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Rickman, Hannah M., Robert F. Miller, Stephen Morris-Jones, Lusha Kellgren, Simon G. Edwards, and Alison D. Grant. "Missed opportunities for tuberculosis prevention among patients accessing a UK HIV service." International Journal of STD & AIDS 29, no. 12 (May 11, 2018): 1234–37. http://dx.doi.org/10.1177/0956462418773010.
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United Kingdom guidelines recommend screening for and treatment of latent tuberculosis infection (LTBI) in HIV-positive patients at high risk of active tuberculosis (TB) disease, but implementation is suboptimal. We investigated potential missed opportunities to identify and treat LTBI among HIV-positive patients accessing a large HIV outpatient service in London. Case records of all adult patients attending our service for HIV care diagnosed with active TB between 2011 and 2015 were reviewed to determine whether they met criteria for LTBI screening and whether screening was undertaken. Twenty-five patients were treated for TB. Of 15 (60%) patients who started TB treatment ≥6 months after HIV diagnosis, 14 (93%) met UK guideline-recommended criteria for LTBI screening and treatment; only one (7%) had been screened for LTBI. Eight of these 15 (53%) patients had additional risk factors for TB which are not reflected in current UK guidelines. Of 15 patients treated for TB ≥6 months after diagnosis of HIV, 14 (93%) had not been screened for LTBI, suggesting missed opportunities for TB prevention. People living with HIV may benefit from a broader approach to LTBI screening which takes into account additional recognised TB risk factors and ongoing TB exposure.
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Percudani, Mauro, Giovanni Fattore, Gian Carlo Belloni, Simone Gerzeli, and Agostino Contini. "Service utilisation and costs of first-contact patients in a community psychiatric service in Italy." European Psychiatry 17, no. 8 (December 2002): 434–42. http://dx.doi.org/10.1016/s0924-9338(02)00704-6.
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SummaryThis study describes service utilisation under routine clinical activity and the costs of providing mental health care for 24 months for the whole population of 330 subjects who had first contact with the Magenta Community Mental Health Centre during one year. The mean age of patients was 42.5 years, and 61% were females. According to ICD 10 criteria, 7% were diagnosed as having schizophrenia, 22% mood disorders, 37% neurotic disorders, 15% personality disorders and 19% other diagnoses. The clinical routine activity was monitored for 24 months from the first contact for each patient. The mean cost for a schizophrenic patient is more than double that of other patients. In-patient activity and community services accounted, respectively, for 49.7% and 50.3% of the total costs. Total health care costs per patient differ widely according to whether patients had been hospitalised during the observation period. Patients with a previous psychiatric contact and a longer duration of illness were more costly than the other patients. Multiple regression analysis was used to assess the association between all the individual variables and costs. For the whole population, the model explains 50% of the cost variation. Higher treatment costs were positively associated with the presence of previous psychiatric contacts and referral to the CPS by other sources than a general practitioner, and negatively associated with age.
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Moors, Martins, and Juris Osis. "Evaluation of results of social rehabilitation programs for young people with behavioural problems." SHS Web of Conferences 68 (2019): 03001. http://dx.doi.org/10.1051/shsconf/20196803001.
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New targeted social service – social rehabilitation program for young people with behavioural problems is implemented in Riga since 2016. The program beneficiaries are young people from social risk families with multiple social problems – learning difficulties, delinquency, low communication skills, difficulties in problem and conflict resolution, addictions, social isolation, etc. The program is provided by two organizations – “The Samaritan Association of Latvia” and the “Social Services Agency”. The duration of the programs is 6 months and 8 months respectively, each Program provides services for 15 young people aged 13 to 18 years. The study analyses results of the Program implemented by the “Social Service Agency” for 15 young people. The main objective was to determine if the implementation of the Program improves the social functioning of young people having behavioural problems.
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Saadé, Raafat George, and Rustam Vahidov. "Situated Service-Oriented Modeling." International Journal of Service Science, Management, Engineering, and Technology 2, no. 1 (January 2011): 52–72. http://dx.doi.org/10.4018/jssmet.2011010104.
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The emergence of e-services benefited the stakeholders due to ease of access to data, information and knowledge sources. Service-based applications have evolved into flexible and adaptable systems capable of coping with changes in user requirements and business processes. The shift from monolithic application silos towards service-oriented approaches is evident in the literature today. The benefits of service-oriented approaches include cost effectiveness, improved inter-operability, reusability, and flexibility. The benefits are not enjoyed without the threat of cognitively overloading managers in their decision making activities. Tools for effective management of information are necessary. Effective and efficient service-oriented applications need to operate within their situational boundaries. As such, decision support type tools require tight integration with the service-based approach. This study proposes an integrated Situated Service-Oriented Model and demonstrates its value via a case study of an e-learning service-based application used over a period of 15 months. Two designs were used; component-based and service-oriented. The significance of this study is in the tangible value of the model proposed and demonstrated by the e-learning case study.
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Lewis, Llewellyn, Christine O'Keeffe, Ian Smyth, Judi Mallalieu, Laura Baldock, and Sam Oliver. "Maintaining Adherence Programme: evaluation of an innovative service model." BJPsych Bulletin 40, no. 1 (February 2016): 5–11. http://dx.doi.org/10.1192/pb.bp.114.048496.
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Aims and methodThe Maintaining Adherence Programme (MAP) is a new model of care for patients with schizophrenia, schizoaffective disorder and bipolar affective disorder which aims to encourage adherence and prevent relapse. This evaluation, conducted by retrospective and prospective data collection (including patient questionnaires and staff interviews), aimed to describe MAP's impact on healthcare resource use, clinical measures and patient and staff satisfaction, following its implementation in a university National Health Service (NHS) foundation trust in England. We included 143 consenting patients who entered MAP before 31 March 2012.ResultsIn-patient bed days and non-MAP NHS costs reduced significantly in the 18 months post-MAP entry. At 15–18 months post-MAP, Medication Adherence Rating Scale scores had improved significantly from baseline and there was a shift towards less severe clinician-rated disease categories. Based on patient surveys, 96% would recommend MAP to friends, and staff were also overwhelmingly positive about the service.Clinical implicationsMAP was associated with reduced cost of treatment, improvements in clinical outcomes and very high patient and staff satisfaction.
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Boysen, James C., Stacie A. Salsbury, Dustin Derby, and Dana J. Lawrence. "A focus group study of chiropractic students following international service learning experiences." Journal of Chiropractic Education 30, no. 2 (October 1, 2016): 124–30. http://dx.doi.org/10.7899/jce-15-25.
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Objective: One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. Methods: Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. Results: The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor–patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. Conclusion: Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.
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Lisk, R., M. Krasuski, H. Watters, C. Parsons, and K. Yeong. "P-439: 12 months impact of an Orthopaedic Early Supportive Discharge (OSD) team in our hip fracture service." European Geriatric Medicine 6 (September 2015): S150. http://dx.doi.org/10.1016/s1878-7649(15)30536-2.
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Ramirez, Glenda M., Pamela Kum, and Julia J. Kelly. "The Association Between Care Coordination and Preventive Care Among Children With Special Health Care Needs." Clinical Pediatrics 59, no. 7 (March 7, 2020): 663–70. http://dx.doi.org/10.1177/0009922820910823.
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Care coordination (CC) has shown positive outcomes among children with special health care needs (CSHCN); however, the association between CC and well-child care (WCC) visits is unknown. We hypothesize that CSHCN who receive CC are more likely to attend the recommended WCC visits. A retrospective cohort analysis was conducted of patients aged 15 months attending the Arizona Children’s Center clinic. Logistic regression models explored the association between children receiving CC and attending the recommended minimum WCC visits before 15 months of age. CC was associated with higher odds of proper WCC attendance (any CC service, adjusted odds ratio = 2.14, 95% confidence interval = 1.75-2.62; high level of CC, adjusted odds ratio = 2.61, 95% confidence interval = 1.73-3.94). Pediatric CC is associated with greater up-to-date status of the WCC schedule among CSHCN 15 months of age, and higher odds among children who receive higher levels of CC. Further research is needed to validate findings.
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Bolton, Patrick, Sharryn Ganon, and David Aro. "HealthConnect: a trial of an after-hours telephone triage service." Australian Health Review 25, no. 2 (2002): 95. http://dx.doi.org/10.1071/ah020095.
