Referral Rate Of Patients Research Articles

Screening and referral programs for diabetes and cardiovascular disease: Can community pharmacists bridge the care gap?

Background and ObjectivesHeart disease and diabetes are leading causes of death in the U.S., with timely screening, referrals, and education being critical for effective treatment. The Community-based Valued-driven Care Initiative (CVCI) aimed to develop, implement, and evaluate the feasibility of delivering patient-centered care interventions for high priority disease states in community pharmacies. This article focuses specifically on two of the selected interventions, both of which were screening and referral (S&R) programs for the prevention and treatment of cardiovascular disease (CVD) and diabetes (DM) respectively. This exploratory evaluation was designed as an effectiveness-implementation hybrid Type II study. Its objectives were to assess both implementation and preliminary program effectiveness using mixed data. MethodsFifteen community pharmacies opted to implement one of the two programs over a 12-month period. Implementation feasibility involved examining program adoption rates by sites and patients; acceptability, appropriateness, feasibility, and intent to sustain use survey scores; and pharmacists' interviews. Program effectiveness was based on patient referral rates, physician follow-up communication rates, and perceived outcomes, collected via patient logs, surveys, and interviews. ResultsTwo of the 15 sites discontinued participation, yielding an 87 % adoption rate. Patient adoption varied based on contact and screening rates, due to differences in patient recruitment, staffing, and workflow. Pharmacist acceptability, compatibility, and feasibility remained high throughout implementation; however, only three pharmacy sites planned on continuing offering the programs. All at-risk patients were appropriately referred based on screening results, with 65 % having their screening results communicated to their primary healthcare providers. The programs were perceived as beneficial, increasing pharmacists' knowledge and motivation, enhancing relationships with patients, and producing an impact on patients'' health. DiscussionResults highlight the implementation feasibility and preliminary outcomes of delivering DM and CVD S&R programs in community pharmacies. However, despite these positive results, most pharmacies did not intend to continue the programs, underscoring the continued need for sustainable clinical services models in non-traditional settings. Success with broader implementation will require a paradigm shift in support of community pharmacists as clinical care extenders.

How Do Paediatricians Manage Comfort with Uncertainty in Clinical Decision-Making.

While healthcare practice is inherently characterised by uncertainty, there is a paucity of formal curricular training to support comfort with uncertainty (CWU) in postgraduate training. Indeed, some evidence suggests medical training inherently conflicts with CWU in emphasizing pedagogies focussing on "fixing" the problem. While referral patterns increase significantly, dealing with uncertainty has direct implications for patient referral rates and use of valuable healthcare resources. Paediatricians in Ireland were invited to participate. Face-to-face interviews were conducted after participants watched videos of varied clinician-patient interactions.. Two researchers independently analysed the collected data using thematic analysis. Triangulation and member checking was performed to ensure validity of findings. A reflection journal documented the research journey. Thirty four paediatricians participated. Five themes were identified: the interplay between quality of information, uncertainty and decision-making, confidence in clinical assessment and first-hand patient evaluation, anxiety and fear experienced by medical professionals when dealing with complex and serious conditions, strategies employed by medical professionals in managing their own uncertainty and the impact of societal and parental expectations on medical decision-making. These are moderated by a number of factors, most significantly the child's caregivers' comfort with doctors reassurance (CDR). Enacted management will diverge from the consultant's clinical plan when the caregiver's CDR cannot be satisfactorily supported. Clinician CWU in the paediatric context is inextricably linked to caregiver CDR. The complexities and central importance of social context in understanding CWU has important implications for how we develop educational activities to support clinician CWU and patient/care-giver CDR. This may translate to efficient use of limited resources in healthcare settings.

The effectiveness of intervention in hepatitis C patients and improvement in their referral rate

