pré-Escolar , Estudos Transversais , Demografia , Feminino , Geografia , Humanos , Lactente , Masculino , Atenção Primária à Saúde/métodos , Fatores de Tempo , Tóquio
2.
Wiad Lek ; 72(7): 1229-1235, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31398147

RESUMO

The palliative care patient is definitely a unique type of patient. Due to the complexity of the symptoms requires a holistic therapeutic approach. Modern methods of treatment in palliative and hospice care underline an important role of physio, kinesiotherapy and pharmacological treatment coexistence. The rehabilitation reduces clinical symptoms, accompanying the basic disease and increases the quality of life of palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Due to the high dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The goal of palliative care is to achieve the best possible quality of life for patients and their families.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Cuidados Paliativos , Assistência Ambulatorial , Humanos , Qualidade de Vida
3.
Implement Sci ; 14(1): 78, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399105

RESUMO

BACKGROUND: Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. METHODS: Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. RESULTS: Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). CONCLUSIONS: To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.


Assuntos
Assistência Ambulatorial/normas , Assistência à Saúde/normas , Ciência da Implementação , Modelos Organizacionais , Neurocirurgia/normas , Ortopedia/normas , Pacientes Ambulatoriais , Técnicas de Planejamento , Melhoria de Qualidade , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa Qualitativa , Queensland
4.
Schmerz ; 33(4): 320-328, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31267168

RESUMO

OBJECTIVE: This study examines the perspectives of patients and family caregivers on outpatient palliative care networks. It contrasts primary palliative care (AAPV) and specialized outpatient care (SAPV) services, particularly in regard to pain management. METHODS: The study is based on 27 semi-structured, problem-focussed interviews with 21 patients and 19 informal caregivers. Recruitment was based on purposive sampling in two regions of Brandenburg, Germany. The data were analysed using qualitative content analysis. RESULTS: In AAPV, the general practitioner (GP) is both the central point of contact as well as the coordinator of the care network. In SAPV, the GP plays a less important role. This can lead to conflicts between GPs and health care professionals of the palliative care team. Compared to AAPV, palliative care teams are attributed greater intervention capacities in acute situations as well as expertise in pain therapy. Thus, the option of parenteral administration of opioids is considered a benefit of specialized care. The use of nursing services varies considerably depending on the individual care network-in some cases care is completely taken over by relatives. Relatives are the closest to the patient within the care network and perform key tasks. CONCLUSION: The personal and professional composition of networks of outpatient palliative care varies individually according to care situation and form. Care networks of AAPV and SAPV differ with regard to the accessibility of health care professionals and pain therapy. Home-based palliative care is often made possible by informal care givers in the first place.


Assuntos
Serviços de Assistência Domiciliar , Cuidados Paliativos , Assistência Ambulatorial , Cuidadores/estatística & dados numéricos , Alemanha , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Cuidados Paliativos/estatística & dados numéricos
5.
Medicine (Baltimore) ; 98(28): e16242, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305402

RESUMO

The real-world cure rates for hepatitis C (HCV) with direct-acting antivirals (DAAs) based on intention-to-treat (ITT) analysis may be lower than reported in the literature because of non-compliance.To determine whether patients treated in a structured outpatient HCV clinic (SHC) had higher compliance and treatment success rates compared to those treated in general hepatology clinics (GHC).In this study, we compared the treatment and compliance success rates of 488 and 840 patients treated in the SHC and GHC, respectively. The SHC required a pre-treatment clinic visit when patients picked up their initial medication, and received detailed education of the treatment plan and follow-up. In the GHC, the medications were delivered to patients' homes, and there was less formal education. Compliance success was defined as a combination of treatment completion and obtaining at least 1 post-treatment viral load at week 4 or 12. Treatment success was defined as either SVR4 or SVR12.Fifty of 488 (10.3%) patients from the SHC and 163 of 840 (19.4%) patients from the GHC were lost to follow-up (P < .0001). sustained virological response (SVR) rates were similar in compliant patients in both the SHC (419/438, 95.6%) and GHC (642/677, 94.8%), but treatment success rates by intention to treat (ITT) (overall 79.9%) were higher in SHC compared to GHC (85.9% vs 76.4%, P < .0001). Multivariate analysis showed that female patients (P = .01), older age (P = .0005), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/simeprevir compared to sofosbuvir/ledipasvir had higher odds of compliance success; elbasvir/grazoprevir or dasabuvir/ombitasvir/paritaprevir/ritonavir had lower odds of compliance success compared to sofosbuvir/ledipasvir. Female patients (P = .02), older age (P < .0001), previous treatment (P = .03), treatment in SHC (OR 1.7, 95% CI 1.2, 2.3, P = .0008), and sofosbuvir/ledipasvir compared to sofosbuvir/velpatasvir, sofosbuvir, or elbasvir/grazoprevir had higher odds of treatment success. With 1:1 matching, the SHC group still had significantly higher odds than the GHC group of achieving treatment and compliance success.Our study shows that the effectiveness of HCV treatment could be improved by coordinating treatment in a structured HCV clinic.


