Higher Referral Rates Research Articles

Pattern of Utilization of Consultation-Liaison Psychiatry Services in A Tertiary Centre in South India

Background and Objective: Consultation-Liaison Psychiatry (C-LP) services, an important aspect of every general hospital has wide variations in their pattern of services being utilized. Studies in this area are mostly conducted in northern states of India. Our study aims to see the pattern of inpatient referrals to the department of psychiatry in a tertiary hospital in South India. Material and Methods: One hundred and seventeen inpatient referrals to the Department of Psychiatry of a tertiary care hospital in Puducherry over a period of six months were included for the study. Informed consent was taken. Information about sociodemographic profiles was collected. Mini International Neuropsychiatric Interview (MINI-PLUS), a semi-structured diagnostic interview tool was administered for psychiatric diagnosis. Results: The inpatient referral rate was 1.50%. Evaluation of para-suicide was the commonest reason for referral (36.7%), followed by depressive symptoms (12.8%), alcohol related problems (12.8%), and abnormal behaviour (10.3%). Psychiatric diagnosis was found in 86% of cases referred; 41% had multiple psychiatric diagnoses. Deliberate Self-harm (DSH) was present in 28% and depressive disorder in 22% of cases. Gastro-intestinal disorders (12%), infectious disorders (11%) and cardiovascular disorders (9%) were the commonest medical diagnoses in the population. Department of Medicine had the highest referral rate; however referrals from most departments were very low. Conclusion: The study depicts a low referral rate which can be attributed to the lack of knowledge and high rate of stigma of psychiatric disorders. Thus, there is an urgent need to strengthen the existing C-LP services and screen for psychiatric disorders in non-psychiatric inpatients.

Newborn Hearing Screening Test: A Comparison between Infants in Neonatal Intensive Care Unit versus Nursery

Objective: The purpose of this study is to compare the clinical characteristics of newborn hearing test results between infants in well-baby nursery (WBN) versus neonatal intensive care unit (NICU) and to determine the optimal strategies of hearing screening for each group. Methods: A total of 2,161 newborns admitted to WBN and NICU were enrolled in this retrospective cohort study. Automated audio brainstem response was used for hearing screening test. The screening rates, referral rates, prevalence rates, false positive rates and predictive positive value (PPV) were analyzed for infants in WBN and NICU. Results: The referral rates of the screening test were 2.2% and 5.0% in WBN and NICU groups (P<0.01); the prevalence rate of congenital hearing loss (HL) were 0.5% and 4.6% in the WBN and NICU groups (P<0.01). The false positive rates and PPV of screening test were 0.9% and 36.8% in WBN; 0.8% and 80% in NICU. Infants with bilateral refer results in both WBN and NICU were at the higher risk of congenital HL, compared with infants with unilateral refer results in WBN who were mostly confirmed to have false positive. Conclusion: The infants in WBN showed high unilateral referral rate with low prevalence rate of HL. However, the infants with bilateral refer results in WBN and uni- or bi-lateral refer results in NICU had higher prevalence rate of HL, compared with those with unilateral refer results in WBN. Different strategies for hearing screening might be considered in infants in WBN and NICU.

Evaluation of an E-Learning Course for Clubfoot Treatment in Tanzania: A Multicenter Study.

In total, 80% of clubfoot cases occur in low- and middle-income countries, where lack of clinical knowledge of the Ponseti method of treatment presents as a major barrier to treatment. This study aims to determine the effectiveness of an electronic learning course to teach clinicians in Tanzania Ponseti method theory. A total of 30 clinicians were recruited from clinics with high referral rates for clubfoot patients and invited to 1 of 3 training sites: Mbeya (n = 15), Zanzibar (n = 10), and Mwanza (n = 5). Baseline knowledge, measured through a pretest, was compared to performance on a posttest after e-learning course completion. Scores for Mbeya and Zanzibar participants improved from 44 ± 12.5 to 69.8 ± 16.5 (P < .0001) and 44.3 ± 14.0 to 67.9 ± 21.4 (P = .01), respectively. Our results suggest that an e-learning course may be an effective method of disseminating Ponseti method theory in Tanzania. Successful implementation requires an understanding of the device availability and technology literacy of the users.

Hanging and asphyxia: Interventions, patient outcomes and resource utilisation in a UK tertiary intensive care unit.

