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1.
Middle East Afr J Ophthalmol ; 26(2): 83-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543665

RESUMO

PURPOSE: The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa. METHODS: Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management. RESULTS: Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%). CONCLUSION: Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.


Assuntos
Extração de Catarata , Catarata/diagnóstico , Serviços de Saúde Comunitária/organização & administração , Organizações Religiosas/organização & administração , Encaminhamento e Consulta/organização & administração , Adolescente , Cegueira/prevenção & controle , Catarata/terapia , Criança , Pré-Escolar , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria , Voluntários
2.
Prim Care ; 46(3): 303-317, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31375183

RESUMO

Hospice is a model of care that offers significant benefits to patients at the end of their lives, their families, and also to the primary care physicians who have diligently cared for their patients. As comprehensive care physicians, primary care physicians can benefit from a strong understanding of hospice and the Medicare Hospice Benefit. This article describes the history of hospice, palliative care versus hospice care, clinical appropriateness of the hospice patient, the regulatory guidelines of the Medicare Hospice Benefit, hospice reimbursement, primary care reimbursement, and employment opportunities in hospice.


Assuntos
Cuidados Paliativos na Terminalidade da Vida/métodos , Médicos de Atenção Primária , Atenção Primária à Saúde/organização & administração , Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Reembolso de Seguro de Saúde , Comunicação Interdisciplinar , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Prognóstico , Qualidade de Vida , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Revelação da Verdade
3.
BMC Musculoskelet Disord ; 20(1): 324, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299929

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, principally affecting the older population. Highly prevalent, disabling diseases such as osteoarthritis strain the capacity of health systems, and can result in unmet need for services. The Joint Clinic was initiated to provide secondary care consultations and access to outpatient services for people with advanced hip or knee osteoarthritis, who were referred by their general practitioner for orthopaedic consultation but not offered an orthopaedic specialist appointment. METHODS: This longitudinal programme evaluation comprised four components: a proof-of-concept evaluation; an implementation evaluation; a process evaluation; and an outcomes evaluation. Interviews and surveys of general practitioners, staff, and patients were conducted pre- and post-implementation. Interviews were transcribed, and thematic analysis was completed. In addition, Joint Clinic patient visits and outcomes were reviewed. RESULTS: One hundred and eleven primary care physicians (GPs) and 66 patients were surveyed, and 28 semi-structured interviews of hospital staff and GPs were conducted. Proof of concept was satisfied. Interim and final implementation evaluations indicated adherence to the concept model, high levels of acceptance of and confidence in the programme and its staff, and timely completion within budget. Process evaluation revealed positive impacts of the programme and positive stakeholder perceptions, with some weaknesses in communication to the outer context of primary care. The Joint Clinic saw a total of 637 patient visits during 2 years of operation. Unmet need was reduced by 90%. Patient and referring physician satisfaction was high. Hospital management confirmed that the programme will continue. CONCLUSIONS: This evaluation indicates that the Joint Clinic concept model is fit for purpose, functioned well within the organisation, and achieved its primary objective of reducing unmet need of secondary care consultation for those suffering advanced hip or knee osteoarthritis.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Joelho/diagnóstico , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida
4.
Eur J Oncol Nurs ; 40: 10-21, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229198

RESUMO

PURPOSE: Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse. METHOD: This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations. RESULTS: The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse-a person-oriented discourse localising health problems within the patient's personal and sociocultural context. CONCLUSIONS: The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions.


Assuntos
Comunicação , Neoplasias/enfermagem , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/psicologia , Assistência Centrada no Paciente/organização & administração , Encaminhamento e Consulta/organização & administração , Feminino , Humanos , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem , Pesquisa Qualitativa
5.
BMC Health Serv Res ; 19(1): 429, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248420

RESUMO

BACKGROUND: With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study. METHODS: Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use. RESULTS: More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by "using gestures" (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified. CONCLUSION: Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.


