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1.
BMC Endocr Disord ; 22(1): 78, 2022 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-35346169

RESUMO

BACKGROUND: Comprehensive, real-world osteoporosis care has many facets not explicitly addressed in practice guidelines. We sought to determine the areas of knowledge and practice needs in osteoporosis medicine for the purpose of developing an osteoporosis curriculum for specialist trainees and knowledge translation tools for primary care. METHODS: This was a retrospective review of referral questions received from primary care and specialists to an academic, multi-disciplinary tertiary osteoporosis and metabolic bone clinic. There were 400 referrals in each of 5 years (2015-2019) selected randomly for review. The primary referral question was elucidated and assigned to one of 16 pre-determined referral topics reflecting questions in the care of osteoporosis and metabolic bone patients. The top 7 referral topics by frequency were determined while recording the referral source. RESULTS: The majority of referrals (71%) came from urban primary care. The most common specialists to request care included rheumatology, oncology, gastroenterology and orthopedic surgery (fracture liaison services). Primary care referrals predominantly requested assistance with routine osteoporosis assessments, bisphosphonate holidays, bisphosphonate adverse effects/alternatives, fractures occurring despite therapy and adverse changes on bone densitometry despite treatment. Specialists most often referred patients with complex secondary bone diseases or cancer. The main study limitation was that knowledge needs of referring physicians were inferred from the referral question rather than tested directly. CONCLUSION: By assessing actual community demand for services, this study identified several such topics that may be useful targets to develop high quality knowledge translation tools and curriculum design in programs training specialists in osteoporosis care.


Assuntos
Fraturas Ósseas , Osteoporose , Medicina Comunitária , Humanos , Osteoporose/terapia , Encaminhamento e Consulta , Estudos Retrospectivos
2.
Ann R Coll Surg Engl ; 104(4): 257-260, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34939845

RESUMO

INTRODUCTION: The aim of this study was to assess faecal immunochemical test (FIT) negativity in terms of its effect on cancer risk in the local symptomatic two-week wait (2WW) population. FIT was introduced to the colorectal 2WW pathway at the start of the pandemic. This study analyses the FIT-negative (<10µg Hb/g) cohort and calculates the relative risk and odds ratio associated with a negative FIT test. METHODS: FIT tests were sent to symptomatic 2WW patients without rectal bleeding, iron-deficient anaemia or palpable mass. Where FIT was <10µg Hb/g investigations were moved to a radiology protocol. RESULTS: The test return rate was 91% with a FIT-negative (<10µg Hb/g) rate of 82%. The FIT-negative group in the symptomatic referral pathway in Cornwall have a low (1.4%) risk of colon cancer but a significant risk (6.6%) when all cancer types are considered. The impact of a negative quantitative FIT changes the odds ratio of a patient having a luminal cancer by 0.26. The odds ratio for 'all cancer' risk was affected by 0.83. CONCLUSION: A negative FIT test within the local NG12 symptomatic patient group signifies a low risk of colon cancer and identifies patients who can be initially investigated with cross-sectional imaging. However, when all cancer types are considered, cancer prevalence in this group remains above 6%. In relative risk terms a negative FIT represents a small change in overall risk and this patient group still qualify for investigation through 2WW pathways.


Assuntos
Neoplasias do Colo , Neoplasias Colorretais , Neoplasias do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer/métodos , Fezes , Humanos , Sangue Oculto , Reto , Encaminhamento e Consulta
3.
PLoS One ; 17(8): e0269477, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913933

RESUMO

OBJECTIVE: The objective of this study was to assess the potential of the use of asynchronous tele-expertise (ASTE) to provide prenatal diagnosis from a medical and economic point of view. POPULATION: Patients screened by a midwife at a primary center. METHODS: A technical and clinical evaluation was conducted retrospectively, and a cost minimization study compared asynchronous tele-expertise to face-to-face consultations that would have been performed without ASTE. MAIN OUTCOME MEASURES: In our study we assessed the feasibility of ASTE, what were the origins of the requests for expertise, whether patients need to be moved and the reasons for doing so, and the costs of tele-expertise and conventional consultation. RESULTS: In this retrospective analysis 322 advices from 260 patients were interpreted remotely via a platform. The results revealed a 90.68% feasibility of transmitting in a satisfactory and interpretable way ultrasound images and videos via the tele-expertise platform (292/322 files). In our series, asynchronous analysis allowed the required physician to make an accurate diagnosis and identify 74 (28.5%, 95% CI [23% -33.9%]) pregnancies associated with malformations and rule out abnormalities in 186 (71.5%, 95% CI [66.1% -77%]) of the cases. The ASTE was not associated with face-to-face consultations for 72.7% (189/260) of the patients, who without moving, were able to have access to a precise diagnosis by ruling out the presence of anomalies in 163/189 of these patients and confirming them in 26/189 patients. The practice of ASTE would result from a societal point of view, an average saving of 61.8% (€ 120.57) per patient compared to a face-to-face consultation. CONCLUSION: The use of asynchronous tele-expertise (ASTE) using fetal ultrasound, is feasible and may contribute to increased diagnostic accuracy while generating a significant reduction in costs for society.