Suicide is increasing in the UK, and hanging is now the commonest mechanism. United Kingdom intensive care unit outcomes (including organ donation) after hanging have not been reported. Retrospective analysis of cases admitted to a UK tertiary intensive care unit with a primary or secondary diagnosis of hanging/asphyxia. Case analysis divided between those with and without a history of cardiopulmonary resuscitation, and outcomes described using the cerebral performance category score. A total of 33 cases were reviewed, 19 with a history of cardiopulmonary resuscitation (three survivors with cerebral performance category of 1-2), 14 without history of cardiopulmonary resuscitation (14 survivors, 11 cerebral performance category score of 1, 3 cerebral performance category score of 3). Three cases went on to have a good neurological outcome with a cerebral performance category score of one, and 16 died. The three survivors only had bystander cardiopulmonary resuscitation and cardiac arrest was not independently confirmed. All three had a good neurological recovery despite two having hypoxic-ischaemic encephalopathy on computed tomography head. Of the three survivors, one received no temperature management and two received targeted temperature management. Median intensive care unit length of stay after hanging with cardiopulmonary resuscitation was 3.0 days (2.4-6.7 days). Fifteen patients were discussed with the organ donation specialist nurse, with six consenting to donation and six declining consent, with 18 solid organs donated. All 14 of those without a history of cardiopulmonary resuscitation survived, 11 with a cerebral performance category score of 1 and three having a cerebral performance category score of 3. No patients received active temperature management. Median intensive care unit length of stay in this group was 2.9 days (1.2-3.8). Outcomes after confirmed cardiac arrest following hanging are poor, in keeping with existing international data, even in those surviving to intensive care unit admission. Despite low rates of consent to organ donation, the overall organ donation is high due to high referral rates. Despite the poor prognosis in this population, early initiation of full resuscitation should be offered to optimise survival and facilitate the possibility of donation.

Use of the Electronic Medical Record to Facilitate Intervention for Patients With Rising Prostate-Specific Antigen Values After Radical Prostatectomy: A Feasibility Study.

Salvage radiotherapy (SRT) is the standard of care offered when postprostatectomy prostate-specific antigen (PSA) levels are ≥ 0.2 ng/mL. However, emerging evidence suggests that early SRT (ie, SRT delivered at PSA values < 0.2 ng/mL, but generally ≥ 0.05 ng/mL) improves oncologic outcomes. We evaluated the feasibility of improving referral rates for discussion of early SRT by using a dynamic registry that identifies through the electronic medical record patients with rising postprostatectomy PSA levels. We developed an iteratively updated registry that identifies patients who fall within two postoperative PSA strata: ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL. We compared referral rates to radiation oncology during a 3-year period before use of this registry with those during a 1-year period after promotion of the registry in multidisciplinary tumor board settings. Before promotion of the registry, referral rates for patients with PSA values ≥ 0.05 to < 0.1 ng/mL and ≥ 0.1 to < 0.2 ng/mL were 35% and 65%, respectively. After promotion of the registry, referral rates within each stratum increased significantly to 82% and 94%, respectively ( P < .05 for both by Fisher's exact test). The overall rate of referral for patients with PSA values ≥ 0.05 to < 0.2 ng/mL rose from 48% to 90% ( P < .001). The creation of a registry of patients with rising postprostatectomy PSA values can facilitate increased referral rates for early SRT without burdening providers with a clinical support tool embedded within the EMR itself. This is true even in the case of already high baseline rates of referral for early SRT. The changes reported herein most likely reflect a Hawthorne effect wherein the ability to track referrals rather than a direct function of the registry influenced practice patterns. Nonetheless, the registry provided an integral framework to allow for tracking.

Postural Screening for Adolescent Idiopathic Scoliosis with Infrared Thermography

Adolescent idiopathic scoliosis (AIS) is a multifactorial, three-dimensional deformity of the spine and trunk. School scoliosis screening (SSS) is recommended by researchers as a means of early detection of AIS to prevent its progression in school-aged children. The traditional screening technique for AIS is the forward bending test because it is simple, non-invasive and inexpensive. Other tests, such as the use of Moiré topography, have reduced the high false referral rates. The use of infrared (IR) thermography for screening purposes based on the findings of previous studies on the asymmetrical paraspinal muscle activity of scoliotic patients compared with non-scoliotic subjects was explored in this study. IR thermography is performed with an IR camera to determine the temperature differences in paraspinal muscle activity. A statistical analysis showed that scoliotic subjects demonstrate a statistically significant difference between the left and right sides of the regions of interest. This difference could be due to the higher IR emission of the convex side of the observed area, thereby creating a higher temperature distribution. The findings of this study suggest the feasibility of incorporating IR thermography as part of SSS. However, future studies could also consider a larger sample of both non-scoliotic and scoliotic subjects to further validate the findings.