Background To investigate the effectiveness of the intervention with critical value management and push short messaging service (SMS), and to determine improvement in the referral rate of patients with positive hepatitis C antibody (anti-HCV). Methods No intervention was done for patients with positive anti-HCV screening results from 1 January 2015 to 31 October 2021. Patients with positive anti-HCV results at our hospital from 1 November 2021 to 31 July 2022 were informed vide critical value management and push SMS. For inpatients, a competent physician was requested to liaise with the infectious disease physician for consultation, and patients seen in the OPD (outpatient department) were asked to visit the liver disease clinic. The Chi-square correlation test, one-sided two-ratio test and linear regression were used to test the relationship between intervention and referral rate. Results A total of 638,308 cases were tested for anti-hepatitis C virus (HCV) in our hospital and 5983 of them were positive. 51.8% of the referred patients were aged 18–59 years and 10.8% were aged ≥75 years. The result of Chi-square correlation test between intervention and referral was p = .0000, p < .05. One-sided two-ratio test was performed for statistics of pre-intervention referral rate (p1) and post-intervention referral rate (p2). Normal approximation and Fisher’s exact test for the results obtained were 0.000, p < .05, and the alternative hypothesis p1 − p 2 < 0 was accepted. The linear regression equation was referral = 0.1396 × intervention + 0.3743, and the result model p = 8.79e − 09, p < .05. The model was significant, and the coefficient of intervention was 0.1396. Conclusions The interventions of critical value management and push SMS were correlated with the referral rate of patients with positive anti-HCV.

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center.

The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being "somewhat" familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

Patient referral pattern in northern Ghana: a retrospective study of the tamale teaching hospital

Background: Patient referral involves transferring the responsibility for the care of a patient from one level of care to the other. Several factors account for the referral of patients, and all categories of patients are referred.&#x0D; Objective: This study sought to assess the most common medical and surgical conditions that are referred, as well as the demographics of patients mostly involved in medical referrals.&#x0D; Materials and Methods: A retrospective cross-sectional study was conducted to examine the patterns of patient referral from peripheral facilities into the Tamale Teaching Hospital in 2021. Data on patient referral into the facility, including medical condition, age, gender, and other demographic information within a period of one year was retrieved from the nursing department under the consent of the nurse manager and analyzed using SPSS version 23.&#x0D; Results: A total of 1565 referrals were made into the facility within the period under review. The main reasons for referral were to perform diagnostic investigations and for further management. Majority of the patients (53%) referred to facility were males within the ages of 20-49years. The commonest conditions that were referred were head injuries (19.9%) followed by fractures (12.8) most of which were sustained through road traffic accidents. Eighty two percent (82%) of the attempted referrals were successful whilst 12% was rejected for various reasons including improper referral procedures, whilst the remaining 6% were to call back after some issues have been resolved.&#x0D; Conclusion: There is a high rate of patient referral in northern Ghana, most of whom are as a result of head injuries and fractures resulting from road traffic accidents.

Development and Validation of the Chronic Subdural HematOma Referral oUtcome Prediction Using Statistics (CHORUS) Score: A Retrospective Study at a National Tertiary Center

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing rate of patient referrals. CSDH referral decision-making is a subjective clinical process, and our aim was to develop a simple scoring system capable of acting as a decision support tool aiding referral triage. A single tertiary center retrospective case series analysis of all CSDH patient referrals from 2015 to 2020 was conducted. Ten independent variables used in the referral process were analyzed to predict the binary outcome of either accepting or rejecting the CSDH referral. Following feature selection analysis, a multivariable scoring system was developed and evaluated. 1500 patient referrals were included. Stepwise multivariable logistic and least absolute shrinkage and selection operator regression identified age <85years, the presence of headaches, dementia, motor weakness, radiological midline shift, a reasonable premorbid quality of life, and a large sized hematoma to be statistically significant predictors of CSDH referral acceptance (P<0.04). These variables derived a scoring system ranging from -9 to 6 with an optimal cut-off for referral acceptance at any score >1 (P<0.0001). This scoring system demonstrated optimal calibration (brier score loss=0.0552), with a score >1 predicting referral acceptance with an area under the curve of 0.899 (0.876-0.922), a sensitivity of 83.838% (76.587-91.089), and a specificity of 96.000% (94.080-97.920). Certain patient specific clinical and radiological characteristics can predict the acceptance or rejection of a CSDH referral. Considering the precision of this scoring system, it has the potential for effectively triaging CSDH referrals.

