Mean Number Of Visits Research Articles

Observations of nesting in the Papuan Flyrobin and the Olive Flyrobin, and post-fledging care in the Torrent Flycatcher, all endemic to New Guinea

We studied parental care in the Jacky Winter Microeca fascinans at Gluepot Reserve, South Australia, for one breeding season from 16 August to 9 November 2001, supplemented by observations on breeding and social behaviour in September 2012. We monitored ten nests in 2001, nine of which were attended by pairs and one by three adults, and watched three nests for a total of c. 117 hours. Female incubation constancy was 69%, duration of incubation sessions averaged 4.58 minutes and absences from the nest 2.07 minutes. Mean number of nest visits per hour by two pairs during the incubation period was 10.6 and for a group of three adults (two males, one female) was 15.8. Female care included brooding, feeding of nestlings, and nest-hygiene. Male care included delivering food to the sitting female, feeding the nestlings, nest-hygiene, nest-defence, and territoriality. Mean female brooding constancy was 55%. Mean number of feeding trips per hour by male and female combined for the entire nestling period was 14.6. Older young, 12, 13 and 14 days of age, received 21, 20, and 29 feeds/h respectively or one feed about every 2 minutes. Mean number of visits per hour by male and female combined to a nest with two young was 16.5 for Days 1–10 and 20.4 for Days 11–18 of the nestling period. High nest-predation is discussed in relation to nest placement and concealment, high nest visitation during incubation and nestling stages, anti-predator behaviour, nest-defence and types of predators, and re-nesting capacity, and compared with other Australasian robins and northern temperate and tropical songbirds. The small nest, small clutch-size, high nest failure, and anti-predator posture and mottled plumage of nestlings suggest that nest-predation is a strong selective pressure in the Jacky Winter. However, the moderately long nestling period, brood-size reduction, high rates of feeding young and nest visits by both male and female, and short and frequent incubation and brooding bouts on and off the nest relative to other robins are not consistent with nest-predation theory, and suggest behavioural responses to food availability and an ultimate response to food limitation. Incubation behaviour on and off the nest, parental care of young, nest visitation and other life-history traits that influence reproductive effort are discussed to elucidate the breeding strategy compared with other Australasian robins. The nesting season, nest materials and dimensions, nest-site, and incubation and anti-predator behaviour of the Papuan Flyrobin Devioeca papuana , and nest and egg of the Olive Flyrobin Kempiella flavovirescens , both species endemic to New Guinea, are described. An observation of cooperative post-fledging care of two juvenile Torrent Flycatchers Monachella muelleriana is presented. Incubation feeding occurred in the Papuan Flyrobin and incubation constancy was 54%. Papuan Flyrobin incubation behaviour, such as nest-attentiveness, frequency of nest visits and duration of on- and off-bouts, and nest failure are discussed and compared with those of the Jacky Winter Microeca fascinans , Lemon-bellied Flycatcher M. flavigaster and northern temperate passerines. Flyrobin nest failure and potential avian predators are discussed.

Parental care and breeding strategies of the Jacky Winter and its life-history traits compared with other Australasian robins, and northern temperate and tropical songbirds

We studied parental care in the Jacky Winter Microeca fascinans at Gluepot Reserve, South Australia, for one breeding season from 16 August to 9 November 2001, supplemented by observations on breeding and social behaviour in September 2012. We monitored ten nests in 2001, nine of which were attended by pairs and one by three adults, and watched three nests for a total of c. 117 hours. Female incubation constancy was 69%, duration of incubation sessions averaged 4.58 minutes and absences from the nest 2.07 minutes. Mean number of nest visits per hour by two pairs during the incubation period was 10.6 and for a group of three adults (two males, one female) was 15.8. Female care included brooding, feeding of nestlings, and nest-hygiene. Male care included delivering food to the sitting female, feeding the nestlings, nest-hygiene, nest-defence, and territoriality. Mean female brooding constancy was 55%. Mean number of feeding trips per hour by male and female combined for the entire nestling period was 14.6. Older young, 12, 13 and 14 days of age, received 21, 20, and 29 feeds/h respectively or one feed about every 2 minutes. Mean number of visits per hour by male and female combined to a nest with two young was 16.5 for Days 1–10 and 20.4 for Days 11–18 of the nestling period. High nest-predation is discussed in relation to nest placement and concealment, high nest visitation during incubation and nestling stages, anti-predator behaviour, nest-defence and types of predators, and re-nesting capacity, and compared with other Australasian robins and northern temperate and tropical songbirds. The small nest, small clutch-size, high nest failure, and anti-predator posture and mottled plumage of nestlings suggest that nest-predation is a strong selective pressure in the Jacky Winter. However, the moderately long nestling period, brood-size reduction, high rates of feeding young and nest visits by both male and female, and short and frequent incubation and brooding bouts on and off the nest relative to other robins are not consistent with nest-predation theory, and suggest behavioural responses to food availability and an ultimate response to food limitation. Incubation behaviour on and off the nest, parental care of young, nest visitation and other life-history traits that influence reproductive effort are discussed to elucidate the breeding strategy compared with other Australasian robins.