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This paper describes HealthConnect, an after-hours telephone triage and advice service which operated for 15 months in 2000 and 2001. We describe the service, discuss utilisation and implementation issues, and conclude with a description of the key lessons learned from the trial. The service received over of 12000 calls, of which over half were for information rather than immediately seeking care.Continuing marketing appears to be required in order to ensure ongoing demand for services of this kind. Qualityassurance is essential to ensure that an optimal service is provided, and staff recruitment and training are critical tothis. A national standardised approach to services of this kind is desirable to provide a consistent service to consumers and realise economies of scale.
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Wade, Darryl, Susy Harrigan, Meredith G. Harris, Darryl Wade, Susy Harrigan, Meredith G. Harris, Jane Edwards, et al. "Pattern and Correlates of Inpatient Admission During the Initial Acute Phase of First-Episode Psychosis." Australian & New Zealand Journal of Psychiatry 40, no. 5 (May 2006): 429–36. http://dx.doi.org/10.1080/j.1440-1614.2006.01819.x.
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Objectives: The first aim of this study was to examine the rate, pattern and correlates of inpatient admission during the first 3 months of treatment for first-episode psychosis (FEP). The second aim was to determine whether the pattern of inpatient admission during this period was associated with remission of psychotic symptoms or inpatient service use at 15-month follow-up. Method: One hundred and four consecutive patients with FEP at a specialist treatment service were approached to participate in a follow-up study. Patients were grouped on the basis of the pattern of inpatient admission (none, one, or multiple) during the first 3 months of treatment. Clinical ratings at baseline and 3-month follow-up, and ratings of remission of psychotic symptoms at 3 and 15-month follow-up, were available for two-thirds of the patients. Inpatient data for the 15-month follow-up period were derived from an electronic database for most patients (n = 98). Results: Eighty (76.9%) of the 104 patients were admitted to an inpatient unit during the first 3 months of treatment. Fifty-nine (56.7%) patients had a single admission and 21 (20.2%) had multiple admissions. At baseline, inpatient admission was associated with a diagnosis of affective psychosis and more severe behavioural and functional disturbance but not positive psychotic symptoms. Multiple admissions were associated with risks to self or others at baseline and 3-month follow-up, and lack of remission of positive symptoms at 3 and 15-month follow-up. There was no association between the pattern of inpatient admission during the initial 3-month period and inpatient service use during the following 12-month period. Conclusions: The substantial proportion of young patients with FEP admitted to hospital emphasizes the need for youth-friendly treatment environments and practices. Although patients with multiple admissions during the initial treatment period are less likely to achieve remission, these patients are no more likely to establish a pattern of revolvingdoor hospitalizations compared with other patients.
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Feleke, Fentaw Wassie, and Getahun Fentaw Mulaw. "Minimum Acceptable Diet and its Predictors among Children Aged 6-23 Months in Mareka District, Southern Ethiopia: Community Based Cross-Sectional Study." International Journal of Child Health and Nutrition 9, no. 4 (November 27, 2020): 202–11. http://dx.doi.org/10.6000/1929-4247.2020.09.04.7.
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Background: Optimal infant and young child feeding practices are essential for normal growth, better health, and mental and physical development. Even though there are a lot of nutrition intervention programs in Ethiopia, still suboptimal feeding practices are prevalent. This study was devised to assess a level of minimum acceptable diet (MAD) and predictors among children aged 6-23 months in Mareka District, south Ethiopia. Method: A community-based cross-sectional study was employed on 662 study participants from August 15 to September 15/ 2015. They were selected by a multi-stage sampling technique. Data were collected by interviewer-administered semi-structured questionnaires. Statistical significance was declared at p-value <0.05 at multivariable logistic regression. Result: The study showed that 35.5 % of the children aged 6-23 months met the recommended MAD. Maternal primary and secondary education (AOR: 1.90; 95% CI: 1.15-3.16 and AOR: 2.06, 95% CI: 1.12-3.77), Media exposure (AOR: 2.16; 95% CI: 1.46-3.29), health facility delivery (AOR:2.52; 95% CI: 1.54-4.13), child age of 9-11 and 12-23 months (AOR:2.73; 95% CI: 1.41-5.49 and AOR:2.55; 95% CI: 1.39-4.69) and GMP service utilization (AOR: 4.09; 95% CI: 2.51-6.65) were associated with MAD of children. Conclusion: The level of MAD among children was low. Maternal educational status, media exposure, institutional delivery, child age, and GMP service utilization were associated with MAD. Increasing utilization of GMP service, health facility delivery, maternal education, and media promotion was recommended to increase the level of MAD.
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Payne, Sally, and Claire Howell. "An Evaluation of the Clinical Use of the Assessment of Motor and Process Skills with Children." British Journal of Occupational Therapy 68, no. 6 (June 2005): 277–80. http://dx.doi.org/10.1177/030802260506800606.
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This article reports on the use of the Assessment of Motor and Process Skills (AMPS) within a community paediatric occupational therapy service. The AMPS is a widely used observational assessment of functional ability for people from 3 years of age. There is extensive evidence of its validity and reliability, but there has been little published on its clinical use with children. This article describes the application of the AMPS as the first part of an audit in a service to children over a period of 15 months. The clinical utility of the AMPS is discussed.
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Asif, Saima, and Andrew McKechanie. "A new service model in East Lothian community learning disability team: evaluation of service with and without specialist positive behaviour support team." BJPsych Open 7, S1 (June 2021): S309. http://dx.doi.org/10.1192/bjo.2021.817.
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AimsTo evaluate the provision of services to patients with challenging behaviour in East Lothian Community Learning Disability population with and without specialist behaviour support team.BackgroundBehaviour that proves to be a challenge to manage (Challenging behaviour) is not uncommon in adults with intellectual disability and has a reported prevalence of 10–15%.1,2Positive behaviour support (PBS) is recommended as evidence-based intervention for adults with intellectual disability who have challenging behaviour. East Lothian community learning disability team (CLDT) underwent a change in service model for people with challenging behaviour. This change followed a Health and Social care partnership agreement that behaviour support and management could be provided by multidisciplinary CLDT rather than region-wide specialist team.MethodData collection was split into two cycles. First cycle looked retrospectively at six months prior to exit of Specialist Positive Behaviour Support Team (SPBST). Second cycle looked prospectively at 6 months after exit of SPBST.In first cycle, data were collected doing retrospective review of cases known and referred to SPBST. This included calculating time spent on each individual case by SPBST and by CLDT. SPBST provided information in the form of hours spent on each individual case for patients identified by them. For CLDT, electronic medical records system (TRAK) was used by looking at appointment entries on TRAK. For second cycle, newly developed Complex Behaviour pathway was used to identify the patients. Data were collected by using TRAK system as in the first cycle for CLDT.Data collected in both cycles was compared at the end of second cycle.ResultIn first cycle, 5 patients were managed jointly by SPBST and CLDT in 96.4 hours over six months and average clinical time spent on each patient was 19 hours. SPBST spent a total of 59 hours and CLDT spent 40 clinical hours. In second cycle, 12 patients were managed by CLDT alone in 130 hours over six months and average clinical time spent on each patient was nearly 11 hours.ConclusionResults of this evaluation suggest that SPBST had been providing significant contribution to East Lothian CLDT not only with their expertise but also with clinical time. More than 50 % of total clinical time spent on the patients with challenging behaviour in first cycle, was provided by SPBST. This is also evidenced in second cycle where there is an increase in clinical time of some professions when SPBST was withdrawn.
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Krywanczyk, Alison, Elaine Amoresano, Kanayo Tatsumi, and Sharon Mount. "Autopsy Service Death Certificate Review." Archives of Pathology & Laboratory Medicine 144, no. 9 (January 27, 2020): 1092–96. http://dx.doi.org/10.5858/arpa.2019-0452-oa.
