Network Of Outpatient Clinics Research Articles

SEVERAL ORGANIZATIONAL ASPECTS FOR PERFORMANCE OPTIMIZATION OF EMERGENCY STATIONS

The initiation of the common register of all the patients who suffers from chronic diseases and is also observed by specialized clinics for all the city out-patient clinics and the emergency stations will significantly optimize the performance of both the emergency service and the network of out-patient clinics. The initiation of the common register will allow to hand the part of emergency calls from patients observed by a specialized clinic over to the emergency medical aid services of local policlinics. Owing to the information concerning patients presented in the register both the diagnostics quality during the pre-hospital period carried out by the emergency specialists and the performance of the adequate qualified medical care of the patients observed by a specialized clinic.

ХАРАКТЕРИСТИКА ДІЯЛЬНОСТІ АМБУЛАТОРНИХ ЗАКЛАДІВ МІСТА КИЄВА ЗА УМОВ РЕФОРМУВАННЯ СИСТЕМИ ОХОРОНИ ЗДОРОВ’Я

Мета: проаналізувати ресурси і діяльність мережі амбулаторно-поліклінічних закладів, консультативно-діагностичних центрів у м. Києві в 2014–2016 рр.Матеріали і методи. Матеріалами для проведення аналізу були дані звітних статистичних форм № 17, № 20, а також статистичні довідники Київського міського інформаційно-аналітичного центру.Результати. У м. Києві на базі існуючих поліклінік створено 28 центрів первинної медико-санітарної допомоги та 13 консультативно-діагностичних центрів. Консультативно-діагностичні центри забезпечують 38,6–57,1 % серед усіх відвідувань амбулаторно-поліклінічних закладів. Основними ресурсними проблемами консультативно-діагностичних центрів є недостатнє фінансування, застаріле лікувально-діагностичне обладнання, неповнаукомплектованість кадрів.Висновки. Виявлені характерні особливості діяльності консультативно-діагностичних центрів будуть враховані при розробці функціонально-організаційної моделі консультативно-діагностичних центрів на принципах ДПП.

Diagnosis of hepatitis C virus infection in pregnant women in the healthcare system in Poland

The hepatitis C virus (HCV) is globally recognized as a serious public health concern. Current statistics indicate that approximately 2% of people worldwide and 1.9% of people in Poland suffer from HCV infection.This study was conducted to assess the anti-HCV seroprevalence in pregnant women in Poland and subsequently provide recommendations on the rationale for obligatory screening.A total of 42,274 women participated in our study, of which 16,130 were pregnant. We were granted access to their health data stored in the form of electronic medical records kept by the network of outpatient clinics throughout Poland.The lowest rate of positive anti-HCV test results was found in women ages 25 to 34 (0.73%); however, younger and older age groups had similar rates (15–24 = 0.86%; 35–44 = 0.84%). Additional analysis of data from the period between 2011 and 2014 revealed a downward trend in the proportion of positive anti-HCV tests among pregnant women (mean positive anti-HCV = −0.001 × year + 1.9451; R2 = 0.7274). Regardless of the gradual increase in the number of female patients undergoing screening between 2004 and 2015, there has been a constant decrease in the rate of positive cases. The rate of pregnant women potentially infected with HCV was twice as lower than that in a control group of women undergoing tests for other medical circumstances: 0.76% vs 1.67% (P < 0.0001).Analysis of real-world data of female patients in Poland provides evidence that screening based on an individual's medical history and behavioral risk factors in clinical circumstances would be more effective than obligatory testing of all pregnant women.

Pharmacologic Prophylaxis for Venous Thromboembolism Among Hospitalized Patients with Acute Medical Illness: An Electronic Medical Records Study