Primary Health Care Problems and Necessities In Georgia

In the article it is discussed the essence, purpose of primary health care and the results of the reforms that have been implemented in it since Georgia gained independence. As it is well known, primary health care in highly developed countries receives the special attention from the government because it is responsible for taking care of the health of patients, their families and the community it serves. In 2014, the government of Georgia declared primary health care as a priority for Europe, but this is not reflected in its state funding. Primary health care accounts for 23.2% of the state funding of health care, and the hospital sector - 65.5%. The referral rate of patients in primary healthcare is 3.6 in Georgia, and 7.5 in Europe. In addition, in primary healthcare in Georgia, out-of-pocket payments account for 47%, in Germany 5%, etc. The goal of the reforms implemented in the primary health care of Georgia (the formation of the "Family Doctor" Institute, the implementation of the "Village Doctor" program, etc.) was to raise the image of the primary health care organizations, to turn patients to them, but this did not happen. Today, only 51% of patients refer to primary healthcare clinics in Georgia. In-depth reforms of primary healthcare in Georgia started in 2000. Financially, Great Britain, the World Bank, the European Union and others participated in it. The general plan for the development of primary health care for the years 200-2009 was developed, the department of primary health care was also established, which was abolished again a year later, etc. Although after that, the referral rate of primary care institutions increased by 25%, but this did not mean the final victory in the regulation of primary care. As a result, in 2015, the relevant ministry announced a new, fundamental reform of primary healthcare and adopted the 2016-2023 project for the development of this field. Today is 2022, that is, six years have passed since the announcement of this supposedly fundamental reform, during which the number of patients referred to primary health care rose to 3.6. But even this is not enough - the institution of "family doctor" and "rural doctor" in Georgia is still underdeveloped: studies show that 18% of respondents evaluated the institution of "family doctor" negatively, 47% call for cardinal changes in it and etc. Moreover, in order to respond to these challenges, the article emphasizes the need for the relevant bodies of Georgia to familiarize themselves with the European framework - "Health 2020" and to build the primary health care of Georgia in a European manner. Keywords: Primary health care; the patient; "Family doctor"; "Village Doctor"; "Health - 2020".

S1453 Weight Loss in Bariatric Surgery Patients Treated at a Novel Clinic Incorporating Obesity Medicine for Treatment of Nonalcoholic Fatty Liver Disease

Introduction: The Yale Fatty Liver Disease Program (YFLDP) is a patient care model incorporating weight management with standard hepatology care for targeted treatment of nonalcoholic fatty liver disease (NAFLD). Weight management is the mainstay treatment for NAFLD, with 10% total body weight loss (TBWL) leading to disease improvement. Bariatric surgery is an effective treatment for obesity and associated metabolic diseases, though only an estimated 1% of eligible patients receive referral nationwide. We studied YFLDP patient referral rates to bariatric surgery, clinical and surgical characteristics, and weight loss outcomes. Methods: We retrospectively extracted demographic, surgical, and weight loss outcome data of adult YFLDP patients from 10/2015 to 5/2022. Standard eligibility criteria included body mass index (BMI) >40 kg/m2 or >35 kg/m2 with an obesity-associated comorbidity. Actual 1-year weight loss outcomes were compared to predicted weight-loss outcomes calculated using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator and assessed with a 2-tailed t-test. Results: There were 1,166 patients, of whom 596 (51.1%) were eligible for bariatric surgery (Table). Of these, 150 (25.3%) received referral, 32 patients (21.3%) underwent surgery (22 received sleeve gastrectomy (SG) and 10 had a Roux-en-Y gastric bypass [RYGB]). Patients who received surgery were more likely female and upper class compared to those who continued with lifestyle/medication management. Patients receiving SG and RYGB had mean TBWL 21.5% and 20.0%, respectively, while patients who continued medication/lifestyle management had TBWL of 3%. There was no significant difference comparing actual vs predicted final BMI (P=0.12), actual vs predicted weight loss (P=0.13), and actual vs predicted TBWL (P=0.13) post-bariatric surgery for all procedures (Figure). Conclusion: Integration of weight management with hepatology medical care is an effective model for NAFLD weight loss treatment. Patients receive referral for bariatric surgical evaluation at a rate 25 times greater than the national average, and those that receive surgery have comparable weight loss to that predicted in all patients receiving these surgeries, and on average exceeded the treatment threshold expected to treat NAFLD. Further study to identify patients who would most benefit from bariatric surgery would help to inform better patient selection and proactive referral efforts.Figure 1.: Predicted vs actual bariatric surgical outcomes in patients referred for surgery. (A) Actual vs Predicted Final Body Mass Index (BMI) post Bariatric Surgery: Comparison between YFLDP (Yale Fatty Liver Disease Program) patients’ actual BMI post bariatric surgery vs predicted BMI post bariatric surgery using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator. There was no statistically significant difference between actual and predicted BMI (P=0.12). (B) Total Body Weight Loss (TBWL) in Patients given Bariatric Surgery Referral: Comparison between YFDLP patients’ total body weight % reduction in patients given a bariatric surgery referral who either underwent a gastric bypass or sleeve gastrectomy or did not have surgery and continued with lifestyle/medication management. Patients who underwent surgery had a statistically significant percent reduction in TBWL compared to patients managed with only lifestyle/medications. Error bars represent standard error. ***P< 0.001 Table 1. - Demographic and surgical characteristics of Yale Fatty Liver Disease Program patients who were referred for bariatric surgery Patient Characteristics Referred, Underwent Bariatric Surgery (+)(n=32) Referred, Did Not Undergo Bariatric Surgery (-)(n=118) P Sex n (%) Male 6 (19) 35 (30) 0.22 Female 26 (81) 83 (70) Age years (SD) 49 (10.3) 51 (12.98) 0.60 Medicare Qualifying n (%) 2 (6) 19 (12.98) 0.15 Race n (%) White 22 (69) 86 (73) 0.29 Black 4 (13) 15 (13) Asian 1 (3) 0 (0) Other/Declined 5 (15) 17 (14) Ethnicity n (%) Hispanic 6 (19) 27 (23) 0.62 Non-Hispanic 26 (81) 91 (77) Insurance Status n (%) Uninsured 0 (0) 0 (0) 0.045 Medicaid 14 (44) 31 (26) Medicare 2 (6) 27 (23) Private 16 (50) 60 (51) Median House Income by Zip Code n (%) < $50k 7 (22) 29 (25) 0.48 $50k-100k 19 (59) 75 (63) >$100k 6 (19) 14 (12) Anti-Obesity Medications n (%) Lifetime 16 (47) 38 (32) 0.78 Since YFLDP 10 (31) 29 (25) BMI Reduction mean (SD) RYGB (n=10) 8.3 (5.4) Predicted 1.3 (3.9) < 0.001 SG (n=22) 9.4 (6.1) < 0.001 TBWL % (SE) RYGB (n=10) 20.5 (3.5) Predicted 3 (0.8) < 0.001 SG (n=22) 21 (2.73) < 0.001 (+) Surgery denotes patients who underwent bariatric surgery after referral. (-) Surgery denotes patients who did not undergo bariatric surgery after referral. Patients who underwent bariatric surgery had statistically significant greater reduction in mean BMI compared to patients who did not have surgery. SD is standard deviation, SE is standard error, BMI is body mass index (kg/m2), RYGB is Roux-en-Y gastric bypass, SG is sleeve gastrectomy, TBWL is total body weight loss.

