Higher Number Of Consultations Research Articles

Documentation of shared decision-making in diagnostic testing for dementia in Dutch general practice: A retrospective study in electronic patient records

ObjectiveTo explore (1) documentation of shared decision-making (SDM) in diagnostic testing for dementia in electronic patient records (EPR) in general practice and (2) study whether documentation of SDM is related to specific patient characteristics. MethodsIn this retrospective observational study, EPRs of 228 patients in three Dutch general practices were explored for the documentation of SDM elements using Elwyn’s model (team talk, option talk, decision talk). Patient characteristics (gender, age, comorbidities, chronic polypharmacy, the number of consultations on memory complaints) and decision outcome (wait-and-see, GP diagnostics, referral) were also extracted. ResultsIn EPRs of most patients (62.6 %), at least one SDM element was documented. Most often this concerned team talk (61.6 %). Considerably less often option talk (4.3 %) and decision talk (12.8 %) were documented. SDM elements were more frequently documented in patients with lower comorbidity scores and patients with a relatively high number of consultations. Decision talk was more frequently documented in referred patients. ConclusionPatients' and significant others’ needs, goals, and wishes on diagnostic testing for dementia are often documented in EPRs. Practice implicationsLimited documentation of option and decision talk stresses the need for future SDM interventions to facilitate timely dementia diagnosis.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study.

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

COVID-19 pandemisinde ilk kısıtlama dönemi ile birinci normalleşmeye geçiş dönemi arasında üçüncü basamak acil servise başvuran hastaların demografik analizi

Objective: The COVID-19 virus has become a global threat by spreading all over the world. Countries are often unprepared for pandemics or other disasters, especially in the beginning, they experience organizational problems and the health system is adversely affected by this situation. The aim of this study is to analyze the patients who applied to the emergency department from the date of the first case in our country to the first day of the normalization process and to investigate the effects of different restraint decisions on the emergency patient characteristics. Material and Methods: This study was carried out retrospectively on patients who applied to the emergency department of Kırıkkale University Medical Faculty Hospital between 11.03.2020 and 01.06.2020. During this period, the dates of the critical restriction decisions regarding the pandemic were determined, and the patients were divided into four different periods according to the time of admission. Period-I: Between 11 March and 21 March, Period-II: Between 21 March and 3 April, Period-III: Between 3 April and 4 May, and Period-IV: Between 4 May and 1 June. Demographic data, application forms, units for which consultation was requested, diagnoses and hospitalization status of all patients were recorded. Obtained data were evaluated with SPSS 22.0 program and p<0.05 value was considered significant. Results: It was determined that 6507 patients applied to the emergency department during the study period. Period-I, n=1111; Period-II, n=723; Period-III consisted of n=2231 and Period-IV consisted of n=2442 patients. While the number of patient admissions was 78.39±28.46/day, 8.4% of them applied by ambulance. While 14.9% of all patients were infectious diseases emergencies, 17.3% were trauma. While simple traumas constituted 36.7% of the trauma patients, this was followed by falls and stab wounds. In Periods III and IV, the rate of stab wounds, blow and gunshot wounds increased. The highest number of consultations was requested from the Obstetrics and Gynecology clinic, followed by Internal Medicine and Cardiology. 14.8% of all patients were hospitalized and treated. The highest number of hospitalizations was in Internal Medicine, followed by Gynecology and Obstetrics and Cardiology. Conclusion: As the pandemic process progressed, the rate of admissions by ambulance increased, and the characteristics of trauma cases changed. The application of pregnant patients to the hospital continued even during the pandemic.

GPs’ identification of patients with mental distress: a coupled questionnaire and cohort study from norwegian urban general practice

BackgroundMental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients’ self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses.MethodsA questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16–65 years in six GP offices in Oslo, Norway during 21 months in 2014–2016.ResultsWe found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis.ConclusionsWe found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue.Trial registrationTrial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.

