Patients In Public Hospitals Research Articles

Prediction of in-hospital mortality after pancreatic resection in pancreatic cancer patients: A boosting approach via a population-based study using health administrative data.

BackgroundOne reason for the aggressiveness of the pancreatic cancer is that it is diagnosed late, which often limits both the therapeutic options that are available and patient survival. The long-term survival of pancreatic cancer patients is not possible if the tumor is not resected, even among patients who receive chemotherapy in the earliest stages. The main objective of this study was to create a prediction model for in-hospital mortality after a pancreatectomy in pancreatic cancer patients.MethodsWe performed a retrospective study of all pancreatic resections in pancreatic cancer patients in Spanish public hospitals (2013). Data were obtained from records in the Minimum Basic Data Set. To develop the prediction model, we used a boosting method.ResultsThe in-hospital mortality of pancreatic resections in pancreatic cancer patients was 8.48% in Spain. Our model showed high predictive accuracy, with an AUC of 0.91 and a Brier score of 0.09, which indicated that the probabilities were well calibrated. In addition, a sensitivity analysis of the information available prior to the surgery revealed that our model has high predictive accuracy, with an AUC of 0.802.ConclusionsIn this study, we developed a nation-wide system that is capable of generating accurate and reliable predictions of in-hospital mortality after pancreatic resection in patients with pancreatic cancer. Our model could help surgeons understand the importance of the patients’ characteristics prior to surgery and the health effects that may follow resection.

Pengaruh Kualitas Pelayanan dan Kepuasan Pasien Peserta BPJS Kesehatan sebagai Mediasi terhadap Loyalitas Pasien

Terbentuknya persepsi positif dari pasien diharapkan dapat memunculkan kepuasan pelayanan farmasi terutama dalam informasi obat sehingga adanya loyalitas pasien atas jasa lembaga pelayanan kesehatan yang pernah digunakannya. Rancangan jenis penelitian ini adalah probability sampling, dengan populasi pasien dilingkungan rumah sakit umum pemerintah di kota Padang, yaitu RSUP Dr. M. Djamil Padang, RSUD Dr. Rasidin Padang dan RST Dr. Reksodiwiryo Padang yang pernah berobat menggunakan kartu BPJS Kesehatan dari Januari sampai Juni 2014. Teknik pengambilan sampel berupa Simple Random Sampling (105 pasien) dengan kuesioner. Analisis data dilakukan dengan menggunakan Analisis cronbach’s alpha, Regresi Berganda, R Square, Uji t dan path analysis dengan SPSS versi 11.5. Hasil penelitian ini menunjukkan bahwa kualitas pelayanan berpengaruh terhadap kepuasan pasien pada dimensi daya tanggap, jaminan dan bukti langsung bernilai p<0,05 sedangkan terhadap loyalitas pasien pada dimensi bukti langsung bernilai p<0,05 dan terhadap loyalitas pasien dengan dimediasi kepuasan pasien pada dimensi bukti langsung bernilai p<0,05.

Enhanced Recovery After Surgery for Hip and Knee Replacements.

Enhanced recovery after surgery (ERAS) programs or hip and knee replacements have had a significant effect on streamlining patient care with shorter stays, no increase in complications, and improved outcomes including reduced mortality. To compare outcomes following the introduction of an ERAS program for hip and knee replacements developed at our institution with a historical cohort of patients. ERAS protocols were developed at our institution for patients undergoing hip and knee joint replacements. Key aspects were changes in preadmission, a new education session, improved management of perioperative anemia, standardized anesthetic guidelines, day of surgery mobilization, and improved discharge planning. The results of the first 18 months (528 consecutive patients) were compared with those of a historical cohort of 507 patients from the 18 months prior to their introduction. In the ERAS group, the mean age was 68.3 years for patients who underwent hip replacement and 70.4 years for patients who underwent knee replacement. Thirty-two percent of patients were ASA (American Society of Anesthesiologists) Grades III and IV. The average preoperative Oxford score was 11. The average length of stay (ALOS) fell from 5.6 to 4.3 days for patients who underwent hip replacement and from 5.7 to 4.8 days for patients who underwent knee replacement (p < .001). Ninety-six percent of patients were discharged home. The 30-day readmission rate increased from 3.2% to 5.5% (p = .065). Six-month Oxford knee scores were higher in the ERAS group (39.8 vs. 36.3, p = .03). There was no increase in mortality or early revision rate. Substantial reductions in ALOS can be gained with the introduction of ERAS protocols, with high patient satisfaction and no increase in complications in a consecutive unselected group of public hospital patients. This requires a multidisciplinary approach and a strong clinical input.

Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia

Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients’ journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.

Information Mismatch: Cancer Risk Counseling with Diverse Underserved Patients

As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine GC-patient communication in real time, to assess its effectiveness from the patient perspective, and then to pilot intervention strategies to improve the communication. We observed 64 English-, 35 Spanish- and 25 Chinese-speaking (n = 124) public hospital patients and 10 GCs in 170 GC appointments, and interviewed 49 patients who were offered testing using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory methods and revealed a fundamental mismatch between the information provided by GCs and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. Our findings indicate a need to transform the standard model of genetic counseling communication using evidence-based principles and strategies from other fields of Medicine. The high rates of limited health literacy in the US, increasing access of diverse populations to genetic services, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence is likely to exacerbate health disparities in the genomic age.

Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?

Institutional corruption in the health care sector has gained considerable attention during recent years, as it acknowledges the fact that service providers who are acting in accordance with the institutional and environmental settings can nevertheless undermine a health care system’s purposes as a result of the (financial) conflicts of interest to which the service providers are exposed. The present analysis aims to contribute to the examination of institutional corruption in the health sector by analyzing whether the current payment mechanism of separately remunerating salaried hospital physicians for treating supplementary insured patients in public hospitals, in combination with the public hospital physician’s possibility of taking up dual practice as a self-employed physician with a private practice and/or as an attending physician in private hospitals, has the potential to undermine the primary purposes of the Austrian public health care system. Based on the analysis of the institutional design of the Austrian public hospital sector, legal provisions and directives have been identified, which have the potential to promote conduct on the part of the public hospital physician that systematically undermines the achievement of the Austrian public health system’s primary purposes.

Effective Cancer Risk Communication to Prevent Disparities in the Era of Precision Medicine

Abstract As genetics and genomics become part of mainstream Medicine, these advances have the potential to reduce or exacerbate health disparities. Gaps in effective communication (where all parties share the same meaning) are widely recognized as a major contributor to health disparities. The purpose of this study was to examine cancer genetic counselor-patient communication, to assess its effectiveness from the patient perspective, and to pilot intervention strategies to improve it. We used multiple inductive methods, including standard ethnographic techniques to systematically observe and audio-record genetic counseling sessions, and qualitative interviews with observed patients using the audio recordings to stimulate recall and probe specific aspects of the communication. Data analyses were conducted using grounded theory. We observed 64 English-, 35 Spanish- and 25 Cantonese- speaking public hospital patients (n = 124) and 10 Genetic Counselors in 170 appointments, and interviewed 49 patients who had been offered testing. We identified a fundamental mismatch between the information provided by genetic counselors and the information desired and meaningful to patients. Several components of the communication that contributed to this mismatch and often resulted in ineffective communication included: (1) too much information; (2) complex terminology and conceptually difficult presentation of information; (3) information perceived as not relevant by the patient; (4) unintentional inhibition of patient engagement and question-asking; (5) vague discussions of screening and prevention recommendations. To address these communication barriers, we adapted from other fields of Medicine to the genetic counseling context and pilot tested evidence-based strategies for effective communication with limited literacy patients. Our findings indicate a need to transform the standard model of hereditary cancer risk communication. The increasing access of diverse populations to genetic services, high rates of limited health literacy in the US, and growing complexity of genetic information have created a perfect storm. If not directly addressed, this convergence can be expected to exacerbate health disparities in the genomic age.