Usage and perceptions of telemedicine among health care professionals in China

ObjectiveTo explore health care professionals' usage and perceptions of telemedicine, including their experience, evaluation and attitude towards telemedicine, and the factors affecting their satisfaction, using intention, and willingness to recommend telemedicine. MethodsA nationwide and web-based survey was conducted. Statistical charts were used to describe the usage and perceptions of telemedicine by health care professionals. And the ordinal logistic regression was applied to analyze the influencing factors. ResultsA total of 1349 valid questionnaires were collected. In the survey, 74.0 % of Chinese health care professionals used telemedicine once a week. The average duration of participating in telemedicine services lasted mainly 11–30 min (64.0 %). More than half (52.5 %) of participants' hospitals adopted fee subsidy measures, followed by the award for excellent evaluation (36.4 %). The majority (92.5 %) believed that telemedicine could reduce patient referral rates. More than 95 % were satisfied with telemedicine, were willing to continue, and would recommend telemedicine for patients, respectively. The main problems existing were: incomplete system equipment, insufficient timeliness, high costs, inability to reimburse medical insurance, non-standardized medical records, inadequate publicity, cumbersome processes and long waiting time. Ordinal logistic regression showed that too short service duration (≤10 min) could significantly reduce medical professionals' overall satisfaction, using intention and willingness to recommend (P = 0.026, P = 0.017 and P = 0.040 respectively), while the convenience of the operating system had a significant positive impact (P = 0.005, P = 0.003 and P = 0.001 respectively). And cost subsidy incentive and the promotion of professional titles could significantly enhance their overall satisfaction(P = 0.006, P = 0.030), using intention (P = 0.011, P = 0.001), and willingness to recommend (P = 0.040, P = 0.004). ConclusionsThe usage of telemedicine is relatively insufficient. Most health care professionals have fairly positive opinions toward telemedicine. The most mentioned issues and expectations for telemedicine can be roughly divided into four categories: infrastructure, service process, charge and cost, and popularity. It is possible to improve their evaluation by improving system convenience, enhancing service punctuality, avoiding excessively short service duration and adopting incentive measures.

Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis.

Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns. The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis. Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested). Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.

Management of Patients via Telemedicine Who were Admitted to the Emergency Department in a Rural Settlement in Turkey

Aim: There are a limited number of studies on the use of telemedicine by primary care physicians in Turkey. Our aim in this study was to investigate the consultation results of patients living in rural areas who were admitted to the district integrated hospital with chest pain and evaluated by a cardiologist by telemedicine. Methods: This was a retrospective cohort study. The study was conducted with patients who came to the Emergency Department of Büyükorhan Integrated Hospital with chest pain. Emergency observation forms, electrocardiograms and cardiac blood markers (CK-MB, Troponin) were evaluated. The case group consisted of 50 patients who were consulted by a cardiologist. A control group was randomly selected among patients with chest pain who were admitted to the emergency department of the hospital in a similar time period but who were not consulted. Results of these consultations including two-year survival rates of the patients were evaluated. Results: The rate of angiography and stent administration for patients consulted by a specialist cardiologist was significantly higher than in non-consulted cases. However, there was no difference in survival times of the consulted cases compared to the controls. Age was found to be a statistically significant factor when examining the causes that affected two-year survival of patients. Hypertension and coronary artery disease were associated with two-year mortality. Referrals, intensive care admissions and hospital admissions were also among the identified risks for two-year mortality. Conclusions: According to the results of the current study, patient referral rates and interventional procedures increased with consultation. Although the increase in the number of referrals and diagnoses did not affect mortality, it is likely that it positively affected quality of life.

Factors influencing genetic counseling and testing for hereditary breast and ovarian cancer syndrome in a large US health care system.

Investigate whether disparities and other factors influence referral to genetic counseling and testing for hereditary breast and ovarian cancer syndrome (HBOC) in a large health care system. Examination of clinical, demographic, and socioeconomic factors from electronic health records associated with genetic referral and testing within 12months after a new cancer diagnosed between August 1, 2013 and December 31, 2018. For patients meeting institutional criteria for HBOC testing, 60.6% were referred for genetic counseling, 88% of whom underwent germline testing; at least one pathogenic variant was found in 15.3%. Referral rates for patients with breast (69%) or ovarian cancer (65.7%) were much higher than for metastatic prostate (11.1%, p< 0.0001) or pancreatic cancer (22.3%, p< 0.0001); referral criteria were implemented more recently for the latter two cancers. Younger age, family history, and chemotherapy were associated with referral. Higher Elixhauser comorbidity score and prior cancer were associated with non-referral. No other factors were associated with genetic referral for all eligible cancers combined, although differences were seen in specific cancers. Race was a significant factor only for breast cancer, with fewer Asians than Whites referred. Health disparities in referral to genetics for HBOC cancers are mitigated in a comprehensive integrated health care system.

Üroloji doktorlarının radyasyona bağlı hemorajik sistitte hiperbarik oksijen tedavisi uygulamasına dair bilgi düzeyleri ve görüşleri: anket çalışması

Objective: Radiation-induced hemorrhagic cystitis (RHC) is an accepted hyperbaric oxygen therapy (HBOT) indication. We aimed to analyze the knowledge and the opinions of urology physicians on HBOT in RHS patients with a survey. Materials and Methods: The questionnaires were conducted face to face or online on urology physicians. Results: Seventy-seven urology physicians participated in our study. Physicians have been working for 11 ± 10.5 years in the field of Urology. The 84.4% of our physicians had an average of 0-10 RHC patient administration in a year. However, the majority of the participants stated that they have never referred RHC patients to HBOT. Similarly, 48.1% of the physicians stated that they have insufficient knowledge of HBOT for their specialty. On the other hand, the majority were not sure about the HBOT as an effective treatment option in RHC patients (54.5%), about the cost-effectiveness of HBOT for RHC (66.2%), and the ability of HBOT on shortening the recovery period of RHC patients (49.9%). We observed that physicians who did not have any knowledge on HBOT had statistically significantly lower RHC patient referral rates to HBOT and had more negative opinions on the effectiveness of HBOT in RHC patients (respectively p&lt;0.001, p=0.002). Likewise, physicians who had RHC patient admissions had statistically significantly more positive opinions about HBOT in terms of treatment efficiency, shortening the recovery period, and being a safe treatment option in RHC patients compared to the physicians who did not have any RHC patient admissions (respectively p&lt;0.001, p&lt;0,001, p&lt;0.001). Conclusion: We found that the urology physicians’ knowledge of HBOT application in RHC patients was insufficient. Thus, we realized that they were doubtful about HBOT as an effective RHC treatment option. Likewise, we found out that most of the urology physicians do not refer RHC patients for HBOT. Keywords: hyperbaric oxygen therapy, cystitis, radiation injuries, bladder, urologists

Patients eligible and referred for bariatric surgery in southeastern Ontario: Retrospective cohort study.