Assuntos
Diagnóstico Pré-Natal , Telemedicina , Redução de Custos , Feminino , Humanos , Gravidez , Encaminhamento e Consulta , Estudos Retrospectivos , Telemedicina/métodos , Ultrassonografia
4.
BMC Health Serv Res ; 22(1): 980, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915498

RESUMO

BACKGROUND: Community medicine outlets (CMOs) are the first point of call for individuals presenting with cough in Ghana. Although operators of CMOs comprising pharmacists and over-the-counter (OTC) medicine sellers largely support the public-private mix strategy which seeks to engage pharmacies in tuberculosis (TB) case detection, a significant proportion is not involved in TB referral services. The study explores the barriers to and motivation for presumptive TB case referral among CMO operators. METHODS: We used open- and close-ended questions nested in a telephone survey which assessed factors associated with presumptive TB case referral among CMO operators (n = 465). We interviewed participants using computer assisted telephone interviews and analysed the qualitative data using adjusted Mayring's structured qualitative content analysis. RESULTS: Based on participants' own experiences, non-referral was attributed to negative attitudes of presumed cases (48.2%) and inability to meet the financial demands of referred presumed cases (26.3%). Regarding their perception of barriers to TB referral for their professional colleagues, an assumed lack of TB training (44.5%) and an assumed negative attitude of operators (43.6%) were mentioned. From close-ended questions, most chosen barriers to referral were: the assumption of not having seen a presumptive TB case yet (31.8%), lack of TB training (22.2%) and no monetary motivation for operators (10.5%). Most operators (81.6%) view TB referral services as their social responsibility and feel self-motivated to refer cases in order to control the spread of TB in their communities. Of 152 further comments extracted as recommendations to improve referral, 101 (66.4%) of respondents would only refer with the availability of support systems in the form of TB training and making TB diagnostic testing more accessible. CONCLUSION: Operators of CMOs are predominantly self-motivated to refer presumptive TB cases. Barriers to referral might be mitigated by providing more training to operators and specific financial support such as reimbursement of travel costs to presumptive cases.


Assuntos
Motivação , Tuberculose , Medicina Comunitária , Gana , Humanos , Encaminhamento e Consulta , Tuberculose/diagnóstico
5.
Afr J Prim Health Care Fam Med ; 14(1): e1-e10, 2022 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-35792630

RESUMO

BACKGROUND:  Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking. AIM:  This study aimed to explore doctors' and patients' perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction. SETTING:  The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province. METHODS:  This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used. RESULTS:  There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints. CONCLUSION:  A disconnect between patients and doctors caused by the doctors' perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.


Assuntos
Relações Médico-Paciente , Disfunções Sexuais Fisiológicas , Adulto , Humanos , Anamnese , Atenção Primária à Saúde , Encaminhamento e Consulta , África do Sul
7.
Ethiop J Health Sci ; 32(3): 513-522, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35813672

RESUMO

Background: Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns. Methods: This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05. Results: Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia. Conclusion: In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.