Abstract 2074 Introduction:Patients hospitalized with acute medical illness have an elevated risk of venous thromboembolism (VTE). ACCP guidelines list various risk factors including active cancer, congestive heart failure (CHF), respiratory failure, chronic obstructive pulmonary disease (COPD), sepsis, advanced age, history of VTE and immobility. These guidelines also recommend prophylactic anticoagulation using fondaparinux, low molecular-weight heparin, or low-dose unfractionated heparin. This study examined pharmacologic prophylaxis against VTE among hospitalized medically ill patients and assessed demographic and clinical correlates related to VTE prophylaxis. Methods:A retrospective observational study was conducted with electronic medical records (EMR) in a large Midwestern U.S. public hospital and its network of outpatient clinics between 1999 and 2010. Patients >=40 years old were included if they were hospitalized with a primary diagnosis (ICD-9 code) of CHF, pneumonia, cancer, stroke, infectious diseases, sepsis, severe respiratory disorders (including COPD, asthma, and acute respiratory failure), inflammatory bowel disease (IBD), or neurologic disorders, or were hospitalized for VTE within the year before the index admission. Each patient’s first qualifying hospitalization during the 12-year period was included in the analysis. Patients were excluded if the length of stay was <3 days, the primary diagnosis was VTE, if a hospital diagnosis of VTE was given in the past 30 days, or if IV heparin or a treatment dose of subcutaneous (SC) heparin (>15,000 units/day) or enoxaparin (>40 mg/day) was started within one day of admission. Patients treated with warfarin (and not heparin or enoxaparin) were also excluded. Fondaparinux was not on the formulary. Prophylaxis was defined as present if the first dose (during the hospital stay) of anticoagulation with SC heparin or enoxaparin was lower than the treatment dose levels defined above. All IV heparin was considered to be at treatment-level doses. SC heparin records with missing doses were considered to be at prophylaxis-level doses. Logistic regression was used to examine factors associated with VTE prophylaxis. Results:Of 13,029 patients eligible for the study, mean age was 58.6 years; 51% were women; 47% were white, 47% African-American, 6% other; 58% had public healthcare coverage, 15% commercial insurance, 27% self-pay. Among patients with a BMI stored in the EMR, 44% were obese, 23% overweight, and 28% normal. There was a history of cigarette smoking in 44% and atrial fibrillation in 8%. The primary hospital diagnoses were infectious diseases 21.2%, cancer 19.9%, severe respiratory disorders 14.5%, pneumonia 12.7%, CHF 12.2%, stroke 9.6%, sepsis 8.9%, IBD <1%, neurologic disorders <1%, and other <1%. Mean length of stay was 7.8 days (median 5 days).The overall prophylaxis rate was 22.1% (14.8% for 1999–2002, 22.0% for 2003–2006, 28.5% for 2007–2010), including 11.8% with enoxaparin and 10.3% with SC heparin. Multivariable logistic regression showed that VTE prophylaxis was significantly associated with year of hospitalization (OR=2.2 for ‘07-'10, OR=1.7 for ‘03-'06 vs. ‘99-'02, P<.001), SC heparin in the 30 days before admission (OR=1.6, p=0.02), aspirin use (OR=1.4, p<.0001), a primary hospital diagnosis of sepsis (OR=1.4, p<.0001), self-pay status (OR=1.2 vs. commercial insurance, p=0.01), and age (for 10 year increments, OR=1.07, p=0.001). The following factors were associated with reduced likelihood of VTE prophylaxis: smoking (OR=0.9, p=.005), alcohol use (OR=0.9, p=.04), warfarin in the past 30 days (OR=0.5, p=0.02), and a primary diagnosis of stroke (OR=0.7, p<0.0001), infectious disease (OR=0.7, p<.0001), or IBD (OR=0.3, p=.003). Conclusion:Pharmacologic VTE prophylaxis has increased significantly over the past 12 years but is still largely underused in patients hospitalized with acute medical illness. Multiple demographic, behavioral and clinical factors are associated with VTE prophylaxis during hospitalization. Further research is needed to examine if VTE prophylaxis is associated with reduced VTE risk and healthcare utilization. Disclosures:Rosenman:Bristol-Myers Squibb: Research Funding; Pfizer: Research Funding. Liu:Pfizer: Employment. Phatak:Bristol-Myers Squibb: Employment. Qi:Pfizer: Research Funding; Bristol-Myers Squibb: Research Funding. Teal:Pfizer: Research Funding; Bristol-Myers Squibb: Research Funding. Nisi:Pfizer: Research Funding; Bristol-Myers Squibb: Research Funding. Liu:Pfizer: Employment, Equity Ownership. Ramacciotti:Bristol-Myers Squibb: Employment.

War and the Practice of Psychotherapy: The UK Experience 1939–1960

During the Second World War, it is argued, “the neuroses of battle” not only deepened an understanding of “psychopathological mechanisms”, but also created opportunities for the practice of psychotherapy, while its perceived efficacy led to a broader acceptance within medicine and society once peace had returned. This recognition is contrasted with the aftermath of the First World War when a network of outpatient clinics, set up by the Ministry of Pensions to treat veterans with shell shock, were closed within a few years in response to financial pressures and doubts about their therapeutic value. In the private sector, psychoanalysis under the leadership of Ernest Jones remained an idiosyncratic activity confined largely to the affluent middle classes of London. According to Gregorio Kohon, “it was strongly opposed by the general public, the Church, the medical and psychiatric establishment, and the press”. The Medico-Psychological Clinic of London, originally set up in 1913, offered psychotherapy on three afternoons a week in premises at 30 Brunswick Square under the direction of Dr James Glover. However, it closed in 1923 after Glover and his brother Edward had both become psychoanalysts. As the First World War drew to a close, Maurice Craig helped to persuade Sir Ernest Cassel to fund a hospital for ‘Functional and Nervous Disorders’ at Penshurst, Kent, to treat neuroses in the civilian population. Although moved to permanent premises near Richmond, it remained small-scale and at the time no attempt was made to establish a network of similar institutions throughout the UK. The Tavistock Clinic, opened in Bloomsbury in 1920, struggled to secure funding throughout the interwar period and its efforts to win official recognition from the University of London were consistently rebutted. Thus, despite the epidemic of shell shock and other so-called war neuroses, psychotherapy remained a marginal activity during the 1920s and 1930s.

Automated ultrasonic diagnostic systems for outpatient clinics

Some ways to improve informative capacity of ultrasonic diagnostic examinations are discussed, and their application in an extended network of outpatient clinics by using the state-of-the-art automated devices, microcomputers and microprocessors in particular, are considered. Possible approaches to automating ultrasonic diagnostic examinations are analysed, and requirements for hardware and software of ultrasonic complexes are specified. A configuration structure of complexes for processing monodimensional and bidimensional echo signals is presented.