Health Care Units Research Articles

Tumor Board Practice and Current Approach of Oncologists in Türkiye

Objective: Interdisciplinary cooperation is essential in treating and following up cancer disease. The primary objective of multidisciplinary tumor councils (MDTCs) is to identify the most suitable and effective treatment strategies for cancer patients through the collective decision-making of experts in oncology. MDTC plays a key role in breaking traditional taboos, providing the most up-to-date approach to the patient, sharing responsibility and accountability, and encouraging interdisciplinary communication and collaboration. Material and Methods: In this study, the perspectives, expectations, and experiences of medical oncologists regarding tumor boards were evaluated. The survey consisted of 10 questions and was conducted as an online survey at the '7th National Immunotherapy and Oncology Congress'. This study was cross-sectional and online. While those who were actively working as medical oncologists and those who wanted to voluntarily participate in the survey were included in the study, those who were not medical oncologists, those who were not actively working, and those who worked in private clinics were not included in the study. Participants were asked various questions about multidisciplinary tumor boards. They were asked about the specialties they most needed on the boards, the other clinics participating in the boards, and the clinics they felt were essential. The necessity of genetic clinics and molecular boards in shaping the future of oncology through molecular assessments was also assessed. The impact of board decisions on patient treatment and management was investigated. Results: A total of 624 oncologists participated in the survey. The majority of the participants were young oncologists. Most participants worked in tertiary healthcare units, including university hospitals and training and research hospitals. Almost all of the participants stated that they did MDTC. The most frequent and regular councils are; thoracic cancers and gastrointestinal cancers. The most needed and hard to reach branch was the medical genetics department. Conclusion: Cancer treatment is a complex process that cannot be confined to a single expertise. Multidisciplinary tumor boards (MDTB) are one of the cornerstones of a comprehensive approach to cancer treatment. In multidisciplinary tumor boards, various topics such as medical treatment planning for patients, diagnosis, surgical and radiotherapy planning, side effect management, and palliative care can be examined. MDTB not only provides effective treatment for cancer patients from a broad perspective but also ensures rapid and comprehensive solutions in case of potential complications.

Candida auris: Outbreak, surveillance and epidemiological monitoring in Northern Greece.

Candida auris is an emerging fungal pathogen associated with multi-drug resistance rates and widespread outbreaks in hospitals and healthcare units worldwide. Sequencing studies have revealed that different clonal lineages of the fungus seem to be prevalent among distinct geographical sites. The first case of C. auris in Northern Greece was reported in Thessaloniki in October 2022, almost 2 years after the first isolation in Greece (Athens 2019). The Mycology Laboratory of the Medical School of Aristotle University of Thessaloniki stands as the reference laboratory for fungal diseases in Northern Greece and a meticulous search for the yeast, in plenty of suspicious samples, has been run since 2019 in the Lab as well as a retrospective analysis of all its yeasts' collection, back to 2008, with negative results for the presence of C. auris. Here, are presented the findings concerning the outbreak and surveillance of C. auris in Northern Greece, mainly the region of Thessaloniki and the broader area of Macedonia, from October 2022 until August 2023. The isolates from Northern Greece continue to fall in Clade I and present with an almost equal and stable sensitivity profile until now.

Job satisfaction, professional competence, and self-efficacy: a multicenter cross-sectional study among registered nurses in Sweden and Norway

BackgroundHealthcare organizations worldwide face persistent challenges relating to turnover and intention to leave the nursing profession among registered nurses. Factors contributing to their retention and well-being at work include high job satisfaction, professional competence, and self-efficacy. Few multicenter studies have investigated these factors in relation to work experience in a Nordic context. Therefore, this study aimed to investigate job satisfaction, professional competence, and self-efficacy among registered nurses.MethodsThis multicenter cross-sectional study survey was part of a larger overarching Swedish-Norwegian project, and was conducted among registered nurses (n = 1137) in September 2021. The participants worked in a variety of health care units, e.g., hospital units, primary health care, and home care. Data was subjected to descriptive and comparative statistical analysis; chi-square test, one-way between-groups analysis of variance (ANOVA) and Kruskal-Wallis test.ResultsThe findings show that job satisfaction is reported as lowest in registered nurses with medium-term work experience as compared to newly qualified and long-term work-experienced registered nurses. Professional competence and self-efficacy are reported as higher among registered nurses with long-term work experience as compared to those with medium-term work experience and newly qualified registered nurses. However, the participants reported their professional competence as highest in relation to the same factor – “Value-based nursing care” – regardless of their work experience.Conclusions and implicationsThis study underscores the need for continuous support and professional development for registered nurses throughout their careers. Proactive support for newly qualified nurses may improve job satisfaction as they progress to being registered nurses with medium-term work experience. Tailored interventions to address the distinct needs of both newly qualified and medium-term work-experienced registered nurses are crucial for nurturing a sustainable nursing workforce.

Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus.

The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

Development and Preliminary Validation of Health Service Measurement Scale (HSMS) for Measuring Effectiveness of Health Care Services in Universities

The aim of this study was to develop and validate a Health Service Measurement Scale (HSMS) for measuring the effectiveness of health care services in public sector universities. For data collection, a deductive method was used. Based on review of literature, a survey questionnaire was developed and administered to 484 teachers from three public universities of Malakand division: university of Swat, university of Malakand and University of Sheringal (SBBU) upper Dir. The scale was developed based on DeVellis (2003) four phase scale development procedure. Factor Analysis technique was utilized for assessing factors which affect the health care services in universities. This study identified four important factors affecting the health care services in universities. These factor were clear communication skills, professional behavior, clinical competency and patient satisfaction. The scale may be used to enhance the effectiveness of the health care units inside the universities regarding provision of necessary treatment as per the approved protocol of health industry. The findings of this study further provide key insights to the management to review the health services and policy makers to enact effective health care policies for the universities. The limitations of the study along with recommendations are provided for future research.

Factors associated with maternal mortality in Kazakhstan: a pre- and during-pandemic comparison.

The maternal mortality indicator serves as a crucial reflection of a nation's overall healthcare, economic, and social standing. It is necessary to identify the variations in its impacts across diverse populations, especially those at higher risk, to effectively reduce maternal mortality and enhance maternal health. The global healthcare landscape has been significantly reshaped by the COVID-19 pandemic, pressing disparities and stalling progress toward achieving Sustainable Development Goals, particularly in maternal mortality reduction. This study investigates the determinants of maternal mortality in Kazakhstan from 2019 to 2020 and maternal mortality trends in 17 regions from 2000 to 2020, employing data extracted from national statistical reports. Stepwise linear regression analysis is utilized to explore trends in maternal mortality ratios in relation to socioeconomic factors and healthcare service indicators. The national maternal mortality ratio in Kazakhstan nearly tripled from 13.7 in 2019 to 36.5 per 100,000 live births in 2020. A remarkable decrease was observed from 2000 until around 2015 with rates spiked by 2020. Significant factors associated with maternal mortality include antenatal care coverage and the number of primary healthcare units. Additionally, socioeconomic factors such as secondary education enrollment and cases of domestic violence against women emerged as predictors of MMR. Moreover, the impact of the pandemic was evident in the shift of coefficients for certain predictors, such as antenatal care coverage in our case. In 2020, predictors of MMR continued to include secondary education enrollment and reported cases of domestic violence. Despite Kazakhstan's efforts and commitment toward achieving Sustainable Development Goals, particularly in maternal mortality reduction, the impact of the COVID-19 pandemic poses alarming challenges. Addressing these challenges and strengthening efforts to mitigate maternal mortality remains imperative for advancing maternal health outcomes in Kazakhstan.

Accelerating resident research within quantitative collaboration units in academic healthcare

With increased access to biomedical and electronic health records data and the complexity of research questions, individuals in residency programmes who aim to conduct research require specialized educational programmes and biostatistics support. Biostatistics collaboration units in academic health centres often work with residents to conduct data‐intensive research. These units face numerous challenges related to providing training in statistical literacy and collaborating on resident‐led research within very restricted timelines. Since 2019, the Duke Biostatistics, Epidemiology, and Research Design (BERD) Methods Core has supported over 247 resident‐led projects by developing tools and resources to address these challenges. This manuscript presents novel processes and training materials that other institutions can use to help biostatistics collaboration units effectively support resident training programmes. We provide a framework to support the development of collaborative teams, along with specialized training materials for residents who collaborate with these teams.