To evaluate the proportion of eligible individuals, within one health region in Ontario, who were referred for publicly funded medical and surgical weight-loss interventions (MSWLI). A retrospective cohort study that used primary care data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and referral data from the Ontario Bariatric Network (OBN). Primary care practices within southeastern Ontario that contribute data to CPCSSN. Patients with class II (body mass index [BMI] 35.0 to 39.9 kg/m2) or III (BMI ≥ 40 kg/m2) obesity who were eligible for referral to the OBN for MSWLI. Primary care data about patients within the CPCSSN database were linked to referral records within the OBN database using 3 indirect identifiers to determine the proportion of patients with class II and III obesity who were referred to the OBN for MSWLI. An adjusted multivariate logistic regression model was used to determine the most significant predictors of referral. Of the 87 276 patients within one health region in Ontario, 15 526 (17.8%) patients had class II or III obesity and were eligible for referral for MSWLI. Only 966 out of those 15 526 (6.2%) patients were actually referred for MSWLI. In the multivariate regression analysis, BMI had the strongest association with referral in terms of adjusted odds ratio (AOR), varying from 2.50 (95% CI 2.04 to 3.06) for a BMI of 40.0 to 44.9 kg/m2, to 5.15 (95% CI 4.21 to 6.30) for a BMI of 50.0 kg/m2 or greater. Referral was more likely for female than male patients (AOR = 2.18; 95% CI 1.86 to 2.57), those living rurally than for urban dwellers (AOR = 1.39; 95% CI 1.20 to 1.60), and those aged 30 to 39 (AOR = 1.61; 95% CI 1.24 to 2.09) and 40 to 49 (AOR = 1.53; 95% CI 1.18 to 1.98) compared with other age groups. Within one health region in Ontario, the referral rate of patients with class II and III obesity for MSWLI was low. Our findings highlight the need for further research to understand and address the barriers to referral of patients with class II and III obesity for MSWLI.

Four-steps surgery for infected pancreatic necrosis based on "Step-up" strategy: a retrospective study

Objective: To examine the effect of the "four-steps" treatment on infectious pancreatic necrosis(IPN). Methods: The data of 207 patients who were diagnosed with IPN from January 2013 to December 2017 at Department of Pancreaticobiliary Surgery, the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among 207 patients, 132(63.8%) were males and 75(36.2%) were females. The median age was 45 years old (range: 19 to 80 years old). One hundred and fifty-eight patients(76.3%) suffered severe acute pancreatitis and 49 patients(23.7%) suffered moderately severe acute pancreatitis. Percutaneous catheter drainage(PCD) was performed on all the patients(Step 1). Patients received "four-steps" minimally invasive treatment strategy in step-up group(173 patients). The following steps after PCD were mini-incision access pancreatic necrosectomy(MIAPN) (Step 2), sinus tract endoscopic debridement and(or) PCD for residual infections(Step 3) and finally conventional open pancreatic necrosectomy(OPN) (Step 4). Patients(34 cases) received conventional open pancreatic necrosectomy after invalided PCD in OPN group. The perioperative parameters and prognosis were compared between Step-up group and OPN group. Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ(2) test or Fisher exact test, respectively. Results: The basic characteristics of the two groups of patients were similar, but the referral rate of patients and the rate of preoperative 3 days organ failure in the OPN group were significantly higher than those of step-up group patients(47.1% vs. 28.9%, χ(2)=4.313, P=0.038; 26.5% vs. 9.2%, χ(2)=2.819, P=0.011). The frequency of PCD and the number of PCD tube (root) were less than those in the step-up group(1(1) vs. 2(1), Z=-3.373, P=0.018; 2(1) vs. 3(2), Z=-2.208, P=0.027). Compared with the OPN group, the interval time from onset to surgery and the MIAPN operation time were significantly shorter in the step-up group(29(15) days vs. 36(17)days, Z=-0.567, P=0.008; 58(27)minutes vs. 90(56)minutes, Z=-3.908, P<0.01); postoperative mortality was lower(5.8% vs.17.6%, χ(2)=4.070, P=0.044); the overall incidence of postoperative complications was reduced(23.1% vs. 55.9%, χ(2)=14.960, P<0.01) and the incidence of new-onset organ failure was decreased after operation in the step-up group(37.5% vs.47.4%, χ(2)=7.133, P=0.007). The incidence of local abdominal complications (pancreatic fistula, intra-abdominal hemorrhage, gastrointestinal fistula) showed no significant difference between the two groups (P>0.05). Fewer patients required ICU treatment after operation in the step-up group compared with OPN group(22.0% vs. 44.1%, χ(2)=6.204, P=0.013). Patients in the Step-up group has shorter hospital stay than patients in OPN group (46(13) days vs. 52(13)days, Z=-1.993, P=0.046). Conclusions: The clinical effects of "four-steps" exhibited the superiority of minimally invasive treatment of IPN.And MIAPN is a simple, safe and effective procedure to remove pancreatic necrotic tissue and decrease complications.

