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1.
Medicine (Baltimore) ; 99(12): e19578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195971

RESUMO

INTRODUCTION: Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit. PATIENT CONCERNS: A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression. DIAGNOSES: L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture. INTERVENTIONS: For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury. OUTCOMES: Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment. CONCLUSIONS: We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.


Assuntos
Dor nas Costas/diagnóstico , Anormalidades Congênitas/diagnóstico , Vértebras Lombares/lesões , Espondilolistese/diagnóstico por imagem , Acidentes por Quedas , Adulto , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Radiografia/métodos , Fusão Vertebral/métodos , Coluna Vertebral/anormalidades , Espondilolistese/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(5): e18532, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000362

RESUMO

Fever is one of the most common symptoms seen in patients. The work-up and follow-up of fever in an outpatient-only setting is a reasonable option for stable patients referred for unexplained fever; however, the safety and efficacy of outpatient follow-up for those patients remain unclear. We conducted this study to evaluate the safety and efficacy of outpatient follow-up for referred patients with unexplained fever.This study was a retrospective cohort study. We included patients referred to the outpatient department of the diagnostic medicine of our university hospital for unexplained fever between October 2016 and September 2017. Exclusion criteria were recurrent fever or admission for fever evaluation prior to referral. Main outcomes of interest were the rate of admission without diagnosis, rate of remission of fever, and the total duration of fever in undiagnosed patients.Among 84 patients included in this study, 17 (20%) were diagnosed during outpatient follow-up, 6 (7%) were admitted due to worsened condition, 5 (6%) were lost to follow-up, and 56 (67%) were followed up as outpatients without a diagnosis. Among the 56 undiagnosed patients, fever resolved in 53 during outpatient follow-up with or without treatment (95%). The total duration of resolved fever in undiagnosed patients was within 8 weeks.Follow-up of patients referred for unexplained fever in an outpatient setting is safe and effective.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Febre de Causa Desconhecida , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Urologe A ; 59(2): 162-168, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32047953

RESUMO

BACKGROUND: Renal cell carcinoma is the third most common tumor of the genitourinary system. Small tumors are increasingly treated by nephron-sparing surgery, focal therapy via cryoablation or radiofrequency ablation and also active surveillance. These treatment options are associated with increased follow-up care. OBJECTIVES: What are the current recommendations on follow-up care for different therapeutic approaches in renal cell carcinoma? MATERIALS AND METHODS: We analyzed different biological aspects regarding renal cell carcinoma, diagnostic procedures as well as recommendations of current guidelines (e.g. German S3, EAU AUA). RESULTS: Follow-up of renal cell carcinoma is not well standardized due to the limited amount of data. In general, follow-up should be intensified during the first 3 years following initial therapy as well as in patients with increased risk for tumor recurrence. For risk calculation different prognostic models based on clinical parameters have been published. CONCLUSIONS: Current recommendations on follow-up care in renal cell carcinoma are based on retrospective studies. Future strategies must include markers and be studied in a prospective manner.


Assuntos
Assistência ao Convalescente/métodos , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Rim/patologia , Recidiva Local de Neoplasia/prevenção & controle , Carcinoma de Células Renais/patologia , Seguimentos , Humanos , Neoplasias Renais/patologia , Estadiamento de Neoplasias , Nefrectomia , Estudos Retrospectivos , Resultado do Tratamento
5.
Unfallchirurg ; 123(1): 76-79, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915877

RESUMO

A 60-year-old patient suffered an ankle distortion resulting in a comminuted fracture of the fifth metatarsal. On the same day the accident occurred the patient presented to an emergency department and immediate operative treatment of the fracture was performed by intramedullary Kirschner wires with closed reduction and internal fixation. The aftercare was carried out on an outpatient basis by a registered orthopedist in accordance with the surgeon's instructions. In the radiological control 14 days after surgery a dislocation of the fracture was detected and 1 week later a rectification operation was carried out in a second clinic with removal of the Kirschner wires, open reduction and internal fixation with a locking plate. The patient suspected inadequate treatment by the first clinic, which in turn did not accept any inadequacies in the surgical treatment or the aftercare. In the subsequent legal dispute the appointed experts came to the conclusion that an initial good fracture position was achieved but that the aftercare treatment with a forefoot relief shoe was inadequate for the type of internal fixation chosen. The arbitration board came to the conclusion that the multifragmented fracture situation was treated by a questionably stable osteosynthesis using Kirschner wires. This should have required a very strict aftercare with partial weight bearing on crutches and immobilization in a stable orthosis or cast.