Community determinants of COPD exacerbations in elderly patients in Lodz province, Poland: a retrospective observational Big Data cohort study

ObjectivesTo evaluate the prevalence and identify demographic, economic and environmental local community determinants of chronic obstructive pulmonary disease (COPD) exacerbations in elderly in primary care using Big Data approach.DesignRetrospective observational...

Distribution of dermatoses encountered in children seen in Dermatological Consultations in Lomé (Togo)

RésuméObjectifLe but de cette étude était d’établir le panorama des dermatoses chez les enfants vus en consultation dermatologique à Lomé et de décrire les tendances de ces dermatoses entre 1992 et 2020.MéthodeIl s'agit d'une étude rétrospective descriptive portant sur les dossiers des patients de 0 à 15 ans vus en consultation dans les services publics de dermatologie de Lomé du 1er janvier 2010 au 31 décembre 2019. Une comparaison des différentes dermatoses a été faite avec celles recensées lors d'une précédente étude similaire en 1992.RésultatsAu cours de la période d’étude, 3 767 enfants ont consulté pour une affection dermatologique (14,2 % de consultations pédiatriques parmi les consultations dermatologiques). L’âge moyen des patients était de 7,4 ans et le sexe ratio M/F était de 0,7. Les mois de juillet, août et septembre étaient ceux qui enregistraient le plus de consultations. Les trois premiers motifs de consultation étaient l'eczéma (26,6%), le prurigo strophulus (15,3%) et la dermatite atopique (4,9%). Aussi, 51,3 % des pathologies cutanées chez les enfants étaient représentées par les dermatoses immunoallergiques, suivies des dermatoses infectieuses (23,6%). Les dermatoses infectieuses prédominantes étaient mycosiques (34,4%) et bactériennes (30,3%). On note entre 1992 et 2019 une augmentation de la prévalence des dermatoses immunoallergiques et une réduction des dermatoses infectieuses.ConclusionLes résultats de cette étude montrent que les dermatoses immunoallergiques sont prédominantes et en nette augmentation chez les enfants vus en consultation dermatologique à Lomé. Nous l'attribuons à l'urbanisation et aux changements climatiques.

Emergency Medical Teams' Responses during the West Japan Heavy Rain 2018: J-SPEED Data Analysis.

Rainfall-induced floods and landslides accounted for 20.7% of all disaster events in Japan from 1985 through 2018 and caused a variety of health problems, both directly and indirectly, including injuries, infectious diseases, exacerbation of pre-existing medical conditions, and psychological issues. More evidence of health problems caused by floods or heavy rain is needed to improve preparedness and preventive measures; however, collecting health data surrounding disaster events is a major challenge due to environmental hazards, logistical constraints, political and economic issues, difficulties in communication among stakeholders, and cultural barriers. In response to the West Japan Heavy Rain in July 2018, Emergency Medical Teams (EMTs) used Japan - Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a daily reporting template, collecting data on the number and type of patients they treated and sending it to an EMT coordination cell (EMTCC) during the response. The aim of the study was to conduct a descriptive epidemiology study using J-SPEED data to better understand the health problems during floods and heavy rain disasters. The number and types of health problems treated by EMTs in accordance with the J-SPEED (Ver 1.0) form were reported daily by 85 EMTs to an EMTCC, where data were compiled during the West Japan Heavy Rain from July 8 through September 11, 2018. Reported items in the J-SPEED form were analyzed by age, gender, area (prefecture), and time period. The analysis of J-SPEED data from the West Japan Heavy Rain 2018 revealed the characteristics of a total of 3,617 consultations with the highest number of consultations (2,579; 71.3%) occurring between Day 5 and Day 12 of the 65-day EMT response. During the response period, skin disease was the most frequently reported health event (17.3%), followed by wounds (14.3%), disaster stress-related symptoms (10.0%), conjunctivitis (6.3%), and acute respiratory infections (ARI; 5.4%). During the response period, skin disease was the most frequently reported health event, followed by wounds, stress, conjunctivitis, and ARIs. The health impacts of a natural disaster are determined by a variety of factors, and the current study's findings are highly context dependent; however, it is expected that as more data are gathered, the consistency of finding will increase.

