Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.743
Filtrar
1.
Medicine (Baltimore) ; 98(52): e18399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876712

RESUMO

Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.


Assuntos
Transtornos Mentais/epidemiologia , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , África do Sul , Adulto Jovem
2.
Pan Afr Med J ; 33: 306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692846

RESUMO

Introduction: An effective referral system is considered as a key to saving mothers' and children's lives. The aims of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian tertiary care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme (NPP) guidelines. Methods: A descriptive study was undertaken among women referred to Farhat Hached University Hospital in Sousse, Tunisia with antenatal complications requiring urgent delivery and those referred while in labour or with immediate post partum complications. The ICD-10 was used to code recorded indications and diagnoses for referrals. Results: Referrals represents 15.23% of the obstetric activity in this facility. There were 32 reasons for referrals with the most common being premature rupture of membranes (14.1%) and fetal distress (13.5%). A fifth of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (95.8%) did not conform to the list of referral indications of the NPP. Twenty eight diagnoses were retained after referrals: the most common of which were prolonged pregnancy (29.5%) and premature rupture of membranes (19.3%). In 41% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital. Conclusion: The current referral system in the region of Sousse still faces several challenges that need to be addressed in order to make it more effective.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Trabalho de Parto , Guias de Prática Clínica como Assunto , Gravidez , Atenção Terciária à Saúde , Tunísia , Adulto Jovem
3.
J Surg Oncol ; 120(8): 1365-1370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31642056

RESUMO

BACKGROUND: Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown. METHODS: Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. RESULTS: Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P < .001). DMT did not alter HCV screening for HCC (23%). HCV patients screened for HCC had earlier stage disease (P = .001). CONCLUSION: Implementation of a DMT at GMH is associated with increased HCC patients referred for/receiving treatment, as well as improved survival. Few patients with HCV at risk for HCC are screened, despite DMT. Future efforts should aim to establish screening programs for HCV patients at risk for HCC.


Assuntos
Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Gerenciamento Clínico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Equipe de Assistência ao Paciente , Carcinoma Hepatocelular/patologia , Terapia Combinada , Grupos de Populações Continentais/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Provedores de Redes de Segurança , Estados Unidos/epidemiologia
4.
Einstein (Sao Paulo) ; 18: eAO4620, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664329

RESUMO

OBJECTIVE: To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. METHODS: This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. RESULTS: The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. CONCLUSION: This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Estudos Transversais , Demografia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Prevalência , Distribuição por Sexo , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Adulto Jovem
5.
J Laryngol Otol ; 133(8): 704-712, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31370911

RESUMO

OBJECTIVES: The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses. METHODS: The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer. RESULTS: Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent. CONCLUSION: The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10-15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 439, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262280

RESUMO

BACKGROUND: Research suggested that waiting time and consultation time are associated with overall patient satisfaction concerning health services. However, there is a lack of information regarding this subject in Latin American countries, where particular aspects of health systems and population characteristics could modify this association. Our aim was to evaluate the association of waiting time and consultation time with patient satisfaction, in Peruvian ambulatory care facilities and propose a cut-off points of waiting and consultation time based on patient satisfaction. METHODS: Cross-sectional secondary data analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD-2015), a national-wide survey with a probabilistic sample of 181 Peruvian ambulatory care facilities. Patient satisfaction, waiting time, consultation time, and sociodemographic variables were collected from the ENSUSALUD-2015. All variables were collected by survey directly to patients, from the selected ambulatory care facilities, after their consultation. Complex survey sampling was considered for data analysis. In the association analysis, we grouped the waiting time and consultation time variables, every 10 min, because for it is more relevant and helpful in the statistical and practical interpretation of the results, instead of the every-minute unit. RESULTS: The survey was performed in 13,360 participants. Response rate were 99.8 to 100% in the main variables. Waiting time (for every 10 min) was inversely associated with patient satisfaction (aOR: 0.98, 95% CI: 0.97-0.99), although the aOR was lower among those who reported a waiting time ≤ 90 min (aOR: 0.92, 95% CI: 0.89-0.96). Consultation time (for every 10 min) was directly associated with patient satisfaction (aOR: 1.59, 95% CI: 1.26-2.01), although the aOR was higher among those who reported a consultation time ≤ 15 min (aOR: 2.31, 95% CI: 1.66-3.21). CONCLUSION: In Peruvian ambulatory care facilities, both waiting time and consultation time showed an association with overall patient satisfaction, which was stronger in the first 90 min of waiting time and in the first 15 min of consultation time. This should be taken into consideration when designing interventions to improve waiting times and consultation times in ambulatory care facilities from Peru or from similar contexts.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Análise de Dados , Feminino , Humanos , Masculino , Peru/epidemiologia
8.
Pan Afr Med J ; 33: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303949