The Influence of Insurance Type on Management of Carpal Tunnel Syndrome: An Analysis of Nationwide Practice Trends.

The purpose of this study was to evaluate the impact of insurance type on use of diagnostic testing, treatments, and the efficiency of care for patients with carpal tunnel syndrome. The 2009 to 2013 Truven MarketScan Databases were used to identify adult patients with carpal tunnel syndrome. Insurance type was categorized as fee-for-service versus capitated managed care. Multivariable regression models were created to evaluate the relationship between insurance type and costs, number of visits, treatment, and electrodiagnostic study use, and controlling for demographic characteristics and comorbidities. The cohort included 233,572 patients, of which 86 percent carried fee-for-service insurance. Predicted probabilities were clinically similar between the capitated and fee-for-service insurance types for therapy (0.23 versus 0.24), steroid injection (0.07 versus 0.09), and electrodiagnostic study use (0.44 versus 0.47). The difference in predicted probabilities between the insurance groups was greatest for surgery use (0.22 versus 0.28 for managed care and fee-for-service, respectively). The mean number of visits was similar between the two groups (2.1 versus 2.0 visits). In the controlled analysis, managed care was associated with a 10 percent decrease in cost compared to patients with fee-for-service (p < 0.001). Managed care was associated with a lower probability of surgery than fee-for-service, but similar use of less costly services. These data may be used to predict future practice trends with increased implementation of bundled payment reimbursement. Routine collection of validated patient outcomes measures is critical to assess patient outcomes associated with anticipated reduction of surgical services. Risk, II.

The effectiveness of adolescent-specific prenatal interventions on improving attendance and reducing harm during and after birth: a systematic review.

Adolescent pregnancy has been associated with poor pregnancy outcomes including pre-term birth (PTB), low birth weight (LBW) and perinatal death. To systematically review the effect of adolescent-specific interventions on reducing PTB, LBW, and perinatal death and increasing prenatal care attendance. Possible studies for inclusion were identified by a comprehensive search of OvidSP MEDLINE (limits: humans, 1990-present), EMBASE (limits: humans, 1990-2015), Popline and Global Health Database from the World Health Organisation (WHO) and PubMed International scientific databases, and references of identified articles were searched from 1990 to present. All types of controlled studies of prenatal interventions were exclusive to adolescents and at least one of the outcomes of interest. Investigators identified relevant studies and entered the data in a pro forma. Data were summarised as forest plots and narrative synthesis. Twenty-two studies (three randomised controlled trials (RCTs), four prospective cohort studies, nine retrospective cohort studies, five case controls and one natural experiment) were included with all but one study being carried out in higher-income countries. Seven of the 16 studies reporting on PTB found a statistically significant reduction in PTB rates between adolescent-specific prenatal care (intervention) and non-age specific prenatal care odds ratio (OR) and 95% confidence intervals (CIs) ranged from OR: 0.15 (95% CI: 0.03-0.83) to OR: 0.59 (95% CI: 0.45-0.78). Nine of the 12 studies reported statistically significant higher mean prenatal attendance rates among the intervention group compared to controls (ranging from a mean number of visits of 14.3 vs. 10.7 p<0.001 to 10.8 vs. 7.6 visits p<0.001). The type and construct of the interventions, their implementation and local population differed sufficiently that a statistical synthesis was deemed inappropriate. There is some evidence that adolescent-specific programs can increase prenatal attendance and reduce the risk of PTB and low birth rate but their effect on perinatal death is uncertain. There is a distinct lack of evidence of the effectiveness of these interventions for adolescents living in low-middle income countries, despite having the majority of adolescent pregnancies, and associated risk of harm. No high-quality intervention studies were identified. Robust, cluster-based RCTs are an urgent necessity to quantify the impact of these interventions and to identify factors contributing to their success.