Impact de l’incendie de l’usine Lubrizol à Rouen le 26 septembre 2019 sur la fréquentation des urgences ophtalmologiques

A fire at the Lubrizol chemical factory in Rouen on September 26, 2019 generated a huge column of smoke directed northeast toward the city. As the eye might be particularly affected by the smoke and other toxic emissions from the fire, we assessed the impact of this industrial and ecological disaster on irritative eye surface disease in the week following the accident. We retrospectively collected the medical data of the patients who presented to the Ophthalmology Emergency Department (OED) of Rouen University Hospital (the only OED open during the days following the accident) during the week following the fire (W1). We compared these data with those of patients who presented during the week before the fire (W-1). We also collected data on patients presenting to the ED in general during W-1 and W1, including the number of visits directly related to the fire. 361 patients presented to the OED during W1 following the fire, compared with 384 in W-1. Of these patients, 83 (23%) had ocular surface disease in W1, versus 76 (20%) in W-1. Conjunctivitis was found in 54 patients in W1 (39 viral, 9 allergic, 6 undetermined) versus 44 in W-1 (27 viral, 12 allergic, 5 undetermined). A dry irritative syndrome was present in 29 patients in W1 versus 32 in W-1. Only 4 patients directly attributed their symptoms to the fire: 2 viral conjunctivitis, 1 allergic conjunctivitis and 1 worried patient (at D2, D5, D7 and D7 following the fire respectively). The number of emergency eye consultations did not change in the week following the Lubrizol factory fire (except for a decrease the day of the accident, related to the lock-down). There was a higher number of consultations in W1 for conjunctivitis, mostly viral in appearance and probably not directly related to the fire. The number of consultations for dry irritative syndrome was comparable between the two periods. Despite major media coverage of the event at the national level and a very high level of concern among the population, the fire does not seem to have had an effect on OED activity at Rouen University Hospital, nor on general ED visits. The stay-at-home order on the first day may have had a protective effect, avoiding direct exposure to smoke. The long-term consequences of the soot deposits on the ground as the smoke cloud passed over remain undetermined and are under surveillance. A review of the literature on the ocular consequences of industrial accidents is presented. The Ophthalmology Emergency Department did not record increased activity in the week following the Lubrizol Rouen fire, and ocular surface disease did not give rise to more consultations than the week before the fire. This suggests that there was no or minimal immediate ocular toxicity of the smoke from the fire.

Descriptive Epidemiology in Allergic Rhinoconjunctivitis in the Last 5 Years in Northern Mexico

Purpose: To determine the frequency of allergic conjunctivitis in the period from 2015 to 2020 at the Regional Center of Allergy and Clinical Immunology of the University Hospital “Dr. José Eleuterio González” in Monterrey, Nuevo Leon, Mexico. Methods: Observational, retrospective and descriptive study. The database of all patients with diagnosis of allergic rhinoconjunctivitis seen in the outpatient clinics from January 2015 to May 2020 was reviewed. Results: The incidence from 2015 to 2020 of allergic rhinoconjunctivitis in the Regional Center of Allergy and Clinical Immunology was 1.5% in 2015, 2.7% in 2016, 2.8% in 2017, 3.2% in 2018, 4.2% in 2019 and 2.3% in 2020. The age group with the highest frequency for allergic rhinoconjunctivitis was found in those over 18 years of age; no significant difference was found between men and women. The year 2019 had the highest number of cases. The most common positive allergens in the skin tests of these patients were Dermatophagoides, Cynodon dactylon and Fraxinus americana, for the last two their pollination season were parallel to the peaks where the highest number of consultations were registered in March, April and August. Conclusions: Allergic rhinoconjunctivitis is a disease that has been increasing in recent years and despite the economic and labor burden it represents, there are currently few studies that address the epidemiological characteristics of these patients.

Interventional Radiology Outpatient Clinics (IROC): Clinical Impact and Patient Satisfaction.