Assuntos
Antivirais/uso terapêutico , Assistência à Saúde/métodos , Hepatite C/tratamento farmacológico , Assistência Ambulatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Especialização , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(28): e16465, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305480

RESUMO

Actinic keratoses (AKs) are precancerous epidermal lesions that develop on sensitive, frequently sun-exposed skin surfaces. There are very little data regarding AK prevalance. The aim of this study was to investigate the prevalence of AK and related conditions among patients in a dermatology outpatient clinic.Patients attending our dermatology outpatient clinic between January 1, 2015 and December 31, 2017 were evaluated retrospectively usingan automated system. A total of 54,786 patients aged ≥30 years attending the dermatology outpatient clinic were included in the study. We identified 1375 patients diagnosed with AK.In our study, the AK prevalence was 0.01% for patients between 30 and 39 years of age, 0.45% for patients between 40 and 49 years of age, 1.77% for patients between 50 and 59 years of age, 4.61% for patients between 60 and 69 years of age, 9.38% for patients between 70 and 79 years of age, and 14.57% for patients ≥80 years. AK prevalence was 2.50% among patients of all ages.The exposure to sunlight is excessive due to the geographical location of our country. Due to the tendency of AKs to convert to malignancies, the identification of patients at high risk for AK development and the identification of high-risk anatomical regions are important to establish the basis of effective screening programs to support public health.


Assuntos
Ceratose Actínica/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Dermatologia , Feminino , Humanos , Ceratose Actínica/terapia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Reconhecimento Automatizado de Padrão , Prevalência , Exposição à Radiação , Estudos Retrospectivos , Pigmentação da Pele , Fatores Socioeconômicos , Raios Ultravioleta/efeitos adversos , Adulto Jovem
7.
Medicine (Baltimore) ; 98(26): e16071, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261516

RESUMO

Kazakhstan has a high burden of multidrug-resistant tuberculosis (TB). The patient-centered National Program for the treatment and prevention of TB has been implemented in Kazakhstan. The program is aimed at meeting the needs of patients and expansion of the outpatient treatment of TB in the country.The aim of the study was to compare the efficacy of the outpatient and inpatient treatment of drug-susceptible TB.This study was a retrospective cohort study.A total of 36.926 TB cases were included. The majority of patients were treated as inpatients. The socioeconomic factors, sex, age, HIV status, and other diagnostic factors (e.g., sputum smear results, extrapulmonary disease) may serve as risk factors to estimate the likely TB treatment outcome. The outpatient treatment of drug-susceptible TB seems to be a comparable option to the inpatient treatment in terms of efficacy.The socioeconomic factors are the main modifiable risk factors for treatment failure. The outpatient treatment of drug-susceptible TB is safe and effective.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adolescente , Adulto , Assistência Ambulatorial , Feminino , Hospitalização , Humanos , Cazaquistão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Adulto Jovem
8.
Lima; Perú. Ministerio de Salud; 20190700. 20 p.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1006655

RESUMO

Fortalecer la organización del sector salud, para una oportuna y adecuada respuesta, ante la inminencia u ocurrencia de un evento adverso, emergencia o desastre, que pone en riesgo la salud de la población y el funcionamiento de los establecimientos.