EPV 20. Vascular encephalopathy is a major risk factor for poor vestibular compensation

Background and aim Acute unilateral vestibular loss leads to vertigo sensation, nystagmus and postural imbalance. As a rule, a behavioral recovery of the signs and symptoms follows over days to months due to central vestibular compensation (VC). The present study aimed to investigate the influence of cerebral vascular lesions on VC by following a large cohort of patients after vestibular neuritis. Methods 235 patients (mean age: 54.2 ± 15.2, 53.4% men) with the clinical picture or history of an acute unilateral vestibulopathy, who were seen at the Department of Neurology and the German Center for Vertigo and Balance Disorders over the last 10 years, were included in the study. All patients underwent a detailed neuro-ophthalmological and neurological examination, including measures of the subjective visual vertical (SVV), ocular torsion (OT), head impulse test (HIT), provocation nystagmus (PN), visual acuity and postural control and were followed along their course of VC (mean number of visits 3.5 ± 1.2, mean time of follow-up 217 ± 625 days). In all patients a cranial MRI was available at onset of vestibular failure. The MRI was assessed by a two senior neuro-radiologist. Extent of supra- and infratentorial vascular white matter lesions was classified by the ARWMC scale (0–3 points). Strategic lesions in the vestibular network (medulla, vestibulocerebellum, thalamus) were registered separately. Patients were indicated as poorly compensated, if deviation of SVV (>2.5°), PN and postural asymmetry persisted for longer than 3 months after vestibular failure. Results 13.3% of patients were classified as poorly compensated at 3 months (PN: 55%, SVV deviation: 36%, postural asymmetry: 22%), 12.8% at 6 months and 10.6% at 12 months after acute unilateral vestibulopathy. These patients had significantly higher ARWMC scales as compared to patients with regular VC ( p Conclusions About 10% of patients have an impeded course of VC after acute unilateral vestibulopathy. Supratentorial vascular encephalopathy is a major risk factor for poor VC and should be considered to guide the intensity of physical treatment following acute unilateral vestibulopathy.

PTU-128 Prevalence and Management of Irritable Bowel Syndrome Seen in Colorectal Surgery and Gastroenterology Clinics

Introduction Irritable bowel syndrome (IBS) in the UK accounts for a large proportion of patients seen in secondary care. Pathways to the diagnosis of IBS are not standardised, and patients are often reviewed outside a luminal Gastroenterology service. We examined the burden of IBS in both Colorectal Surgery and Gastroenterology clinics. Methods All patients seen with IBS in either Gastroenterology (GE) or Colorectal Surgery (CS) clinics over a 1 month period January to February 2014 at Leeds Teaching Hospitals NHS Trust were identified. The following data were retrospectively recorded: age/sex of the patient, investigations prior to diagnosis, number of visits to that speciality clinic, number and type of medications prescribed, and final placement of the patient. We compared management of patients in both settings using a Chi-squared test. Results There were a total of 76 patients with IBS seen in CS clinics (mean age 49.6 years, 39 (51.3%) female) and 57 patients in GE clinics (mean age 39.1 years, 39 (68.4%) female). The number and type of investigations requested prior to diagnosis are detailed in Table 1. In CS clinics, colonic imaging (colonoscopy, sigmoidoscopy or barium enema) was requested in 70 (92.1%) patients, compared with 39 (68.4%) patients in GE clinics (P = 0.001). Cross-sectional imaging was utilised in 36 (47.4%) patients in CS clinics, compared with 19 (33.3%) patients in GE clinics (P = 0.15). Serological testing for coeliac disease was not performed in 22 (29.9%) patients in CS clinics, and 5 (8.8%) patients in GE clinics (P = 0.008). For the CS clinic patients the mean number of visits was 2.7 (range 1–14) with 22 (28.95%) patients offered prescribed therapy. In the GE clinic patients the mean number of visits was 2.5 (range 1–5), with 43 (75.4%) patients offered prescribed therapy (P Conclusion These data highlight the need for a more consistent referral process, and a more specialised approach to the management of this patient group. This should be based on current guidelines for the management of IBS using evidence-based treatments and with easy access to dietetic, psychological, and specialist nurse support. Disclosure of Interest None Declared

Symptom management in women with recurrent ovarian cancer: Do patients and providers agree on what symptoms are most important?