To retrospectively analyze our interventional radiology outpatient clinics (IROC) for referral patterns, impact on interventional practice, and patient satisfaction. Consultations performed between 2011 and 2019 were extracted. The two consecutive years with the highest number of consultations (n2018 = 1426; n2019 = 1595) were compared for unattended consultations (i.e., scheduled consultations with patients not showing-up); initial/follow-up consultations; hospital clinician/general practitioner referrals; initial consultations with radiologists not recommending interventions; procedural conversion rate (PCR; i.e., No. initial consultations resulting in interventions over the total number of initial consultations performed for the same clinical indication). A survey was conducted in 159 patients to determine their satisfaction. Consultations increased from 2011 to 2019 by 130%. In 2018-2019, the number of unattended consultations was stable (7.0% vs 6.6%; P = .68). The referrals were for back pain (42.2%), interventional oncology (40.5%), and arteriovenous malformations (9.0%). For back pain, in 2019, there were fewer consultations with radiologists not recommending interventions and increased PCR compared to 2018 (11.9% vs. 17.7%; 88.1% vs. 82.3%; respectively; P = .01). For interventional oncology, follow-up consultations and general practitioner referrals increased in 2019 compared to 2018 (43.0% vs 35.3%; P = .01; 24.4% vs. 12.7%; P < .01; respectively). No other changes were noted. Cumulative 2018-2019 PCR was ≥ 85.4%. 99.2% responders highly appreciated their IROC experience. Quality of secretarial and medical services were the main aspects evaluated to rate the experience with IROC. IROC results in high PCR. Recent changes in referral/impact on IR practice were noted with patients referred for back pain and interventional oncology. Level 4, Case Series.

The Burden Of Visits For Fever At A Paediatric Emergency Room: A Retrospective Study On Patients Presenting At The Cantons Hospital Of Fribourg, A Peripheral Public Hospital Of Switzerland.

IntroductionFever is the chief complaint of up to one-third of all paediatric office visits in many places. The high number of consultations at our emergency department (ED) led us to hypothesise that this increase was due to febrile paediatric patients with lower urgency seeking medical advice.MethodsWe retrospectively analysed the number and characteristics of patients 3 months to 5 years of age consulting for a body temperature of 38.5°C or higher during the 6 winter months of 2011–2012.ResultsTwenty-four percent of all consultations were requested by the patients included in our group. None of the 835 patients had to be hospitalised, 95% of these patients had additional respiratory or gastrointestinal symptoms, 36.7% required antibiotic therapy, and 17.6% (laryngitis and lower respiratory tract infection (RTI)) required temporary respiratory support. A total of 56.2% of patients sought advice outside of the normal working hours.ConclusionThe majority of patients had fever accompanied by additional symptoms justifying a medical consultation. However, most of these did not require the infrastructure of an ED for their health care problem and probably visited the ED because of the open hours.

Clinical practice guidelines for management of depression in elderly

Depressive disorders are one of the common psychiatric ailments seen in elderly population. As per the World Health Organization (WHO) prevalence of depressive disorders among elderly is 10 to 20%. Data from India reveals a wide variation in the prevalence rate of depression. Prevalence in community-based studies have varied from 8.9% to 62.16% and clinic based studies have estimated the prevalence of depression to range from 42.4 to 72%. Unfortunately, depression among elderly is often considered as part and parcel of life and is under-recognised and under-diagnosed. Depression in elderly has been shown to be associated with significant negative consequences ranging from poor quality of life, difficulties with activities of daily living, physical comorbidities, premature mortality and cognitive impairments. Although the incidence of depression among elderly is similar to that reported in adult population, depression in elderly is associated with higher risk of suicide, more frequent hospitalization, higher number of consultations with the treatment agencies and family burden. Hence, it is very important to recognise depression among elderly and manage the same. Timely recognition and adequate management of depression among elderly can lead to improvement in quality of life, maintaining optimal levels of function and independence, reduction in morbidity, reduction in mortality due to suicide, development of medical illnesses and treatment costs. Indian Psychiatric Society (IPS) published Clinical Practice Guidelines (CPGs) for management of depression among elderly, for the first time in the year 2007. IPS also published revised CPGs for management of depression in adult patients in the year 2017. Current version of the CPGs is an update of the earlier version of CPGs for management of depression in elderly. The current version of the CPGs for depression in elderly must be read in conjunction with the previous version of CPGs for depression in elderly and revised CPGs for management of depression in adult population. These guidelines provide a broad framework for assessment, management and follow-up of elderly patients presenting with depression. Most of the recommendations made as part of the guidelines are evidence based. However, these guidelines should not be considered as a sustitute for professional knowledge and clinical judgment. The recommendations made as part of these guidelines have to be tailored to address the clinical needs of the individual patient and treatment setting.