Assuntos
Alerta em Desastres , Planos de Contingência , Emergências , Instalações de Saúde , Diagnóstico da Situação de Saúde , Assistência Ambulatorial
9.
Wiad Lek ; 72(6): 1165-1169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31175721

RESUMO

In a modern approach to palliative and hospice care, apart from pharmacological treatment, physio- and kinesiotherapy also play an important role. It affects the reduction of clinical symptoms, accompanying the basic disease and also significantly increase of the quality of life for palliative patients and their families. It becomes an inseparable element of treatment, both in outpatient care as well as in stationary care and home care. Thanks to modern forms of physio- and kinesiotherapy, it is possible to adapt therapeutic methods to the individual needs and clinical condition of the patient. Such individualization of treatment in physiotherapy is the main goal of the above methods in palliative and hospice treatment. Due to the dynamics onset of cancer in the group of geriatric patients there is a need for a broader analysis of the topic. The work presents available information of physiotherapy in palliative and hospice care. The problem of relative and absolute indications and contraindications for physiotherapy was discussed. Based analysis of the above topic can lead to the conclusion that there is a necessity undertaking further research on the impact of rehabilitation treatments on reducing patients complaints and improvement of patients life quality.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Cuidados Paliativos , Idoso , Assistência Ambulatorial , Humanos , Neoplasias/terapia , Qualidade de Vida
10.
BMC Health Serv Res ; 19(1): 388, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200709

RESUMO

BACKGROUND: There is an increasing number of pediatric urgent care centers that are largely staffed by pediatric residency graduates. It is unclear if pediatric residency adequately prepares a physician to fully and successfully provide care in an urgent care setting. The goal of this study is to conduct an assessment of urgent care directors' perceptions of recent pediatric residency graduates' preparedness to successfully provide pediatric urgent care after graduation. METHODS: This is a 2018 cross-sectional survey of all pediatric emergency medicine division chiefs in the United States and all pediatric urgent care directors who are members of the Society for Pediatric Urgent Care. An electronic survey was distributed consisting of eight multiple choice questions regarding perceived preparedness and knowledge gaps of recent pediatric residency graduates for independent practice in urgent care. Descriptive statistics were used to analyze results and qualitative data were analyzed via an inductive thematic approach. RESULTS: Forty-two percent (65/154) of surveys were completed. No respondents believed that a recent pediatric residency graduate would be adequately prepared to independently practice in a pediatric urgent care and 81% of respondents recommended some additional training. Most respondents described this training as important (46%) or very important (35%). Most respondents recommended between 6 months and 1 year as the appropriate amount of time to achieve competency. CONCLUSIONS: Despite the growing number pediatric residency graduates staffing pediatric urgent care centers, the majority of surveyed pediatric emergency medicine division chiefs and pediatric urgent care directors do not think that pediatric residency adequately prepares graduates to successfully provide urgent care to pediatric patients. We recommend further exploration of gaps in knowledge of recent pediatric residency graduates as a next step towards developing systems for further training for pediatric residency graduates to gain competency in urgent care management.


Assuntos
Medicina de Emergência/educação , Internato e Residência/normas , Pediatria/educação , Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Estudos Transversais , Assistência à Saúde/normas , Medicina de Família e Comunidade , Bolsas de Estudo , Humanos , Internato e Residência/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Diretores Médicos/psicologia , Médicos , Inquéritos e Questionários , Estados Unidos
11.
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
12.
Artigo em Russo | MEDLINE | ID: mdl-31251871

RESUMO

The article presents the results of external auditing on the section "The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning" in 30 medical organizations of the Russian Federation based on "The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)". The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.