Objectives: Symptom management requires communication, documentation, and intervention, yet little is known about how this occurs within gynecologic oncology. This study analyzes concordance between patient-reported symptoms within a randomized controlled trial and those documented by providers during the same time period. Methods: The WRITE Symptoms Study (NIH/NR010735; GOG 259) is a randomized controlled trial of web-based ovarian cancer symptom management that included 497 women with recurrent ovarian, fallopian tube, or primary peritoneal cancer from 68 GOG sites. This analysis includes 50 women from a single institution. Women completed the Symptom Representation Questionnaire for 28 symptoms and selected 3 priority symptoms (PS). Electronic medical records were reviewed for provider documentation of symptoms and interventions pursued. Results: Table 1 describes PS reported, documented, and intervened for. Providers documented at least 1 PS in 92% of patients and intervened in 58% of patients. Of 150 PS, 53% were never documented. Providers never documented PS of sexuality concerns, hot flashes, or memory problems. When documented, the mean number of visits in which a PS was documented was 2.3. Twenty-nine patients (58%) had at least 1 PS intervention. On average, PS intervened for were documented at 2.58 visits (1–7) versus 0.50 visits (0–5) for PS not receiving intervention (P ≤ .0001). Conclusions: The 4 most common PS were also the 4 most commonly documented PS, showing that providers are identifying and documenting symptoms important to patients. Symptoms documented by providers but not reported by patients tended to be related to physiologic effects of disease and acute treatment toxicity, whereas symptoms reported by patients but not documented by providers tended to be more psychosocial in nature. The number of visits documenting a PS correlated with intervention, suggesting that improving physician-patient communication could improve intervention rates. The etiology of discordance between patient and provider-report is likely multifactorial and requires further investigation; this study illustrates the need to improve identification of PS and increase intervention rates to enhance quality of life in women with recurrent ovarian cancer.Table 1Priority Symptoms (PS) Reported, Documented and Intervened for.

Molar–incisor hypomineralization and the association with childhood illnesses and antibiotics in a group of Finnish children

Objective: Molar–incisor hypomineralization (MIH) is a developmental enamel defect affecting 1–4 first permanent molars (FPMs) and often also incisors. The aim of this study was to assess whether childhood illnesses or medication are associated with MIH.Material and methods: FPMs and incisors of 287 Finnish children were examined for MIH in line with the criteria of the EAPD. Health data from the first 3 years of life was collected from medical records and the associations with MIH and MIH2 (lesions in at least one FPM and incisor) were assessed using simple and multiple logistic regression analyses.Results: The prevalence of MIH and MIH2 were 11.5% and 6.3%, respectively. During the first 3 years of life, the children with MIH had sought care for infectious illnesses more often than the children without MIH (mean number of visits (SD) 7.9(6.4) vs. 6.0(5.1), p = 0.045, independent samples t-test). After adjustment for confounding factors, children who had received penicillin or macrolides within the first year, or amoxicillin within the first 3 years had a higher risk for MIH (2.61, 4.07 and 2.58 times, adjusted OR, respectively) or MIH2 (3.16 times, aOR for penicillin and amoxicillin) compared to those who had not received that antibiotic. Of the illnesses, children with at least one episode of otitis within the first year had a higher risk for MIH (2.28 times, aOR) than those who had not suffered from otitis.Conclusions: Acute otitis media and the use of certain antibiotics were associated with the elevated risk of MIH/MIH2.

