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1.
Rev Med Liege ; 75(2): 83-88, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030931

RESUMO

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.


Assuntos
Serviço Hospitalar de Emergência , Atenção Secundária à Saúde , Triagem , Emergências , Humanos , Reprodutibilidade dos Testes , Telefone
2.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 29-36, jan.-dez. 2020. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047855

RESUMO

Objetivo: desenvolver Procedimentos Operacionais Padrão (POP) para a assistência de enfermagem na realização de exames diagnósticos na atenção secundária à saúde. Método: elaborou-se uma comissão de Sistematização da Assistência de Enfermagem (SAE), que avaliou os setores em que estavam sendo implantadas novas tecnologias diagnósticas e levantou a necessidade de treinamento da equipe técnica que realizava estes exames para padronizar os procedimentos, diminuindo os erros e falhas em sua realização. Os POPs foram descritos através de quadros compostos por: definição do procedimento diagnóstico, material necessário, intervenções de enfermagem e cuidados especiais. Resultados: foram elaborados quatro POPs, relacionados aos exames de: espirometria, polissonografia, retinografia e teste do hidrogênio expirado. Conclusão: através do estudo foi possível não somente conhecer a execução dos exames, mas também entender a aplicabilidade da SAE com foco nas tecnologias diagnósticas, além de fornecer subsídios para futura implementação da SAE na instituição de estudo


Objective: develop Standard Operating Procedures (POPs) for nursing care in performing diagnostic exams in secondary health care. Method: a Systematization Committee for Nursing Assistance (SAE) was developed, which evaluated the sectors in which new diagnostic technologies were being implemented and raised the need for training of the technical team that performed these tests to standardize procedures, reducing errors and failures in its realization. The SOPs were described through tables composed of: definition of the diagnostic procedure, necessary material, nursing interventions and special care. Results: four POPs were elaborated, related to the exams of spirometry, polysomnography, retinography and test of expired hydrogen. Conclusion: through the study it was possible not only to know the execution of the exams, but also to understand the applicability of SAE with a focus on diagnostic technologies, besides providing subsidies for future implementation of SAE in the study institution


Objetivo: desarrollar procedimientos operativos estándar (POP) para la asistencia de enfermería en la realización de exámenes diagnósticos en la atención secundaria a la salud. Métodos: elaboró una comisión de Sistematización de la Asistencia de Enfermería (SAE), que evaluó los sectores en que se estaban implantando nuevas tecnologías diagnósticas y planteó la necesidad de entrenamiento del equipo técnico que realizaba estos exámenes para estandarizar los procedimientos, disminuyendo los errores y fallas en su realización. Los COPs se describieron a través de cuadros compuestos por: definición del procedimiento diagnóstico, material necesario, intervenciones de enfermería y cuidados especiales. Resultados: se elaboraron cuatro COPs, relacionados con los exámenes de: espirometría, polisomnografía, retinografía y prueba del hidrógeno expirado. Conclusiones: A través del estudio fue posible no sólo conocer la ejecución de los exámenes, sino también entender la aplicabilidad de la SAE con foco en las tecnologías diagnósticas, además de proporcionar subsidios para la futura implementación de la SAE en la institución de estudio


Assuntos
Humanos , Atenção Secundária à Saúde , Doença Crônica , Serviços de Diagnóstico , Brasil , Cuidados de Enfermagem
3.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592612

RESUMO

BACKGROUND: The percentage share of children who are diagnosed with autism spectrum disorder has increased considerably since the 1990s in Norway as well as in other countries. It has previously been demonstrated that there is considerable variation between counties with respect to diagnostic practice. MATERIAL AND METHOD: We calculated the percentage of children with autism spectrum disorder by using patient data obtained from the Norwegian Patient Registry and population data obtained from the National Registry. The calculations were made for the country as a whole as well as by county. The diagnostic assessments and documentation were mapped by linking the Norwegian Patient Registry with the Norwegian Mother, Father and Child Cohort study. We also reviewed patient records obtained from the specialist health service and considered whether diagnostic practice satisfied the research criteria for autism spectrum disorder. RESULTS: By the age of eight, 1.1 % of boys and 0.3 % of girls had been diagnosed with autism spectrum disorder. The overall percentages varied from 0.3 to 1.0 between counties. From 2008 to 2016, these percentages increased in all age groups. Our review of patient records included 503 children. In 95 % of cases the patient records provided a high standard of documentation that the diagnostic research criteria had been satisfied. The assessments were largely conducted in accordance with the guidelines drawn up by the various health trusts. INTERPRETATION: Autism diagnoses are generally well documented within the Norwegian specialist health service and meet the diagnostic criteria. In the counties that demonstrate a low prevalence of autism, it appears the health service fails to recognise autism in many children, particularly girls, or the diagnosis is determined late.