Effectiveness of mental health community training on depression and anxiety to the health care profession working in rural centers of eastern Nepal.

Background:Depression and anxiety is the leading cause of disease burden in low- and middle-income countries. It is associated with a worse clinical course over the lifespan. This study aims the post-effect on the approach of managing depression and anxiety after the training on diagnosis and management of depression and anxiety.Methods:This is a prospective observational study done in the health care professionals who had done training on diagnosis and management of depression and anxiety from me. The participants were evaluated with the questionnaire.Results:The training was given in three parts in three different places of eastern Nepal with the health care professionals working near to those centers. There were total of 49 participants from 17 different primary health care centers. The referral rate of patients with depression and anxiety was decreased by 27% as stated by the participants as they can give psychoeducation and counseling in a very well manner after training which was lacking before training.Conclusions:Overall, the findings from the current data suggest that there is merit in continuing to evaluate and deliver community health training programs for depression and anxiety. While prevention type and personnel delivering the intervention account for aspects of the heterogeneity observed, more research is needed to identify how program completion and fidelity impact outcomes.

Hyperbaric oxygen therapy awareness within a doctor population

Hyperbaric medicine is a relatively young specialty that remains in the blind spot of most doctors' awareness. This study endeavors to identify the level of awareness of the indications for hyperbaric oxygen (HBO2) therapy among a doctor population in a developed country and factors which may improve referral rates. An anonymized questionnaire was distributed to doctors licensed to practice in Malta. Questions included physician specialty, demographics and previous exposure to diving and/or hyperbaric medicine. Moreover, two scoring systems were used to score subjects on HBO2-related topics. Binomial logistic regression models and generalized linear models were used in the statistical analysis. A total of 152 full replies were obtained and analyzed. Respondents who had visited a hyperbaric unit (HBU) (p=0.002) or attended a lecture on HBO2 (p=0.006) scored better than their counterparts, indicating better awareness of HBO2 indications and local chamber location. A previous HBU visit (p=0.001), being a hospital-based doctor (p=0.027) and a history of scuba diving (p=0.03) were associated with willingness to refer patients for HBO2 in the future. Encouraging visits to an HBU has been shown to be associated with multiple factors, which are expected to result in improved referral rates. Targeted educational sessions to doctors and medical students are likely to be beneficial in improving correct referral of patients for HBO2. The findings from this study may prove useful in improving appropriate referral rates of patients who may benefit from this useful treatment modality.

SAT-074 LIVE KIDNEY DONATION AOTEAROA - IMPROVING LIVE KIDNEY DONATION IN INDIGENOUS AND MIGRANT POPULATIONS IN SOUTH AUCKLAND, NEW ZEALAND