Association between air pollution and emergency consultations for respiratory diseases

Background: Air pollution has a direct influence on health. Aim: To determine the association between particulate matter and contaminant gas concentrations in the environment with the number of consultations for respiratory diseases in emergency rooms in Metropolitan Santiago, Chile. Material and Methods: During five years, the daily number emergency consultations for respiratory diseases and the daily concentrations of particulate matter and contaminant gases in a community of Santiago, were recorded. The degree of change of these variables during summer and winter was determined. Their correlation coefficients with a 0 to 100 days gap, were calculated. Results: During winter, there was a higher number of consultations and higher pollution levels, except for O3 , which increased in summer. There were positive correlations between the concentrations of different pollutants (mainly 2.5 and 10 μm particulate matter, CO and NO2 ). There was a negative association between consultations for respiratory diseases and O3 concentrations, an almost negligible association with SO2 and variable positive and significant associations with the concentration of other pollutants, with variations according to the time gap. Conclusions: Pollution and respiratory diseases increase during winter. There are variable associations between pollutant concentrations and the number of consultations for respiratory diseases

Consultation patterns of children and adolescents with knee pain in UK general practice: analysis of medical records

BackgroundKnee problems are common in children and adolescents. Despite this, little is known about the epidemiology of knee problems in children and adolescents who consult in general practice. The aim of this study was to describe consultations by children and adolescents about knee problems in general practice, and examine patterns of patient presentations and consultations by age group, sex and area of socio-economic deprivation.MethodsConsultations records specific to the knee region were extracted from a general practice consultation database (CiPCA) over a one year period. Knee consultation codes were organised into ‘symptom’ or ‘diagnosis’ (sub-categorised: ‘trauma’, ‘non-trauma’) categories. Descriptive statistics were used to describe patient presentations and number of consultations overall, and stratified analysis carried out on age group, sex, and area of socio-economic deprivation.ResultsOut of all musculoskeletal consultations, knee problems were the fourth most common patient presentation, responsible for the second highest number of consultations. Patient presentations and consultations increased up to age 12–15 years and then stabilised. Symptoms codes e.g. ‘knee pain’ were used more commonly than diagnosis codes e.g. ‘knee sprain’ overall. However, symptom code use declined as age increased, more symptom codes were used in girls compared to boys, and more diagnosis codes were used in patients from areas of high socio-economic deprivation.ConclusionsThis study provides insight into the epidemiology of knee problems in children and adolescents in general practice. Future research is needed to improve our understanding of the knee problems encountered by GPs, and the influence socio-economic deprivation has on consultations.

Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice.

In Denmark, general practice is responsible for 75% of antibiotic prescribing in the primary care sector. We aimed to identify practice-related factors associated with high prescribers, including prescribers of critically important antibiotics as defined by WHO, after accounting for case mix by practice. We performed a nationwide register-based survey of antibiotic prescribing in Danish general practice from 2012 to 2013. The unit of analysis was the individual practice. We used multivariable regression analyses and an assessment of relative importance to identify practice-related factors driving high antibiotic prescribing rates. We included 98% of general practices in Denmark ( n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case mix had been accounted for, the following practice-related factors were associated with being a high prescriber: lack of access to diagnostic tests in practice (C-reactive protein and urine culture); high use of diagnostic tests (urine culture and strep A throat test); a low percentage of antibiotic prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. An apparent underuse or overuse of diagnostic tests in general practice as well as organizational factors were associated with high-prescribing practices. Furthermore, the choice of antibiotic type seemed less rational among high prescribers.