Assuntos
Transtorno do Espectro Autista , Adolescente , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Registros Médicos , Noruega/epidemiologia , Encaminhamento e Consulta , Sistema de Registros , Atenção Secundária à Saúde , Distribuição por Sexo
4.
Cochrane Database Syst Rev ; 9: CD011414, 2019 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521064

RESUMO

BACKGROUND: The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings. OBJECTIVES: The primary objective was to determine the diagnostic accuracy of the Mini-Cog for detecting Alzheimer's disease dementia and other dementias in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. SEARCH METHODS: We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary. SELECTION CRITERIA: We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants). DATA COLLECTION AND ANALYSIS: We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots. MAIN RESULTS: Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity. AUTHORS' CONCLUSIONS: This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the diagnosis of dementia to help adequately determine its role in the clinical pathway.


Assuntos
Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Testes de Estado Mental e Demência , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Progressão da Doença , Humanos , Testes de Estado Mental e Demência/normas , Atenção Secundária à Saúde , Sensibilidade e Especificidade
5.
J Assoc Physicians India ; 67(9): 46-49, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31561689

RESUMO

Background: Dyspepsia is a common clinical problem and has a great impact on the patient's quality of life. More than half of patients presenting with dyspepsia have no detectable lesion for their symptoms. The common organic causes of dyspepsia include peptic ulcer, esophagitis and cancer. The diagnostic test of choice is endoscopy. Age specific thresholds to trigger endoscopic evaluation may differ by gender, availability of resources and regional disease specific risks. Aim: The aim of the study was to determine the prevalence of significant endoscopic lesions in patients presenting with dyspepsia. Materials and Methods: This was a retrospective study. Data on patients presenting with dyspepsia and scheduled for upper gastrointestinal (UGI) endoscopy between January 2011 and December 2016 was collected. Results: Nine thousand five hundred and twenty five patients with persistent dyspepsia were assessed by Upper GastroIntestinal (UGI) endoscopy. 58.8% were male. The mean age was 41 years. Endoscopy revealed normal findings or miscellaneous irrelevant findings in 6967 patients (73.1%). Significant endoscopic findings were diagnosed in 2558 (26.9%). These included peptic ulcers in 493 patients (5.1%), esophagitis in 560 (5.9%), erosive Gastroduodenitis in 1069 (11.2%), Varices in 40 patients (0.4%) and UGI malignancy in 279 (2.9%). Conclusion: The endoscopic diagnosis of persistent dyspepsia in our setting showed a predominance of functional disease. Every 4th person (26.7%) with persistent dyspepsia had organic lesions whereas UGI malignancy was an uncommon finding. The most frequent significant pathologies included erosive gastroduodenitis, esophagitis and peptic ulcer disease. Patients with recent onset of dyspepsia who are in the age group at risk of gastric malignancy should undergo early endoscopy. UGI endoscopy is simple procedure that can be undertaken for early diagnosis of benign as well as malignant lesions in patient presenting with dyspepsia.


Assuntos
Dispepsia , Adulto , Endoscopia Gastrointestinal , Feminino , Humanos , Índia , Masculino , Qualidade de Vida , Estudos Retrospectivos , Atenção Secundária à Saúde
6.
Artigo em Inglês | MEDLINE | ID: mdl-31547252