RESUMO

Introduction: Self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. Methods: A cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. Results: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. Conclusion: This study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.


Assuntos
Hospitais de Distrito/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Listas de Espera , Adulto , Fatores Etários , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , África do Sul , Inquéritos e Questionários , Fatores de Tempo
9.
BMC Health Serv Res ; 19(1): 479, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299953

RESUMO

BACKGROUND: Intimate partner violence (IPV) is associated with adverse health effects and increased healthcare utilization. Systems-level interventions have been shown to be effective in identifying and referring survivors but little is known about how these strategies impact future utilization. The objective of this study is to examine the impact of a systems-level response on healthcare utilization among patients screening positive for IPV from November 2016 to February 2019 in a large multi-specialty outpatient health system in the Midwest. METHODS: Using electronic health record (EHR) data, we identified patients who screened positive for IPV (N = 756) and categorized their response as accepted printed material (N = 116), accepted direct referrals (N = 85), declined both (N = 271), or missing (N = 255). We used negative binomial models to model post-period utilization as a function of decision group, pre-period utilization, and clinical and demographic factors. RESULTS: After controlling for demographic characteristics and baseline utilization, the printed materials and direct referral groups had higher utilization rates than those who declined printed materials and direct referral during the post-period for every type of service. However, these differences were only statistically significant for outpatient, behavioral health, and social work services. Specifically, the visit rate for patients receiving printed materials was two times higher (rate ratio: 2.18; 95% CI: 1.21, 3.94) for behavioral health services and three times higher (rate ratio: 3.33; 95% CI: 1.3, 8.52) for social work services compared to those who refused printed material and direct referral. For those opting for a direct referral, the visit rate was two times higher for outpatient services (rate ratio: 1.97; 95% CI: 1.13, 3.42) compared to those who refused. CONCLUSIONS: Patients receiving printed materials or direct referrals had more social work and behavioral health visits, highlighting an important outcome of the protocol. However, higher utilization rates among outpatient services and a trend toward higher utilization of other services, including the emergency department, suggest greater health service utilization is not diminished by the systems level response-at least not within a two-year time frame.


Assuntos
Redes Comunitárias/organização & administração , Violência por Parceiro Íntimo , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Meios de Comunicação de Massa/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos
10.
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
11.
Dis Colon Rectum ; 62(7): 840-848, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188185