Therapeutic itinerary of colorectal cancer patients treated in the state of Rio Grande do Sul

ObjectivesThe objective of the study was to evaluate the therapeutic itinerary of patients treated in a specialized center, including its trajectory in seeking treatment and their clinical and epidemiological characteristics. MethodsThis is a cross-sectional prospective descriptive study; patients with colorectal cancer aged over 18 years and who signed the consent form were included in the analysis. Tumor characteristics, such as staging and tumor features; epidemiological characteristics such as age, gender, profession and itinerary in the form of the number of clinical visits needed to obtain the diagnosis; the main symptoms; and mean time between diagnosis and onset of treatment were evaluated. Results34% of patients initially sought primary care (first level of care in the public health system) and 50% were diagnosed in secondary care (second level of care in the public health system); the mean number of visits until obtaining a diagnosis was 2.5 times; and 52% of patients received palliative therapy and 40% had a stage IV diagnosis. ConclusionsThe mean time between the diagnosis and the onset of treatment is in line with the recommendations of the Ministry of Health of Brazil. However, it was found that the patients are unaware of the symptoms of the disease, since the mean time between the onset of symptoms until the decision to visit the doctor was 177 days – which may have been a determining factor for a diagnosis in an advanced stage of disease.

Impact of a Chronic Pain Protocol on Emergency Department Utilization.

Patients suffering from chronic painful conditions frequently present to the emergency department (ED) for pain control. In an effort to better manage these patients we implemented and measured the effect of enrollment in a chronic pain protocol in a single ED. A retrospective (pre) and prospective (post) study design was utilized. We identified 46 frequent ED users suffering from chronic painful conditions. We then retrospectively documented their ED use and prescription controlled substance use for 6months prior to enrollment in a chronic pain protocol and then 6months postenrollment. Preenrollment participating patients visited the ED on average 6.2 times in a 6-month period. Postenrollment their mean number of visits in the following 6months decreased significantly to 2.2 times, or a 65% decrease (p<0.001). Similarly, preenrollment, the patients were prescribed a median of 664 controlled substance pills in the entire state compared to 471 pills in the 6-month period postenrollment, or a 29% decrease (p<0.022). Through instituting a chronic pain protocol, we found significant reductions in the number of return visits to a single ED and the number of controlled substance medications prescribed by all providers. Additional studies using similar protocols could help establish their impact on the care of patients suffering from chronic pain and the potential to reduce healthcare costs, ED overcrowding, and prescription drug abuse.

Toe-Sparing Surgery for Neuropathic Toe Ulcers With Exposed Bone or Joint in an Outpatient Setting

The purpose of this study was to review the results of aggressive surgical debridement of neuropathic toe ulcers with exposed bone or joint. We identified patients with a single toe ulcer with exposed bone or joint that had been operated on in an outpatient setting. The surgery had included aggressive debridement and was performed using a small curette and rongeur, followed by oral antibiotic treatment at home. Success was defined as complete healing with no recurrence 6 months after full wound closure and epitheliazation was achieved. Twenty-five patients with neuropathic toe ulcers (72% male) had a total of 26 primary operations. Their mean age was 60 ± 12 years. In 22 patients, the neuropathy resulted from diabetes mellitus of 17 ± 9 years' duration. The mean ulcer duration was 6 weeks (range 1-24). The mean number of visits per patient was 6.5 (range 3-20). The ulcers closed in a median of 5 weeks (8 ± 6 weeks, range 3-24 weeks, Q1-Q3 4-10 weeks). At 6 months, 3 (11.5%) patients had needed a toe amputation for infection or necrosis that could not be controlled. None needed a major amputation or hospitalization related to the ulcer. Toe-sparing surgery is feasible and in a select population can have a high success rate (88%), even though it does dictate more dedicated patient care.

Abstract P4-11-04: Program evaluation of a female sexual medicine and women's health program