RESUMO

Background: Eye care provision is currently insufficient to meet the population's eye health needs in Kenya. Many people remain unnecessarily visually impaired or at risk of becoming so due to treatable or preventable conditions. A lack of access and awareness of services are key barriers, in large part due to their being too few eye care providers in the health system for this unmet need. Methods: A hospital-based, retrospective analysis of patients who attended Kitale eye unit, Trans Nzoia County, Kenya from 1st January 2013 to 31st December 2015. Age and sex standardized hospital attendance rates by residence, age group, and sex were calculated for Trans Nzoia county and each subcounty. The changing trends in attendance rates were estimated by calculating the difference between base year and last year. Incidence rate ratios for attendance for each age-group, sex, and residence were estimated using a multivariable regression model. Results: 20,695 patients from the county were seen in Kitale Eye Unit in 2013, 2014 and 2015. In that period, 8.3% had either uncorrected refractive error, cataracts or glaucoma, the priority VISION2020 diseases, and 61.0% had allergic or other conjunctivitis or normal eyes, which could potentially be managed at primary eye care. During the study period, overall average annual attendance rate increased from 609 to 792 per 100, 000 population, incidence rate ratio (IRR) 1.30 (95% confidence interval (CI) 1.26-1.35). Attendance rates increased more in females than males (34.7% vs. 25.1%, respectively), IRR 1.07 (1.04-1.10). Attendance rates increased with increasing age, (highest among the elderly compared to the young). We found that in extreme age groups (>75 years and <15years) females were less likely to attend than males and there was reduced utilization from those based furthest from the hospital. Conclusion: Specialist eye services are heavily utilized by people with conditions that could be managed at the primary health care level. Barriers to accessing eye services were distance and gender, especially among the most vulnerable groups (young and the elderly). Integration of primary and secondary eye care services could lower barriers to essential eye care services to the population whilst lowering pressure on the limited specialist services by ensuring more appropriate utilization.


Assuntos
Oftalmopatias/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Quênia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
7.
Z Evid Fortbild Qual Gesundhwes ; 146: 21-27, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324418

RESUMO

BACKGROUND: Pharmacokinetic analyses revealed an increase in the bioavailability of simvastatin when co-administered with amlodipine [Nishio S et al. Hypertensin research 2005; Son H et al. Drug metabolism and pharmacokinetics 2014]. This may induce an increased risk of muscle toxicity for patients who receive this combination. So far, no in vivo data on the clinical relevance of this interaction exist. The objective of the present analysis was to determine the number of patients with concomitant treatment of amlodipine and simvastatin. Subsequently, the data was analyzed for the indication of muscular discomfort. Patients with combined prescription of amlodipine and another hydroxymethylglutaryl-CoA-reductase inhibitor except simvastatin or patients receiving simvastatin without amlodipine served as control groups. METHODS: The present analysis used secondary data from the health insurance company AOK PLUS including information regarding diagnosis and drug prescriptions. RESULTS: In total, 67.081 patients corresponding to 4.93% of the analyzed collective received a combined prescription of amlodipine and simvastatin. The absolute frequency increased continuously over time. Muscular discomfort was detected in a) 6.20% of the patients receiving amlodipine and simvastatin, b) 6.60% of the patients receiving amlodipine and another hydroxymethylglutaryl-CoA- reductase inhibitor and c) 8.04% of the patients with simvastatin only. CONCLUSIONS: The present analysis shows an increasing trend of combined prescriptions of amlodipine and simvastatin. Evidence for simvastatin dose adaptation or therapy switch to another hydroxymethylglutaryl-CoA-reductase inhibitor, however, was not found. Muscular discomfort does not occur more often in patients with amlodipine and simvastatin compared to the two control groups. The results of the present analysis reveal no evidence for a clinically relevant interaction between amlodipine and simvastatin.


Assuntos
Anlodipino , Sinvastatina , Anlodipino/farmacocinética , Área Sob a Curva , Disponibilidade Biológica , Esquema de Medicação , Interações de Medicamentos , Alemanha , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacocinética , Polimedicação , Atenção Secundária à Saúde , Sinvastatina/farmacocinética
8.
Cien Saude Colet ; 24(6): 2125-2134, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269171

RESUMO

Secondary Outpatient Care (SOC) is a subject seldom studied in the literature, but of great importance for the strengthening of Primary Health Care (PHC) and the structuring of the Health Care Network. After the increase of PHC coverage following the Family Health Strategy (FHS) model, through the "CONVERTE APS" project, the State Health Secretariat of the Federal District (SHS-DF) identified the need to organize this level of care throughout the Federal District. SHS-DF has, as its Health Care Planning basis, the knowledge experienced in one of its regions, in addition to the theoretical framework produced and systematized by the National Council of Health Secretariats (CONASS) in recent years, as well as successful experiences in other regions of Brazil and countries with public health systems. The strategies to be used include the following: diagnosis and organization of facility structures, creation of a regional managerial level for Secondary Care, personnel sizing, development of the legal framework for level of care regulation, creation of technical milestones, regulation of medical and non-medical consultations in health regions and matrix support as an education strategy, but also of connection between levels of care.