Assuntos
Serviços Médicos de Emergência , Hospitais , Qualidade da Assistência à Saúde , Assistência Ambulatorial , Emergências , Serviços Médicos de Emergência/normas , Humanos , Federação Russa
13.
Manag Care ; 28(5): 38-43, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31188110

RESUMO

As of November 2018, there were 8,774 such centers in the U.S, up 8% from 8,125 in 2017, according to the Urgent Care Association. And although they are not exclusively for people with insurance, just under half (47%) of the patients seen in urgent care centers are covered by commercial insurance.


Assuntos
Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Humanos , Estados Unidos
14.
Manag Care ; 28(6): 23-25, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31188096

RESUMO

The Emergency Triage, Treat, and Transport, or ET3, pilot would empower EMS crews to treat patients at the scene of a call (sometimes with the help of telehealth) or take a patient to an alternative site like an urgent care facility or a doctor's office.


Assuntos
Serviços Médicos de Emergência , Assistência Ambulatorial , Humanos , Transporte de Pacientes , Triagem
15.
BMC Health Serv Res ; 19(1): 401, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221139

RESUMO

BACKGROUND: Population segmentation of patients into parsimonious and relatively homogenous subgroups or segments based on healthcare requirements can aid healthcare resource planning and the development of targeted intervention programs. In this study, we evaluated the predictive ability of a previously described expert-defined segmentation approach on 3-year hospital utilization and mortality. METHODS: We segmented all adult patients who had a healthcare encounter with Singapore Health Services (SingHealth) in 2012 using the SingHealth Electronic Health Records (SingHealth EHRs). Patients were divided into non-overlapping segments defined as Mostly Healthy, Stable Chronic, Serious Acute, Complex Chronic without Frequent Hospital Admissions, Complex Chronic with Frequent Hospital Admissions, and End of Life, using a previously described expert-defined segmentation approach. Hospital admissions, emergency department attendances (ED), specialist outpatient clinic attendances (SOC) and mortality in different patient subgroups were analyzed from 2013 to 2015. RESULTS: 819,993 patients were included in this study. Patients in Complex Chronic with Frequent Hospital Admissions segment were most likely to have a hospital admission (IRR 22.7; p < 0.001) and ED visit (IRR 14.5; p < 0.001) in the follow-on 3 years compared to other segments. Patients in the End of Life and Complex Chronic with Frequent Hospital Admissions segments had the lowest three-year survival rates of 58.2 and 62.6% respectively whereas other segments had survival rates of above 90% after 3 years. CONCLUSION: In this study, we demonstrated the predictive ability of an expert-driven segmentation framework on longitudinal healthcare utilization and mortality.


Assuntos
Mortalidade/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura/epidemiologia , Adulto Jovem
16.
BMC Health Serv Res ; 19(1): 399, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221167

RESUMO

BACKGROUND: While several studies have tracked the care paths of patients in the early phases of stroke recovery, studies examining the transition from inpatient to outpatient rehabilitation are lacking. Examining this transition allows for improved understanding and refinement of the process whereby patients are referred and admitted to programs. The objective of this study was to examine the referral patterns of stroke rehabilitation inpatients to outpatient stroke therapy services, their demographics, and clinical profile. METHODS: This study examined patients who: (1) were admitted to an inpatient stroke rehabilitation unit between January 1, 2009 and March 1, 2016, (2) had a stroke diagnosis, (3) had an inpatient length of stay of > 1 day, and (4) lived within the geographical boundaries of the South West Local Health Integration Network which allowed them access to both hospital-based and home-based stroke rehabilitation outpatient programs. Patient data was collected from the National Rehabilitation Reporting System, as well as three hospital outpatient administrative databases. These databases were cross-referenced to determine each patient's pathway. Those referred to an outpatient therapy program, and those who attended the outpatient programs, were compared to those who were not, and did not, respectively. RESULTS: 1497 inpatients were included in the analysis. Upon discharge, 1037 (69.3%) of patients had an outpatient clinic, follow-up appointment scheduled; of those, 902 (87.0%) patients attended at least one outpatient clinic visit. 891 (59.5%) were referred to one of the interdisciplinary outpatient stroke rehabilitation programs; of those, an outpatient therapy program was attended by 80.9% of patients (n = 721). Of those receiving outpatient therapy services, the number of patients attending the in-hospital versus home-based program were equal, 360 and 361 individuals, respectively. CONCLUSION: This study allows for a better understanding of the transition between inpatient and outpatient stroke care. There is a paucity of this type of information in stroke rehabilitation literature to date. This study acts as a starting point in improving rehabilitation planning across the continuum of care.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos
17.
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
18.
Khirurgiia (Mosk) ; (5): 42-51, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169818