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Context.— Despite the importance of accurate death statistics for epidemiologic studies and public health initiatives, there remains a high frequency of errors in death certification. This deficiency can be addressed by the hospital autopsy service. Objectives.— To improve the quality and accuracy of death certificates issued in the hospital and improve resident and clinician education by initiating a death certificate review process, performed by pathology residents while on their hospital autopsy rotation. Design.— A resident reviewed all death certificates issued in the hospital daily through the state electronic death certificate filing system and correlated with the decedent's medical record. When errors were found, the resident filed an amended death certificate with the state. If applicable, the Office of the Medical Examiner was contacted to investigate. The original certifying physician was then contacted via email with an explanation for the amendment. Results.— In 12 months, 590 death certificates were issued by the hospital. Eighty-eight of 590 (15%) were amended. Of those 88 amended, 41 (47%) were missing an underlying cause of death, 7 (8%) had an inaccurate cause of death, 41 (47%) failed to include relevant contributory causes of death, and 17 (19%) had major typographic errors. Of 88, 24 (27%) fell under the Office of the Medical Examiner's jurisdiction and were reported with a subsequent change in the manner of death in 23 of 88 cases (26%). Conclusions.— Death certificate review by the autopsy service improves the accuracy of death certification, impacts resident and clinician education, and serves as quality assurance for both the hospital and the state.
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Meldrum, Lenore, and Peter Yellowlees. "The Measurement of a Case Manager's Workload Burden." Australian & New Zealand Journal of Psychiatry 34, no. 4 (August 2000): 658–63. http://dx.doi.org/10.1080/j.1440-1614.2000.00760.x.
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Objective: The aim of this activity was to develop an appropriate scale to accurately assess the level of clinical load carried by each case manager at the Royal Brisbane Hospital Integrated Mental Health Service. Method: A survey of, and consultation with, case managers over a period of 15 months was used to gather data and modify the monitoring tool for future use in the service. Results and Conclusion: Analysis of the data gathered revealed the level of case managers' work load burden and the depth of need required by clients. Professionally the Clinical Load Monitoring scores have been used in the allocation of additional cases for case management and in the supervision by discipline seniors. Service management has used the Clinical Load Monitoring Scale by dividing individual caseloads into low, medium and heavy service users – with low service users being further investigated for discharge from the service. Heavy service users were assessed for entry into more intensive treatment areas.
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Shah, Ketan, Faisal Javed, Chris Alcock, Ketan A. Shah, Pieter Pretorius, and Chris A. Milford. "Parotid cancer treatment with surgery followed by radiotherapy in Oxford over 15 years." Annals of The Royal College of Surgeons of England 93, no. 3 (April 2011): 218–22. http://dx.doi.org/10.1308/003588411x565969.
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INTRODUCTION Primary parotid malignancies represent a rare diagnosis, making high-quality comparative research unfeasible. There is little UK-based evidence to guide practice. A review was therefore undertaken of a large series of patients treated by a multidisciplinary team in a National Health Service tertiary referral centre. PATIENTS AND METHODS Retrospective patient record review at the John Radcliffe Hospital in Oxford identified 401 patients who had undergone parotidectomy between 1995 and 2010, of whom 50 subjects were given a definitive diagnosis of primary parotid malignancy, treated with surgery and postoperative radiotherapy. Case notes, histology and imaging were reviewed by the study team. RESULTS The median follow up for the cohort was 60 months (range: 1-108 months). Facial nerve function was preserved in all patients undergoing partial or total conservative parotidectomy. Although histology showed microscopically close or positive margins in 82% of cases, all patients underwent postoperative radiotherapy and locoregional recurrence was identified in only two (4%) patients. CONCLUSIONS The data presented demonstrate a reasonable and practical multidisciplinary approach to a complex management problem. Facial nerve sparing surgery and postoperative radiotherapy result in good control of locoregional disease.
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Navindi, Fernandopulle, and Yogarajah Mahinda. "THUR 072 A service evaluation of patients attending A&E with seizures." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (October 2018): A48.2—A48. http://dx.doi.org/10.1136/jnnp-2018-abn.164.
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BackgroundEpilepsy is the most common, chronic neurological condition with a prevalence of 0.5% and an incidence of 3 to 5%. Despite anticonvulsant use, there are approximately 60,000 A&E attendances and 40,000 hospital admissions.MethodUsing A&E triage records a list of all patients attending St George’s Hospital A&E department with a seizure within a six month period was derived. By referring to clinical records, management in A&E and beyond was audited according to NICE guidelines.Results382 adults with seizures were identified. 33% attended A&E in the previous 12 months with a seizure. Of those with epilepsy (n=187), 9% were on no drug. In all seizure cases, documentation was often incomplete and a collateral history was only obtained in 44% cases. 44% of patients were admitted, and of these, 15% were unnecessary according to criteria outlined by Iyer et al. Only 8% were asked if they were a driver and alcohol intake was not documented in 44%. Only 37% were referred to a neurologist or epilepsy specialist.ConclusionSeeing as a third of the patients attended A&E in the previous 12 months, it is clear that thorough history taking and better management in the community is necessary.
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Jones, Margaret N., Courtney M. Brown, Michael J. Widener, Heidi J. Sucharew, and Andrew F. Beck. "Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services." Journal of Primary Care & Community Health 7, no. 3 (February 16, 2016): 143–48. http://dx.doi.org/10.1177/2150131916632361.
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We examined 4872 infants born consecutively, 2011-2012, and seen at 3 primary care centers to determine whether area-based socioeconomic measures were associated with noncompletion of common preventive services within the first 15 months. Addresses were geocoded and linked to census tract poverty, adult educational attainment, and household vehicle ownership rates. The quartile of patients in the highest poverty (adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.01-1.54) and lowest vehicle ownership tracts (aOR 1.32; 95% CI 1.07-1.63) had significantly increased odds of service noncompletion. There were significant spatial clusters of low completion in Cincinnati’s urban core. These findings have implications for preventive service delivery.
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Karaman, E., AR Yazici, G. Ozgunaltay, I. Ustunkol, and A. Berber. "Clinical Evaluation of a Silorane- and a Methacrylate-Based Resin Composite in Class II Restorations: 24-Month Results." Operative Dentistry 42, no. 4 (July 1, 2017): E102—E110. http://dx.doi.org/10.2341/15-286-c.
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SUMMARY Objective: To compare the 24-month clinical performance of two different resin composites in class II slot restorations. Methods and Materials: Thirty-seven patients having at least two approximal carious lesions were enrolled in the study. A total of 116 teeth (58 pairs) were restored with either a silorane-based composite (Filtek Silorane) and its self-etch adhesive (Silorane Adhesive System, 3M ESPE) or a methacrylate-based packable resin composite (X-tra Fil) and its self-etch adhesive (Futurabond NR, VOCO GmbH) according to the toss of a coin. The restorations were evaluated at baseline and at six-, 12-, and 24-month recalls by two calibrated examiners according to the modified US Public Health Service criteria. The comparison of the two restorative materials for each category was performed with the Pearson chi-square test. Within group differences of the materials at different recall times were compared using the Cochran Q and Friedman tests. Bonferroni-adjusted McNemar test was used when significant difference was found (p<0.05). Results: After 24 months, no statistically significant differences were found between the two restorative materials for the criteria evaluated. Conclusions: Both silorane- and methacrylate-based resin composites showed clinically acceptable performance in class II slot restorations after 24 months.
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Gallagher, Michael, Lilli Cooper, and Javier Ibanez Mata. "Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape." BMJ Case Reports 14, no. 1 (January 2021): e238418. http://dx.doi.org/10.1136/bcr-2020-238418.
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Calcifying aponeurotic fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. A 15-year-old student presented to his general practitioner with a 1-year history of a progressively enlarging painless finger swelling. The lesion was excised by the local paediatric orthopaedic service and recurred over the course of the following 4 months. Histology confirmed a diagnosis of CAF. He was referred to our specialist hand surgery service and the lesion was excised along with the ulnar lateral band and the overlying skin. At 9 months, there was no clinical evidence of recurrence. We are the first group to report the potential benefit of including of the overlying skin in the histological specimen to reduce the residual disease burden. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand and highlights the importance of centralised specialist care.
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Pena, CE, JA Rodrigues, C. Ely, M. Giannini, and AF Reis. "Two-year Randomized Clinical Trial of Self-etching Adhesives and Selective Enamel Etching." Operative Dentistry 41, no. 3 (May 1, 2016): 249–57. http://dx.doi.org/10.2341/15-130-c.
