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1.
Artigo em Chinês | MEDLINE | ID: mdl-31594123

RESUMO

Objective: To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies. Methods: Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed. Results: Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless." Conclusion: The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumoconiose , China , Cidades , Humanos , Pacientes Ambulatoriais , População Rural , População Urbana
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(5): 856-862, 2019 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-31624389

RESUMO

OBJECTIVE: To find out the prevalence of lower urinary tract symptoms (LUTS) and analyze the characteristics of the urodynamics diagnosis in female outpatients. To study the natural history of detrusor underactive (DU) by the followed up. METHODS: A retrospective study of the female LUTS outpatients in Peking University People's Hospital from Jan. 2005 to Dec. 2015 was performed. The basic information and the urodynamic results of a total of 656 female outpatients were collected. The distribution of storage symptoms, voiding symptoms, complications and urodynamic diagnosis were analyzed. The symptoms and urodynamic results were compared among the groups, which were divided according to age, urodynamic diagnosis and diabetes mellitus. A follow-up of 163 female DU outpatients was performed, including the treatments and the American Urological Association symptoms scores (AUAss). RESULTS: Frequency (25.03%) is the most common symptom in female outpatients, followed by stress urinary incontinence (20.04%), urgency (19.97%), and difficulty of voiding (17.32%). Stress urinary incontinence (SUI) accounted for the first (36.04%) of the whole outpatients, followed by the DU (24.08%), and bladder outlet obstruction (17.58%). The patients aged 51-60 years occupied the peak of almost all the diagnosis. There was a higher proportion of the young female patients than that of the middle and old patients diagnosed with no abnormal after the urodynamic study. The first, strong, urge and maximum bladder capacity were significantly larger in DU patients with diabetes than without diabetes. Follow-up results of the DU patients showed there was no significantly difference of the AUAss scores in both the two groups before and after the follow-up, but the quality of life decreased significantly. CONCLUSION: Female LUTS outpatients showed a main complaint of storage symptoms. SUI ranked the first in female patients with LUTS. With the increase of age, bladder sensation and detrusor function decrease. In elderly patients, DU became the first ranked disease instead of SUI. Diabetes can affect the sensory function of bladder in patients with DU, and then increase the difficulty of voiding. The patients with DU, absent from treatment, experienced a lower quality of life.


Assuntos
Sintomas do Trato Urinário Inferior , Urodinâmica , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Qualidade de Vida , Estudos Retrospectivos
3.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 889-894, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484249

RESUMO

Objective: To understand the seasonality and etiological characteristics of infectious diarrhea in adults from Shanghai. Methods: Adult patients with diarrhea who had visited the enteric disease clinics in 22 hospitals that carrying on the Diarrhea Comprehensive Surveillance sentinel programs in Shanghai during 2014-2017, were surveyed. Stool specimens were collected according to the different intervals of sampling and detected for 12 bacteria and 5 viruses. Concentration ratio and circular distribution method were used for data analysis. Results: From 2014 to 2017, a total of 9 573 stool specimens were collected from the targeted diarrhea patients ≥18 years old (n=96 067), through the Shanghai Diarrhea Comprehensive Surveillance program. The positive rate of detection was 46.44%. Seasonal peaks of infectious diarrhea were both seen in summer (bacteria peak, diarrheagenic Escherichia coli and Vibrio parahaemolyticus, etc.) and in winter (virus peak, Norovirus, etc.). Both bacterial and viral infections presented seasonal concentration (Raleigh's test P<0.001) but more obvious with bacterial infection. Viral infection accounted for 60.19% of the cause of infectious diarrhea. The top five predominant pathogens appeared as Norovirus, Rotavirus, diarrheagenic Escherichia coli, Vibrio parahaemolyticus, and Salmonella spp.. Conclusions: Among the adult outpatients with infectious diarrhea in Shanghai, obvious seasonality was seen, with peaks in both summer and winter. Viral infection with Norovirus in particular, appeared as the predominant source of infection. Active, continuous and comprehensive diarrhea-related surveillance programs would be able to monitor the changing dynamic of pathogen spectrum, and lead to the adoption of targeted preventive measures.