Analysis of patient care in a “Palliative Medicine Day Care Unit” in a hospital in Costa Rica during its first year.

140 Background: A “Palliative Medicine Day Care Unit” (PMDCU) program began in January of 2014 as part of the services provided by the Department of Palliative Medicine in a national hospital in Costa Rica; the program allows patients with hemato-oncological diseases to continue as outpatients while receiving inpatient treatment for their refractory symptoms. This study analyses patient consult rates, results and the dynamics of the unit during its first year in service. Methods: The statistical information of patients attended in the PMDCU, were collected during the period between January and December of 2014. The data included: the population characteristics, the nature of the care provided and the interaction with other departments. Results: A total of 1311 patients were examined in the PMDCU, for a total of 1609 consultations; on average each patient had 3.6 consultations. The average time patients spent with physicians during consultation or receiving treatment were 115 minutes. The most common patient diagnosis was gastrointestinal, gynecological, and prostate cancers. After the initial consult, 63% of patients continued treatment in the outpatient clinic of the same hospital, 34% were scheduled for follow-up consultations in the PMDCU, 2.4% of patients were referred to the Emergency Department and less than 2% of patients were either admitted to the hospital or were referred to other palliative care units. Treatment in the PMDCU included, analgesia treatment administration, paracentesis, thoracocentesis, parenteral nutrition, blood transfusions and patient and family education. Conclusions: The PMDCU has had acceptance among patients with a high number of consultations and adequate follow up of patients. The most common types of cancer diagnosis were gastrointestinal, gynecological and prostate cancers. The majority of patients examined, continued treatment in either the outpatient clinic or follow up in the PMDCU; few were referred to the emergency department. The PMDCU provides treatment that would normally be administered either in an inpatient setting or in the emergency department, but avoiding the extra cost and inconvenience to the patients and their family.

Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients--A Retrospective Cohort Study.

Study objectiveTo assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).MethodsA retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ≥75th percentile of ED-LOS in the study population, which was 208 minutes.ResultsData on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3–4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16–1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0–8.8 and OR 2.3, 95% CI 1.4–3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4–4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.ConclusionOrganisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

Outpatient service profile in a plastic surgery clinic in Southern Brazil

Objective: To describe the outpatient service profile in a plastic surgery clinic in southern Brazil. Materials and Methods: It was conducted a descriptive, exploratory and quantitative study in order to analyze the total outpatient service (consultations and surgeries) performed in a private plastic surgery clinic in the period from January 1th to December 31th of 2010. Results: It was observed that from 671 (60,5%) new consultations, only 205 (18,5%) surgeries were performed. March was the month with the highest number of consultations (10%) and surgeries (11,7%). Of the total of new consultations, the reparative ones were prevalent in 55,6% of the cases, followed by the esthetic with 33,7%. The average age was 37 years and the women were predominant. The ages ranged from 8 months to 89 years. The married patients represented the majority of surgeries (49,8%)and there was a predominance of adult patients (31-59 years) with 316 patients (47,1%). Unimed was the health insurance plan more used (49,3%) in the consultations; the most frequent surgical procedures were excisions and/or scraping of skin disorders and attachment 70 (33,1%), followed by mammoplasty (augmentation mammoplasty, mastopexy, gynecomastia). Conclusion: Although most of the surgical service were exeresis of congenital deformities and/or acquired, the result is not far from the reality found in the rest of Brazil, with a predominance of women and large number of breast implants. The studied clinic is an institution that provides conditions for the feasibility of outpatient care, considering the numerous advantages offered by this method.

Elbow Pain

Elbow pain is a common complaint that affects a significant proportion of the population and accounts for a high number of consultations within general practice. The cause of elbow pain in some patients may be obvious and localized such as in the case of olecranon bursitis, but in others, this may be presentation of an occult multisystem disorder. We have tried to provide both a comprehensive review of the possible causes of elbow pain as well as useful methods of history taking and examination to help differentiate between causes. Most causes of elbow pain may be effectively treated in General Practice and we have included an update on the practical techniques for injections around the joint.