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SUMMARY Objective: The aim of this randomized, controlled prospective clinical trial was to evaluate the clinical effectiveness of restoring noncarious cervical lesions with two self-etching adhesive systems applied with or without selective enamel etching. Methods: A one-step self-etching adhesive (Xeno V+) and a two-step self-etching system (Clearfil SE Bond) were used. The effectiveness of phosphoric acid selective etching of enamel margins was also evaluated. Fifty-six cavities were restored with each adhesive system and divided into two subgroups (n=28; etch and non-etch). All 112 cavities were restored with the nanohybrid composite Esthet.X HD. The clinical effectiveness of restorations was recorded in terms of retention, marginal integrity, marginal staining, caries recurrence, and postoperative sensitivity after 3, 6, 12, 18, and 24 months (modified United States Public Health Service). Results: The Friedman test detected significant differences only after 18 months for marginal staining in the groups Clearfil SE non-etch (p=0.009) and Xeno V+ etch (p=0.004). One restoration was lost during the trial (Xeno V+ etch; p>0.05). Conclusions: Although an increase in marginal staining was recorded for groups Clearfil SE non-etch and Xeno V+ etch, the clinical effectiveness of restorations was considered acceptable for the single-step and two-step self-etching systems with or without selective enamel etching in this 24-month clinical trial.
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Mostari, MP, KS Huque, MS Hasanat, and Z. Gulshan. "Productive and Reproductive Efficiency of Red Chittagong Cattle Under Farm Condition." Progressive Agriculture 18, no. 2 (March 2, 2014): 109–14. http://dx.doi.org/10.3329/pa.v18i2.18166.
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The productive and reproductive efficiency of Red Chittagong cattle (RCC) reared at the Bangladesh Livestock Research Institute (BLRI) farm was evaluated. A total of 46 RCC of different categories were considered under this study. Parameters studied were birth weight, weight at 3, 6 months of age and adult body weight, growth rate, daily milk yield, lactation length, lactation yield, age at puberty, weight at puberty, age at first calving, post partum estrus period, service per conception, calving interval and gestation length of RCC were collected and recorded. The birth weight differed significantly (p<0.01) between male and female and the average birth weight of RCC calves at farm level was 14.87 kg. The growth rates and adult body weight also differed significantly (p<0.05 and p<0.01) between male and female except in growth rate from 3 to 6 months of age. The average daily milk yield, milk yield per lactation and lactation length of RCC were 2.24 kg, 526.81 kg and 238 days, respectively. The age at puberty, service per conception, post partum estrus period and calving interval of RCC heifers and cows were 15 months, 1.15, 40 days and 11 months, respectively. It can be concluded that the RCC is a genetically and economically superior variety of Bangladesh.DOI: http://dx.doi.org/10.3329/pa.v18i2.18166 Progress. Agric. 18(2): 109 - 114, 2007
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Knowles, Noah. "Trends in Snow Cover and Related Quantities at Weather Stations in the Conterminous United States." Journal of Climate 28, no. 19 (September 29, 2015): 7518–28. http://dx.doi.org/10.1175/jcli-d-15-0051.1.
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Abstract Trend tests, linear regression, and canonical correlation analysis were used to quantify changes in National Weather Service Cooperative Observer (COOP) snow depth data and derived quantities, precipitation, snowfall, and temperature over the study period 1950–2010. Despite widespread warming, historical trends in snowfall and snow depth are generally mixed owing to competing influences of trends in precipitation. Trends toward later snow-cover onset in the western half of the conterminous United States and earlier onset in the eastern half and a widespread trend toward earlier final meltoff of snow cover combined to produce trends toward shorter snow seasons in the eastern half of the United States and in the west and longer snow seasons in the Great Plains and southern Rockies. The annual total number of days with snow cover exhibited a widespread decline. Monthly trend patterns show the dominant influence of temperature trends on occurrence of snow cover in the warmer snow-season months and a combination of temperature and precipitation trends in the colder months. A canonical correlation analysis indicated that most trends presented here took hold in the 1970s, consistent with the temporal pattern of global warming during the study period.
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Mudlikah, Siti, and Lidia Aditama Putri. "Pre-Toddler Development Examination Screening (KPSP) at Posyandu Jatikalang Village, Prambon District, Sidoarjo Regency." Jurnal Kebidanan Midwiferia 7, no. 1 (April 5, 2021): 9–15. http://dx.doi.org/10.21070/midwiferia.v7i1.618.
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Delay in the development of children under five occurs around 10% in children aged <5 years. The purpose of community service activities is to carry out checks on child development and assess child development using the Pre-Screening Questionnaire for Child Development. The method uses interviews and observations. The study population is all mothers who have children under five, the sample is all children aged <5 years who come to the posyandu. The results show that the age period of children 3 - 72 months, the majority of children aged 15 months are 11 children (14%), 6 months of age are 10 children (12.9%), 30 months of age are 9 children (11.6%), age 3 month totaling 8 children (10.3%). While children with appropriate development are 65 children (83%), development children are doubting 12 children (15.4%) and children with deviant development are 1 child (1.3%). Thus children who have doubts and deviant developments need to do counseling and stimulation interventions to improve children's optimal developmental abilities.
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Harikumar, R., N. K. Hithin, T. M. Balakrishnan Nair, P. Sirisha, B. Krishna Prasad, C. Jeyakumar, Shailesh Nayak, and S. S. C. Shenoi. "Ocean State Forecast along Ship Routes: Evaluation Using ESSO-INCOIS Real-Time Ship-Mounted Wave Height Meter and Satellite Observations." Journal of Atmospheric and Oceanic Technology 32, no. 11 (November 2015): 2211–22. http://dx.doi.org/10.1175/jtech-d-15-0047.1.
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AbstractOcean state forecast (OSF) along ship routes (OAS) is an advisory service of the Indian National Centre for Ocean Information Services (INCOIS) of the Earth System Science Organization (ESSO) that helps mariners to ensure safe navigation in the Indian Ocean in all seasons as well as in extreme conditions. As there are many users who solely depend on this service for their decision making, it is very important to ensure the reliability and accuracy of the service using the available in situ and satellite observations. This study evaluates the significant wave height (Hs) along the ship track in the Indian Ocean using the ship-mounted wave height meter (SWHM) on board the Oceanographic Research Vessel Sagar Nidhi, and the Cryosat-2 and Jason altimeters. Reliability of the SWHM is confirmed by comparing with collocated buoy and altimeter observations. The comparison along the ship routes using the SWHM shows very good agreement (correlation coefficient > 0.80) in all three oceanic regimes, [the tropical northern Indian Ocean (TNIO), the tropical southern Indian Ocean (TSIO), and extratropical southern Indian Ocean (ETSI)] with respect to the forecasts with a lead time of 48 h. However, the analysis shows ~10% overestimation of forecasted significant wave height in the low wave heights, especially in the TNIO. The forecast is found very reliable and accurate for the three regions during June–September with a higher correlation coefficient (average = 0.88) and a lower scatter index (average = 15%). During other months, overestimation (bias) of lower Hs is visible in the TNIO.
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Öztürk-Bozkurt, F., T. Toz, A. Kara-Tuncer, H. Gözükara-Bağ, and M. Özcan. "Clinical Evaluation of Silorane and Nano-hybrid Resin Composite Restorations in Class II Cavities up to 3 Years." Operative Dentistry 41, no. 6 (November 1, 2016): 599–606. http://dx.doi.org/10.2341/15-259-c.
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SUMMARY In this study, the clinical performance of a silorane-based resin composite (SC) vs a nano-hybrid resin composite (NHC) was evaluated in Class II cavities. From January 2012 to February 2013, a total of 29 patients (eight men, 21 women; mean age, 24 ± 5 years) received 29 pairs of restorations using both SC (Filtek Silorane, 3M ESPE) and NHC (Filtek Z550, 3M ESPE) materials. Patients were followed until February 2015. One operator performed all restorations using the corresponding adhesive resins according to the manufacturers' instructions. Two calibrated independent examiners evaluated the restorations at one week, six months, and then annually using the modified United States Public Health Service (USPHS) criteria for anatomic form, marginal adaptation, color match, surface roughness, marginal discoloration, secondary caries, and postoperative sensitivity. Changes in the USPHS parameters were analyzed with the McNemar test (α=0.05). The mean observation period was 31.2 months. Marginal adaptation was the only parameter that showed a significant difference and was worse for SC than NHC (p=0.012). At the final recall, 17 restorations from the SC group and five from the NHC group received a score of 1 (explorer catches). These scores were significantly different between baseline and final recall for SC (p<0.001) but not for NHC (p>0.05). Both NHC and SC performed similarly in Class II restorations up to three years except for marginal adaptation, for which the latter demonstrated significant deterioration at the final recall compared with baseline.