RESUMO

BACKGROUND: Patients and their family members with hereditary colorectal cancer require longitudinal follow-up that is best achieved through a dedicated program with a registry. However, referrals for these conditions remain poor. Geographic information systems technology is a novel method to evaluate geographic variation in multiple realms but is being used more in health care. OBJECTIVE: The purpose of this study was to evaluate referral patterns with geographic information systems technology to better target efforts for improving overall referrals. We hypothesized that marked variation would exist as to the geospatial locations of referrals and that gastroenterologists would be the dominant referral source. DESIGN: This was a retrospective cross-sectional study. SETTINGS: The study was conducted at Vanderbilt University Medical Center. PATIENTS: The hereditary colorectal cancer registry was queried from June 2007 to August 2016 for demographics, distance to center, genetic mutations, and the specialty of the referring providers. Geospatial data on both patient and referring specialist were collected. MAIN OUTCOME MEASURES: We analyzed patient and referral data with geographic information systems technology to look for gaps and patterns. RESULTS: A total of 676 patients were entered into the registry during this period. Fifty-six percent were women, and the median age was 50 years (interquartile range, 42-60 y). The median distance from the center was 60 miles (interquartile range, 22-120 miles), and 31% carried an identified germline mutation. Gastroenterology represented the overall largest source of referrals and, when broken down by syndrome, they represented the top referral specialty for familial adenomatous polyposis. Surgeons were the largest referral source for Lynch syndrome. LIMITATIONS: The study was limited by covariates in the database. CONCLUSIONS: Our hereditary colorectal cancer registry serves a large geographic area, with the largest group of referrals coming from gastroenterologists. Performing this analysis with geographic information systems technology mapping allowed us to identify clustering of patients and providers throughout the region as well as gaps. This information will help to target outreach and distribution of educational materials for providers and their patients to increase registry enrollment. See Video Abstract at http://links.lww.com/DCR/A950.


Assuntos
Polipose Adenomatosa do Colo , Neoplasias Colorretais Hereditárias sem Polipose , Mapeamento Geográfico , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/terapia , Adulto , Neoplasias Colorretais Hereditárias sem Polipose/terapia , Estudos Transversais , Feminino , Gastroenterologia/estatística & dados numéricos , Sistemas de Informação Geográfica , Mutação em Linhagem Germinativa , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Centros de Atenção Terciária
12.
BMC Health Serv Res ; 19(1): 430, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248402

RESUMO

BACKGROUND: Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care. METHODS: This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements. RESULTS: Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p = .000). CONCLUSIONS: This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.


Assuntos
Cuidadores/educação , Oftalmopatias/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Materno-Infantil/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Criança , Diagnóstico Precoce , Oftalmopatias/epidemiologia , Oftalmopatias/prevenção & controle , Feminino , Grupos Focais , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Gravidez , Pesquisa Qualitativa
13.
Ann R Coll Surg Engl ; 101(6): 411-414, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155886

RESUMO

INTRODUCTION: This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. METHODS: All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. RESULTS: Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). CONCLUSIONS: Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Torção do Cordão Espermático/terapia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Orquiectomia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Torção do Cordão Espermático/diagnóstico , Testículo/cirurgia , Resultado do Tratamento
14.
Gynecol Oncol ; 154(2): 379-382, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31196574

RESUMO

OBJECTIVE: To compare referral patterns, genetic testing and pathogenic variant rates in Black women (BW) and White women (WW) in a large academic Gynecologic Cancer Risk Assessment Clinic (GCRAC). METHODS: Cross sectional study of an IRB-approved prospective, cohort study from a GCRAC. Data evaluated included: age, race, referral provider specialty and indication, genetic testing frequency, as well as frequency and types of pathogenic variants. RESULTS: 588 WW and 57 BW were evaluated from 1/2010-12/2015. Although approximately one-third of BW and WW were referred for family history alone, referral indications varied. BW were more likely referred for a known pathogenic variant (20.0% vs. 6.2%) although less likely referred for a personal history of ovarian cancer (24.0% vs. 46.8%; p = 0.0023). While gynecologic oncologists referred most patients (BW 43.6% vs. WW 63.0%), BW were more likely to be referred by surgical oncologist (23.0% vs. 12.8%) or genetic counselor (12.8% vs. 5.9%) than WW (p = 0.0234). Referral from non-OBGYN primary care providers was <3% in both groups. Genetic testing rates were similar in both races (82.4% vs. 85.5%). Rates of BRCA1 mutations (12.7% vs. 11.5%) were similar; however, BW had more BRCA2 mutations (21.3% vs. 9.5%; p = 0.0194). CONCLUSIONS: Since BW are more likely to be referred by surgical oncology or genetics counselor, breast clinics might be an entry point to ensure genetic counseling and testing. Continued efforts to increase awareness regarding the importance of patient referral at the primary care level may help identify the subset of women not currently undergoing counseling and testing.