Assuntos
Assistência ao Convalescente , Fraturas Ósseas , Ossos do Metatarso , Placas Ósseas , Fios Ortopédicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Humanos , Ossos do Metatarso/lesões , Pessoa de Meia-Idade , Resultado do Tratamento
6.
J Surg Res ; 246: 243-250, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31610352

RESUMO

BACKGROUND: Recent studies demonstrate favorable diabetic foot ulcer (DFU) healing outcomes with the implementation of a multidisciplinary team. We aimed to describe the incidence of and risk factors associated with ulcer recurrence after initial complete healing among a cohort of patients with DFU treated in a multidisciplinary setting. METHODS: All patients presenting to our multidisciplinary diabetic limb preservation service from 6/2012-04/2018 were enrolled in a prospective database. The incidence of ulcer recurrence after complete wound healing was assessed per limb using the Kaplan-Meier method, and a stepwise multivariable Cox proportional hazards model was created to identify independent predictors of ulcer recurrence. RESULTS: A total of 244 patients with 304 affected limbs were included. Ulcer recurrence rates at one and 3 y after healing were 30.6 ± 3.0% and 64.4 ± 5.2%, respectively. Recurrent ulcers were smaller (4.4 ± 1.1 cm2versus 8.2 ± 1.2 cm2; P = 0.04) and had a lower Wound, Ischemia, and foot Infection stage (stage 4: 7.7% versus 22.4%; P < 0.001) than initial ulcers, and wound healing time was significantly reduced (95.0 ± 9.8 versus 131.8 ± 7.0 d; P = 0.004). Independent predictors of ulcer recurrence included abnormal proprioception (HR, 1.57 [95% CI 1.02-4.43]) and younger age (HR 1.02 per year [95% CI 1.01-1.04]). CONCLUSIONS: In this prospective cohort of patients with DFU, time to diagnosis and healing was significantly lower for recurrent ulcers, and downstaging was common. These data suggest that engaging patients with DFU in a multidisciplinary care model with frequent follow-up and focused patient education may serve to decrease DFU morbidity.


Assuntos
Pé Diabético/epidemiologia , Salvamento de Membro , Equipe de Assistência ao Paciente , Prevenção Secundária/métodos , Cicatrização , Assistência ao Convalescente/métodos , Pé Diabético/diagnóstico , Pé Diabético/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
7.
Urology ; 135: 133-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586472

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) are soft tissue sarcomas that arise from peripheral nerve fibers and primarily occur in the setting of neurofibromatosis (NF1). MPNST arising from the penis is very rare and may require mutilating surgery to achieve surgical cure. We previously reported a case of MPNST involving the penis in a 14-month-old boy treated with neoadjuvant chemotherapy, total penectomy, and adjuvant radiation. Here we report intermediate follow-up of the same patient, describe his subsequent genitourinary reconstruction, and discuss management dilemmas that arise following treatment of penile MPNST.


Assuntos
Assistência ao Convalescente/métodos , Neoplasias da Bainha Neural/terapia , Neoplasias Penianas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Criança , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias da Bainha Neural/patologia , Neoplasias Penianas/patologia , Pênis/patologia , Pênis/cirurgia , Escroto/cirurgia , Resultado do Tratamento , Uretra/cirurgia
8.
Bull Cancer ; 107(1): 102-112, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31543271

RESUMO

To heal otherwise in oncology has become an imperative of Public Health and an economic imperative in France. Patients can therefore receive live most of their care outside of hospital with more ambulatory care. This ambulatory shift will benefit from the digital revolution and the development of digital health or e-health. Cancer research will also benefit with Big Data and artificial intelligence, which gather and analyze a huge amount of data. In this synthesis, we describe the different e-health tools and their potential impacts in oncology, at the levels of education and information of patients and caregivers, prevention, screening and diagnosis, treatment, follow-up, and research. A few randomized studies have already demonstrated clinical benefits. Large Big Data projects such as ConSoRe and Health Data Hub have been launched in France. We also discuss the issues and limitations of "cancer outside the hospital walls and e-health" from the point of view of patients, health care professionals, health facilities and government. This new organization will have to provide remote support "outside the walls" with care and follow-up of quality, continuous and prolonged in total safety and equity. Ongoing and future randomized clinical trials will need to definitively demonstrate areas of interest, advantages and drawbacks not only for patients, but also for caregivers, health facilities and governments.