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Krauss, Melissa J., Nhial Tutlam, Eileen Costantinou, Shirley Johnson, Diane Jackson, and Victoria J. Fraser. "Intervention to Prevent Falls on the Medical Service in a Teaching Hospital." Infection Control & Hospital Epidemiology 29, no. 6 (June 2008): 539–45. http://dx.doi.org/10.1086/588222.
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Objective.To evaluate an intervention to prevent falls at a hospital.Design.A quasi-experimental intervention with historical and contemporaneous control groups.Setting and Participants.Nursing staff and patients in the medicine service (comprising 2 intervention floors and 2 control floors) at an academic hospital.Intervention.Nursing staff were educated regarding fall prevention during the period from April through December 2005. Data on implemented prevention strategies were collected on control and intervention floors. Mean monthly fall rates were compared over time and between intervention and control floors, using repeated-measures analysis of variance.Results.Postintervention fall knowledge test scores for the nursing staff were greater than preintervention test scores (mean postintervention test score, 91%; mean preintervention test score, 72%;P< .001). Use of prevention strategies was greater on intervention floors than it was on control floors, including patient education via pamphlets (46% vs 15%;P< .001), use of toileting schedules (36% vs 25%;P= .016), and discussion of high-risk medications (51% vs 30%;P< .001). The mean fall rate for the first 5 months of the intervention was 43% less than that for the 9-month preintervention period for intervention floors (3.81 falls per 1,000 patient-days vs 6.64 falls per 1,000 patient-days;P= .043). Comparisons of mean rates for the overall 9-month intervention period versus the 9-month preintervention period showed a 23% difference in the fall rate for intervention floors, but this did not reach statistical significance (5.09 falls per 1,000 patient-days vs 6.64 falls per 1,000 patient-days;P= .182).Conclusion.The nursing staffs knowledge and use of prevention strategies increased. Fall rates decreased for 5 months after the educational intervention, but the reduction was not sustained.
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Doormaal, B. J. Van. "Linear model evaluations of non-return rates for dairy and beef bulls in Canadian AI." Canadian Journal of Animal Science 73, no. 4 (December 1, 1993): 795–804. http://dx.doi.org/10.4141/cjas93-082.
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Québec artificial insemination data from 518 609 first inseminations performed by 304 AI technicians in 15 488 herds using semen from 1750 dairy and beef AI bulls were analyzed using a mixed linear model. The effects of month of insemination, age of cow, semen price, breed of service sire, technician and herd were included in an evaluation of service sires for 60- to 90-d non-return rate. Herd was found to be the most important factor influencing service sire mixed model solutions with a standard deviation of solutions of 12.2% non-return rate. Technicians had moderate importance with a standard deviation of solutions of 3.7%. Higher fertility solutions resulted for summer months compared with winter months with the largest difference being 5.18% between December and September. Fertility solutions were highest for virgin heifers and decreased with increasing age of cow. Semen from more expensive bulls generally showed lower solutions than for lower-priced bulls. Dairy breeds, except Jerseys, had lower solutions compared with beef breeds. Service sire solutions were only moderately correlated to unadjusted non-return rates (r = 0.58) therefore indicating the importance of using a linear model approach particularly when several breeds of service sires are represented. Based on correlations among three measures of non-return rate, it was recommended to replace 60- to 90-d non-return rate in Canada by 56-d non-return rate. The mixed linear model procedure used in this study has been adopted by CIAQ and disseminated to other Canadian AI centres for implementation. Key words: Non-return rate, AI, cattle, bulls, technicians
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Bergeron, Emilie, Léo-Roch Poirier, Louise Fournier, Pasquale Roberge, and Geneviève Barrette. "Determinants of Service Use among Young Canadians with Mental Disorders." Canadian Journal of Psychiatry 50, no. 10 (August 1, 2005): 629–36. http://dx.doi.org/10.1177/070674370505001009.
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Objective: To identify the determinants of service use by young Canadians with mental health problems. Methods: Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use. Results: In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use. Conclusion: Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.
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Blom, Ellen Eimhjellen, Line Oldervoll, Eivind Aadland, Ane Kristiansen Solbraa, and Guri Kaurstad Skrove. "Impact and implementation of Healthy Life Centres, a primary-care service intervention for behaviour change in Norway: Study design." Scandinavian Journal of Public Health 48, no. 6 (June 19, 2019): 594–601. http://dx.doi.org/10.1177/1403494819856832.
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Aims: This ongoing study is investigating the implementation and long-term impact of Healthy Life Centres (HLCs), a primary-care service intervention for behaviour change in Norway. The primary aim is to study changes in objectively measured physical activity (PA) levels following a HLC intervention in the short (three months) and long term (15 months). Furthermore, the study is evaluating determinants concerning implementation and adaption of the HLC intervention that influence reach and impact on participants outcomes. Methods: This prospective observational study includes 32 HLCs from four different geographical regions in Norway. Subjects aged ⩾18 years were invited to participate. The study has a pre–post design with a 15-month follow-up. The HLC intervention is a three-month individualised program, containing personal consultations and group-based behaviour-specific courses on PA, diet and smoking cessation. Data collection consists of registration of objectively measured PA level, physical examinations, interviews and questionnaires. In addition, HLC organisation, offers, professions and resources are being examined. The Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework is being applied to study the external validation of the HLC intervention. The study enrolled 1020 participants who gave their written informed consent. Post-tests and follow-up data collection is still ongoing and will continue until August 2019. Conclusions: By exploring the HLC intervention in a real-world setting and addressing the elements of RE-AIM, this study will contribute to an improved understanding and development of effective primary-care behaviour interventions such as the HLC model. The strengths of the study are the large sample size and the many HLCs and regions included.
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Mendoza-Sassi, Raúl, Jorge U. Béria, and Aluísio J. D. Barros. "Outpatient health service utilization and associated factors: a population-based study." Revista de Saúde Pública 37, no. 3 (June 2003): 372–78. http://dx.doi.org/10.1590/s0034-89102003000300017.
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OBJECTIVE: To identify factors that lead people to visit a doctor in Brazil and assess differences between socioeconomic groups. METHODS: A cross-sectional study comprising 1,260 subjects aged 15 or more was carried out in southern Brazil. Demographic, socioeconomic, health needs and regular source of care data were analyzed concerning visits to a doctor within two months from the interview. Adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression. RESULTS: Adjusted PR showed that women having stressful life events, health insurance, and a regular doctor increased the outcome. A dose-related response was found with self-reported health, and the probability of visiting a doctor increased with health needs. Analysis in the chronic disease group revealed that uneducated lower income subjects had a 62% reduction in the chance of visiting a doctor compared to uneducated higher income ones. However, as it was seen a significant interaction between income and education, years of schooling increased utilization in this group. CONCLUSIONS: Results suggest the existence of health inequity in the poorest group that could be overcome with education. Specific measures reinforcing the importance of having a regular doctor may also improve access in the underserved group.
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Roberts, Joanne E., Barry Prizant, and R. A. McWilliam. "Out-of-Class Versus In-Class Service Delivery in Language Intervention." American Journal of Speech-Language Pathology 4, no. 2 (May 1995): 87–94. http://dx.doi.org/10.1044/1058-0360.0402.87.
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The interactions of young children and their speech-language pathologist during out-of-class and in-class language intervention were compared for 15 children with disabilities attending a mainstreamed childcare center. Children were pair matched and randomly assigned to either in-class or out-of-class special services. After 3 months, treatment sessions were videotaped. The results indicated that some, but not all, aspects of both speech-language pathologists' and children's interactions differed during in-class versus out-of-class treatment sessions. During out-of-class sessions, speech-language pathologists took more turns than during in-class sessions. Children complied more with requests during out-of-class sessions and responded less to requests during in-class sessions. The results suggest that because in-class and out-of-class models have differential effects only on some aspects of clinician and child behavior, selection of service delivery models must be determined by a myriad of factors. Furthermore, these findings suggest that, in the absence of more conclusive data, it is premature to equate a particular mode of service delivery with a higher degree of treatment efficacy.
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Giorgadze, Gvantsa, Maka Mania, Maka Kukava, Ana Dzagnidze, Ekaterine Mirvelashvili, Timothy J. Steiner, and Zaza Katsarava. "Implementation of effective, self-sustaining headache services in the Republic of Georgia: Evaluation of their impact on headache-related disability and quality of life of people with headache." Cephalalgia 38, no. 4 (April 4, 2017): 639–45. http://dx.doi.org/10.1177/0333102417702131.