Assuntos
Predisposição Genética para Doença , Testes Genéticos/estatística & dados numéricos , Neoplasias Ovarianas , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/etnologia , Estudos Prospectivos , Fatores de Risco , Sudeste dos Estados Unidos/epidemiologia
15.
BMC Health Serv Res ; 19(1): 346, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151446

RESUMO

BACKGROUND: With an extensive rise in the number of acute patients and increases in both admissions and readmissions, hospitals are at times overcrowded and under immense pressure and this may challenge patient safety. This study evaluated an innovative strategy converting acute internal medicine inpatient take to an outpatient take. Here, acute patients, following referral, underwent fast-track assessment to the needed level of medical care as outpatients, directly in internal medicine wards. METHOD: The two internal medicine wards at Diagnostic Centre, Silkeborg, Denmark, changed their take of acute patients 1st of March 2017. The intervention consisted of acute medical patients being received in medical examination chairs, going through accelerated evaluation as outpatients with assessment within one hour for either admission or another form of treatment. A before-and-after study design was used to evaluate changes in activity. All referred patients for 10 months following implementation of the intervention were compared with patients referred in corresponding months the previous year. RESULTS: A total of 5339 contacts (3632 patients) who underwent acute medical assessment (2633 contacts before and 2706 after) were included. Median hospital length-of-stay decreased from 32.6 h to 22.3 h, and the proportion of referred acute patients admitted decreased with 36.3% points from 94.5 to 58.2%. The median length-of-admission time for the admitted patients increased as expected after the intervention. The risk of being admitted, being readmitted as well as having a hospital length-of-time longer than 24 h, 72 h or 7 days, respectively, were significantly lower during the after-period in comparison to the before-period. Adverse effects, unplanned re-contacts, total contacts to general practice and mortality did not change after the intervention. CONCLUSION: Assessing referred acute patients in medical examination chairs as outpatients directly in internal medicine wards and promoting an accelerated trajectory, reduced inpatient admissions and total length-of-stay considerably. This strategy seems effective in everyday acute medical patients and has the potential to ease the increasing pressure on the acute take for wards receiving acute medical patients.


Assuntos
Hospitalização/estatística & dados numéricos , Medicina Interna/estatística & dados numéricos , Idoso , Estudos Controlados Antes e Depois , Dinamarca , Feminino , Medicina Geral/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
16.
Z Rheumatol ; 78(9): 832-838, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31197458

RESUMO

This article presents a retrospective analysis of patients who attended a rheumatology specialist practice (with two specialist rheumatologists) between 2016 and 2018 via an appointment arranged by the appointment service office (Terminservicestelle, TSS). Patients were analyzed in a pseudonymized manner and categorized according to the following criteria: 1. patient did not keep the appointment, 2. patient had no inflammatory rheumatic disease, 3. patient suffered from an inflammatory rheumatic disease but had no urgent indications to be seen and 4. patient suffered from an inflammatory rheumatic disease with urgent indications to be seen. Since the start of the TSS at the beginning of 2016 until the end of 2018 a total of 103 patients were allocated to this specialist practice via the TSS. An appointment was offered to 102 patients who underwent further analysis: 4.9% of the patients (n = 5) suffered from an acute inflammatory rheumatic disease and had urgent indications to be seen, 18.63% of patients (n = 19) suffered from an inflammatory rheumatic disease with no urgent indications to attend, 28.43% of patients (n = 29) did not keep the appointment and 48.04% of patients (n = 49) did not have an inflammatory rheumatic disease but other diseases, such as osteoarthritis, fibromyalgia and other forms of chronic pain syndromes. The positive predictive value (PPV) for patients with inflammatory rheumatic disease and urgent indications was 0.05 when all patients were included in the analysis and 0.07 when only patients who showed up were included. This retrospective analysis demonstrates that the TSS does not fulfill its purpose, namely to promptly arrange appointments at a specalist rheumatologist practice for patients with an acute inflammatory rheumatic disease.