Systematic Review of School Scoliosis Screening

ObjectivesThe aim of this study was to review the literature on school screening and its reported effectiveness. Summary of Background DataThere is no worldwide consensus concerning the mandating of school screening for scoliosis. This remains a controversial issue. MethodsThe following databases were employed: Medline, Premedline, CINAHL, CENTRAL, AMED, Embase, SCOPUS, Ovid nursing, and Web of Science. These data were generated from the Forward Bend Test, the angle of trunk rotation and Moire topography. The first and second authors each independently screened titles and abstracts for potential studies. Fulltext papers of potential studies were also independently read by the first two authors to identify studies to be included based on strict inclusion/exclusion criteria. A heterogeneity test was performed by testing for the significance of the between-study variance. Publication bias was examined by a funnel plot. ResultsWe found 20 studies that met our inclusion criteria. The pooled estimate of prevalence of scoliosis curves in the population was 1.1% for curves greater than 10°, and 0.2% for curves greater than 20°. The pooled referral rate to radiography during the screening process was 6.6%. The pooled positive predictive values for detecting curves >10° and >20° were 32.3% and 6.5% respectively. Analysis of data demonstrated significant heterogeneity between studies but was not suggestive of the presence of publication bias. ConclusionsWe support the implementation of scoliosis screening as a means of detecting curves at an early treatable stage. The current available evidence in the literature for routine scoliosis screening is low to moderate. Challenges exist to the school scoliosis screening including a high referral rate to radiology.

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

Is it possible to provide low-intensity cognitive behavioral treatment (CBT Lite) in Canada without additional costs to the health system? First-year evaluation of a pilot CBT Lite program

ABSTRACTThere is a scarcity of publicly funded Cognitive Behavioral Therapy (CBT) programs in Canada. The evidence-based psychological services can not only reduce the burden of disease, but such services can also potentially pay for themselves. We ran a pilot project of a Cognitive Behavioral Therapy: Low InTEnsity (CBT Lite) which was delivered by the front line workers in a community mental health organization. Low intensity CBT was provided for non-psychotic disorders after a short period of training, under regular supervision and within 6 to 10 sessions to clients attending a community mental health organization in Kingston, Ontario, Canada. Analyses were conducted using statistical package for the social sciences (SPSS) v21. We had a high rate of referrals. The dropout rates were low. We provided low intensity CBT to 47 persons. Statistically, significant differences were noted in post-treatment measures of psychopathology (P = 0.000), anxiety (P = 0.000), depression (P = 0.000) and disability (P = 0.000). A majority of clients were exited from the service (27/47) after completion of the program. None of the attendees returned with a relapse during the study period. The average number of work days by the group increased from 1.5 to 3.53 (P = 0.000). We estimate that an input of CAD $1 would return more than CAD $3 per annum into the national economy. The results of this pilot, CBT Lite program, suggests that it is possible to provide low-intensity CBT by adding resources to the existing health system. Such program will not only cover its costs; it will further add to the national economy.

: Dysmenorrhea and impact on Quality of Life

Background: Dysmenorrhea, painful menstruation, is a common chronic condition of pain that affects a wide range of young women capable of reducing their quality of life, decrease their ability to function at a 100 percent and ultimately causing a reduction in productively for the affected person for a period of time.&#x0D; Many studies have shown that the level of knowledge about dysmenorrhea is unsatisfactory especially in young women and that it indeed has the ability to disrupt a peaceful flow in rhythm and pattern of women in executing daily activities, the aim of this study is therefore to determine the true extent at which dysmenorrhea interferes with daily activities.&#x0D; Materials and Methods: Data collection was done using an 18-item self-administered questionnaire developed to capture the aim of this study between September and November, 2016. Data was entered and analyzed using Statistical Package for Social Sciences 11.5 (SPSS 11.5). Descriptive statistics of socio-demographic information, menstrual history and symptoms of participants regarding dysmenorrhea as well as impact on quality of life were determined and reported in the forms of mean, standard deviation, proportions and percentages.&#x0D; &#x0D; Results: The average participant’s age was 20 years +/- 1.206 years (ranging from 17-30 years). 24% (76) were found to be less than 20 years of age whereas only 8% (25) were above 22 years of age. Most of the responders, 68% (216) fell within the age group of 20-24. The mean BMI of the participants was 22.03 +/- 2.27 kg/m2 (ranging from 16.8 kg/m2 to 33.04 kg/m2 ). Most of the participants had a normal BMI (18.5-25) which was around 69% of the total participants. Participants in the underweight and overweight categories had almost equal distribution with 17% were and 14% respectively&#x0D; Conclusion: Dysmenorrhea is a common health problem and high gynecological referral rate due to its high prevalence rate. It exerts a significant effect on the daily activities and a detrimental effect on the quality of life among the female population&#x0D;

Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses

ObjectiveObservational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses.Methods118 general practitioners (GPs) in the Netherlands...

Monogenic diabetes prevalence among Polish children-Summary of 11 years-long nationwide genetic screening program.

Estimated monogenic diabetes (MD) prevalence increases as screening programs proceeds. To estimate prevalence of MD among Polish children. Patients and their family members suspected of suffering from MD (defined as causative mutation in one of the Maturity Onset Diabetes of the Young or permanent neonatal diabetes mellitus genes) were recruited between January 2005 and December 2015. Nationwide prevalence was estimated based on data from 6 administrative provinces (out of 16 in Poland) with high referral rates of patients (>10 per 100 000 children). During the analysis, probands from 322 of 788 screened families tested positive yielding a total of 409 children and 299 family members with MD. An average of 70 probands/year were referred. Screening success rate reached 40% over the study period. We estimated the prevalence of MD in 2015 to 7.52/100 000 children (1 in 13 000). The most frequent MODY in this group was GCK- MODY (6.88/100 000). The prevalence estimates increased nearly 2-fold since our report in 2011 (4.4/100 000). However, the figure reached a plateau because of screening saturation in 2014 what was also proven by lowering of the median age of diagnosis lowered in time (R = -0.73, P = .0172) along with shortening of the delay between clinical and genetic diagnosis (R = -0.65, P = .0417). The screening for childhood MD in Poland reached a plateau phase after 10 years showing a stable prevalence estimate. The true frequency of MD in the overall population may be higher given later onset of reportedly more frequent types of MD than GCK -MODY.

Participant referral rate in the National Eye Health Survey (NEHS).

PurposeTo present the rates of referral of participants in the National Eye Health Survey (NEHS) for further eye care.Materials & methodsA national sample of 3098 non-Indigenous Australians aged 50–98 and 1738 Indigenous Australians aged 40–92 years living in 30 randomly selected sites was recruited using a door-to-door approach. Participants completed a general questionnaire and a series of eye tests, including vision and anterior segment assessment, intra-ocular pressure measurement, visual field testing and fundus photography. A predefined protocol was used to guide the referral of participants for follow up eye care. An ophthalmologist was on-call to assist with the triaging of participants.ResultsOf the total sample, 32.1% (994/3098) of non-Indigenous participants and 43.6% (757/1738) of Indigenous participants were referred for further eye care (p<0.001). A significant difference in referral rates for Indigenous Australians was observed between regions of differing geographic remoteness [range = 32.2% (Inner Regional)—60.4% (Very Remote), p <0.001]. After adjusting for covariates, males (OR = 1.24, 95% CI: 1.06–1.46), older age (OR = 1.02 per year, 95% CI: 1.01, 1.02) and longer time since previous eye examination (OR = 1.15 per year, 95% CI: 1.12, 1.19) were associated with higher rates of eye care referral in the non-Indigenous population. In the Indigenous population, older age (OR = 1.02 per year, 95% CI: 1.01–1.03), self-reported diabetes (OR = 1.70, 95% CI: 1.37–2.12), greater geographical remoteness (OR = 1.19, 95% CI: 1.09–1.29) and longer time since previous eye examination (OR = 1.10 per year, 95% CI: 1.07, 1.13) were associated with a higher rate of referral after multivariate adjustments. A total of 25 participants (1.4%) were referred for urgent follow-up of potentially sight threatening conditions.ConclusionsOur data has identified several high risk groups that required ophthalmic referral including older Australians, non-Indigenous men, Indigenous Australians with self-reported diabetes and those residing in very remote populations who may benefit from improvements in the provision and/or uptake of eye health services. Future longitudinal research is warranted to evaluate the feasibility and efficacy of implementing a referral protocol within a population-based research setting.

Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study

Reducing alcohol misuse is a priority for U.S. health officials considering that misuse of alcohol is a leading preventable cause of morbidity and mortality. Consequently, health centers are integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) for alcohol misuse within usual care. Although SBIRT is well validated among general patient samples, results have not generalized to drinkers with probable alcohol use disorder; moreover, little is known about the efficacy of SBIRT with patients who are of low-income or ethnic or racial minority status. Members of these groups are of particular concern because they are at risk to experience trauma, potentially in concert with alcohol misuse. Therefore, translational approaches to delivering SBIRT particularly with these groups of interest might be needed to meet the Grand Challenge of reducing alcohol misuse. Accordingly, this study combined SBIRT with a model designed to address psychological trauma: T-SBIRT. With a sample of 112 adults, most of whom were African American or Latino/a, authors analyzed multiple indicators of feasibility. Results indicated that T-SBIRT is suitable for and acceptable to patients accessing community-based health services, and T-SBIRT can promote high referral acceptance rates to specialty treatment, particularly among patients with probable alcohol use disorder.

Primary Prevention of Sudden Cardiac Death With Device Therapy in Urban and Rural Populations

BackgroundImplantable cardioverter defibrillators (ICDs) have shown benefit in reducing mortality in patients with heart failure, after myocardial infarction, and those with reduced ejection fraction. We sought to explore the use of this therapy in specialized heart function clinics, in rural and urban locations. MethodsThis was a retrospective cohort study performed in 3 specialized heart function clinics in Nova Scotia, 2 of which were in rural locations. All patients with an initial left ventricular ejection fraction ≤ 35% were included from 2006 to 2011. Rates of referral, ICD implantation, and mortality were compared between urban and rural groups. ResultsThere were 922 patients included in the study; 636 patients in the urban clinic, 286 in the rural locations. Referral rates were higher in the urban clinic compared with the rural locations (80.4% vs 68.3%; P = 0.024). Refusal rates for referral were higher in the rural locations (13.7% vs 2.1%; P < 0.0001). Higher referral rates were associated with urban location (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.01-3.26; P = 0.047), and younger age (OR, 0.96; 95% CI, 0.93-0.99; P = 0.003); lower referral rates for women was observed (OR, 2.29; 95% CI, 1.13-4.63; P = 0.021). Mortality was significantly associated with older age, lack of referral, presence of comorbidities (renal failure, diabetes, peripheral vascular disease) and a rural location. ConclusionsSpecialized heart function clinics have a high rate of appropriate referral for primary prevention ICDs, but referral rates for this life-saving therapy remain lower in rural jurisdictions. This disparity in access to care is associated with increased mortality and might require particular attention to prevent unnecessary deaths.

Exploring the Psychological Profile of Patients with Delusional Infestation.

Delusional infestation (DI) is an uncommon psychiatric disorder in which patients present with the false and fixed belief (i.e. a delusion) that their skin and/or their environment is infested despite objective evidence to the contrary. Within psychodermatology specialist clinics there is a high rate of DI referrals. What is not known is the level of psychiatric and psychological co-morbidities associated with DI and whether psychiatric or psychological assessment would be warranted. One-hundred and thirty-eight adult patients with DI attending an outpatient psychodermatology clinic were given 3 standardised questionnaires. The results showed that 81% had a poor quality of life; 52% with anxiety, 41.6% with depression and 49% with appearance-related concerns. This study indicates high levels of psychiatric and psychological disorders in DI which require assessment and appropriate intervention.

Rapid Assessment of functioning of Rogi Kalyan Samiti in Yavatmal District of Maharashtra State, India

Aim of the present research was 1. To study the structure and functioning of RKS, 2. To study the amount of funds available and revenue generated by the RKS and utilization of funds by RKS, 3. To assess the facilitating and inhibiting factors affecting the functioning of RKS. The study was conducted in Yavatmal District, Amaravati Division in Vidarbha region of Maharashtra State. Using multistage purposive sampling design, 2 SDH, 9 RH and 18 PHCS were selected. The study subjects were RKS members (203 members), clients (5 IPD and 5 OPD patients) and beneficiaries (290 patients). A structured and pre-tested self administered questionnaire translated in local language was used for data collection from RKS members and beneficiaries. The third tool for study was onsite observations by the investigator. Data thus collected was analysed using Stata software version 12.1. RKS was constituted during 2005-2007 with governing body following issuance of government of India guidelines. Biological waste management was carried out at all 29 facilities in the study as per the guidelines from MPCB. All funds were received in time and work wise utilization was done as per the guidelines at all chosen health facilities. 41.9% at PHCs and 21.6% at SDH/RH, RKS members reported difficulties in utilization of funds, more difficulties were faced at PHC than at SDH/RH. (90.1%) RKS members are satisfied with overall functioning and activities conducted by the RKS. However, most of the community members and beneficiaries were satisfied with the provision of good quality of medicine, availability of specialist care, high referral rates and higher investigation.