Abstract Objectives: To evaluate the effectiveness of simple sexual/vaginal health treatment strategies in breast cancer patients/survivors seeking treatment at a female sexual medicine program, and to evaluate compliance and clinical outcomes. Methods: Demographics, medical information, and clinical assessments from 94 new visits with at least 1 follow-up from 09/12–10/14 were analyzed. The assessment form consists of a clinician evaluation with the Vaginal Assessment Scale (VAS) and Vulvar Assessment Scale (VuAS), and patient-reported outcomes (PROs) including the Sexual Activity Questionnaire (SAQ), Female Sexual Function Index (FSFI), and exploratory items. Compliance with treatment recommendations at the last visit were summarized. Changes from the first to last visit were compared with regard to clinical outcomes (e.g., vaginal pH, moisture), the VAS and VuAS, and the PROs (FSFI, SAQ, and confidence about future sexual activity). Results: The mean number of visits was 3 (range, 2-7). Mean age was 55.2 years (range, 29-48), 67% (n=63) were married or in an intimate relationship, and 94% (n=88) were menopausal. Seventy-seven percent (n=72) were on some form of active treatment, such as endocrine therapy (89%, 64/72). Only 15% (11/72) reported any hormonal supplementation (e.g., Vagifem). Treatment strategies included the use of vaginal moisturizers, lubricants with sexual activity, pelvic floor exercises, and dilator therapy. At last visit, 94% (80/85) of the women had complied with the clinical recommendation to moisturize 2 to 5+ times per week. Vaginal pH scores &amp;gt;6.5 declined from 31% (29/93) at Visit 1 to 20% (19/93) at the last visit (p=0.049). Vaginal (VAS) symptoms improved from the first to last visit (mean 1.2 to 0.59, p&amp;lt;0.001) as did the Vulvar (VuAS) symptoms (mean 0.78 to 0.57, p=0.007). Only 17% (15/19) had normal vaginal moisture at Visit 1, compared to 29% (26/90) at the last visit (p=0.04). Sixty-seven percent (59/88) reported performing pelvic floor exercises a few times per week to daily at their last visit. FSFI arousal mean scores improved from the first (mean=2.30) to last visit (mean=2.93) (p=0.003), and urinary incontinence rates declined from the first (58%, 32/55) to last visit (24%, 13/55). At Visit 1, 51% (43/85) of the women reported current sexual activity with a partner, and sexual activity rates increased over time—61% at last visit (52/85, p=0.049). FSFI total scores significantly improved from the first (mean=12.91) to last visit (mean=17.44) (p&amp;lt;0.001). Confidence about future sexual activity increased from 43% (34/79) at Visit 1 to 67% (53/79) at the last visit (p&amp;lt;0.001). Concerns about sexual/vaginal health (scale of 0-10) decreased over time, with 54% (43/80) rating their concern at 9 or 10 at the first visit and 28% (22/80) at the last visit (p&amp;lt;0.001). Conclusions: Breast cancer patients/survivors attending our female sexual medicine program reported improvement of vaginal and vulvar symptoms, sexual function and activity, and had clinical improvement over time on vaginal pH and moisture. Preliminary findings suggest that simple strategies, education, and support can improve vaginal/sexual health concerns in cancer survivorship. Citation Format: Carter J, Seidel B, Stabile C, Baser R, Eaton A, Goldfarb S, Goldfrank D. Program evaluation of a female sexual medicine and women's health program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-04.

Changing from a pro re nata treatment regimen to a treat and extend regimen with ranibizumab in neovascular age-related macular degeneration

BackgroundTreat and extend (TE) treatment regimens have the potential to reduce the treatment burden placed upon patients receiving ranibizumab for neovascular age-related macular degeneration (nAMD). This study aimed to analyse...

Clinical Teaching of Prosthodontics in Undergraduate Courses in a German Dental School: Patients, Visits, Efforts, and Incentives

It is unknown what disadvantages are faced by patients deciding for a prosthodontic treatment by inexperienced students. Commonly, the related extra effort and time are compensated by cost reduction of treatment fees. Thereby, the dental schools subsidize treatments to teach clinical prosthodontics. The aim of this study was to clarify the benefits to patients as well as the efforts of the dental school. Data collected from three courses in a dental school in Germany were patient gender, age, occupation, zip code, number of visits, scope of treatment including costs, financial discount, and remaining copayment. Travel costs were calculated based on zip code. Balance of travel costs and treatment discount was defined as financial benefit. The results showed that 185 patients (95 male) aged 32 to 82 years (median=58) were treated with fixed restorations (FR, n=110), telescopic dentures (TD, n=87), complete dentures (CD, n=17), or other (RD, n=3). The mean number of visits was 11 for FR, 12 for TD, and 9 for CD. Single distance to the clinic ranged from 0.6 to 65 miles (median=12). Total costs of prosthodontics were reduced by 19% on average. The mean financial benefit was 429 USD (median=298, min=-482, max=4025). The financial benefits were found to differ widely, including additional expenditures of patients. Participation, travel burden, and copayment did not depend on age, gender, or occupation. The financial benefit was relativized because students needed at least twice the sessions of a dentist. As a result, the financial efforts of dental schools are significant and compromise a cost-covering education.