RESUMO

AIM: To assess 1-year results of differentiated treatment of patients with diabetic foot syndrome (DFS) who were included into 3-year register of diabetic foot outpatient practice (DFOP). MATERIAL AND METHODS: It was performed retrospective analysis of 570 patients with DFS (2015-2017): group I - neuropathic form (n=285), group II - neuroischemic form (n=285). Patients were classified according to Texas grade. Group I - 107 (37.5%) patients (BI-III); 91 (31.9%) patients (AII+BII-III). Diabetic osteoarthropathy was diagnosed in 97 (34.0%) cases. Group II included 113 (45.2%) patients with DI-III and 171 (60.0%) patients with CII-II+DII-III. 308 patients received combined outpatient treatment (including limb off-loading in 88%), 195 patients - in-hospital surgical treatment (including endovascular procedures - 52), 67 patients - treatment at the place of residence. Postoperative follow-up was in diabetic foot outpatient practice. Statistical analysis of data was performed by using of Biostat software package. RESULTS: In group I 1-year results are unknown in 76 (26.7%) patients. Epitheliazation was noted in 101 (35.4%) cases, persistent diabetic ulcer - in 27 (12.9%), small amputations - 16 (7.7%), high amputations - 2 (0.95%). In group II results are unknown in 29 (10.2%) patients. Epitheliazation occurred in 121 (47.3%) cases, persistent diabetic ulcer - 53 (20.7%), small amputations - 47 (18.4%), high amputations - in 35 (13.7%) cases. CONCLUSION: DFOP is a key organizational unit of specialized medical care for patients with DFS. Regular follow-up of patients in DFOP and combined treatment at the stage of specialized surgical care allows to preserve limb in 99% of patients with neuropathic foot and in 86.3% of patients with neuroischemic foot.


Assuntos
Assistência Ambulatorial , Pé Diabético/terapia , Amputação , Terapia Combinada , Pé Diabético/cirurgia , Procedimentos Endovasculares , Humanos , Estudos Retrospectivos , Federação Russa
19.
Invest. educ. enferm ; 37(2): [E08], 15-06-2019. Tab 1, Tab 2, Tab 3
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1007628

RESUMO

Abstract Objective. To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. Methods. Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. Results. A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). Conclusion. In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.


Resumen Objetivo. Identificar los diagnósticos de enfermería a partir de los registros en el seguimiento de los pacientes que acuden a un centro ambulatorio especializado en cardiopatía isquémica en la ciudad de Porto Alegre, Brasil. Métodos. Estudio transversal con toma de información retrospectiva de la historia clínica. A partir de los datos recolectados, los diagnósticos de enfermería identificados por los investigadores se sometieron a valoración de enfermeros especialistas en cardiología. Resultados. Se identificaron 13 diagnósticos de enfermería en las historias clínicas de 50 pacientes ambulatorios, con la siguiente concordancia de validación entre los especialistas: control ineficaz de la salud (100%), falta de adherencia (100%), estilo de vida sedentario (100%), Intolerancia a la actividad (100%), Débito cardíaco disminuido (88%), Riego de perfusión tisular cardíaca disminuida (76%), Dolor agudo (76%), Mantenimiento ineficaz de la salud (65%), Comportamiento de salud propenso a riesgo (65%), Riesgo de débito cardíaco disminuido (65%), Riesgo de intolerancia a la actividad (65%), Patrón respiratorio ineficaz (53%), Memoria perjudicada (29%). Conclusión. En este estudio los diagnósticos de enfermería validados para los pacientes cardiópatas estables están relacionados con la adherencia al tratamiento y a la respuesta cardiovascular a las intervenciones, reforzando la importancia de intervención precoz. Esos resultados permiten, en equipos multiprofesionales, individualizar las metas e intervenciones para los pacientes con cardiopatía isquémica.