Assuntos
Bactérias/isolamento & purificação , Diarreia/diagnóstico , Diarreia/etiologia , Disenteria/diagnóstico , Disenteria/etiologia , Fezes , Pacientes Ambulatoriais/estatística & dados numéricos , Vigilância da População/métodos , Vírus/isolamento & purificação , Adolescente , Adulto , Bactérias/classificação , Criança , Pré-Escolar , China/epidemiologia , Diarreia/epidemiologia , Disenteria/epidemiologia , Escherichia coli/isolamento & purificação , Fezes/microbiologia , Fezes/virologia , Humanos , Pessoa de Meia-Idade , Norovirus/isolamento & purificação , Rotavirus/isolamento & purificação , Salmonella/classificação , Salmonella/isolamento & purificação , Estações do Ano , Vibrio parahaemolyticus/isolamento & purificação , Vírus/classificação
4.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 900-903, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484251

RESUMO

Objective: To understand the epidemiological characteristics and antibiotic resistance profiles of Campylobacter spp. in Shanghai from 2013 to 2016. Methods: Stool samples collected from diarrhea outpatients were cultured for Campylobacter spp., using the membrane filter method in 23 hospitals under the sentinel programs, from 2013 to 2016. All the strains were identified by biochemical tests and PCR. Broth microdilution method was used to investigate the antibiotic resistance of 179 Campylobacter spp. strains that including azithromycin, ciprofloxacin, erythromycin, gentamicin, tetracycline, nalidixic acid, telycin, klinthromycin and flurbenicol. Results: A total of 179 Campylobacter spp. strains were isolated from 10 444 stool samples (1.7%). Campylobacter jejuni and Campylobacter coli appeared as the predominant ones (94.4% and 5.6%). The incidence rate was higher in children than that in adults, with peaks of infections mainly from April to June and October to December. Campylobacter jejuni strains seemed highly resistant to ciprofloxacin (96.4%), tetracycline (83.4%) and nalidixic acid (81.7%). The resistant rates appeared higher on Campylobacter coli strains that isolated from patients. Some strains were resistant to multi-drugs. Conclusions: Campylobacter spp. seemed one of the important pathogens that isolated from outpatients with diarrhea, in Shanghai. Both age and season related characteristics of Campylobacter spp. were seen. Campylobacter spp. isolated from patients was highly resistant to ciprofloxacin, tetracycline and nalidixic acid.


Assuntos
Antibacterianos/farmacologia , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/epidemiologia , Campylobacter/efeitos dos fármacos , Campylobacter/isolamento & purificação , Diarreia/microbiologia , Fezes/microbiologia , Adolescente , Adulto , Distribuição por Idade , Antibacterianos/uso terapêutico , Campylobacter/classificação , Infecções por Campylobacter/diagnóstico , Infecções por Campylobacter/microbiologia , Campylobacter coli/efeitos dos fármacos , Campylobacter coli/isolamento & purificação , Criança , Pré-Escolar , China/epidemiologia , Diarreia/epidemiologia , Farmacorresistência Bacteriana , Humanos , Incidência , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Vigilância da População
5.
Pan Afr Med J ; 33: 95, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489073