Assuntos
Assistência Ambulatorial , Inteligência Artificial , Big Data , Alfabetização em Saúde , Neoplasias/terapia , Acesso à Informação , Assistência ao Convalescente , Detecção Precoce de Câncer , Pessoal de Saúde/educação , Humanos , Comportamento de Busca de Informação , Internet , Neoplasias/diagnóstico , Neoplasias/prevenção & controle , Saúde Pública , Telemedicina
9.
Rehabilitation (Stuttg) ; 59(1): 17-25, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31207652

RESUMO

PURPOSE: Physical inactivity is considered the most important modifiable risk factor of cardio-vascular diseases. Therefore medical rehabilitation is focused on the improvement of physical activity. To maintain physical activity after rehabilitation aftercare strategies are necessary which help to transfer the skills learned during rehabilitation into daily routine. In this study the aftercare concept "Neues Credo" which has been evaluated several times has been implemented and evaluated into cardiological follow-up rehabilitation. METHODS: Prospective, controlled, multicentre study with 4 cardiological rehabilitation institutions. INCLUSION CRITERIA: rehabilitants with initial diagnosis from the ICD groups I20-25 and I34-43. In the first phase of the study, patients received standard rehabilitation and standard aftercare (control group (KG)). In the second phase, patients received rehabilitation based on the conditions of "Neues Credo" with the focus on increasing physical activity (intervention group (IG)). Data for evaluation were collected by paper-and-pencil questionnaires at 3 points in time. Primary outcome variable: restriction in participation (IMET); secondary outcome variables: depression (CES-D), several scales of subjective health and physical activity. Analysis of variance with repeated measures was used for the evaluation of long-term effects. RESULTS: Complete data could be evaluated from 152 patients of the IG and from 165 patients of the KG. At the end of rehabilitation both IG and KG showed improvements in outcome variables. In the period after rehabilitation patients in the IG improved their physical activity significantly more often than members of the KG (66 vs. 42%, p<0,01), they showed more physical activity than the KG (p=0,040) and they performed endurance sports more often (58 vs. 38%, p<0,01). The primary outcome of participation shows significant improvements in both groups (p<0,01) 12 months after the rehabilitation, difference between groups did not reach statistical significance but indicated a clear tendency in favour of the IG. Similar trends could be found for the secondary outcome-data CONCLUSION: In this study, the "Neues Credo" was applied and evaluated in cardiologic rehabilitation for the first time. Participants reported high practicability and high satisfaction. Health- related outcomes show a trend of positive effects in favour of the IG, but the interaction effects did not reach statistical significance in most cases. Regarding physical activity the intervention group shows clear advantage and will probably benefit from the long-term effects of regular endurance training.


Assuntos
Assistência ao Convalescente , Reabilitação Cardíaca , Seguimentos , Alemanha , Humanos , Estudos Prospectivos , Resultado do Tratamento
10.
Best Pract Res Clin Obstet Gynaecol ; 62: 101-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31331743

RESUMO

FIGO established a Working Group on the Prevention of Unsafe Abortion in 2007 and a parallel program or "Initiative" with the same name. The initiative involved 46 FIGO member societies from seven regions: South-Southeast Asia, Eastern-Central Europe and Central Asia, North Africa and Eastern Mediterranean, Eastern-Central-Southern Africa, Western-Central Africa, Central America and Caribbean, and South America. Each society working in collaboration with the corresponding Ministry of Health and other agencies conducted a situational analysis and prepared a plan of action based on the findings. Such plans of action are continuously monitored by annual evaluation of the progress in the implementation at regional workshops. A substantial progress has been achieved in providing legal and safe abortion services, replacing curettage for manual vacuum aspiration or misoprostol and introducing and expanding postabortion contraception with emphasis on long-acting methods, such as IUDs and contraceptive implants.