Assuntos
Pacientes não Comparecentes , Encaminhamento e Consulta/estatística & dados numéricos , Doenças Reumáticas , Humanos , Pacientes não Comparecentes/estatística & dados numéricos , Estudos Retrospectivos
17.
AIDS Behav ; 23(Suppl 2): 120-128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31161462

RESUMO

To successfully link to care, persons living with HIV must negotiate a complex series of processes from HIV diagnosis through initial engagement with HIV care systems and providers. Despite the complexity involved, linkage to care is often oversimplified and portrayed as a single referral step. In this article, we offer a new conceptual framework for linkage to care, tailored to the current universal test and treat era that presents linkage to care as its own nuanced pathway within the larger HIV care cascade. Conceptualizing linkage to care in this way may help better identify and specify processes posing a barrier to linkage, and allow for the development of targeted implementation and behavioral science-based approaches to address them. Such approaches are likely to be most relevant to programmatic and clinical settings with limited resources and high HIV burden.


Assuntos
Antirretrovirais/uso terapêutico , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Assistência à Saúde/organização & administração , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Continuidade da Assistência ao Paciente/normas , Infecções por HIV/prevenção & controle , Humanos , Ciência da Implementação , Programas de Rastreamento/métodos , Inquéritos e Questionários , Estados Unidos/epidemiologia
18.
BMC Public Health ; 19(1): 721, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182067

RESUMO

BACKGROUND: Pastoralists rely on traditional healers (THs) for general health problems. However, some studies indicate that such practices result in delays in the diagnosis and treatment of tuberculosis (TB) cases. This study aims to assess the role of traditional healers in the detection and referral of active TB cases in a pastoralist community. METHODS: We identified 22 traditional healers from 7 villages of Kereyu pastoralist community in the Fentale district in Ethiopia in January 2015. We trained these THs in identifying presumptive TB symptoms and early referral to the nearby healthcare facilities. The training was held during a 1 week period that included a visit to their villages and follow-up. A 1 day meeting was held with the traditional healers, the district TB care and prevention coordinator and health extension workers from the selected sub-district to discuss the referral link between THs and the nearby healthcare facilities. Health providers working at the TB units in the selected healthcare facilities were oriented about the training given and planned involvement of THs in referring presumptive TB case. In addition, documentation of the presumptive TB cases was discussed. RESULTS: We succeeded in tracing and interviewing 8 of the 22 THs. The rest were on seasonal migration. According to the THs report for the 1 year period, these 8 THs had referred 24 TB suspects to the healthcare facilities. Sputum smear microscopy confirmed 13 of the 24 suspects as having TB cases. Among those confirmed, 10 completed treatment and three were on treatment. Five presumptive TB cases were confirmed non TB cases through further evaluation at the healthcare facilities and six of the presumptive TB cases were lost to follow up by the THs. Whereas, four of the presumptive TB cases were lost to follow up to the healthcare facility. CONCLUSIONS: Results of the present study indicate that THs can contribute to the detection of undiagnosed active TB cases in a pastoralist community, provided they are given appropriate training and support.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Medicina Tradicional/estatística & dados numéricos , Papel Profissional , Encaminhamento e Consulta/estatística & dados numéricos , Tuberculose/diagnóstico , Adulto , Etiópia , Feminino , Humanos , Masculino , Assistência Religiosa , Projetos Piloto
19.
Rev. neurol. (Ed. impr.) ; 68(12): 510-516, 16 jun., 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-180478