Assuntos
Barreiras de Comunicação , Comunicação , Atenção Primária à Saúde , Encaminhamento e Consulta/organização & administração , Migrantes , Tradução , Adulto , Pessoal Técnico de Saúde/organização & administração , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Suíça , Migrantes/estatística & dados numéricos
6.
Rev Infirm ; 68(251): 25-27, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31208562

RESUMO

COMPLEXITY OF PREVENTION AND SCREENING PROGRAMMES AMONG MIGRANTS: The healthcare and advice clinic in Nice offers a prevention and screening consultation for migrants, with insecure rights and precarious living conditions, recently arrived in France and wishing to stay. Time, availability and the chance to open up to others help to establish the connection needed to carry out screenings and pass on prevention messages to men and women for whom this is not a priority. A volunteer nurse shares her experience of designing and setting up such a consultation, in partnership with a pulmonologist.


Assuntos
Programas de Rastreamento/organização & administração , Serviços Preventivos de Saúde/organização & administração , Migrantes , Feminino , França , Humanos , Masculino , Enfermeiras e Enfermeiros/psicologia , Encaminhamento e Consulta/organização & administração , Voluntários/psicologia
7.
Soins ; 64(836): 37-39, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208581

RESUMO

In transcultural consultations, clinical psychologists meet families who do not share their same language, nor the same cultural reference system. This activates in them countless countertransference materials qualified as archaic. The position of co-therapist, in a group session, helps to bring together this content and present it in a secondary form to feed the patient's therapeutic process.


Assuntos
Características Culturais , Psicoterapia de Grupo/organização & administração , Encaminhamento e Consulta/organização & administração , Humanos
8.
Early Interv Psychiatry ; 13 Suppl 1: 14-19, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243911

RESUMO

AIM: This paper outlines the transformation of youth mental health services in Edmonton, Alberta, a large city in Western Canada. We describe the processes and challenges involved in restructuring how services and care are delivered to youth (11-25 years old) with mental health needs based on the objectives of the pan-Canadian ACCESS Open Minds network. METHODS: We provide a narrative review of how youth mental health services have developed since our engagement with the ACCESS Open Minds initiative, based on its five central objectives of early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. RESULTS: Building on an initial community mapping exercise, a service network has been developed; teams that were previously age-oriented have been integrated together to seamlessly cover the age 11 to 25 range; early identification has thus far focused on high-school populations; and an actual drop-in space facilitates rapid access and linkages to appropriate care within the 30-day benchmark. CONCLUSIONS: Initial aspects of the transformation have relied on restructuring and partnerships that have generated early successes. However, further transformation over the longer term will depend on data demonstrating how this has impacted clinical outcomes and service utilization. Ultimately, sustainability in a large urban centre will likely involve scaling up to a network of similar services to cover the entire population of the city.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Serviços Urbanos de Saúde/organização & administração , Adolescente , Adulto , Alberta , Criança , Assistência à Saúde , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Encaminhamento e Consulta/organização & administração , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 263, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035983

RESUMO

BACKGROUND: Effective referral systems from the community to the health care facility are essential to save lives and ensure quality and a continuum of care. The effectiveness of referral systems in Mozambique depends on multiple factors that involve three main stakeholders: clients/community members; community health workers (CHWs); and facility-based health care workers. Each stakeholder is dependent on the other and could form either a barrier or a facilitator of referral within the complex health system of Mozambique. METHODS: This qualitative study, aiming to explore barriers and enablers of referral within the lens of complex adaptive health systems, employed 22 in-depth interviews with CHWs, their supervisors and community leaders and 8 focus group discussion with 63 community members. Interviews were recorded, transcribed and read for identification of themes and sub-themes related to barriers and enablers of client referrals. Data analysis was supported by the use of NVivo (v10). Results were summarized in narratives, reviewed, discussed and adjusted. RESULTS: All stakeholders acknowledged the centrality of the referral system in a continuum of quality care. CHWs and community members identified similar enablers and barriers to uptake of referral. A major common facilitator was the existence of referral slips to expedite treatment upon reaching the health facility. A common barrier was the failure for referred clients to receive preferential treatment at the facility, despite the presence of a referral slip. Long distances and opportunity and transport costs were presented as barriers to accessibility and affordability of referral services at the health facility level. Supervisors identified barriers related to use of referral data, rather than uptake of referral. Supervisors and CHWs perceived the lack of feedback as a barrier to a functional referral system. CONCLUSIONS: The barriers and enablers of referral systems shape both healthcare system functionality and community perceptions of care. Addressing common barriers to and strengthening the efficiency of referral systems have the potential to improve health at community level. Improved communication and feedback between involved stakeholders - especially strengthening the intermediate role of CHWs - and active community engagement will be key to stimulate better use of referral services and healthcare facilities.