RESUMO

Introduction: Successful and long-term positive impact of antiretroviral treatment requires high rates of adherence (> 90%). In Senegal, there is a lack of data regarding adherence to antiretroviral treatment and only a few studies have looked at the determinants. The aim of this study is to assess the prevalence and determinants contributing to antiretroviral (ARV) adherence among Human Immunodeficiency Virus (HIV) infected outpatients receiving care at four public hospitals in Dakar, Senegal. Methods: A cross-sectional based study was carried out among HIV-positive ART adults in Dakar, Senegal. Patients were systematically sampled during either their clinical visits or visit to collect ARV drugs from six public hospitals and data collected with a questionnaire. The study outcome was adherence to antiretroviral treatment assessed by a multiple approach method which combined three self-reported adherence tools: self-reporting, Visual Analog Scale (VAS), and the Simplified Medication Adherence Questionnaire (SMAQ). Data were entered with an Excel spreadsheet and transferred to STATA for descriptive, bivariate and multivariate analysis. All the statistical tests were done at the threshold level of 0.05. Results: A total of 150 HIV-positive patients on first line ART regimen at six public health facilities were enrolled into the study. The mean age of patients was 43.1 years with a sex ratio of 0.3. Most of the patients were prescribed Tenofovir-based regimen. Of these patients, 26.67% were found to be highly adherent. After adjusting for health-related variables, demographic and socio-economic variables, better adherence was associated with participating actively within an association of persons living with HIV (AoR=2.89; 95% CI: 1.04 - 7.99; p value 0.041) while being widowed patient was associated with lower adherence (AoR=0.17; 95% CI: 0.03 - 0.94; p value 0.043). Conclusion: Our study findings imply that adherence should be routinely assessed during medical visits. Ongoing strategies to improve adherence such as out-of-clinic group-based models or psychological support should be directed toward outpatients' clinics to assist in improving adherence and long term virologic suppression in Senegal.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Pacientes Ambulatoriais , Prevalência , Senegal , Inquéritos e Questionários
7.
Niger J Clin Pract ; 22(9): 1281-1285, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489867

RESUMO

Background: The Medication Adherence Rating Scale (MARS) is a 10-item self-report measure of medication adherence in psychosis which is a vital predictor of illness course and outcome in patient with schizophrenia. The initial and subsequent studies have shown that MARS has good reliability and validity scores after correction for the small sample size in the index study. Aim: This study aimed to determine the psychometric properties of MARS among outpatients with schizophrenia at the outpatient clinic of the Neuropsychiatric Hospital Aro Abeokuta Ogun State Nigeria. Methods: Intra-class correlation coefficient (ICC) was used to determine the internal consistency, item-total correlations, and reliability of the instrument. Factor analysis was done using principal component analysis with varimax rotation. Results: The intra-class correlation coefficient (ICC) for these 10 items (at time T1) was 0.6 with a P value of <0.001 while for the test--retest analysis was 0.7 with a P value of 0.04. A principal components factor analysis with varimax rotation produced a four-factor solution and factor 4 was found to be the most internally consistent, with Cronbach's alpha of 0.63. Conclusion: This study supports the internal consistency, test--retest reliability, and constructs validity of the MARS.


Assuntos
Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Psicometria/instrumentação , Esquizofrenia/tratamento farmacológico , Inquéritos e Questionários/normas , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Pacientes Ambulatoriais , Transtornos Psicóticos , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , Autorrelato
8.
Pan Afr Med J ; 33: 76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448038

RESUMO

Introduction: Active involvement of patients in the management of their health has been suggested as a major means of curtailing medication errors. This study aimed to assess the steps taken by hypertensive patients in avoiding medication errors before, during and after clinic visits. Methods: A cross-sectional study was conducted in Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria (June to August, 2016) using a standardized 35-item interviewer-administered questionnaire. The IBM SPSS Version 20.0 was utilized for statistical analysis with P < 0.05, considered statistically significant. Results: A total of 200 questionnaires were completed and returned. Few (24.4%) of the respondents were taking non-prescribed medicines and most (61.5%) knew their names. Only 41.9% of the patients monitor their blood pressure very often. There was a statistical difference between the mean scores of steps to avoid medication errors after the clinic visit for the different occupations (F = 8.109; P < 0.001) and educational level (F = 6.182; P < 0.001). Conclusion: Patients that took necessary steps in avoiding medication errors before their clinic visits were likely to avoid errors at the clinic. Also, patients that avoided medication errors at the clinic were likely to avoid medication errors after the doctor's visit.