Reaching the unreached through building trust: a mixed-method study on COVID-19 vaccination in rural Lao PDR

IntroductionThe global COVID-19 vaccine rollout has been impacted by socioeconomic disparities and vaccine hesitancy, but few studies examine reasons for changed attitudes. In Lao People’s Democratic Republic (Lao PDR), a...

Update of the clinical guideline for hypertension diagnosis and treatment in Iran

BackgroundThis article introduces the updated version of the Iranian guideline for the diagnosis and treatment of hypertension in adults. The initial version of the national guideline was developed in 2011 and updated in 2014. Among the reasons necessitating the update of this guideline were the passage of time, the incompleteness of the scopes, the limitation of the target group, and more important is the request of the ministry of health in Iran.MethodThe members of the guideline updating group, after reviewing the original version and the new evidence, prepared 10 clinical questions regarding hypertension, and based on the evidence found from the latest scientific documents, provided recommendations or suggestions to answer these questions.ResultAccording to the updated guideline, the threshold for office prehypertension diagnosis should be considered the systolic blood pressure (SBP) of 130-139 mmHg and/or the diastolic blood pressure (DBP) of 80-89 mmHg, and in adults under 75 years of age without comorbidities, the threshold for office hypertension diagnosis should be SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg.The goal of treatment in adults who lack comorbidities and risk factors is SBP < 140 mmHg and DBP < 90 mmHg. The first-line treatment recommended in people with prehypertension is lifestyle modification, while for those with hypertension, pharmacotherapy along with lifestyle modification. The threshold to start drug therapy is determined at SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg, and the first-line treatment is considered a drug or a combined pill of antihypertensive drugs, including ACEIs, ARBs, thiazide and thiazide-like agents, or CCBs.At the beginning of the pharmacotherapy, the Guideline Updating Group members suggested studying serum electrolytes, creatinine, lipid profile, fasting sugar, urinalysis, and an electrocardiogram. Regarding the visit intervals, monthly visits are suggested at the beginning of the treatment or in case of any change in the type or dosage of the drug until achieving the treatment goal, followed by every 3-to-6-month visits. Moreover, to reduce further complications, it was suggested that healthcare unit employees use telehealth strategies.ConclusionsIn this guideline, specific recommendations and suggestions have been presented for adults and subgroups like older people or those with cardiovascular disease, diabetes mellitus, chronic kidney disease, and COVID-19.

Retrospective Characterization of Bone Histomorphometric Findings in Clinical Patient Specimens.

Bone histomorphometry provides comprehensive information on bone metabolism and microstructure. In this retrospective study, we aimed to obtain an overview of the typical indications, referring hospitals, and histomorphometric quantification-based diagnoses of the bone tissue in our histomorphometry laboratory, the only laboratory in Finland carrying out histomorphometric examination of clinical bone biopsies. Between January 1, 2005 and December 31, 2020, 553 clinical bone biopsies were sent to our histomorphometry laboratory for histomorphometric examination. The median age of the patients was 55 years (range, 0.2-89.9 years), 51% of them were males, and 18% comprised pediatric patients. We received bone biopsy specimens from 23 hospitals or healthcare units. The majority of the samples we sent by nephrologists. The most common bone biopsy indications were suspicion of renal osteodystrophy (ROD), unknown bone turnover status in osteoporosis, and several or untypical fractures. The most common quantitative bone histomorphometry-based diagnosis was ROD. This study provides information on the clinical application of bone histomorphometry in Finland. Precise and quantitative ROD evaluation is the most common indication for bone histomorphometry, being crucial in clinical decision-making and targeted treatment of this patient group.

Situational analysis of hypertension management at primary health care level in São Paulo, Brazil: population, healthcare professional and health system perspectives

BackgroundGovernment-led, population-wide initiatives are crucial for advancing the management of hypertension − a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control.MethodsFirst, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city– Itaquera and Penha– which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents.ResultsData gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans.ConclusionsThis situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.

Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

Exploring Loneliness, Trust, and Psychosocial Meanings Among Primary Care Attendees: A Cross-Sectional Study From a General Practice Setting in Crete, Greece.

Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is still challenging in terms of research. The present study aimed to investigate to what extent loneliness and trust interact and if there is any association between loneliness and routine events or behaviors that affect overall well-being. This cross-sectional sample of 120 participants, aged between 40 and 75 years, was collected from an urban Primary Health Care Unit, between May and July 2023, in a consecutive manner, after criteria application. The University of California, Los Angeles (UCLA) Loneliness Scale (Version 3) and the Personal Trust and Connections Scale (PerTC) were completed. Hierarchical multiple linear regression analysis in steps and multiple logistic regression analysis were performed. The mean age of the participants was 59.8 years and the majority were females (73.3%). Only 10.8% were found to have no Behavioral Risk Factors (BRFs). A higher sense of loneliness was associated with being widowed/unmarried/divorced (unstandardized β=-4.10, p=0.045), not having children (β=-2.80, p=0.038), having more BRFs (β=2.03, p=0.032), or being in contact with fewer friends (β=-0.56, p<0.001). A higher sense of loneliness was related to lower levels of trust (β=-1.29, p=0.032). Lower odds of demonstrating high levels of loneliness were found among married individuals (odds ratio (OR): 0.38; 95% confidence interval (CI) 0.15, 0.95; p=0.039) and those who reported six or more routine contacts or meetings with friends (OR: 0.31; 95% CI 0.13, 0.74; p=0.008). A lower score on the total PerTC scale was related to higher odds of increased loneliness (OR: 2.78; 95%CI 1.01, 7.62; p=0.048). Being married and coming in contact or meeting with more friends was associated with lower odds of reporting high feelings of loneliness, while lower trust was correlated with increased odds of loneliness. Also, persons with more BRFs were found to have a higher loneliness score. Given their inverse correlation, tools that measure levels of loneliness and trust, like the UCLA and PerTC scales, may be used within primary care consultation to offer new insights on health risk behaviors and their possible synergistic influences.

A Systematic Review about Cervical Pregnancy and our Experience.

Cervical ectopic pregnancy is a relatively rare type of ectopic pregnancy and has no standardized guidelines for management. This systematic review is based on the collection of case reports, published in PubMed/MEDLINE about the resolution of ectopic cervical pregnancies over the last decade and the presentation of a case managed in our healthcare unit. Studies involving cervical pregnancy in the first trimester with the presence of a viable embryo and β-hCG in the serum below 100.000 mIU/mL were included, while heterotopic pregnancies were excluded. Nineteen articles reporting twenty-three case reports are demonstrated explicitly emphasizing on the management techniques. There is no established approach for the management of this type of ectopic pregnancy. It is important to consider the conservative approaches as first-line treatment in all cases of cervical pregnancy preserving fertility. Minimally invasive methods are also described and preferred as second-line treatment, as reported in our literature review.

“You get out of the house, you talk to each other, you laugh…And that’s fantastic” – a qualitative study about older people’s perceptions of social prescribing in mainland Portugal

BackgroundSocial prescribing (SP) is a non-clinical approach, most commonly based in healthcare units, that aims to address non-medical health-related social needs by connecting individuals with community-based services. This qualitative study explores the perception of Portuguese older adults regarding the benefits of SP and their willingness to participate in SP initiatives.MethodsThree face-to-face focus group sessions were conducted with 23 participants in different cities in Portugal. Open and semi-open questions were used to guide the discussions and thematic analysis was used to analyze the data.ResultsThe participants recognized the potential benefits of SP for older adults, including diversifying leisure activities, improving mental health, and complementing existing support systems. They highlighted the need for external support, usually in the form of link workers, to facilitate personalized referrals and consider individual characteristics and preferences. While some participants expressed reluctance to engage in SP due to their existing busy schedules and a perceived sense of imposition, others showed openness to having new experiences and recognized the potential value of SP in promoting activity. Barriers to participation, including resistance to change, mobility issues, and family responsibilities, were identified.ConclusionsThe study emphasizes the importance of a person-centered and co-designed approach to SP, involving older adults in the planning and implementation of interventions. The findings provide valuable insights for the development of SP programs tailored to the unique needs and aspirations of older adults in Portugal, ultimately promoting active and healthy aging. Future research should consider the perspectives of family doctors and include a broader representation of older adults from diverse geographic areas.