Resumo Objetivo. Identificar os diagnósticos de enfermagem através dos registros no seguimento dos pacientes que vão a um centro ambulatório especializado em cardiopatia isquêmica na cidade de Porto Alegre, Brasil. Métodos. Estudo transversal com toma de informação retrospectiva da história clínica. A partir dos dados recolhido, os diagnósticos de enfermagem identificados pelos investigadores foram submetidos a valoração de enfermeiros especialistas em cardiologia. Resultados. Foram identificados 13 diagnósticos de enfermagem nas histórias clínicas de 50 pacientes ambulatórios, com a seguinte concordância de validação entre os especialistas: controle ineficaz da saúde (100%), falta de aderência (100%), estilo de vida sedentário (100%), Intolerância à atividade (100%), Débito cardíaco diminuído (88%), irrigação de perfusão tissular cardíaca diminuída (76%), Dor agudo (76%), Manutenção ineficaz da saúde (65%), Comportamento de saúde propenso a risco (65%), Risco de débito cardíaco diminuído (65%), Risco de intolerância à atividade (65%), Padrão respiratório ineficaz (53%), Memória prejudicada (29%). Conclusão. Neste estudo os diagnósticos de enfermagem validados para os pacientes cardiopatas estáveis estão relacionados com a aderência ao tratamento e à resposta cardiovascular às intervenções dos pacientes, reforçando a importância de intervenção precoce. Esses resultados permitem em equipes multiprofissionais


Assuntos
Humanos , Pacientes Ambulatoriais , Diagnóstico de Enfermagem , Estudos Transversais , Isquemia Miocárdica , Assistência Ambulatorial , Processo de Enfermagem
20.
Ann Vasc Surg ; 59: 167-172, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077768

RESUMO

BACKGROUND: We analyze the impact of outpatient telemedicine services on the travel burden of vascular surgery patients with regard to distance, time, and cost, as well as the emission of environmental pollutants. METHODS: Retrospective analysis was used to compare the patient travel expenditure and environmental impact associated with telemedicine encounters versus hypothetical in-person traditional consultations for all outpatient virtual care encounters with vascular surgery patients from October 2015 to October 2017. The primary outcomes measured were travel distance saved, travel time saved, travel costs saved, reduction in fuel consumption, and reduction in environmental pollutant emission. RESULTS: Over a two-year period, 146 outpatient telemedicine encounters were conducted among 87 unique patients (61 females, 26 males; mean age, 60 ± 13 years). The average one-way distance saved by the utilization of telemedicine services was 15.6 ± 6.3 miles, with an average roundtrip savings of 31.2 miles. The average one-way travel time saved was 19.5 ± 9.2 minutes, with an average roundtrip savings of 39 minutes. By using telemedicine services, these vascular surgery patients saved an average of $4.26 in gas and parking costs at each telemedicine encounter. The total reduction in passenger vehicle emission of environmental pollutants, including carbon dioxide, carbon monoxide, nitric oxides, and volatile organic compounds was 1632 kg, 42,867 g, 3160 g, and 4715 g, respectively, with a total of 194 gallons of gas saved from driving. CONCLUSIONS: Utilization of telemedicine services reduces the travel distance, time, and costs for vascular surgery patients. Outpatient telemedicine programs may also provide environmental benefit through the reduction of greenhouse gas and pollutant emissions.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Assistência Ambulatorial/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Cuidados Pós-Operatórios/economia , Telemedicina/economia , Poluição Relacionada com o Tráfego/prevenção & controle , Transporte de Pacientes/economia , Procedimentos Cirúrgicos Vasculares/economia , Emissões de Veículos/prevenção & controle , Idoso , Assistência Ambulatorial/métodos , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Telemedicina/métodos , Fatores de Tempo
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