Assuntos
Anti-Hipertensivos/administração & dosagem , Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Erros de Medicação/prevenção & controle , Adulto , Estudos Transversais , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Nigéria , Pacientes Ambulatoriais , Inquéritos e Questionários
9.
Implement Sci ; 14(1): 78, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399105

RESUMO

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


Assuntos
Assistência Ambulatorial/normas , Assistência à Saúde/normas , Ciência da Implementação , Modelos Organizacionais , Neurocirurgia/normas , Ortopedia/normas , Pacientes Ambulatoriais , Técnicas de Planejamento , Melhoria de Qualidade , Grupos Focais , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa Qualitativa , Queensland
10.
Unfallchirurg ; 122(10): 771-777, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456044

RESUMO

Despite the high incidence of osteoporosis, the high risk of subsequent fractures after an initial fracture and effective treatment options, there is a substantial deficit in the diagnostics and treatment of patients suffering from osteoporosis in Germany and worldwide. The reasons for this are multifactorial and can be attributed to physicians and patients as well as mismanagement inherent to the system. This article provides an overview of the challenges in the treatment of osteoporosis patients and shows the possibilities for improvement of care in the outpatient area. With respect to the exact schedule of the diagnostics and treatment of osteoporosis, reference is made to the pocket-sized edition of the current guidelines of the Governing Body Osteology (DVO).


Assuntos
Osteoporose/terapia , Pacientes Ambulatoriais , Fraturas Ósseas , Alemanha , Humanos , Osteologia
11.
Stud Health Technol Inform ; 264: 1352-1355, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438146

RESUMO

Health organizations aim to identify patients with high fall risk in the different attention scenarios in order to provide safety and quality care. In order to address this issue, we designed an assessment tool that surveys fall risk through three questions in self-service terminals in the outpatient setting. Our objectives in this article are to describe the implementation process. A cross sectional design was used for the pilot (between October and November 2018). The issued tickets rate with high fall risk (defined as 2/3 positive responses) was 34.3%. Some adjustments needed to be done because some patients did not have true risk criteria due to self-report. We conclude that this tool will allow quicker identification of patients with true high risk. Effective prevention strategies will be necessary to improve safety after risk fall identification.


Assuntos
Acidentes por Quedas , Pacientes Ambulatoriais , Estudos Transversais , Humanos , Medição de Risco , Inquéritos e Questionários
13.
Gastrointest Endosc ; 90(3): 538-539, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31439140
14.
Z Rheumatol ; 78(8): 765-773, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456005

RESUMO

Since April 2018, the new third level care model of outpatient specialist care (ASV) according to §116b of the Social Code Book V (SGBV) has been available for patients with chronic inflammatory rheumatic diseases in Germany. Not only is a multiprofessional cooperation between the disciplines involved in treating rheumatic diseases promoted but also the cooperation between specialized rheumatologists and other specialists in private practice and in hospitals is encouraged. As budget capping limiting services and number of cases do not apply in ASV, a significant improvement of patient care in rheumatology is expected due to an increase in provider capacity. At the end of May 2019, 72 rheumatologists in the first 9 newly approved ASV teams had qualified for this new care concept. Bureaucratic obstacles have so far delayed the implementation of ASV. Difficulties arose in building a team with different specialties, in the process of registration of the teams and the assessment of the registration by certain regional boards responsible for access control. The national associations of rheumatologists, the Professional Association of German Rheumatologists (BDRh), the VRA (Verband der Rheumatologischen Akutkliniken e. V.) and the German Society of Rheumatology (DGRh) campaign for an easier admission of providers to the ASV and for adequate financing of all specialties involved in the ASV. The aim is to realize the chance of the ASV for better rheumatological care nationwide with shorter waiting times for a medical appointment and a better cooperation between specialists.