Assuntos
Asfixia Neonatal , Morte Perinatal , Asfixia/epidemiologia , Asfixia/etiologia , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/etiologia , Peso ao Nascer , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Hospitais Especializados , Humanos , Lactente , Recém-Nascido , Gravidez , Encaminhamento e Consulta , Fatores de Risco
8.
World J Surg Oncol ; 20(1): 232, 2022 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-35820927

RESUMO

BACKGROUND: Patients with malignancy often require urgent surgical consultation for treatment or palliation of disease. The objective of this study is to explore the prognostic determinants affecting care in acute cancer-related surgical presentations and the effect on patient outcomes. MAIN BODY: This is a retrospective review of patients referred to the acute general surgery (ACS) service at a tertiary hospital for management of cancer-related problem from July 2017 to September 2018. Patient demographics, course in hospital, and survival were recorded. Multivariant logistic regression and Kaplan-Meier estimates were performed. One hundred eighty-nine patients were identified (53% female) with a mean age of 65.9 years. Forty-two patients (22%) were newly diagnosed with cancer on presentation, and 94 (50%) patients had metastatic disease. Cancer staging was completed in 84% of patients, and 65% had multidisciplinary team (MDT) assessment during their hospital stay. Surgery was performed on 90 (48%) patients, of which 31.2% was with palliative intent. Overall mortality was 56% with 30- and 60-day mortality of 15% and 22%, respectively. The adjusted odds ratio (OR) for a 60-day mortality was high in patients presenting with new cancer diagnosis (OR 3.18, 95% CI 1.18-9.02, p=0.03), metastatic disease (OR 5.11, 95% CI 2.03-12.85, p=0.001), or systemic therapy on presentation (OR 3.46, 95% CI 1.30-9.22, p=0.013). CONCLUSION: Emergency surgical referral is common in patients with malignancy. Surgical decision making can be challenging due to the heterogeneity of this population and their associated comorbidities. Optimizing prognostic determinants such as goal-directed palliative care, MDT discussions, and bridging to systemic therapy can improve patient outcomes.


Assuntos
Neoplasias , Encaminhamento e Consulta , Idoso , Feminino , Humanos , Masculino , Neoplasias/cirurgia , Cuidados Paliativos , Prognóstico , Estudos Retrospectivos
9.
BMC Med Educ ; 22(1): 538, 2022 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-35831886

RESUMO

BACKGROUND: Well performed clinical communication is a cornerstone of collaborative care in medicine but may be confounded by inconsistent intentions of the messenger and biased interpretation by the recipient. A comparison of the findings of electronic echocardiography reports with clinician-completed standardised request forms provided an opportunity to assess communication quality. AIM: The study aimed to determine clinician aptitude to complete written echocardiography referral forms by assessing the completeness, appropriateness, accuracy, and coherency of the reported clinical findings, conclusions and requests made on the referral forms. The study explored factors that may influence the quality of communication through this referral medium. METHODS: A retrospective cohort study was conducted on patients who underwent trans-thoracic echocardiography imaging at Cecilia Makiwane Hospital in East London over 26 months. Paper echocardiography request forms that recorded the requesting clinician's findings on examination, the provisional clinical diagnosis, and the specific echocardiographic information sought, were compared with the actual findings on echocardiography. RESULTS: Of 613 request forms reviewed, 97 cases were excluded due to illegibility or because they lacked analysable information or requester details, leaving 516 forms suitable for study. No pathology was found on echocardiography in 31%. Of the murmurs expected from the echocardiography findings, only half were recorded on the request form (sensitivity and positive predictive value both 52%.). Only 35% of request forms that mentioned a mitral systolic murmur gave a working diagnosis of mitral regurgitation and only 38% of request forms that mentioned an aortic systolic murmur considered aortic stenosis. Clinically suspected cardiomyopathy (CMO) had a PPV of 43% and echocardiographic CMO was missed clinically in 41%. Apex beat displacement reported clinically was not associated with echocardiographic LV dilatation in 65% of cases. One-third (34%) of forms reporting murmurs did not request valve function assessment and 17% considering cardiomyopathy did not request left ventricular function assessment. CONCLUSION: Echocardiography request forms highlight vulnerabilities in clinical communication. Specifically, important clinical features were missing and more concerningly, included when unlikely to be present. There was a lack of concordance between recorded clinical findings and postulated diagnoses. Clinicians sometimes appeared unclear about the value or appropriateness of the requested assistance. Greater emphasis on teaching examination and communication skills may foster safer and more efficient use of scarce resources.