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Background Headache disorders are widespread and disabling. They are common in Georgia, especially headache on ≥15 days/month (HA ≥ 15), but there are no headache services. Objective We established headache services meeting local needs, investigating feasibility, consumer uptake and satisfaction, and cost, with an exit strategy bequeathing effective, self-sustaining services that could be rolled out nationwide. Methods We created headache centres in Tbilisi and Gori offering free expert care for three visits over three months, and affordable medication thereafter. The primary outcome measure was the percentage of patients using the service beyond the free period – a measure of both satisfaction and sustainability. Results Of 1,445 patients (age 43.7 ± 12.4 years; 10.5% male), 49.8% had episodic migraine, 22.5% episodic tension-type headache, 25.7% HA ≥ 15 (24.5% overusing medication) and 2.0% trigeminal autonomic cephalalgias. Only 454 (31.4%) and 51 (3.5%) returned for second and third visits; in these, headache improved and treatment costs decreased. As information about the service spread, five other headache clinics opened in Tbilisi and Kutaisi (western Georgia). Pharmaceutical companies reduced prices (sumatriptan 100 mg from US$7 to US$1). Conclusion The study failed to achieve its primary outcome, but sustainable headache services operating to international standards were successfully implemented nonetheless, with demand increasing.
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Kirkpatrick, Tim, Charlotte Lennox, Rod Taylor, Rob Anderson, Michael Maguire, Mark Haddad, Susan Michie, et al. "Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial." BMJ Open 8, no. 2 (February 2018): e017931. http://dx.doi.org/10.1136/bmjopen-2017-017931.
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IntroductionThe ‘Engager’ programme is a ‘through-the-gate’ intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention.Methods and analysisThe study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either: (a) the Engager intervention plus standard care (intervention group) or (b) standard care alone (control group) across two investigation centres (South West and North West of England). Two hundred and eighty prisoners meeting eligibility criteria will take part. Engager is a person-centred complex intervention delivered by practitioners and aimed at addressing offenders’ mental health and social care needs. It comprises one-to-one support for participants prior to release from prison and for up to 20 weeks postrelease. The primary outcome is change in psychological distress measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure at 6 months postrelease. Secondary outcomes include: assessment of subjective met/unmet need, drug and alcohol use, health-related quality of life and well-being-related quality of life measured at 3, 6 and 12 months postrelease; change in objective social domains, drug and alcohol dependence, service utilisation and perceived helpfulness of services and change in psychological constructs related to desistence at 6 and 12 months postrelease; and recidivism at 12 months postrelease. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action and look for unintended consequences. An economic evaluation will estimate the cost-effectiveness.Ethics and disseminationThis study has been approved by the Wales Research Ethics Committee 3 (ref: 15/WA/0314) and the National Offender Management Service (ref: 2015–283). Findings will be disseminated to commissioners, clinicians and service users via papers and presentations.Trial registration numberISRCTN11707331; Pre-results.
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Lopes, LS, FS Calazans, R. Hidalgo, LL Buitrago, F. Gutierrez, A. Reis, AD Loguercio, and MO Barceleiro. "Six-month Follow-up of Cervical Composite Restorations Placed With a New Universal Adhesive System: A Randomized Clinical Trial." Operative Dentistry 41, no. 5 (September 1, 2016): 465–80. http://dx.doi.org/10.2341/15-309-c.
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SUMMARY Purpose: The objective of this double-blind, randomized clinical trial was to evaluate the six-month clinical performance of a new universal adhesive (Xeno Select, Dentsply) in noncarious cervical lesions (NCCLs) using two evaluation criteria: World Dental Federation (FDI) and the US Public Health Service (USPHS). Methods and Materials: A total of 124 restorations were randomly placed in 31 patients according to the following groups: ER-D = etch-and-rinse/dry dentin; ER-M = etch-and-rinse/moist dentin; SE-et = selective enamel etching; and SET = self-etch. The composite resin EVOLUX (Dentsply) was placed incrementally. The restorations were evaluated after one week (baseline) and at six months using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α=0.05). Results: Fifteen restorations were lost or fractured at six months (one for ER-D, three for ER-M, five for SE-et, and six for SET) (p>0.05 at six-month recall). When ER (ER-D and ER-M) was compared with SE (SE-et and SET) there was a significant difference in the retention rate after six months (p=0.001). Marginal staining and postoperative sensitivity to air were only observed in three (one for ER-M and two for SET) and two restorations (two for ER-D) in both evaluation criteria (p>0.05), respectively. Forty-seven restorations were considered to have minor discrepancies in marginal adaptation at the six-month recall using the FDI criteria (13 for ER-D, 10 for ER-M, 11 for SE-et, and 13 for SET; p>0.05 between groups). However, for all groups, a significant difference was detected when baseline and six-month data were compared (p<0.05). Conclusions: The six-month clinical behavior of Xeno Select Universal Adhesive depends on the bonding strategy used. The universal adhesive did not fulfill the American Dental Association criteria for full approval when used in the self-etch mode.
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Suh, Koung Jin, Ki Hwan Kim, Jin Lim, Jin Hyun Park, Jin-Soo Kim, and In Sil Choi. "Lung Cancer in Homeless People: Clinical Outcomes and Cost Analysis in a Single Institute." Canadian Respiratory Journal 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/3727689.
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Introduction. To characterize the demographic and clinical features, outcomes, and treatment costs of lung cancer in homeless people. Methods. Medical records of 22 homeless patients with lung cancer at Seoul National University Boramae Medical Center in Seoul, South Korea, were retrospectively analyzed. Results. All patients were men (median age, 62 years). Most patients (78%) had advanced disease (stage IIIB, n=2; stage IV, n=15). Seven died during initial hospitalization (median survival, 1.5 months). Six were lost to follow-up after initial outpatient visits or discharges from initial admission (median follow-up, 13 days). Only 4 received appropriate treatment for their disease and survived for 1, 15, 19, and 28 months, respectively. Conversely, 4 of 5 patients with early stage disease (stage I, n=4; stage IIA, n=1) received curative surgery (median follow-up 25.5 months). The median treatment cost based on 29 days of hospitalization and 2 outpatient visits was $12,513, constituting 47.3% of the 2013 per capita income. Inpatient treatment accounted for 90% of the total costs. The National Health Insurance Service paid 82% of the costs. Conclusion. Among the homeless, lung cancer seems to be associated with poor prognosis and substantial costs during a relatively short follow-up and survival period.
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Freedman, Jonathan, and Marion Richardson. "Introducing Voluntary Donations to Fund Primary Care Acupuncture – a User Survey." Acupuncture in Medicine 23, no. 3 (September 2005): 137–40. http://dx.doi.org/10.1136/aim.23.3.137.
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An acupuncture clinic has been running in general practice without any funding for nine years. However, reorganisation of the health service meant that it had to become self-funding. A scheme for voluntary donations was introduced, with a target of £15 per treatment. In the first six months, the scheme covered the clinic's costs. A user survey was undertaken to elicit patients’ views on the scheme. The majority of patients thought that the scheme was a good idea, and the amount about right. However, a few patients found payment difficult, and stated that they would be less likely to use the service for that reason, or feel guilty about using it without paying. This information should be used to try to obtain public funding through public funds in the future.
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Yung, Alison R., Bridget A. Organ, and Meredith G. Harris. "Management of Early Psychosis in a Generic Adult Mental Health Service." Australian & New Zealand Journal of Psychiatry 37, no. 4 (August 2003): 429–36. http://dx.doi.org/10.1046/j.1440-1614.2003.01196.x.