Assuntos
Aborto Induzido/normas , Aborto Legal , Assistência ao Convalescente/métodos , Agências Internacionais/organização & administração , Sociedades Médicas/organização & administração , Aborto Induzido/legislação & jurisprudência , Anticoncepção/métodos , Feminino , Acesso aos Serviços de Saúde , Humanos , Gravidez
11.
Gastroenterology ; 158(1): 215-225.e6, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574268

RESUMO

BACKGROUND & AIMS: There have been conflicting results from studies comparing the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection treated with tenofovir disoproxil fumarate (TDF) vs those treated with entecavir. We compared the effects of TDF vs entecavir on HCC risk in a large cohort of patients with chronic HBV infection in China. METHODS: We performed a retrospective study of consecutive adults with chronic HBV infection who initially received treatment with entecavir or TDF, for at least 6 months, from January 2008 through June 2018. Patients who had cancers or liver transplantation before or within the first 6 months of treatment were excluded. Propensity score weighting and 1:5 matching were used to balance the clinical characteristics between the 2 groups. Fine-Gray model was used to adjust for competing risk of death and liver transplantation. RESULTS: We analyzed data from 29,350 patients (mean age, 52.9 ± 13.2 years; 18,685 men [63.7%]); 1309 were first treated with TDF (4.5%) and 28,041 were first treated with entecavir (95.5%). TDF-treated patients were younger (mean age, 43.2 years vs 53.4 years) and a lower proportion had cirrhosis (38 patients [2.9%] vs 3822 patients treated with entecavir [13.6%]). At a median follow-up time of 3.6 years after treatment began (interquartile range, 1.7-5.0 years), 8 TDF-treated patients (0.6%) and 1386 entecavir-treated patients (4.9%) developed HCC. Patients' clinical characteristics were comparable after propensity score weighting. TDF treatment was associated with a lower risk of HCC than entecavir treatment after propensity score weighting (weighted subdistribution hazard ratio, 0.36; 95% confidence interval 0.16-0.80; P = .013) and 1:5 matching (weighted subdistribution hazard ratio, 0.39; 95% confidence interval 0.18-0.84; P = .016). CONCLUSIONS: In a retrospective analysis of 29,350 patients with chronic HBV infection in China, treatment with TDF was associated with a lower risk of HCC than treatment with entecavir, over a median follow-up time of 3.6 years.


Assuntos
Antivirais/administração & dosagem , Carcinoma Hepatocelular/prevenção & controle , Guanina/análogos & derivados , Hepatite B Crônica/tratamento farmacológico , Neoplasias Hepáticas/prevenção & controle , Tenofovir/administração & dosagem , Adulto , Assistência ao Convalescente , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/virologia , China/epidemiologia , Progressão da Doença , Feminino , Guanina/administração & dosagem , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/patologia , Hepatite B Crônica/virologia , Humanos , Incidência , Fígado/efeitos dos fármacos , Fígado/patologia , Fígado/virologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/prevenção & controle , Cirrose Hepática/virologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
J Surg Res ; 245: 656-662, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31585352

RESUMO

BACKGROUND: Incisional hernia (IH) is one of the most frequent complications after abdominal surgery. Follow-up with regard to IH remains challenging. Physical examination and imaging to diagnose IH are time-consuming and costly, require devotion of both the physician and patient, and are often not prioritized. Therefore, a patient-reported diagnostic questionnaire for the diagnosis of IH was developed. Objective of this study was to validate this questionnaire in a consecutive sample of patients. METHODS: All patients above 18 y of age who underwent abdominal surgery with a midline incision at least 12 mo ago were eligible for inclusion. Included patients visited the outpatient clinic where they filled out the diagnostic questionnaire and underwent physical examination. The questionnaire answers were compared with the physical examination results. The diagnostic accuracy of the entire questionnaire was assessed by multivariable logistic regression. RESULTS: In total, 241 patients visited the outpatient clinic prospectively. 54 (22%) patients were diagnosed with IH during physical examination. The area under the receiver operating characteristic curve of the diagnostic questionnaire was 0.82. Sensitivity and specificity were respectively 81.5% and 77.5%. The positive and negative predictive values were 51.2% and 94%, respectively. Ten (19%) patients with IH were missed by the questionnaire. CONCLUSIONS: The patient-reported diagnostic questionnaire as currently proposed cannot be used to diagnose IH. However, given the high negative predictive value, the questionnaire might be used to rule out an IH. Long-term follow-up for the diagnosis of IH should be performed by clinical examination.