Assuntos
Assistência Ambulatorial/normas , Reumatologia , Especialização , Assistência Ambulatorial/organização & administração , Alemanha , Humanos , Pacientes Ambulatoriais , Reumatologia/organização & administração , Reumatologia/normas , Resultado do Tratamento
15.
BMC Infect Dis ; 19(1): 678, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370804

RESUMO

BACKGROUND: Fecal colonization with carbapenem-resistant Enterobacteriaceae (CRE) is a risk factor for bacterial translocation resulting in subsequent endogenous infections. The purpose of this study is to investigate the prevalence of CRE strains colonization in stool samples of outpatient in a tertiary pediatric hospital of Shanghai, China. METHODS: In a retrospective study, fecal samples were consecutively obtained from patients in 2016 and screening test for CRE was conducted by using home-made MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and ß-lactamases were characterized by polymerase chain reaction (PCR) assays and DNA sequencing. Multilocus sequence typing (MLST) was performed for the genetic relationships of the isolates. RESULTS: A total of 880 fecal samples were included for this screening test and 32 CRE strains were identified in 32 non-duplicate fecal samples from 32 children (1.3 ± 1.5 years), with a carriage rate of 3.6%. These strains mainly distributed in Klebsiella pnuemoniae (37.5%) and Escherichia coli (37.5%). All CRE strains showed high resistance to most of the routinely used antibiotics (> 90%) except for polymyxin B and tigecycline. The blaNDM gene was the major carbapenemase gene harbored by gastrointestinal CRE strains, followed by blaKPC-2, blaIMP-26, and blaIMP-4. Other ß-Lactamase genes including blaCTX-M, blaSHV, blaTEM-1, and blaDHA-1 were also detected. MLST analysis revealed that various sequence types (STs) were detected in these strains, with ST11 and ST37 being more prevalent in K.pneumoniae and ST101 in E.coli. CONCLUSIONS: This study revealed the prevalence of CRE fecal carriage in children from outpatient and urgent implementation of infection control measure should be conducted to limit the spread of CRE strains.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/patogenicidade , Infecções por Enterobacteriaceae/epidemiologia , Fezes/microbiologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Pré-Escolar , China/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/genética , Feminino , Humanos , Lactente , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , beta-Lactamases/genética
16.
BMC Public Health ; 19(1): 1050, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382942

RESUMO

BACKGROUND: Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7-8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients' satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. METHODS: A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. RESULTS: The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11-12) vs. 10(8-11), p < 0.001). The study group had a 'time in therapeutic INR' range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. CONCLUSIONS: Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. TRIAL REGISTRATION: The study was retrospectively registered with: NCT03650777 ; 9/18/18.


Assuntos
Computadores de Mão , Grupos Minoritários/educação , Pacientes Ambulatoriais/educação , Educação de Pacientes como Assunto/métodos , Pobreza/estatística & dados numéricos , Gravação de Videoteipe , Varfarina/uso terapêutico , Idoso , Instituições de Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Farmacêuticos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
17.
J Opioid Manag ; 15(3): 253-259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343726

RESUMO

OBJECTIVES: The goal of this study was to investigate whether patients were knowledgeable about naloxone, and whether they would accept overdose (OD) education and naloxone distribution (OEND), if available. DESIGN: This is a cross-sectional study to ascertain participants knowledge about OEND. A questionnaire was designed requesting information regarding age, gender, ethnicity, previous OD experience, type of substance(s) used, availability and use of naloxone for reversal, other treatment interventions utilized if witnessed OD, ways of seeking help for OD, knowledge about OEND, and willingness to accept OEND. SETTING: Study was conducted at the ambulatory detoxification clinic of a tertiary healthcare institution. PARTICIPANTS: Consecutive 131 patients, who presented for primary treatment of opioid detoxification during their visits to the ambulatory detoxification clinic between a predefined timeline from October 2014 through February 2015, were invited to participate, and all 131 agreed to be included in the study. A total of 124 participants returned completed questionnaires (95 percent response rate.) RESULTS: Overall, 68 (52 percent) of the participants indicated that they would accept OEND. A logistic regression analysis showed that younger participants (95% CI: 0.9-1, p = 0.02) and those who identified as non-white (95% CI: 0-0.8, p = 0.01) had higher odds for accepting OEND. Furthermore, prior administration of naloxone was significantly associated with OEND acceptance (95% CI: 1.6-68.6, p = 0.01). CONCLUSIONS: Results indicate more than half of participants presenting for outpatient detoxification from opioids have had an OD or witnessed an OD. More than half of the participants were willing to accept OEND. This study provides evidence that patients starting their recovery are willing to accept naloxone.