Assuntos
Assistência Ambulatorial/organização & administração , Saúde da Família , Atenção Primária à Saúde/organização & administração , Atenção Secundária à Saúde/organização & administração , Brasil , Humanos , Programas Nacionais de Saúde/organização & administração , Saúde Pública , Especialização
9.
Diab Vasc Dis Res ; 16(4): 385-395, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31271312

RESUMO

AIM: Analyse the effects of professional flash glucose monitoring system (FreeStyle Libre Pro™) on glycaemic control in insulin-treated type 2 diabetes. METHODS: Primary (n = 17) and secondary care centres (n = 5) randomised 148 type 2 diabetes patients into three groups: (A) self-monitoring of blood glucose (n = 52), (B) self-monitoring of blood glucose and two Libre Pro sensor wears (n = 46) or (C) self-monitoring of blood glucose and four sensor wears (n = 50). Primary endpoint was time in range (glucose 3.9-10 mmol/L) within group C comparing baseline with days 172-187. Predefined secondary endpoints included HbA1c, hypoglycaemia and quality of life measures analysed within and between groups (clinicaltrials.gov, NCT02434315). RESULTS: In group C, time in range in the first 14 days (baseline) and days 172-187 was similar at 15.0 ± 5.0 and 14.1 ± 4.7 h/day (mean ± SD), respectively, (p = 0.1589). In contrast, HbA1c reduced from baseline to study end within group C by 4.9 ± 8.8 mmol/mol (0.44% ± 0.81%; p = 0.0003). HbA1c was also lower in group C compared with A at study end by 5.4 ± 1.79 mmol/mol (0.48% ± 0.16%; p = 0.0041, adjusted mean ± SE), without increased time in hypoglycaemia (p = 0.1795). Treatment satisfaction scores improved in group C compared with A (p = 0.0225) and no device-related serious adverse events were reported. CONCLUSIONS: Libre Pro can improve HbA1c and treatment satisfaction without increasing hypoglycaemic exposure in insulin-treated type 2 diabetes individuals managed in primary/secondary care centres.


Assuntos
Automonitorização da Glicemia , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/metabolismo , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Atenção Primária à Saúde , Atenção Secundária à Saúde , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Automonitorização da Glicemia/instrumentação , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Regulação para Baixo , Inglaterra , Feminino , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
11.
Cien Saude Colet ; 24(6): 1981-1990, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269155

RESUMO

This paper aims to show a set of strategies and care management and organization actions that have been undertaken in what was conventionally called the Health Sector Reform of the Government of the Federal District in the period 2015-2018, which was based on the strengthening of primary health care, the organization of secondary care, the establishment of the health regulatory complex, the proposed regionalization and decentralization, the systematization of contracting and contractual implementation, and the proposal and establishment of a new management model for the main public hospital in Brasília.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Brasil , Hospitais Públicos/organização & administração , Humanos , Atenção Secundária à Saúde/organização & administração
12.
Seizure ; 69: 298-303, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31152984

RESUMO

PURPOSE: Studies in adults with epilepsy, mainly in specialized epilepsy clinics, have shown that sleep disturbances were twice as prevalent in people with epilepsy as in healthy controls. Our aim was to determine the prevalence of sleep disturbances in people with epilepsy treated in district hospitals, as well as the impact of it on Quality of Life. METHOD: Adults with epilepsy, attending outpatient clinics in three district hospitals were invited to participate. Those who accepted (N = 122) provided their own controls matched for age and sex. Both groups completed four questionnaires (Groningen Sleep Quality Scale (GSQ), Medical Outcomes Study-Sleep scale (MOSS), Sleep Diagnosis List (SDL) and Epworth Sleepiness Scale) to measure their sleep over different periods and the 36-Item Short Form Health Survey (SF-36) to measure Quality of Life (QoL). The prevalence of sleep disturbances and scores on QoL were compared between both groups. RESULTS: Sleep quality, measured by the SDL, was in the pathological range 50% more often in the epilepsy group than in controls. This was confirmed by the MOSSINDEX and GSQ. People with epilepsy experienced excessive daytime sleepiness more often than controls. The lowest scores on nearly all domains of the SF-36 were seen in people with epilepsy and associated sleep disturbances. CONCLUSION: We confirmed the higher prevalence of sleep disturbances in people with epilepsy compared to controls as previously reported from specialized settings. The (co-morbid) sleep disturbances result in lower QoL scores, in both people with epilepsy and in controls, but more in people with epilepsy.