Assuntos
Assistência ao Convalescente/métodos , Hérnia Incisional/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Exame Físico , Ferida Cirúrgica/complicações , Idoso , Estudos de Viabilidade , Feminino , Humanos , Hérnia Incisional/etiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
13.
J Pediatr Orthop ; 40(1): e37-e41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30973475

RESUMO

BACKGROUND: We looked at long-term follow-up of spine stapling with Nitinol Staples. This was a cohort of all adolescent idiopathic scoliosis (AIS) patients with curves at high risk to progress based on curve magnitude, premenarchal status in all females, failure of brace treatment, and skeletal immaturity. METHODS: This is a single surgeon retrospective review of consecutive AIS patients treated with Nitinol staples for progressive scoliosis. Fourteen patients, 16 curves from 2005 to 2008 were eligible. Minimum curve for stapling was 30 degrees. Standard preoperative, intraoperative, and postoperative data were collected. All patients were followed for a minimum of 36 months and to skeletal maturity. Three groups were: improved (group 1), correction of any amount; minimal progression (group 2), progression ≤10 degrees; and failure (group 3), ≥10 degrees of progression. RESULTS: A total of 13 thoracic curves and 2 compensatory lumbar curves met the inclusion criteria (94%). Average follow-up was 61 months. The mean preoperative main thoracic curve was 35 degrees. All but 1 patients progressed at least 9 degrees in a brace prior to stapling. Females were all premenarchal, 10 patients were Risser 0 and 3 Risser 1. The average number of vertebrae stapled per curve was 6. Group 1 included 6 curves (40%). Group 2, 5 curves (33%). Group 3, 4 curves (27%). Three patients went on to uncomplicated fusion. Final curve measurement at the end of follow-up or before fusion (P=0.0037), curve progression (P≤0.001), and percentage of coronal correction on first postoperative standing radiograph (P=0.042) were the significant differences between groups 1+2 (successful) versus group 3 (failures). In total, 73% of this group either progressed ≤10 degrees or improved. CONCLUSIONS: This is the first study that follows AIS patients treated with spine stapling to skeletal maturity. Staples likely changed natural history in some of our patients. Initial percentage of correction on first standing postoperative PA x-rays was the only predictor of success. Stapling was safe without any long-term complications. LEVEL OF EVIDENCE: Level III-retrospective study.


Assuntos
Vértebras Lombares/cirurgia , Escoliose/cirurgia , Grampeamento Cirúrgico , Vértebras Torácicas/cirurgia , Adolescente , Assistência ao Convalescente , Ligas , Desenvolvimento Ósseo , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Radiografia , Reoperação , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral , Fatores de Tempo , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-31847490

RESUMO

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.


Assuntos
Assistência ao Convalescente , Doenças Cardiovasculares/terapia , Hospitais Rurais/organização & administração , Serviços de Saúde Rural/organização & administração , Doença Aguda , Humanos , Qualidade da Assistência à Saúde , População Rural
16.
BMC Infect Dis ; 19(1): 1059, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847823

RESUMO

BACKGROUND: West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the next decade. Though endemic in the most populous areas of North America, few studies have estimated the healthcare costs associated with WNV. The objective of this study was to determine direct healthcare costs attributable to WNV illness in Ontario, Canada. METHODS: We conducted a cost-of-illness study on incident laboratory confirmed and probable WNV infected subjects identified from the provincial laboratory database from Jan 1, 2002 through Dec 31, 2012. Infected subjects were linked to health administrative data and matched to uninfected subjects. We used phase-of-care methods to calculate costs for 3 phases of illness: acute infection, continuing care, and final care prior to death. Mean 10-day attributable costs were reported in 2014 Canadian dollars, per capita. Sensitivity analysis was conducted to test the impact of WNV neurologic syndromes on healthcare costs. RESULTS: One thousand five hundred fifty-one laboratory confirmed and probable WNV infected subjects were ascertained; 1540 (99.3%) were matched to uninfected subjects. Mean age of WNV infected subjects was 49.1 ± 18.4 years, 50.5% were female. Mean costs attributable to WNV were $1177 (95% CI: $1001, $1352) for acute infection, $180 (95% CI: $122, $238) for continuing care, $11,614 (95% CI: $5916, $17,313) for final care - acute death, and $3199 (95% CI: $1770, $4627) for final care - late death. Expected 1-year costs were $13,648, adjusted for survival. Three hundred seventeen infected subjects were diagnosed with at least one neurologic syndrome and greatest healthcare costs in acute infection were associated with encephalitis ($4710, 95% CI: $3770, $5650). CONCLUSIONS: WNV is associated with increased healthcare resource utilization across all phases of care. High-quality studies are needed to understand the health system impact of vector-borne diseases and evaluate the cost effectiveness of novel WNV interventions.