Nurses’ knowledge and Perceived Barriers About Pressure Ulcer Prevention for Admitted Patients in Public Hospitals in Addis Ababa, Ethiopia

Background: There is limited evidence on nurses’ knowledge and perceived barriers to prevent pressure ulcer in Ethiopia. The present study aimed to assess nurses’ knowledge and perceived barriers to prevent pressure ulcer in public hospitals in Addis Ababa, Ethiopia. Methodology: A self-reported cross-sectional survey design was used to collect data from 356 nurses who were providing care to patients with pressure ulcers between 21 April and 28 May 2015. We used a structured questionnaire, which was adapted from previous studies to collect the data. Data were coded and entered in computer using EPI data version 3.1 statistical packages, and transported into SPSS version 20 for data analysis. Descriptive statistics were used to describe demographic characteristics, level of nurses' knowledge on PU prevention and treatment, and perceived barriers to carry out PU prevention and treatment. Results: Findings of the present study revealed that the majority of nurses who participated in this study had unsatisfactory knowledge (63.85%) as regards the pressure ulcers management. Nurses were questioned to specify their agreement about the presence of specific barriers in the work environment. Shortage of staff was the utmost frequently cited barrier to carrying out PU-prevention measures (83.1%), followed by limited resources (67.7%) and lack of guidelines (policies) about PU prevention (59.8%). Conclusions: In-service training and educational program should be designed for nurses to enhance their Knowledge and practice. Satisfactory dissemination of PU prevention and treatment guidelines appears to be essential to advance quality of PU prevention and treatment.

The attitude of Greek society to public-private partnerships in the public health sector

The need for reengineering the National Health Service of Greece is undeniable. Public private partnerships are examined as a possible funding tool. The research focus was on the social reaction of Greek society towards implementation of PPPs in the public health sector. Previous attempts to implement PPPs failed as a result of intense opposition from the citizens. A structured questionnaire survey took place. There were 500 recorded responses. Descriptive statistics and correlation analysis focusing on place of residence, age, and gender, were implemented, using SPSS. Both approaches appear to lead to the same conclusions. Respondents indicated that a positive social reaction was found towards the involvement of the private sector in providing specific support services during the contract. On the other hand, there is a great reluctance to involve the private sector in any service related to the direct provision of curative care to the patients in public hospitals.

The attitude of Greek society to public-private partnerships in the public health sector

The need for reengineering the National Health Service of Greece is undeniable. Public private partnerships are examined as a possible funding tool. The research focus was on the social reaction of Greek society towards implementation of PPPs in the public health sector. Previous attempts to implement PPPs failed as a result of intense opposition from the citizens. A structured questionnaire survey took place. There were 500 recorded responses. Descriptive statistics and correlation analysis focusing on place of residence, age, and gender, were implemented, using SPSS. Both approaches appear to lead to the same conclusions. Respondents indicated that a positive social reaction was found towards the involvement of the private sector in providing specific support services during the contract. On the other hand, there is a great reluctance to involve the private sector in any service related to the direct provision of curative care to the patients in public hospitals.

PARAMETERS FOR THE EVALUATION OF CERVICAL SAGITTAL BALANCE IN IDIOPATHIC SCOLIOSIS

ABSTRACT Objective: There are no values defined as standard in the literature for the parameters of assessment of cervical sagittal balance in patients with idiopathic scoliosis. This study describes the sagittal cervical parameters in patients with idiopathic scoliosis. Methods: Study carried out in a tertiary public hospital in patients with adolescent idiopathic scoliosis, through the evaluation of panoramic radiographs in lateral view. The Cobb method was used to evaluate cervical lordosis from C2 to C7, distance from the center of gravity (COG) of the skull to C7, measurement of T1 slope, thoracic inlet angle (TIA), neck tilt, and plumb line from C7 to S1 (SVA C7-S1). A statistical analysis was performed, to demonstrate the relationship between the alignment of the thoracic spine in the sagittal plane and the cervical sagittal balance of patients with scoliosis. Results: Thirty-four patients were female (69.4%) and 15 male (30.6%). The mean values for COG-C7 were 0.71 mm (median 0.8 mm/standard deviation [SD]= 0.51 mm). For Cobb C2-C7, the mean was -11.7° (median -10°/SD= 20.4°). The mean slope of T1 was 23.5° (median 25°/SD= 9.5°). The mean cervical version was 58.8° (median 60°/DP= 15.4°). The mean TIA was 81.8° (median 85°/SD= 16.7°). The mean plumb line C7-S1 was -0.28 (-0.3/SD= 1.0). Conclusion: The analysis of the results showed that the mean values for the cervical lordosis are lower than the values described as normal in the literature, suggesting a loss of sagittal cervical balance in these patients.