Assuntos
Epilepsia/epidemiologia , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Comorbidade , Estudos Transversais , Epilepsia/psicologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Secundária à Saúde , Sonolência , Adulto Jovem
13.
Br Dent J ; 226(12): 911, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31253886
14.
Br Dent J ; 226(12): 963-966, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31253918

RESUMO

Introduction Commissioners in England use the Commissioning for Quality and Innovation (CQUIN) payments mechanism to encourage the best provision of orthodontic treatment. However, CQUIN only use the patient's orthodontic need as a measure of complexity, rather than the levels outlined in the orthodontic commissioning guide published by NHS England. A service evaluation was designed to ascertain a secondary care setting's compliance with the commissioning complexity levels, as a new comparator for CQUIN case-mix assessment.Materials and methods A prospective evaluation was conducted for all new patients referred to the Mid Yorkshire NHS Trust orthodontic department in a 12-month period, using the levels categorised by the commissioning guide. A standard was set to accept no fewer than 80% level 3b patients.Results Of patients accepted for orthodontic treatment, 89.9% were of the highest level 3b complexity. This was compared to only 69.8% of patients having an Index of Orthodontic Treatment Need, Dental Health Component, 5.Conclusion The findings support a recommendation that commissioners should consider complexity based on the commissioning guidance, rather than orthodontic need alone; it is important that the economic drivers of commissioning implementation fairly reflect the specialist work being carried out by the workforce.


Assuntos
Assistência Odontológica , Atenção Secundária à Saúde , Inglaterra , Humanos , Estudos Prospectivos , Medicina Estatal
15.
Cien Saude Colet ; 24(5): 1915-1923, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31166524

RESUMO

Missed appointments have a great economic, social and administrative impact on the management of public health services. This research aimed to study factors associated with non-attendance to the first appointments of pediatric patients in secondary dental care services in the city of Curitiba, Brazil. A cross-sectional study was performed using secondary data from the electronic health records of the Curitiba Municipal Secretary of Health. The study included all children (0-12 years) referred to secondary dental clinics in the years 2010 to 2013. Data were analyzed by the chi-square test and Pearson linear trend chi-square (α = 0.05). Binary logistic regression models were built. Data from 1,663 children were assessed and the prevalence of non-attendance was 28.3%. The variables associated with the non-attendance in inferential analysis (p < 0.05) and in the final model were the household income per capita (95% CI: 1.93-2.82) and the waiting time in virtual queue (95% CI: 1.000-1.002). Socioeconomic aspects and the waiting time in virtual queue, should be considered in the strategic planning of health services as they may influence the attendance of pediatric patients in secondary dental referral service.


Assuntos
Agendamento de Consultas , Assistência Odontológica/estatística & dados numéricos , Pacientes não Comparecentes/estatística & dados numéricos , Listas de Espera , Brasil , Criança , Pré-Escolar , Estudos Transversais , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Masculino , Encaminhamento e Consulta , Atenção Secundária à Saúde , Fatores Socioeconômicos , Fatores de Tempo
16.
BMC Cancer ; 19(1): 616, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234813

RESUMO

BACKGROUND: Time to diagnosis (TTD) concerns teenagers and young adults (TYA) with cancer and may affect outcome. METHODS: Healthcare records from 105 TYA in a regional cancer service were assessed to document events from 1st symptom to treatment start. Detailed pathway construction was possible for 104 patients and allowed a multidisciplinary panel review of each pathway with assessment of good practice and lessons for the future. RESULTS: 1st presentation was to primary care in 86, and 93% consulted in primary care before diagnosis. Routes to Diagnosis were 45% via urgent 2 Week Wait pathways and 38% as emergency referrals. Total Interval (time from 1st presentation to treatment start) was median 63 (range 1-559) days, varying within/between diagnoses. Patient interval (time from 1st symptom to 1st presentation) was longest for lymphoma, carcinoma and bone tumour (medians: 9, 12, 20 days). Overall, time in primary care was short (median 3, range 0-537 days) compared to secondary care (median 29, range 0-195 days) and longest for lymphoma, carcinoma, brain/CNS (medians: 10, 15, 16 days). Specialist Care interval (time from 1st specialist visit to treatment start) was longest for bone, brain/CNS, lymphoma, carcinoma (medians: 30, 33, 36, 48 days). 40% pathways were rated as showing good/best practice but 16% were less than satisfactory. Continued safety-netting/support was identified from primary care but analysis suggested opportunities for improvement in transition through secondary care. CONCLUSIONS: Previous reports of prolonged TTD have focused on delay in referral from primary care but this study suggests that this might be reduced by optimising management in secondary care.