Assuntos
Agentes Comunitários de Saúde , Programas Governamentais/organização & administração , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Adulto , Agentes Comunitários de Saúde/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Moçambique/epidemiologia , Saúde Pública , Pesquisa Qualitativa , Adulto Jovem
10.
BMC Public Health ; 19(1): 532, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072352

RESUMO

BACKGROUND: In 2012, South Africa adopted the Contraception and Fertility Planning guidelines to incorporate safer conception services into care for HIV-affected couples trying to conceive. These guidelines lacked clear implementation and training recommendations. The objective of this study was to investigate factors influencing integration of safer conception services in a clinical setting. METHODS: Twenty in-depth interviews were conducted between October-November 2017 with providers and staff at Witkoppen Clinic in Johannesburg, where the Sakh'umndeni safer conception demonstration project had enrolled patients from July 2013-July 2017. Semi-structured interview guides engaged providers on their perspectives following the Sakh'umndeni project and possible integration plans to inform the translation of the stand-alone Sakh'umndeni services into a routine service. A grounded theory approach was used to code interviews and an adaptation of the Atun et al. (2010) 'Integration of Targeted Interventions into Health Systems' conceptual framework was applied as an analysis tool. RESULTS: Five themes emerged: (1) The need for safer conception training; (2) The importance of messaging and demand generation; (3) A spectrum of views around the extent of integration of safer conception services; (4) Limitations of family planning services as an integration focal point; and (5) Benefits and challenges of a "couples-based" intervention. In-depth interviews suggested that counselors, as the first point of contact, should inform patients about safer conceptions services, followed by targeted reinforcement of safer conception messaging by all clinicians, and referral to more intensively trained safer conception providers. CONCLUSION: A safer conception counseling guide would facilitate consultations. While many providers felt that the services belonged in family planning, lack of HIV management skills, men and women trying to conceive within family planning may pose barriers.


Assuntos
Anticoncepção/estatística & dados numéricos , Aconselhamento/organização & administração , Serviços de Planejamento Familiar/organização & administração , Infecções por HIV/prevenção & controle , Atitude do Pessoal de Saúde , Fertilização , Teoria Fundamentada , Humanos , Segurança do Paciente , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , África do Sul
12.
J Pediatr Surg ; 54(7): 1277-1285, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30948199

RESUMO

BACKGROUND: The pediatric surgeon is in a unique position to assess, stabilize, and manage a victim of child physical abuse (formerly nonaccidental trauma [NAT]) in the setting of a formal trauma system. METHODS: The American Pediatric Surgical Association (APSA) endorses the concept of child physical abuse as a traumatic disease that justifies the resource utilization of a trauma system to appropriately evaluate and manage this patient population including evaluation by pediatric surgeons. RESULTS: APSA recommends the implementation of a standardized tool to screen for child physical abuse at all state designated trauma or ACS verified trauma and children's surgery hospitals. APSA encourages the admission of a suspected child abuse patient to a surgical trauma service because of the potential for polytrauma and increased severity of injury and to provide reliable coordination of services. Nevertheless, APSA recognizes the need for pediatric surgeons to participate in a multidisciplinary team including child abuse pediatricians, social work, and Child Protective Services (CPS) to coordinate the screening, evaluation, and management of patients with suspected child physical abuse. Finally, APSA recognizes that if a pediatric surgeon suspects abuse, a report to CPS for further investigation is mandated by law. CONCLUSION: APSA supports data accrual on abuse screening and diagnosis into a trauma registry, the NTDB and the Pediatric ACS TQIP® for benchmarking purposes and quality improvement.