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Objective: To evaluate current practice at a generic adult mental health service, St Vincent's Mental Health Service (SVMHS) in relation to management of patients with early psychosis. A further aim was to compare treatment of early psychosis patients within this generic service with management of a similar group in a specialized early psychosis service. Method: A case file audit of all patients identified as having early psychosis (within the first 2 years of treatment) was undertaken using a standardized audit tool. Variables including proportion of early psychosis admitted as inpatients to the psychiatric unit, average length of stay (LOS), use of seclusion, involvement of police in admission process, mean neuroleptic dose and estimated duration of untreated psychosis (DUP) were studied. Results of this audit were then compared with published evaluative data from the Early Psychosis Prevention and Intervention Centre (EPPIC), a service specifically catering for young people with early psychosis (within the first 18 months of treatment). Results: Data were collected on 62 of 68 patients identified as having early psychosis. Within the generic service, mean DUP was found to be about 15 months, a high proportion (81%) of patients were admitted and secluded (22% of those admitted), average length of stay was 46.5 days and use of police in the admission process was also high (40% of those admitted). This compares unfavourably with the EPPIC data of mean DUP of just over 6 months, 64.1% of patients admitted, 10.3% secluded, average LOS 12.9 days, and police involved in 3.8% of admissions. Conclusions: We believe that practice at SVMHS in relation to early psychosis patients is fairly typical of management of these patients within generic services as a whole. These services tend to focus on the needs of the majority of their patients, those with chronic schizophrenia, rather than the small group of patients with early psychosis (who make up about 8% of current case-load at SVMHS). Failure to assertively assess and follow-up young people with early psychosis may contribute to long DUPs, which may in turn result in patients being more disturbed at time of initial treatment, thus requiring inpatient treatment and longer length of stay. Additionally, staff at generic services may not feel confident in managing early psychosis patients and may be unaware of the special needs of this patient group. These preliminary data suggest that generic services are not optimal for treatment of early psychosis patients and that treatment of early psychosis within them is not cost-effective
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Setiati, Ning, Ely Rudyatmi, Krispinus Kedatipukan, and Dyah Rini Indriyanti. "Assistance of Indigofera Cultivation as Batik Natural Dyes in Kampung Alam Malon, Gunungpati Semarang." Journal of Dedicators Community 5, no. 1 (January 30, 2021): 37–48. http://dx.doi.org/10.34001/jdc.v5i1.1142.
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This community service aim to motivate kelompok Tani Gunungpati 03 Kampung Alam Malon and kelompok Tani Gunungpati 02 Nglarang, Gunungpati to start planting Indigofera. Production can be used to fulfill a part of batik natural dye for cheaper. Special target is availability qualified Indigofera with criteria dark green leaves (green bluish) and oval shape with brownish black seed. The target is from 1000 seeds can be generate 1000 qualified plant ready to harvest in 3 months, and next re-harvest in 2 months. Some activities already done such as socialization community service attended by 36 of farmer team and they held active discussion about the use and additional income from planting indigo. Training in make natural dye paste from indigo is given to 15 of farmer team by experienced trainer. The result of this activity were the farmer group be able to cultivate indigofera, built 2 water shelter to drainage indigo plant. The result of seedlings is not satisfied yet because the growth of sprouts were not simultaneously and not applying hormone gibrelin technology so that for next step need revision in raise seeding. The farmer group ca easily harvest their indigofera to make paste for batik dye color
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Batey, Natalie, Dushyant Batra, Jon Dorling, and Jayesh Mahendra Bhatt. "Impact of a protocol-driven unified service for neonates with bronchopulmonary dysplasia." ERJ Open Research 5, no. 1 (February 2019): 00183–2018. http://dx.doi.org/10.1183/23120541.00183-2018.
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AimA new specialised service for preterm infants with bronchopulmonary dysplasia requiring long-term oxygen therapy (LTOT) was established in 2007, led by the paediatric respiratory team, transitioning from neonatal-led follow-up. The new service included the utilisation of a clear protocol. Our objective was to review whether this service initiation led to a reduction of time in LTOT and hospital readmissions.MethodsWe performed a retrospective cohort study of infants born at <32 weeks’ gestation requiring LTOT in a single tertiary neonatal service. Cases were identified from hospital records, BadgerNet and a local database for two cohorts, 2004–2006 and 2008–2010. Data collected for infants requiring LTOT included demographic details, length of neonatal stay, time in oxygen and hospital attendance rates.ResultsThe initiation of the service led to an increase in the number of discharges in LTOT: 13.1% of infants born alive before 32 weeks’ gestation in comparison to 3.5% (p<0.001). However, the length of time in LTOT reduced from 15 to 5 months (p=0.01). There was no difference in hospital readmission rates (p=0.365).ConclusionsIn our experience the increase in neonates requiring LTOT is likely to be due to enhanced provision of overnight oximetry studies prior to discharge. Structured monitoring and weaning led to a shorter duration of home oxygen therapy.
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Brennan, Aline, Mary Horgan, Arthur Jackson, John P. Browne, and Colm J. Bergin. "Utilisation patterns and cost of hospital care for people living with HIV in Ireland in 2012: a single-centre study." International Journal of STD & AIDS 28, no. 3 (July 10, 2016): 229–37. http://dx.doi.org/10.1177/0956462416640167.
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Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.
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Bracey, Daniel N., Tunc C. Kiymaz, David C. Holst, Kamran S. Hamid, Johannes F. Plate, Erik C. Summers, Cynthia L. Emory, and Riyaz H. Jinnah. "An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay." Geriatric Orthopaedic Surgery & Rehabilitation 7, no. 4 (August 19, 2016): 171–77. http://dx.doi.org/10.1177/2151458516661383.
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Introduction: Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients. We sought to determine whether the OHC (1) improves the efficiency of hip fracture management as measured by inpatient length of stay (LOS) and time to surgery (TTS) and (2) whether our results are comparable to those reported in hip fracture comanagement literature. Methods: A comparative retrospective–prospective cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before (n = 45) and 10 months after implementation (n = 54) of the OHC at a single academic hospital. Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours, 30-day readmission rates, and mortality. Outcomes were compared to comanagement study results published in MEDLINE-indexed journals. Results: Patient cohort demographics and comorbidities were similar. Inpatient LOS was reduced by 1.6 days after implementation of the OHC ( P = .01) without an increase in 30-day readmission rates or mortality. Time to surgery was insignificantly reduced from 27.4 to 21.9 hours ( P = .27) and surgery within 48 hours increased from 86% to 96% ( P = .15). Discussion: The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution. Conclusion: Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly expanding patient population.
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Dowie, Robin, Hema Mistry, Tracey A. Young, Rodney CG Franklin, and Helena M. Gardiner. "Cost implications of introducing a telecardiology service to support fetal ultrasound screening." Journal of Telemedicine and Telecare 14, no. 8 (December 2008): 421–26. http://dx.doi.org/10.1258/jtt.2008.080401.
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A district hospital in south-east England used a telecardiology service for fetal cardiac diagnosis alongside an existing arrangement for referring pregnant women directly to perinatal cardiologists in London for detailed fetal echocardiography. Women were identified for referral according to local protocols when having a second trimester anomaly scan. For the telemedicine referrals, the sonographers video-recorded images from the anomaly scans for transmission during monthly videoconferences. The cost of the women's antenatal care was calculated from the specialist assessment until delivery, while family costs were collected in a postal survey. Over 15 months, telemedicine was used in 52 cases, while 24 women were seen in London. The London women were more likely to have had an ultrasound abnormality (29% v 10%, P = 0.047). A telemedicine assessment of 5 min duration was more costly than an examination in London (mean cost per referral of £206 v £74, P < 0.001). However, the telecardiology service was cost neutral after 14 days and for the extended period until delivery. Travel costs for London women averaged £37 compared with £5.50 for the telemedicine referrals. Telemedicine may be useful to support perinatal cardiologists in the UK whose workloads are expanding in response to improved standards in antenatal ultrasound screening.
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Malla, A. "A Pilot Randomized Controlled Evaluation of “Extended Specialized Early Intervention Service” vs. “Regular Care” for Longterm Management of Early Psychosis." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70345-1.
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Introduction:Short term benefits of Specialized Early Intervention (SEI) services for treatment of first episode of psychosis (FEP) are not sustained after transfer to regular care. Optimum length of SEI services remains to be determined.Objective:To carry out a randomized controlled trial (RCT) of extending SEI service for an additional three years compared to “regular” care after both groups have received two years of SEI treatment.Hypothesis:The experimental group (extended SEI) will have better clinical (remission length and proportion) and functional outcomes and be cost effective compared to the control group (regular care).Methods:Remission (length and proportion in remission) are the primary outcomes. We aim to randomize a total of 212 patients following two years of SEI service for their FEP. Outcome evaluations to assess symptoms, functioning and service utilization are carried out at entry and every three months. In this presentation we will report only the method and preliminary results (success of urn randomization, drop out and relapse rates) on the sample recruited thus far.Results:Of the 58 patients approached 50 (86%) agreed to be randomized. Patients were young (mean age 25), mostly male (with a diagnosis of Schizophrenia Spectrum Psychosis (71%). The average length of follow up to date is 13.2 months (s.d. = 5.4). Treatment discontinuation in the experimental and control conditions were 0 and 4 (15%), respectively.Conclusion:The pilot results show the feasibility for carrying out such a study. The methodological challenges of conducting this long term RCT will be discussed.