Assuntos
Detecção Precoce de Câncer , Neoplasias/diagnóstico , Neoplasias/terapia , Tempo , Adolescente , Assistência à Saúde , Feminino , Humanos , Masculino , Enfermeiras Especialistas , Atenção Primária à Saúde , Encaminhamento e Consulta , Atenção Secundária à Saúde , Tempo para o Tratamento , Adulto Jovem
17.
BMC Health Serv Res ; 19(1): 431, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248405

RESUMO

BACKGROUND: Primary and secondary healthcare service usage is assessed in the year before and following a cancer diagnosis, in cancer cases versus matched non-cancer controls in New South Wales (NSW), Australia over 2006-2012, for all invasive cancers collectively and for selected common sites: breast, prostate, colorectal and lung, and melanoma. METHODS: The 45 and Up cohort (n ≈267,000) was linked to NSW Cancer Register (NSWCR), Emergency Department Data Collection (EDDC) and Medical Benefits Schedule (MBS) data using probabilistic record linkage. First-ever malignant cancers diagnosed after enrolment in the 45 and Up study comprised the study cases. Where possible, five controls were randomly selected per case from the 45 and Up cohort, matched by sex and year of birth. Controls comprised those with no cancer recorded on the NSWCR. For each month in the year preceding and following the cancer diagnosis, general practitioner, specialist and specified hospital ED service use was compared between cases and controls using proportions, means, and odds ratios derived from conditional logistic regression. RESULTS: Compared to controls, cases of all cancers combined had a significantly higher likelihood of GP and specialist consultation in the year leading up to diagnosis. This was most pronounced in the 3-4 months leading up diagnosis for all cancers, similarly for lung cancer (GPs and specialists) and melanoma (GPs), and colorectal cancer (specialists). Likelihood of a GP consultation remained significantly higher in cases than controls in the 12 months following diagnosis. During most of the year preceding cancer diagnosis, the likelihood of specified ED presentations was also significantly higher in cases than controls for all cancers, and most pronounced in the 2-3 months before diagnosis. Excepting melanoma, the likelihood of specified ED presentations remained significantly elevated for most of the year following diagnosis for all cancers combined and for the selected cancers. CONCLUSIONS: People with cancer experience a higher use of primary and secondary healthcare services in the year preceding and following diagnosis, with GPs continuing to play a significant role post diagnosis. The higher likelihood of pre-diagnosis GP consultations among cancer cases requires further investigation, including whether signals might be derived to alert GPs to possibilities for earlier cancer detection.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Neoplasias/diagnóstico , Neoplasias/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Secundária à Saúde/estatística & dados numéricos , Estudos de Coortes , Humanos , Armazenamento e Recuperação da Informação , New South Wales/epidemiologia
19.
PLoS One ; 14(5): e0216430, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048875

RESUMO

The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Pessoal de Saúde , Modelos Teóricos , Neoplasias/terapia , Atenção Secundária à Saúde , Assistência Ambulatorial , Feminino , Humanos , Masculino , Alta do Paciente
20.
J Orthod ; 46(2): 143-147, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060464

RESUMO

The purpose of undertaking Orthodontic (Oral Health) Needs Assessment is to identify unmet healthcare need in a systematic way. The NHS Five Year Forward View set out a clear direction for the NHS in 2014, showing why change is needed and what it will look like. It has been recognised that the health needs and personal preferences of individuals are continuously adapting; therefore, orthodontic services are required to meet this changing environment. Here, we describe some of the challenges for orthodontic needs assessment. Current methods used to assess normative, perceived and expressed need are reviewed, highlighting how these may fail to accurately identify current orthodontic need. Currently, there is no index assessing either psychological need or psychological benefit from orthodontic treatment, despite evidence to suggest that there is a moderate improvement in the emotional and social wellbeing dimensions of the oral health-related quality of life of adolescents following orthodontic treatment. Commissioning of NHS orthodontic services should be guided by the best available evidence of need. As such, a number of recommendations are made which include establishment of comprehensive and comparable datasets for both primary and secondary care providers; review of the instruments used for measuring normative need in view of a changing society influenced by social media developments; and electronic referral management systems should be established which accurately monitor treatment provision. Moreover, further research is required to understand the health inequalities associated with orthodontic care and determine how social deprivation impacts on orthodontic treatment needs and uptake in local populations.


Assuntos
Qualidade de Vida , Medicina Estatal , Adolescente , Inglaterra , Humanos , Determinação de Necessidades de Cuidados de Saúde , Atenção Secundária à Saúde
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