Green Hospitals: A a remedy for the Climate Change Burden on the Polish Healthcare System

The global healthcare sector faces challenges, including an aging population and climate change concerns, contributing 4.4% to global greenhouse gas emissions. The Polish healthcare system, surpassing global averages in environmental impact, grapples with demographic challenges and disproportionate carbon emissions. This study explores the potential of green hospitals, integrating sustainable practices, to reduce the sector's environmental footprint. Recommendations for policymakers and healthcare stakeholders focus on energy, water management, and waste/recycling practices. The brief emphasizes water conservation in healthcare, citing successful case studies like the French Nephrocare network. Energy-efficient solutions, exemplified by the Philips BlueSeal MRI coupled with SmartSpeed acceleration engine, offer cost savings despite upfront expenses, aligning with Green Public Procurement (GPP) practices. Sustainable waste management practices – crucial for healthcare units – require training programs and recycling initiatives in green hospitals to minimize environmental impact. Despite challenges, green hospitals offer a promising avenue for the future of healthcare, contributing to improved patient outcomes, reduced costs, and a sustainable healthcare infrastructure. The brief emphasizes the need for immediate action, encouraging stakeholders to advocate for green hospital policies to minimize climate change's impact on public health.

Assessment of the surface water quality and primary health risk in urban wastewater and its receiving river Kathajodi, Cuttack of eastern India.

Kathajodi, the principal southern distributary of the Mahanadi River, is the vital source of irrigation and domestic water use for densely populated Cuttack city which receives anthropogenic wastes abundantly. This study assesses the contamination level and primary health status of urban wastewater, and its receiving river Kathajodi based on the physicochemical quality indices employing inductively coupled plasma mass spectroscopy and aligning with guidelines from the United States Environmental Protection Agency (USEPA) and WHO. The high WQI, HPI, and HEI in the catchment area (KJ2, KJ3, and KJ4) indicate poor water quality due to the influx of domestic waste through the primary drainage system and effluents of healthcare units. A high BOD (4.33-19.66mg L-1) in the catchment indicates high organic matter, animal waste, bacteriological contamination, and low DO, resulting in deterioration of water quality. CR values beyond limits (1.00E - 06 to 1.00E - 04) in three locations of catchment due to higher Cd, Pb, and As indicate significant carcinogenic risk, while high Mn, Cu, and Al content is responsible for several non-carcinogenic ailments and arsenic-induced physiological disorders. The elevated heavy metals Cd, Cu, Fe, Mn, Ni, and Zn, in Kathajodi, could be due to heavy coal combustion, vehicle exhaust, and industrial waste. On the other hand, Cu, Fe, K, and Al could be from agricultural practices, weathered rocks, and crustal materials. Positive significant (p ≤ 0.05) Pearson correlations between physicochemical parameters indicate their common anthropogenic origin and similar chemical characteristics. A strong correlation of PCA between elements and physiological parameters indicates their role in water quality deterioration. Assessing the surface water quality and heavy metal contents from this study will offer critical data to policymakers for monitoring and managing public health concerns.

Activities of the oral health teams in primary health care: a time-motion study

BackgroundEfficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population’s needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience.ObjectiveCalculate the average time parameters for the activities carried out by the oral health team in primary health care.MethodThis is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week.ResultsA total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists’ main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation.ConclusionThe study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.

Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil.

Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.

Prison Nurseries: A Review of Maternal and Infant Rooming in Outcomes for Incarcerated Mothers

Women are the fastest growing prison population in Canada, and at incarceration, 4-10 percent of women are pregnant. These women, their correctional facilities, and Canadian health care services are increasingly forced to address the issues of motherhood and reproductive health care during incarceration. Most incarcerated women are separated from their infants soon after birth. The authors claim that prison nurseries, as a harm reduction strategy, are a positive alternative to this separation. Midwives could play a valuable role in these health care units. Methods: This paper is a literature review examining the outcomes of mother-infant dyads who have access to prison nurseries. The search strategy included 15 health research databases, applying similar search terms to all databases. This article has been peer reviewed.