Assuntos
Maus-Tratos Infantis/diagnóstico , Serviços de Proteção Infantil/organização & administração , Notificação de Abuso , Encaminhamento e Consulta/organização & administração , Cirurgiões , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Comunicação Interdisciplinar , Sociedades Médicas , Estados Unidos/epidemiologia
13.
Br J Gen Pract ; 69(682): e314-e320, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30962224

RESUMO

BACKGROUND: Physiotherapists are currently working in primary care as first contact practitioners (FCP), assessing and managing patients with musculoskeletal conditions instead of GPs. There are no published data on these types of services. AIM: To evaluate a new service presenting the first 2 years of data. DESIGN AND SETTING: Analysis of 2 years' data of patient outcomes and a patient experience questionnaire from two GP practices in Forth Valley NHS, UK. The service was launched in November 2015 in response to GP shortages. METHOD: Data were collected from every patient contact in the first 2 years. This included outcomes of appointments, GP support, capacity of the service, referral rates to physiotherapy and orthopaedics, numbers of steroid injections, and outcomes from orthopaedic referrals. A patient experience questionnaire was also conducted. RESULTS: A total of 8417 patient contacts were made, with the majority managed within primary care (n = 7348; 87.3%) and 60.4% (n = 5083) requiring self-management alone. Referrals to orthopaedics were substantially reduced in both practices. Practice A from 1.1 to 0.7 per 1000 patients; practice B from 2.4 to 0.8 per 1000 patients. Of referrals to orthopaedics, 86% were considered 'appropriate'. Extended scope physiotherapists (ESPs) asked for a GP review in 1% of patients. CONCLUSION: The results suggest that patients with musculoskeletal conditions may be assessed and managed independently and effectively by physiotherapists instead of GPs. This has the potential to significantly reduce workload for GPs as the service requires minimal GP support. The majority of patients were managed within primary care, with low referral rates and highly appropriate referrals to orthopaedics. Patients reported positive views regarding the service.


Assuntos
Medicina Geral , Doenças Musculoesqueléticas , Fisioterapeutas/normas , Qualidade da Assistência à Saúde , Encaminhamento e Consulta/organização & administração , Medicina Geral/métodos , Medicina Geral/organização & administração , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Satisfação do Paciente , Reino Unido
14.
Scand J Trauma Resusc Emerg Med ; 27(1): 44, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975160

RESUMO

BACKGROUND: Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide systematic assessment of the caller's perspective. Research demonstrated that callers can scale their degree-of-worry (DOW) in a telephone contact with OOH services, but its impact on triage response is undetermined. The aim of this study was to investigate the association between call-handlers' awareness of the caller's DOW and the telephone triage response. METHODS: A randomized controlled trial at a Danish OOH service using telephone triage with quantitative analyses and qualitative process evaluation. Prior to contact with a call-handler, callers were asked to rate their DOW on a five-point scale. Calls were randomized to show or not show DOW on the call-handlers' screens. Triage response (telephone consultation or face-to-face consultation) was analysed using Chi-square tests. Process evaluation incorporated a quantitative and qualitative assessment of intervention implementation and fidelity. RESULTS: Of 11,413 calls, 5705 were allocated to the intervention and 5708 to the control group. No difference in number of face-to-face consultations was detected between the two groups (OR 1.05, 95% CI 0.98 to 1.14, p = 0.17). The process evaluation showed that call-handlers did not use the DOW systematically and were reluctant to use DOW. CONCLUSION: Awareness of DOW did not affect the triage response, but this finding could reflect a weak implementation strategy. Future studies should emphasise the implementation strategy to determine the effect of DOW on triage response. TRIAL REGISTRATION: Registration number, Clinicaltrials.gov NCT02979457 .


Assuntos
Plantão Médico/organização & administração , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Telefone , Triagem/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
PLoS One ; 14(4): e0214675, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30933997

RESUMO

BACKGROUND: Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. METHODS: Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider's perspective and expressed in 2015 USD. RESULTS: Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. CONCLUSIONS: Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.