Assuntos
Custos de Cuidados de Saúde , Laboratórios , Febre do Nilo Ocidental/economia , Febre do Nilo Ocidental/epidemiologia , Vírus do Nilo Ocidental/isolamento & purificação , Adolescente , Adulto , Assistência ao Convalescente/economia , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise Custo-Benefício , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Projetos de Pesquisa , Febre do Nilo Ocidental/prevenção & controle , Adulto Jovem
17.
Br J Nurs ; 28(19): 1234-1238, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680571

RESUMO

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.


Assuntos
Assistência ao Convalescente/organização & administração , Neoplasias Colorretais/cirurgia , Enfermeiras Especialistas , Telefone , Difusão de Inovações , Pesquisa sobre Serviços de Saúde , Humanos , Medicina Estatal/organização & administração , Reino Unido
18.
BMC Infect Dis ; 19(1): 943, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703669

RESUMO

BACKGROUND: A large proportion of people who inject drugs (PWID) living with hepatitis C virus (HCV) infection have not been treated. It is unknown whether inclusion of HCV diagnostics and treatment into integrated substance use disorder treatment and care clinics will improve uptake and outcome of HCV treatment in PWID. The aim is to assess the efficacy of integrating HCV treatment to PWID and this paper will present the protocol for an ongoing trial. METHODS: INTRO-HCV is a multicentre, randomised controlled clinical trial that will compare the efficacy of integrated treatment of HCV in PWID with the current standard treatment. Integrated treatment includes testing for HCV, assessing liver fibrosis with transient elastography, counselling, treatment delivery, follow-up and evaluation provided by integrated substance use disorder treatment and care clinics. Most of these clinics for PWID provide opioid agonist therapy while some clinics provide low-threshold care without opioid agonist therapy. Standard care involves referral to further diagnostics, treatment and treatment follow-up given in a hospital outpatient clinic with equivalent medications. The differences between the delivery platforms in the two trial arms involve use of a drop-in approach rather than specific appointment times, no need for additional travelling, less blood samples taken during treatment, and treatment given from already known clinicians. The trial will recruit approximately 200 HCV infected individuals in Bergen and Stavanger, Norway. The primary outcomes are time to treatment initiation and sustained virologic response, defined as undetectable HCV RNA 12 weeks after end of treatment. Secondary outcomes are cost-effectiveness, treatment adherence, changes in quality of life, fatigue and psychological well-being, changes in drug use, infection related risk behaviour, and risk of reinfection. The target group is PWID with HCV diagnosed receiving treatment and care within clinics for PWID. DISCUSSION: This study will inform on the effects of an integrated treatment program for HCV in clinics for PWID compared to standard care aiming to increase access to treatment and improving treatment adherence. If the integrated treatment model is found to be safe and efficacious, it can be considered for further scale-up. TRIAL REGISTRATION: ClinicalTrials.gov.no. NCT03155906.


Assuntos
Antivirais/uso terapêutico , Prestação Integrada de Cuidados de Saúde/métodos , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Tratamento de Substituição de Opiáceos , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Assistência ao Convalescente , Análise Custo-Benefício , Aconselhamento , Feminino , Hepatite C/etiologia , Humanos , Masculino , Noruega , Reação em Cadeia da Polimerase , Qualidade de Vida , Recidiva , Abuso de Substâncias por Via Intravenosa/complicações , Resposta Viral Sustentada , Cooperação e Adesão ao Tratamento
19.
Bone Joint J ; 101-B(11): 1431-1437, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674251

RESUMO

AIMS: It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS: Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS: Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION: Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.


Assuntos
Artroplastia de Quadril/reabilitação , Nível de Saúde , Atividades Cotidianas , Adulto , Assistência ao Convalescente/estatística & dados numéricos , Artroplastia de Quadril/métodos , Transplante Ósseo/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/reabilitação , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários
20.
Lakartidningen ; 1162019 Nov 01.
Artigo em Sueco | MEDLINE | ID: mdl-31688945

RESUMO

By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.


Assuntos
Administração de Caso , Depressão/terapia , Transtorno Depressivo/terapia , Administração dos Cuidados ao Paciente , Assistência ao Convalescente , Atitude do Pessoal de Saúde , Continuidade da Assistência ao Paciente , Análise Custo-Benefício , Depressão/economia , Transtorno Depressivo/economia , Progressão da Doença , Humanos , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Retorno ao Trabalho , Licença Médica , Suécia , Resultado do Tratamento
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