Rational use in drug health literacy: A public hospital patients on an investigation

The drug is only effective as long as it is used correctly. Drug users need to have health literacy in the use of Rational Drug Use (RDU), such as the right drug, right time, right amount, right use and retention. This study was carried out in order to determine the levels of Health Literacy (HL) in RDU by determining the behavior and preferences of inpatient treatment harvests in Seydisehir State Hospital about drug, drug use, preservation and procurement durations in general terms. The study was a cross-sectional and descriptive type study and included patients who were hospitalized in the Seydisehir State Hospital between 01.04.2015 and 31.05.2015. During this period, 146 patients were reached. As a total means of data, the questionnaire created by the researcher based on the literature was used. In the question set; Questions were asked to determine the levels of Health and Literacy in the RDU except for some descriptive questions asking about the age, gender, marital status, place of residence, educational status, number of hospitalizations previously, and the presence of medicines that were constantly used. The questionnaires were applied with face-to-face interview technique with care for volunteerism. Surveys were conducted with written permission from the top management of the institution. The obtained data were evaluated as frequency and percentage in SPSS 16.0 package program. Of the patients, 66 (45.2%) reported that they had been treated inpatient 2-5 times previously and 82 (56.2% It was found out that 64 of the patients (43.8%) had drugs not in use at home, 94 (64.4%) were staying in the home, 121 (82.9% (37%) had taken medication from the pharmacist for precautionary purposes, 89 (61%) were on vacation, 71 (48.6%) were taking medicines for preventive purposes while on their way to travel, 42 (28.8%) stated that they would use drugs for their use, 118’1 (80.8%) said they were using medicines while they were prescribing a doctor, 121 (82.9%) stated food or drug allergy (61%) injected with antibiotics without examination in complaints such as influenza, colds, colds, etc. (76%) (52.1%) had stopped using their medication when their complaints had passed, (69.9%), 45 (30.8%) antibiotics could treat each disease and 82 (56.2%) patients had the same effect (79.5%) looked at the expiry date of drugs used, and 110 (75.3%) indicated that they were using their advertised products for treatment purposes. Patients stated that they would keep the remaining remedies that they did not use frequently (35.9%), disposal (26.6%) and health care facilities (25.9%), respectively, Patients frequently reported that they kept their medication in a cupboard (50,7%), in the refrigerator (39,2%) and in the bag (8,5%), frequently disinfected medicines, Very painkillers and antibiotics were taking medications. There are important tasks for drug users in AIK. Drug users, AIK awareness and SOY levels are leading factors in providing rational drug use. In the direction of the findings obtained in the study; To take medicines from the pharmacy without any illness, to use the medicines at home without going to the medicine in case of illness and to take antibiotics for complaints such as colds and colds, taking medicines for the purpose of prevention and travel, Treatment with antibiotics will cure diseases more quickly and that antibiotics can treat every disease, choosing the expensive two drugs of the same effect, discarding overdose drugs and taking medicines from antibiotics and antibiotics for preventive purposes, The level of awareness and the level of health literacy are inadequate. In the study, positive situations such as checking the last usage dates of the drugs used and kept by the patients, recalling the medicines used when prescribing, recalling the conditions of food and drug allergies and reading the drug prescriptions are considered as remarkable. In conclusion, it was seen that the patients who were receiving inpatient treatment at Seydisehir State Hospital were found to have low awareness of RDU and HL levels. It is intended that the establishment of RDU Culture at both institutional and national level should be aimed at raising awareness and HL level of RDU and it is considered that the development of joint projects with drug users at center will be effective for all RDU Stakeholders (drug users, drug producers, pharmacists and health administrators) for this purpose.

Demographics and Satisfaction with Discharge Information in Cardio- and Cerebrovascular Patients

Background: This study aimed to evaluate the perceptions of cardio- and cerebrovascular patients recently admitted to public hospitals of their satisfaction with discharge processes and to determine if this differs by demographic groups. Methods: A sample of eligible public hospital inpatients recently discharged after a cardio- or cerebrovascular event was extracted from a consumer experience surveillance system. Respondents were aged ≥16 years and interviewed via telephone by trained personnel regarding their experiences during their hospital stay. Questions relating to the discharge process were analysed using descriptive statistics to compare patient satisfaction levels against demographic variables. Results: A total of 536 respondents discharged after cardio- or cerebrovascular events were included. The median age was 74 years ± 12.6, 60.6% male, 65.5% Australian born. Dissatisfaction with aspects of the discharge process was markedly higher than dissatisfaction with overall care during the hospital admission (overall care 2.6%, discharge aspects 11.8% - 37.8%). Dissatisfaction rates were highest within the ‘Written information provided’ (37.8%) and ‘Danger signals communicated’ (34.7%) categories. Women and people aged ≥80 were more likely to express dissatisfaction. Conclusion: Although respondents were largely satisfied, there were some important differences in the socio-demographic characteristics of those that were dissatisfied. The communication of important discharge information to older people and women, in particular, was less likely to meet their expectations. More flexible and targeted models of information sharing and discharge planning that cater for individual characteristics may improve outcomes.