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Pathak, Bhavana, Ann M. Eapen, and Jason A. Zell. "FitFirms: A wellness option for oncology trainees." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 10537. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.10537.
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10537 Background: Burnout in oncologists has been rising over the past decade. Burnout leads to poor patient outcomes and poor physician health. Younger oncologists are at higher risk for burnout. The Firm System was designed by Victor McKusick at the Johns Hopkins hospital in 1975 to integrate faculty and trainees into clinical and psychologically supportive cohorts. Here we describe an adapted Firm System called the FitFirms, which focused on social connectivity and altruistic service as means to combat burnout in oncology trainees. Methods: We divided the Hematology and Oncology Division of an academic Comprehensive Cancer Care center into four cohorts of faculty-fellow teams called FitFirms. Each FitFirm was named after a notable local or national female leader in the field of cancer medicine—The Henrietta Lacks Firm, The Jane Wright Firm, The Padmini Iyer Firm, and The Rita Mehta Firm. The faculty and fellows interacted on an at-minimum quarterly basis in casual social events and/or community service-oriented events for 15 months. The social events included group dinners, bowling, paint and game nights. The service events included participation in 5K walk/run fundraiser for our institution’s cancer center and support of a National Cancer Survivors Day event for US Veterans. A didactic discussion series was created to explore concepts of resiliency, work-life balance, and the role of art in medicine—mentored by faculty across the spectrum of oncologic disciplines (Surgical Oncology, Gynecologic Oncology, Palliative Care, and Health Communication). The Maslach Burnout Inventory survey was used to survey the oncology trainees before and after the interventions. Results: Nine pre-intervention surveys were collected with 78% of trainees describing themselves as on the burnout spectrum of feeling either ineffective, overextended, disengaged, or burned out (22% engaged). After 15 months, 10 post-intervention surveys were collected in which 60% of trainees described themselves on the burnout spectrum (40% engaged). Conclusions: The FitFirms are a novel system using social capital to reduce the problem of burnout in oncology trainees by engaging in social connectivity and altruistic service through faculty-mentored, historically-named divisional cohorts.
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Fitzsimons, Kate J., Lynn P. Copley, Jan H. Van Der Meulen, Channa Panagamuwa, and Scott A. Deacon. "Grommet Surgery in Children with Orofacial Clefts in England." Cleft Palate-Craniofacial Journal 54, no. 1 (January 2017): 80–89. http://dx.doi.org/10.1597/15-047.
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Objective To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. Design Analysis of national administrative data of hospital admissions. Setting National Health Service hospitals, England. Patients Patients born between 1997 and 2005 who underwent surgical cleft repair. Intervention Children receiving grommets before the age of 5 years. Outcome Measures The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Results The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Conclusion Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.
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Kesumawati, Devi, and Nurul Hidayah. "DETERMINANTS OF STUNTING IN CHILDREN AGED 24-59 MONTHS IN THE KASREMAN COMMUNITY HEALTH CENTER." Journal of Vocational Nursing 1, no. 2 (October 29, 2020): 146. http://dx.doi.org/10.20473/jovin.v1i2.23563.
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Introduction: In Indonesia stunting still the main problem and concern in the field of nutrition, this condition in mark with height not according to age measured use the z-score. Children said stunting if the z-score <- 2SD until ≥- 3 SD and very short if < - 3 SD. Methods: This study to attemps to analyze the determinant. Stunting using study correlation with case design study case control done measurements on past (retrospektif) 38 group with the total sample case and 38 respondents. Results: The control group thr kind of data used primary data. Respondents who experienced anemia is 20 and 15 respondents (39,5 %) have children stunting and 5 responden (13,5 %) has a normal, with p-value p= 0,019 (p < 0,005) showing there the relationship between the anemia as the stunting in the work area Puskesmas Kasreman Conclusion: The conclusion of research is several factors such in minutely in the work area Puskesmas Kasreman, risk heving the anemia higher have children stunting. Expected health service, parents and knowledge of the factor causing people to stunting to prevent the occurrence stunting
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Williams, Julie, Mary Leamy, Francesca Pesola, Victoria Bird, Clair Le Boutillier, and Mike Slade. "Psychometric evaluation of the Questionnaire about the Process of Recovery (QPR)." British Journal of Psychiatry 207, no. 6 (December 2015): 551–55. http://dx.doi.org/10.1192/bjp.bp.114.161695.
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BackgroundSupporting recovery is the aim of national mental health policy in many countries. However, only one measure of recovery has been developed in England: the Questionnaire about the Process of Recovery (QPR), which measures recovery from the perspective of adult mental health service users with a psychosis diagnosis.AimsTo independently evaluate the psychometric properties of the 15- and 22-item versions of the QPR.MethodTwo samples were used: data-set 1 (n = 88) involved assessment of the QPR at baseline, 2 weeks and 3 months. Data-set 2 (n = 399; trial registration: ISRCTN02507940) involved assessment of the QPR at baseline and 1 year.ResultsFor the 15-item version, internal consistency was 0.89, convergent validity was 0.73, test–retest reliability was 0.74 and sensitivity to change was 0.40. Confirmatory factor analysis showed the 15-item version offered a good fit. For the 22-item version, the interpersonal subscale was found to underperform and the intrapersonal subscale overlaps substantially with the 15-item version.ConclusionsBoth the 15-item and the intrapersonal subscale of the 22-item versions of the QPR demonstrated satisfactory psychometric properties. The 15-item version is slightly more robust and also less burdensome, so it can be recommended for use in research and clinical practice.
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Killaspy, Helen, Stefan Priebe, Peter McPherson, Zohra Zenasni, Lauren Greenberg, Paul McCrone, Sarah Dowling, et al. "Predictors of moving on from mental health supported accommodation in England: national cohort study." British Journal of Psychiatry 216, no. 6 (May 3, 2019): 331–37. http://dx.doi.org/10.1192/bjp.2019.101.
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BackgroundAround 60 000 people in England live in mental health supported accommodation. There are three main types: residential care, supported housing and floating outreach. Supported housing and floating outreach aim to support service users in moving on to more independent accommodation within 2 years, but there has been little research investigating their effectiveness.AimsA 30-month prospective cohort study investigating outcomes for users of mental health supported accommodation.MethodWe used random sampling, accounting for relevant geographical variation factors, to recruit 87 services (22 residential care, 35 supported housing and 30 floating outreach) and 619 service users (residential care 159, supported housing 251, floating outreach 209) across England. We contacted services every 3 months to investigate the proportion of service users who successfully moved on to more independent accommodation. Multilevel modelling was used to estimate how much of the outcome and cost variations were due to service type and quality, after accounting for service-user characteristics.ResultsOverall 243/586 participants successfully moved on (residential care 15/146, supported housing 96/244, floating outreach 132/196). This was most likely for floating outreach service users (versus residential care: odds ratio 7.96, 95% CI 2.92–21.69, P < 0.001; versus supported housing: odds ratio 2.74, 95% CI 1.01–7.41, P < 0.001) and was associated with reduced costs of care and two aspects of service quality: promotion of human rights and recovery-based practice.ConclusionsMost people do not move on from supported accommodation within the expected time frame. Greater focus on human rights and recovery-based practice may increase service effectiveness.
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Costa, Sergio Renato Pais, Alexandre Cruz Henriques, Sergio Henrique Couto Horta, Jaques Waisberg, and Manlio Basílio Speranzini. "En-bloc pancreatoduodenectomy and right hemicolectomy for treating locally advanced right colon cancer (T4): a series of five patients." Arquivos de Gastroenterologia 46, no. 2 (June 2009): 151–53. http://dx.doi.org/10.1590/s0004-28032009000200014.
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A series of five cases of right-colon adenocarcinoma that invaded the proximal duodenum is presented. All patients underwent successful en-bloc pancreatoduodenectomy plus right hemicolectomy by General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2000 and 2007. There were two major complications but no mortality. Three patients did not present any recurrence over the course of 15 to 54 months of follow-up. Multivisceral resection with en-bloc pancreatoduodenectomy should be considered for patients who are fit for major surgery but do not present distant dissemination. Long-term survival may be attained.