Assuntos
Cardiomiopatias , Sopros Sistólicos , Cardiomiopatias/complicações , Comunicação , Ecocardiografia/métodos , Sopros Cardíacos/diagnóstico por imagem , Sopros Cardíacos/etiologia , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos , Sopros Sistólicos/etiologia
10.
BMC Med Educ ; 22(1): 533, 2022 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-35804336

RESUMO

BACKGROUND: Our goal was to improve pediatric residents' advanced communication skills in the setting of referral to address the entrustable professional activity of subspecialty referral identified by the American Board of Pediatrics. To accomplish this aim, we created a referral and consultation curriculum to teach and assess core communication skills in subspecialty referral involving an adolescent with syncope, an anxiety-provoking symptom that is rarely associated with serious pathology. METHODS: We utilized blended multimodal educational interventions to improve resident communication skills in referral of patients. Trainees participated in 1) an interactive online module on syncope focusing on "red-flag" symptoms that would warrant a subspecialty cardiology referral and 2) a 4-h intervention with Standardized Parents (SPs), focusing on the case-based application of communication skills. Communication skills were assessed by two pre- and post- Objective Structured Clinical Examination encounters of patients with syncope, with an SP evaluation using a 20-item checklist. Analysis was performed with Sign test and McNemar's test. Trainees provided feedback on a Critical Incident Questionnaire, which was analyzed qualitatively. RESULTS: Sixty-four residents participated. There was an overall improvement in communication skills based on SP scores (82.7 ± 10.9% to 91.7 ± 5.0%, p < 0.001), and 13/20 items demonstrated significant improvement post-intervention. Residents' improved performance enabled them to address patient/family emotions, explain referral logistics, and clarify concerns to agree on a plan. CONCLUSIONS: By participating in this curriculum, residents' communication skills improved immediately post-intervention. Further research is needed to assess if this intervention improves patient care by providing residents with enduring skills to judiciously manage the referral process.


Assuntos
Internato e Residência , Adolescente , Criança , Competência Clínica , Comunicação , Currículo , Humanos , Encaminhamento e Consulta , Síncope
11.
Artigo em Inglês | MEDLINE | ID: mdl-35805654

RESUMO

Beyond physical pain, patients with coronavirus disease 2019 (COVID-19) experience psychological anxiety during and after quarantine, often facing negative perceptions when returning to their communities. This study evaluated a health consultation program in Korea for post-quarantine patients with COVID-19, designed to help them return to their communities. The program was conducted from 9 March to 5 June 2020, in Daegu, Korea. In total, 20 doctors and 504 recovered patients were surveyed via questionnaire. The survey, comprising open-ended questions rated on a five-point Likert scale, was based on the Context-Input-Process-Product program evaluation model. Reliability was assessed, and descriptive statistics were obtained. A regression analysis was performed on factors affecting product (output) areas. As a main result, both doctors and recovered patients evaluated the program positively. The mean program effectiveness score was 4.00 in the doctors' evaluations and 3.95 in the patients' evaluations. Moreover, the input and process variables affected the product. This first-of-its-kind health consultation program proved to be an effective practical intervention for patients returning to the community after an infectious disease; it also highlights aspects that could increase satisfaction in systemized subsequent programs, with input and process areas for patients and doctors.


Assuntos
COVID-19 , COVID-19/epidemiologia , Seguimentos , Humanos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , República da Coreia/epidemiologia
13.
Arch Osteoporos ; 17(1): 96, 2022 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-35854058

RESUMO

INTRODUCTION: Patients often do not receive osteoporosis screening after a low-energy distal radius fracture (DRF). The effect of osteoporosis on the healing of DRFs remains a debate, and it is unclear if surgical treatment of this injury affects the referral and participation rates in a fracture liaison service (FLS) program. The purpose of this study is to report on a large cohort of low-energy DRFs and identify demographic, clinical, and treatment factors that affect referral and participation rates in an FLS program. METHODS: A retrospective review identified patients over 50 years old who sustained a low-energy DRF between 2013 and 2018. Patients with high-energy or unknown injury mechanisms were excluded. The primary outcome was the effect of DRF surgical treatment on referral and participation rates in an FLS program. Secondary outcomes included patient demographic and clinical characteristic effects on referral and participation rates in an FLS program. RESULTS: In total, 950 patients met inclusion criteria. Two hundred thirty patients (24.2%) were referred and 149 (15.7%) participated in the FLS program. Patients who underwent surgery were more likely to be referred to the FLS (OR 1.893, CI 1.403-2.555, p < 0.001) and participate in the FLS program (OR 2.47, CI 1.723-3.542, p < 0.001) compared to patients who received non-operative treatment of their DRF. CONCLUSIONS: Patients who undergo surgical treatment of a low-energy DRF are more likely to be referred and participate in a FLS program. Further study is needed to identify why surgical treatment may affect referral and participation rates.