Approaches Used in the Interactions between Health Care Professionals and Patients in Diabetes Care in Indonesia

Background: Patients with diabetes require self-management support in order to manage the disease. Little is known about how patients with diabetes have been supported by the health care professionals in Indonesia. Objective: This study explored the nature of interaction between health care professionals and patients in a major public hospital in Indonesia and, specifically, identified the approaches used in the care of patients. Methods: A single case study strategy was employed and 37 direct observations of clinical encounters of patients with diabetes with the health care professionals were conducted. Results: The main themes emerging from analysis across the sources of data included: the outcome of blood sugar level results are suspected as patient noncompliance; communication is mostly driven by the health care professionals; medical content is the focus of clinical encounters; patient education is reactive and focused on the negative aspects of having diabetes; the privileging of medical care approach; passive role shown among patients with diabetes; nurses focus on the heavy administrative workload; and low health literacy issues among the patients with diabetes. These findings demonstrate that Indonesia as a developing country is embracing a medical approach of care while struggling to provide quality care with limited health care resources. Conclusion: The medical paradigm was still embedded and guided the daily care provided for patients with diabetes. Thus, a critical adoption of an approach that supports patient self-management to the Indonesia's diabetes care is necessary.

Hospital discharges and patient activity associated with chronic pancreatitis in Ireland 2009–2013

ObjectiveTo investigate trends in acute public hospital patient discharges in Ireland, to analyse hospital discharge activity for geographical variations, aetiological differences, and to estimate a national prevalence for chronic pancreatitis. MethodWe performed a nationwide retrospective study of all in-patient discharges from acute public hospitals in Ireland, participating in the Hospital In-Patient Enquiry (HIPE) reporting system. We searched for International Classification of Disease, Tenth Revision, Australian Modification (ICD-10-AM) codes K86.0 alcohol-induced chronic pancreatitis, and K86.1 other chronic pancreatitis, and data were extracted for the years 2009–2013. ResultsThere were 4098 emergency admissions for any aetiology chronic pancreatitis during the 5 year study period. Total discharges ranged from 753 in 2009 to 999 in 2013. Total patients ranged from 530 in 2009 to 601 in 2013. Prevalence of chronic pancreatitis is estimated at 11.6 per 100,000 to 13.0 per 100,000 over the five years. ‘Other aetiology chronic pancreatitis’ discharges were almost double that of ‘alcohol chronic pancreatitis’. We found notable geographical variation in hospital discharge activity for chronic pancreatitis. ConclusionsWe report a prevalence which is similar to those worldwide studies who adopted a similar methodology utilising exact counts of patients. Our data are an underestimated as they are based on in-patient discharges only, excluding those attending primary care, outpatient or emergency room visits without admission. Despite studying this disease in a population with high per capita alcohol consumption, we report almost twice as many discharges for non-alcohol aetiology chronic pancreatitis.

Cost of illness for outpatients attending public and private hospitals in Bangladesh.

BackgroundA central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient’s total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh.MethodsThe study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment.ResultsThe costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient’s income, gender, age or illness.ConclusionOverall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0458-x) contains supplementary material, which is available to authorized users.

Oncology patients in the health care safety net: Is it too late for early palliative care?