The Live Kidney Donation Aotearoa Project (LKDA) was a 4 year initiative to increase the number of people donating kidneys to patients with end stage kidney disease either before commencing dialysis or receiving dialysis treatment at a large metropolitan hospital in South Auckland, New Zealand. The project was a joint venture with a patient support group. The focus was on indigenous Maaori and migrant Pasifika people (PI), both donating and receiving kidneys, as there is a demonstrated disparity compared to the rest of the dialysis population that is not entirely explained by medical co-morbidities. Barriers to transplantation and to organ donation include: access to clear and understandable information, lack of cultural skills in relevant health providers, an over-emphasis on dialysis decision-making in the pre-dialysis period, and insufficient resources and operational support for patient workup. Year 1(2013) of the project predominantly involved the development of all the resources with years 2 to 4 of the project being the implementation period. Objectives The project aimed to increase live kidney donation offers and completed donation using a multi-faceted health service delivery improvement project to educate, encourage and facilitate live donation. We established a whole of renal service and community approach to improve live donation offers and transplantation. These included resource development, peer support, home based education, policy change, community engagement and primary health care education. •Live kidney donor offers increased from an estimated 10 per year prior to 2013 to over 80 per year from 2014. (Fig 1)•Live kidney donation has increased from an average of 2 per year prior to 2013 to over 10 a year from 2014. (Fig 2)•Number of living donor renal transplants increased in the Maaori and Pasifika groups from 5 (2 and 3 respectively) during 2006-2013 period to 17 transplants (6 and 11 respectively) during the period from 2013 to mid-2017.•Patient referral rates for renal transplant assessment and LKD increased from 39.4% to 59%.View Large Image Figure ViewerDownload Hi-res image Download (PPT) This project has demonstrated that a wide ranging approach to improving live kidney donation resulted in improved patient outcomes for priority populations.

Reducing attendance at trauma clinics by providing first-point-of-contact treatment.

In 2016, the urgent and ambulatory care service in Oxfordshire formed part of a cross-organisational partnership working group. The group consisted of Oxford Health NHS Foundation Trust community minor injury units (MIUs) at Abingdon and Witney, and Oxford University Hospitals NHS Foundation Trust (OUH) trauma and orthopaedic specialties and emergency department (ED). The aim was to redesign fracture management pathways and delivery of definitive care at patients' first point of contact with the NHS. This article discusses the implementation of the trauma pathways in two of Oxfordshire's community MIUs. In total, a range of seven common fracture pathways seen in the ED and community MIUs were redesigned so that patients were treated definitively at the first point of contact and discharged with a safety net supported by leaflets; a direct contact facility to OUH trauma specialties was part of the safety net allowing patients to self-refer to the trauma clinic if they had any concerns. In total, 513 patients were treated and discharged on see, treat and discharge fracture pathways in the first year of pathway operation, which represented a 21% decrease in patient referral rates to the trauma clinic at OUH compared with the previous year.

Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial.

BackgroundGuidelines for the management of type 2 diabetes universally recommend that adults with type 2 diabetes and obesity be offered individualized interventions to encourage weight loss. Yet despite the existing recommendations, provision of weight management services is currently patchy around the United Kingdom and where services are available, high attrition rates are often reported. In addition, individuals often fail to take up services, that is, after discussion with a general practitioner or practice nurse, individuals are referred to the service but do not attend for an appointment. Qualitative research has identified that the initial discussion raising the issue of weight, motivating the patient, and referring to services is crucial to a successful outcome from weight management.ObjectiveOur aim was to evaluate the effectiveness of an Internet-based training program and practice implementation toolkit with or without face-to-face training for primary care staff. The primary outcome is the change in referral rate of patients with type 2 diabetes to National Health Service adult weight management programs, 3 months pre- and postintervention.MethodsWe used the Behavior Change Wheel to develop an intervention for staff in primary care consisting of a 1-hour Internet-based eLearning package covering the links between obesity, type 2 diabetes, and the benefits of weight management, the treatment of diabetes in patients with obesity, specific training in raising the issue of weight, local services and referral pathways, overview of weight management components/ evidence base, and the role of the referrer. The package also includes a patient pamphlet, a discussion tool, a practice implementation checklist, and an optional 2.5-hour face-to-face training session. We have randomly assigned 100 practices in a 1:1 ratio to either have immediate access to all the resources or have access delayed for 4 months. An intention-to-treat statistical analysis will be performed.ResultsRecruitment to the study is now complete. We will finalize follow-up in 2018 and publish in early 2019.ConclusionsThis protocol describes the development and randomized evaluation of the effectiveness of an intervention to improve referral and uptake rates of weight management programs for adults with type 2 diabetes. At a time when many new dietary and pharmacological weight management interventions are showing large clinical benefits for people with type 2 diabetes, it is vital that primary care practitioners are willing, skilled, and able to discuss weight and make appropriate referrals to services.Trial RegistrationClinicalTrials.gov NCT03360058; https://clinicaltrials.gov/ct2/show/NCT03360058 (Archived by WebCite at http://www.webcitation.org/74HI8ULfn)International Registered Report Identifier (IRRID)DERR1-10.2196/12162