Assuntos
Osteoporose , Fraturas por Osteoporose , Fraturas do Rádio , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Fraturas do Rádio/cirurgia , Encaminhamento e Consulta , Prevenção Secundária
14.
Eur Rev Med Pharmacol Sci ; 26(13): 4893-4901, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35856382

RESUMO

OBJECTIVE: Real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard examination to confirm coronavirus disease 2019 (COVID-19). This study aimed to determine the association between RT-PCR Ct value and COVID-19 clinical severity in the second week of illness. PATIENTS AND METHODS: This study was a cross-sectional study. Data were collected from medical records of COVID-19 patients at the tertiary COVID-19 referral hospital of West Java, Dr. Hasan Sadikin Hospital Bandung, from January to May 2021. A total of 207 patients who met inclusion criteria were divided into four severity groups. The data were analyzed with One Way ANOVA Test. RESULTS: There was no significant difference in RT-PCR Ct value among mild, moderate, severe and critical groups measured in the second week of illness, with p=0.825 for Ct Helicase/ORF1b gene, p=0.821 for Ct RdRp gene and p=0.870 for the lowest Ct gene. CONCLUSIONS: Although Ct value reflects viral load, its role is concluded to be clinically insignificant in terms of association with the severity of COVID-19 in the second week of illness.


Assuntos
COVID-19 , COVID-19/diagnóstico por imagem , Estudos Transversais , Humanos , Indonésia/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Encaminhamento e Consulta , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Índice de Gravidade de Doença , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X
15.
PLoS One ; 17(7): e0268544, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35834530

RESUMO

BACKGROUND: Improvement in practitioners' consultation skills (CSs) can be driven by patient feedback, however, to date, no study has been conducted with reference to pharmacy consultations. The Interpersonal Skills Questionnaire (ISQ) is potentially appropriate for collecting patient feedback on pharmacists' CSs. This study aims to explore the feasibility of collecting patient feedback on hospital pharmacists' CSs using the ISQ, to identify the acceptability of the feedback process, and to identify methods to enhance the process in the future. METHODS: The study was conducted in a teaching hospital, United Kingdom, between 2018 and 2019. A diverse sample of pharmacists with patient-facing roles was purposively selected. The study comprised three phases. Pharmacists collected feedback from patients following their consultation using the ISQ utilising a third person whenever possible (phase-1). Data analysis and individual report writing was conducted by a private company. Interviewing a sample of patient participants by telephone (phase-2), and interviewing pharmacists face-to-face after receiving feedback reports (phase-3). All interviews were transcribed verbatim and thematically analysed. The study received approval by the NHS Health Research Authority. RESULTS: Six pharmacists were included. Of the 119 distributed ISQs, 111 were returned (response rate 93%). Patients were mostly recruited by their consulting pharmacists (72%, n = 80). All pharmacists and 14 patients were interviewed. Participants were positive about patient feedback and its role in enhancing CSs. Most did not encounter any problem with the process, however, some pharmacists struggled to find a third person. The ISQ was mostly viewed suitable to assessing pharmacy consultations. Some reports highlighted areas to improve (e.g. protecting patient's privacy). CONCLUSIONS: Collecting feedback is feasible, acceptable and may enhance CSs, however, the process was associated with challenges such as finding a third person. Several measures should be considered to make the process more feasible within the hospital pharmacy setting.


Assuntos
Serviços Comunitários de Farmácia , Farmacêuticos , Atitude do Pessoal de Saúde , Estudos de Viabilidade , Retroalimentação , Hospitais , Humanos , Papel Profissional , Encaminhamento e Consulta , Habilidades Sociais , Inquéritos e Questionários
16.
Glob Health Action ; 15(1): 2095782, 2022 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-35848796

RESUMO

BACKGROUND: Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. OBJECTIVE: We aimed to determine the geographical access to child TB services in Pakistan. METHOD: We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization's (WHO) recommended 5-km distance. RESULT: At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. CONCLUSION: With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.