128 Background: Studies have suggested that uninsured and Medicaid patients are more likely to present with late-stage cancer than Medicare patients, and may be more likely to be admitted urgently or emergently. However, studies of palliative care interventions for cancer patients suggest that the greatest impact can be achieved if these services begin “early” (≥ 90 days prior to death). In our urban public hospital, we examined where patients receive their initial cancer diagnosis, and at what stage they are diagnosed, in order to determine how to best implement community-based palliative care services. Methods: Retrospective cohort analysis of cancer patients diagnosed over a five year period. Hospital tumor registry data were used to determine the location of diagnosis (inpatient vs. outpatient), stage and type of cancer at diagnosis, and patient status at the end of the study period (alive vs. deceased). Results: Of the 2,928 patients diagnosed with cancer, 26% of patients (n = 759) were diagnosed while hospitalized. Patients who received their diagnosis while hospitalized were more likely to be diagnosed with stage 3-4 disease (49%, n = 372), vs. stage 0-1 (21%, n = 163). 25% of patients who received their diagnosis in the inpatient setting died within 90 days of initial diagnosis. Patients diagnosed in the outpatient setting were more likely to be diagnosed with stage 0-1 (40%, n = 865), vs. stage 3-4 (32%, n = 688). Patients diagnosed while hospitalized were 2.9 times more likely to be diagnosed with late stage disease, compared to those diagnosed as outpatients (95% CI 2.3-3.5, p &lt; 0.0001). Conclusions: A large minority of patients received their cancer diagnosis while hospitalized, and were more likely to be diagnosed with late-stage disease. Additionally, a significant proportion of these patients died within 90 days of their initial diagnosis. In order to provide "early" palliative care for cancer patients in public hospitals, palliative care programs may need to offer initial consultation visits while patients are hospitalized, and then connect them with prompt outpatient follow-up. Safety net programs with palliative care services for cancer patients should emphasize continuity across inpatient and outpatient settings.

Disparities in the Radiation Treatment Time and Outcome of Anal Cancer in Public and Private Hospital Patients

Disparities in the Radiation Treatment Time and Outcome of Anal Cancer in Public and Private Hospital Patients

A Comparison of Quality of Life of Patients in Public and Private Hospitals Admitted with Acne Vulgaris

Objective: In this study, it was aimed to evaluate life quality of the patients with acne vulgaris visiting public and private hospitals using the Skindex 29 scale. Methods: Patients’ ages, genders, education levels, and referenced hospitals were recorded. Skindex 29 scale was used to assess the quality of life. Results: The average symptom, function, and emotion scale scores of patients with acne vulgaris in private hospital were found 45.17±19.03, 31.68±19.44, and 46.90±20.50, respectively. The average scores of these scales in public hospital were 39.41±19.71, 30.01±8.22, and 50.75±25.20, respectively. Conclusion: In this study, the average symptom and function scale scores of the patients with acne vulgaris in private hospital were found higher than those in public hospital. On the other hand, the average emotion scale score of patients with acne vulgaris in public hospital was found higher than those in private hospital. However the difference was not statistically significant. This situation makes us believe that in private hospital the life quality of patients with acne vulgaris is mostly influenced from symptom and function, whereas it is mostly influenced from emotion in public hospital.

Comparison of the Outcomes of 2 Rehabilitation Protocols After Flexor Tendon Repair of the Hand at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background: Flexor tendon repair of the hand and the rehabilitation thereof are commonly discussed between hand surgeons and therapists. There are many patients in public hospitals in South Africa who require this surgery. They are regularly sent to the therapists for rehabilitation, using the early passive motion protocol. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these 2 protocols in the South African context. This study was implemented to compare the outcomes of these 2 protocols in a large public hospital post flexor tendon repair. Methods: Patients (n = 46) who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the 2 groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at 4 weeks post surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8, and 12 weeks post surgery. The collection of data commenced in December 2014 and was completed in January 2016. Results: The results of the study included total active motion and tip to crease and tip to table measurements of the injured and uninjured fingers. At 12 weeks post surgery, the average total active motion of the injured fingers was similar between the early active and early passive motion protocols (57.46%, 61.00%, respectively). Tip to crease and tip to table measurements were also similar between the 2 groups. In terms of patient compliance, 52.17% of participants removed their splints in the initial 4-week period, and 56.52% carried out the prescribed exercises correctly. Tendon rupture occurred in 8.57% (n = 3, early active motion = 5.71%, early passive motion = 2.86%) of patients. Conclusion: There has been a global trend toward the use of an early active motion protocol post flexor tendon repair. This study found that there was no difference in outcomes between the 2 groups. Therefore, either protocol could be implemented in South African public hospitals. However, because the early active motion protocol takes less time to implement, this protocol is recommended. A larger study would be necessary to determine a significant comparison between the 2 groups; however, this is challenging due to poor patient compliance.