Urban Patient Navigator Program Associated with Decreased Emergency Department Use, and Increased Primary Care Use, among Vulnerable Patients

Background: Receiving non-emergent care in the Emergency Department (ED) setting may disrupt continuity of care, may lead to less effective preventive care, and often contributes to overcrowding. Community Health Worker (CHW)-driven patient navigator programs that connect patients to primary care are a promising approach to enhance quality of care for patients and to reduce preventable ED utilization. Methods: Between July 2010 and June 2011, CHWs delivered services to 5,154 predominantly Spanishspeaking patients within 3 large, urban EDs. An evaluation was conducted to determine whether patient navigation services were associated with decreased ED visits or increased primary care visits. Clinical and administrative data were used to compare the mean number of visits 12 months before and 12 months after navigation. Results: Eighty-six percent of patients who presented without a primary care provider had a primary care appointment scheduled upon discharge. Among patients with 6-11 ED visits prior to navigation (n=119), the mean number of visits dropped from 7.27 to 3.93 (paired t-test p<0.001). These findings persisted after adjustment for potential confounders including insurance type and age group. Increased use of primary care was concurrent with the observed decreased ED use, although a statistical test of the association between these trends was of borderline significance. Conclusions: In this population of vulnerable patients who received CHW-driven patient navigation, ED utilization decreased after navigation, particularly among those with highest ED usage. Further research is warranted to determine whether connecting patients to primary care is the driving force behind observed reduced ED utilization and to assess whether there is a concurrent effect on hospital admissions.

Traumatic uveitis in the mid-Atlantic United States.

PurposeThe purpose of this study was to conduct an in-depth analysis of traumatic uveitis in patients managed in a mid-Atlantic tertiary care center with the goal of better characterizing the clinical features and outcomes of this large and important subset of uveitis patients.MethodsThis was a retrospective, observational study comparing traumatic uveitis patients with nontraumatic uveitis patients seen at the University of Virginia, Charlottesville, VA, USA, from 1984 to 2014.ResultsFifty-four traumatic uveitis patients (55 eyes) were identified. The patient population was 70.4% male, 57.4% Caucasian, and 37.0% African American. Mean age at diagnosis was 31.2 years; mean duration of follow-up was 5.4 years; and mean number of visits to the clinic was 4. The most common treatment modality was local steroids (77.8%). Glaucoma was medically managed in eight patients (14.8%). Cataract surgery was performed in five patients (9.3%). Mean best-corrected visual acuity at baseline for traumatic uveitis patients was 0.33 logMAR (SD 0.42) at the initial visit and 0.16 logMAR (SD 0.33) at the final visit. Mean baseline intraocular pressure (IOP) in the traumatic uveitis group was 15.5 mmHg (SD 7.4) at the initial visit and 14.6 mmHg (SD 4.0) at the final visit. Patients in the traumatic uveitis cohort tended to have better visual outcomes than those in the nontraumatic uveitis cohort.ConclusionIn our series, traumatic uveitis patients tended to be young and male and present with unilateral disease, all findings consistent with other reports. Despite relatively good visual outcomes, the traumatic uveitis patients still experienced a high burden of disease, measured both in the number of clinic visits and duration of follow-up. Due to the young mean age of patients, these disease burdens and decreased quality of life are nontrivial, emphasizing the importance of careful management and prompt treatment of this subset of uveitis patients.

Intermediate uveitis, posterior uveitis, and panuveitis in the Mid-Atlantic USA.