Assuntos
Tuberculose , Criança , Geografia , Instalações de Saúde , Acesso aos Serviços de Saúde , Humanos , Paquistão/epidemiologia , Encaminhamento e Consulta , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/terapia
18.
WMJ ; 121(2): 111-115, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35857685

RESUMO

BACKGROUND: Utilization of emergency departments for non-urgent conditions has been a longstanding problem leading to excessive health care spending, unnecessary testing, and missed opportunities for patients to form longitudinal relationships with primary care clinicians. The Milwaukee Health Care Partnership established the Emergency Department Care Coordination program to decrease avoidable emergency department visits and connect high-risk individuals with primary care medical homes. Emergency department providers from 8 hospitals schedule patients to safety net clinics to establish follow-up care. During 2018 and 2019, there were 5,035 appointments scheduled, with a 43% show rate. This project aimed to identify factors influencing the show rate to follow-up appointments and to develop program interventions. METHODS: This project utilized a database of deidentified patient and referral information and performed logistic regressions to determine factors that influence show rates. RESULTS: There was a significant difference in show rates when looking at days between the emergency department visit and follow-up appointment, age, receiving clinic, and insurance status (all P > 0.001). Patients seen within 5 days of emergency department visit, patients 65 and older, and uninsured patients had increased likelihood of attending follow-up appointments. CONCLUSION: These results demonstrate that older adults are more likely to attend appointments, and more efforts are needed to engage younger people. The analysis shows the need to schedule patients with follow-up primary care quickly, as a short number of days from emergency department visit to primary care appointment was strongly correlated with a higher show rate. In addition, uninsured patients are good candidates for Emergency Department Care Coordination program referrals.


Assuntos
Encaminhamento e Consulta , Provedores de Redes de Segurança , Idoso , Agendamento de Consultas , Serviço Hospitalar de Emergência , Humanos , Atenção Primária à Saúde
19.
Rev Bras Enferm ; 75Suppl 2(Suppl 2): e20210820, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35858023

RESUMO

OBJECTIVE: to report on the creation and implementation of telehealth activities developed by the Forest Health Program in communities in conservation areas, in the state of Amazonas, during the COVID-19 pandemic. METHODS: this is an experience report on the creation and implementation of the program. RESULTS: the project began in June 2021 with medical and nursing services and currently has 63 points of connectivity installed. Dermatology was the most requested specialty (30.1%), with dermatitis being the main grievance diagnosed. For nursing, the most requested specialty was obstetrics, followed by pediatrics. Rio Madeira and the Catuá-Ipixema Extractive Reserve requested more than half of all consultations. CONCLUSION: this project showed a differentiated performance of telehealth in riverside communities in Amazonas, especially in the pandemic context, expanding health care in remote areas, such as these.


Assuntos
COVID-19 , Telemedicina , Brasil , COVID-19/epidemiologia , Criança , Feminino , Humanos , Pandemias , Gravidez , Encaminhamento e Consulta
20.
Niger J Clin Pract ; 25(7): 1061-1068, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35859466

RESUMO

Background: Affinity of coronavirus disease to the central nervous system is not well known. Aim: We aimed to share the data of COVID-19 patients with neurological complaints in a pandemia hospital. Material and Method: Consultation results requested from the neurology clinic of Konya Meram State Hospital were retrospectively examined. PCR test positive patients, PCR negative patients with positive clinical, laboratory and radiological findings with COVID-19 were evaluated. Age, gender, history of neurological diseases, and neurological symptoms were recorded. Results: The reason for consultation was acute neurological symptom in 96 (84.2%) patients, counseling for treatment in chronic disease in 15 (13.2%) patients, and worsening in chronic disease in 3 (2.6%) patients. As neurological disorders, 22 (19.3%) had a history of previous stroke, 10 (8.8%) had dementia, 4 (3.5%) had epilepsy, 4 (3.5%) had Parkinson's disease, 3 (2.6%) had multiple sclerosis, 2 (1.8%) had myasthenia graves, and 1 (0.9%) had restless legs syndrome respectively. The most common reason for requesting consultation was changes in consciousness (56.1%). Of the 114 patients who requested neurology consultation, 65 (57%) were discharged, 49 (43%) were died. Conclusion: The change in consciousness was the reason in more than half of the patients who requested neurology consultation during COVID-19 follow-up. Impaired consciousness in a patient with COVID-19 may indicate a poor prognosis. If the studies planned in the near future can shed light on the cause of the unconsciousness developing in COVID-19, it will be promising in terms of treatment plans to reduce mortality.


Assuntos
COVID-19 , Epilepsia , Neurologia , COVID-19/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Hospitais , Humanos , Pandemias , Encaminhamento e Consulta , Estudos Retrospectivos
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