Early Therapy Services Following Neonatal Intensive Care Unit Discharge

ABSTRACTAims: To (1) characterize early therapy services for preterm infants in the first two years of life, and (2) define factors related to accessing early therapy services. Methods: Therapy utilization after discharge from the neonatal intensive care unit (NICU) was tracked in 57 infants born ≤30 weeks gestation from 2007 to 2010. Participants returned for developmental testing at two years. Factors related to early therapy utilization were explored. Results: Fifty-two (91%) infants received a referral for therapy at NICU discharge but only 44 (77%) received at least one type of therapy during the first two years of life. Infants who received early therapy services were more likely to have more days on ventilation (p =.005), have single mothers (p =.047), and exhibit abnormal neurobehavior at term equivalent age (p =.03). On average, infants first received occupational therapy at a mean age of 5.1 ± 4.6 months with a median of 2.6 (1.3–9.0), physical therapy at a mean age of 4.3 ± 4.1 months with a median of 3.7 (0.1–5.5), and speech-language pathology services at a mean age of 14.0 ± 6.1 months with a median of 15.0 (11.3–17.7) months corrected age. Of the 13 children who did not receive any therapy in the first two years after NICU discharge, seven (53%) had a developmental delay at an age of two years. Conclusions: In spite of high referral rates for therapy services, there is a delay in therapy activation following NICU discharge, and some infants who warrant services do not obtain them.

An international physician survey of chronic thromboembolic pulmonary hypertension management.

We conducted an international study to evaluate practices in the diagnosis and management of patients with chronic thromboembolic pulmonary hypertension (CTEPH) globally across different regions. Between August and October 2012, CTEPH-treating physicians completed a 15-minute online questionnaire and provided patient record data for their 2-5 most recent patients with CTEPH. Overall, 496 physicians (Europe: 260; United States: 152; Argentina: 52; Japan: 32) completed the questionnaire and provided patient record data for 1,748 patients. The proportion of physicians who described themselves as working in or affiliated with a specialized pulmonary hypertension (PH) center ranged from 38% in France and Italy to 83% in the United States. A large proportion of patients did not undergo ventilation/perfusion scanning (46%-67%) or right heart catheterization (24%-57%) for the diagnosis of CTEPH. Referral rates for pulmonary endarterectomy evaluation ranged from 25% in Japan to 44% in Europe, with higher referral rates in PH centers; the main reasons for lack of referral were that surgery was not considered unless medical treatment was failing and patient refusal. Other variations in management included greater use of phosphodiesterase 5 inhibitors in the United States than in Europe and Japan and greater use of combination treatment in the United States than in Europe. Physicians' perceptions of their treatment strategy were generally consistent with patient record data. Results from this study, which includes a global aspect of CTEPH care, demonstrate not only regional differences in CTEPH management but, more importantly, considerable nonadherence to the diagnosis and treatment guidelines for CTEPH, even in PH centers.

The outcome of a developmental screening tool (PEDS) in English and Northern Sotho: A comparative study

ABSTRACTIn low- and middle-income countries, there is an increase in the prevalence of developmental delays. In a financially-restricted but linguistically diverse South African primary health care context, adapting assessment tools may be more appropriate than developing new ones. The current study aimed to compare outcomes of the English Parents’ Evaluation of Developmental Status (PEDS) and the Northern Sotho PEDS (PEDS-NS), and to determine language preference. The PEDS was translated into Northern Sotho and back-translated. A panel evaluated the translation to determine the appropriateness of the tool. A total of 95 caregivers were selected via convenience sampling. Participants had to adhere to specific selection criteria. High referral rates were reported, which may be due to participants being from underserved communities. Positive and negative correspondence of the PEDS-NS was high. This proved that the PEDS-NS is an accurate translation of the PEDS. Significant association (p = 0.021) was observed between age and respondents’ language preference.