Assuntos
Overdose de Drogas , Conhecimentos, Atitudes e Prática em Saúde , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Pacientes Ambulatoriais/psicologia , Analgésicos Opioides , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico
19.
Kardiologiia ; 59(7): 52-60, 2019 Jul 19.
Artigo em Russo | MEDLINE | ID: mdl-31322090

RESUMO

All cases of acute myocardial infarction (AMI) can be divided into outpatient-onset AMI and in-hospital-onset AMI depending on the place and circumstances of their development. In this review we consider the problem of in-hospital AMI. Special attention is paid to specific features of its clinical manifestations and the scale of the clinical problem. Possible causes of difficulties in the diagnosis and treatment of this condition are presented in comparison with those in patients with outpatient-onset AMI.


Assuntos
Hospitalização , Infarto do Miocárdio , Hospitais , Humanos , Pacientes Ambulatoriais
20.
BMC Infect Dis ; 19(1): 572, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269906

RESUMO

BACKGROUND: We conducted a diagnostic surveillance study to identify Plasmodium, dengue virus, chikungunya virus, and Orientia tsutsugamushi infections among febrile patients who underwent triage for malaria in the outpatient department at Ispat General Hospital, Rourkela, Odisha, India. METHODS: Febrile patients were enrolled from January 2016-January 2017. Blood smears and small volumes or vacutainers of blood were collected from study participants to carry out diagnostic assays. Malaria was diagnosed using rapid diagnostic tests (RDT), microscopy, and PCR. Dengue, chikungunya, and scrub typhus infections were identified using rapid diagnostic test kits and ELISA. RESULTS: Nine hundred and fifty-four patients were prospectively enrolled in our study. The majority of patients were male (58.4%) and more than 15 years of age (66.4%). All 954 enrollees underwent additional testing for malaria; a subset of enrollees (293/954) that had larger volumes of plasma available was also tested for dengue, chikungunya and scrub typhus by either RDT or ELISA or both tests. Fifty-four of 954 patients (5.7%) were positive for malaria by RDT, or microscopy, or PCR. Seventy-four of 293 patients (25.3%) tested positive for dengue by either RDT or ELISA, and 17 of 293 patients (5.8%) tested positive for chikungunya-specific IgM by either ELISA or RDT. Ten of 287 patients tested (3.5%) were positive for scrub typhus by ELISA specific for scrub typhus IgM. Seventeen patients among 290 (5.9%) with results for ≥3 infections tested positive for more than one infection. Patients with scrub typhus and chikungunya had high rates of co-infection: of the 10 patients positive for scrub typhus, six were positive for dengue (p = 0.009), and five of 17 patients positive for chikungunya (by RDT or ELISA) were also diagnosed with malaria (p < 0.001). CONCLUSIONS: Dengue, chikungunya and scrub typhus are important etiologies of non-malarial febrile illness in Rourkela, Odisha, and comorbidity should be considered. Routine febrile illness surveillance is required to accurately establish the prevalence of these infections in this region, to offer timely treatment, and to implement appropriate methods of control.


Assuntos
Febre de Chikungunya/etiologia , Dengue/etiologia , Febre/etiologia , Tifo por Ácaros/etiologia , Adolescente , Adulto , Idoso , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/epidemiologia , Criança , Pré-Escolar , Dengue/diagnóstico , Ensaio de Imunoadsorção Enzimática , Feminino , Febre/epidemiologia , Humanos , Índia/epidemiologia , Lactente , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , Malária Falciparum/etiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Reação em Cadeia da Polimerase , Prevalência , Kit de Reagentes para Diagnóstico , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/epidemiologia
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