Assuntos
Testes Genéticos , Custos de Cuidados de Saúde , Técnicas de Diagnóstico Molecular , Tuberculose/diagnóstico , Tuberculose/economia , Carga de Trabalho , Adolescente , Técnicas de Tipagem Bacteriana/economia , Técnicas de Tipagem Bacteriana/normas , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Testes Genéticos/economia , Testes Genéticos/métodos , Testes Genéticos/normas , Custos de Cuidados de Saúde/estatística & dados numéricos , Diretrizes para o Planejamento em Saúde , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Técnicas de Diagnóstico Molecular/economia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Tuberculose/epidemiologia , Carga de Trabalho/economia , Carga de Trabalho/estatística & dados numéricos
16.
Rev Epidemiol Sante Publique ; 67(3): 201-204, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31006583

RESUMO

INTRODUCTION: The United Nations Climate Conference (COP21) gathered in France for delegations from all around the world, with 20,000 delegates from 195 countries every day, including 150 heads of states during the first 48hours. A specific medical cover was organized in a particular "post-attacks" context and with harsh constraints due to delimitation of an inner zone under the sole UN authority ("blue zone"). OBJECTIVE: To evaluate medical means involved and medical activity. METHODS: Medical cover was managed by SAMU 93 in collaboration with zonal SAMU and regional health agency for the entire site including the "blue zone". End-points: engaged workforce, number of visits, including transfers and medicalized transfers. RESULTS: In "France zone" (operational headquarters): an emergency physician dispatcher and an assistant for 20 days. In "blue zone": 20 rescuers, mobile intensive care unit H24 and two emergency physicians (consultations) 12/24hours for 16 days. A total of 47 doctors, 25 nurses, 25 paramedics and 20 assistants participated in the medical service. This corresponded to three emergency physician full medical time equivalents (FMTE) for 16 days. Consultations performed: 1238 or 97/day resulting in 34 (3%) transfers including seven medicalized. Patients were 706 (57%) men and 495 (43%) women, with mean age of 43±1 years. Trauma patients were most numerous (20%). CONCLUSION: Medical means involved were consistent for 16 days. The medical activity was sustained, but medicalized transfer rarely required.


Assuntos
Mudança Climática , Medicina de Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Nações Unidas/organização & administração , Adulto , Aeroportos/organização & administração , Congressos como Assunto/organização & administração , Feminino , França , Humanos , Masculino , Corpo Clínico/organização & administração , Pessoa de Meia-Idade , Encaminhamento e Consulta/organização & administração , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração , Transporte de Pacientes/organização & administração
17.
Rev Med Inst Mex Seguro Soc ; 56(6): 513-515, 2019 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-30889337
19.
Eur Eat Disord Rev ; 27(3): 274-282, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30848056

RESUMO

Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization "Encounter Form," a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary "points of access to care" were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Encaminhamento e Consulta/organização & administração , Especialização , Adulto , Feminino , Humanos , Itália , Masculino
20.
J Gastrointestin Liver Dis ; 28(1): 83-88, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851176

RESUMO

BACKGROUND AND AIMS: In 2009, the Danish Government instituted "Fast Track Clinical Pathways" (FTCP) to accelerate diagnosis and treatment of cancers including hepatocellular carcinoma (HCC). We examined how the implementation of FTCP affected the time from referral to diagnosis and treatment as well as the patient survival. METHODS: 309 consecutive patients with suspected HCC were included, 79 referred during the period 2007-2008 (before FTCP) and 230 during 2009-2011. Of those, 271 (88%) were diagnosed with HCC and 161 (60%) had cirrhosis, in most cases caused by alcohol. RESULTS: The time from referral to the first visit was reduced from a mean 16.4 (11.5) to 5.4 (6) days (p<0.001) and the time from the first visit to the Multidisciplinary Tumour Conference (MDT) treatment decision from 34.9 (27.9) to 16.1 (14.4) days (p<0.001). The total time from referral to treatment was reduced from 53.2 (37.9) to 35.9 (23.1) days (p<0.001). There was a weak trend of improved survival after FTCP: 231 (147-368) vs. 293 (227-396) days (p=0.11). CONCLUSIONS: The implementation of FTCP reduced the total time from referral to treatment by three weeks; however, without significant effects on overall mortality. While shortened waiting time is a comfort for the patient, it remains to be elucidated whether it will change the prognosis.


Assuntos
Carcinoma Hepatocelular/terapia , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Detecção Precoce de Câncer/métodos , Neoplasias Hepáticas/terapia , Encaminhamento e Consulta/organização & administração , Tempo para o Tratamento/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Tomada de Decisão Clínica , Dinamarca , Eficiência Organizacional , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Listas de Espera , Adulto Jovem
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