BackgroundThe purpose of this study was to identify the causes, clinical features, and outcomes of intermediate uveitis, posterior uveitis, and panuveitis in patients managed in a mid-Atlantic tertiary care center.MethodsThis was a retrospective observational study of intermediate uveitis, posterior uveitis, and panuveitis patients seen at the University of Virginia from 1984 to 2014.ResultsOne hundred and fifty-nine intermediate uveitis, posterior uveitis, and panuveitis patients (237 eyes) were identified. The patient population was 54.72% female; 67.30% of patients were Caucasian, and 22.01% were African–American. Mean age at diagnosis was 45.5 years. Mean duration of follow-up was 3.95 years. Mean number of visits to the clinic was 10.35. Of 491 uveitis patients, 26 (5.30%) had intermediate uveitis, 62 (12.60%) had posterior uveitis, and 71 (14.50%) had panuveitis. The leading diagnoses in the intermediate uveitis group were pars planitis (73.08%) and sarcoidosis (11.54%); toxoplasma uveitis (17.74%), multifocal choroiditis (14.52%), undifferentiated posterior uveitis (14.52%), and birdshot chorioretinitis (11.29%) in the posterior uveitis group; and undifferentiated panuveitis (29.58%), post-surgical panuveitis (18.31%), sarcoidosis (12.68%), acute retinal necrosis (12.68%), and toxoplasma uveitis (4.23%) in the panuveitis group. The most common treatment modalities included local steroids (57.23%) and systemic steroids (42.14%). Ocular hypertension was found in 38 patients (23.90%). Glaucoma surgery was performed in 18.24% of patients and cataract surgery in 21.38%. Mean best-corrected visual acuity was 0.66 logMAR at baseline across all anatomical locations and 0.57 logMAR at final follow-up. Best-corrected visual acuity improved or remained stable during follow-up in all groups.ConclusionThe most common diagnoses in our series by anatomical location were pars planitis (intermediate uveitis), toxoplasmosis (posterior uveitis), and undifferentiated uveitis (panuveitis). Panuveitis had significantly worse visual outcomes and higher rates of complications than did intermediate or posterior uveitis, a finding that confirms earlier reports. In this series, unilateral disease, regardless of anatomical location, was associated with poorer visual outcome, in contrast with the findings of other reports.

Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP) control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4) was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI), which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients’ mean age was 62.0 years (SD 10.4). The majority was women (59.2%) and married (85.7%). The mean number of visits in a year was 3.85 (SD 1.36). A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff). The mean UPCI was 0.43 (SD 0.34). Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

“Effectiveness of Peak Flow Guided Self Management Plan on Asthma Health Outcomes among Patients with Bronchial Asthma at Chest OPD, SRI Ramachandra Hospital, Chennai-116”

Objective: To identify the effect of peak flow guided self-management plan among asthmatics. Design: Randomized controlled trial Setting: Department of Chest and TB, Outpatient department, SRH Subjects: Mild and moderately Persistent type of asthma. (GINA, 2009) Interventions: Self Management plan guided by peak flow measurements Main outcome measures: Admissions to hospital and outpatient attendance, days off work, lung function. Results: The mean number of visits to Outpatient department , days off work were lower . There were no admissions during the data collection period.. Conclusions: Peak flow guided self management plan reduces the episode of asthma and improves quality of life. Hence the Nurses play an vital role in imparting the knowledge of peak flow monitoring at home as a part of self management plan . This can be facilitated by motivating the nurses to provide outpatient based education to progress towards their well-being.

Prevalência de hiperutilizadores de serviços de saúde com histórico positivo para depressão em Atenção Primária à Saúde

Objetivo: estudar a associação entre história de depressão e hiperutilização de serviços de saúde (HSS) entre usuários da Atenção Primária à Saúde (APS), além de estabelecer a prevalência de HSS, o número médio de consultas e o perfil epidemiológico dos grupos com história positiva e negativa para depressão. Métodos: os dados foram obtidos de prontuários familiares de duas Unidades de Saúde. Para analisar dados sobre o desfecho primário e para comparar o perfil epidemiológico dos grupos foi utilizado o teste qui-quadrado. Para comparar a diferença na média de consultas entre os grupos, utilizou-se o teste t de student. Resultados: foram analisados 278 pacientes. As prevalências de depressão e de HSS na amostra foram, respectivamente, de 15,1 e 4,3%. Houve diferença na prevalência de HSS no grupo com história positiva para depressão, 14,3%, quando comparado ao grupo com história negativa para depressão, 2,5% (RP = 5,62, IC 95% 1,90 a 16,59, p = 0,004). A média de consultas no grupo com história positiva para depressão foi de 5,25 consultas/ano, enquanto no grupo com história negativa para depressão foi de 2,59, com diferença de médias de 2,65 (IC 95% 1,90 a 3,40; p &lt; 0,001). Observou-se também maior prevalência de dispepsia e uso de antidepressivos entre HSS. Conclusão: os resultados reforçam dados da literatura, indicando que pessoas com histórico de depressão tendem a utilizar mais os serviços de APS, apresentando uma prevalência maior de HSS. Dessa forma, um maior conhecimento acerca do perfil dos HSS permitirá desenvolver abordagens mais resolutivas para esses usuários.