RESUMO

Introducción. Las unidades de cefalea surgen por una necesidad de mejorar la asistencia a los pacientes con cefalea; no obstante, se desconocen aspectos importantes de gestión clínica que demuestren su eficiencia. Objetivo. Estimar la necesidad de unidades de cefalea en nuestro medio. Pacientes y métodos. Estudio retrospectivo realizado en dos fases: identificación de las primeras consultas por cefalea durante tres meses consecutivos y recogida de datos asistenciales ocurridos durante un año. Criterios de asistencia en unidades de cefalea: migraña crónica, cefaleas raras, necesidad de técnicas especiales y cefaleas con mala respuesta terapéutica. Resultados. De las 1.418 primeras consultas, en 298 (20,38%) la cefalea fue el motivo asistencial. El 82,9% procedía de atención primaria. La distribución de diagnósticos fue: 54% migraña, 11% cefalea tensional y 35% otras cefaleas. Un total de 108 pacientes cumplía los criterios de derivación a unidades de cefalea: 63 por migraña crónica, 13 por bloqueos nerviosos, 9 por migraña frecuente, 8 por cefaleas trigeminoautonómicas, 5 por necesidad de toxina botulínica y 10 por otros motivos. Los pacientes atendidos por unidades de cefalea acudieron menos veces a urgencias que los de consulta general, se les realizaron menos tomografías cerebrales y se les indicó más toxina botulínica. Conclusión. Las unidades de cefalea están justificadas por gestionar mejor los pacientes con las variantes más graves de cefalea. En nuestro medio se justifican al menos dos consultas semanales para atender un área de 350.000 usuarios del Sistema Nacional de Salud


Introduction. Headache services arise out of a need to improve care for patients with different types of headache; however, some important aspects of clinical management that demonstrate their efficiency remain unknown. Aim. To estimate the need for headache services in our area. Patients and methods. We conducted a retrospective study in two phases: identification of the first visits due to headache during three consecutive months and collection of care data during one year. The care criteria in headache services considered were: chronic migraine, rare headaches, need for special techniques and headaches with poor therapeutic response. Results. Of the 1,418 first visits, in 298 cases (20.38%) the reason for seeking medical attention was headache. Of these, 82.9% were from primary care. The distribution of the diagnoses was: 54%, migraine; 11%, tension-type headache; and 35%, other headaches. Altogether 108 patients met the criteria for referral to headache services: 63 for chronic migraine; 13 for nerve blocks; 9 for frequent migraine; 8 for trigeminal-autonomic cephalgias; 5 due to a need for botulinum toxin; and 10 for other reasons. The patients attended by headache services went to the emergency department less often than those who visited the general outpatient department, had fewer brain scans and more botulinum toxin was indicated. CONCLUSION. Headache services are justified because they offer better management of patients with the most severe variants of headache. In our country, at least two visits a week are needed to cover an area of 350,000 users of the Spanish National Health System


Assuntos
Humanos , Cefaleia/classificação , Encaminhamento e Consulta/estatística & dados numéricos , Estudo Observacional , Estudos Retrospectivos , Estudos de Coortes , Cefaleia/diagnóstico , Cefaleia/terapia , Índice de Gravidade de Doença
20.
Bone Joint J ; 101-B(5): 536-539, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31038998

RESUMO

AIMS: The aim of this retrospective audit was to determine the route of referral or presentation of patients requiring revision following primary total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 4802 patients were implanted with an Orthopaedic Data Evaluation Panel (ODEP) 10A* cementless implant (Corail/Pinnacle) between 2005 and 2015; 80 patients with a mean age of 67.8 years (sd 10.8) underwent a subsequent revision. The primary outcome measure was route of referral for revision. RESULTS: Of the 80 revisions, 31 (38.8%) took place within the first year and 69 (86.3%) took place within six years. Only two of the 80 patients were picked up at a routine review clinic, one for infection and the other for liner dissociation. A total of 36 revised patients (45.0%) were reviewed following self-referral. Of the remaining 44 revised patients (55.0%), 15 (18.8%) were General Practitioner referrals, 13 (16.3%) were other hospital referrals, six (7.5%) were inpatients, six (7.5%) were Emergency Department referrals, and two (2.5%) were readmitted from their homes. No revisions were carried out on asymptomatic patients. CONCLUSION: Our experience suggests that if there is a robust system in place for self-referral, patients with an ODEP 10A* hip implant can, if asymptomatic, be safely discharged at the time of their first postoperative review. Cite this article: Bone Joint J 2019;101-B:536-539.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Encaminhamento e Consulta/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Auditoria Clínica , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Falha de Prótese , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA