Walk-in Clinic Research Articles

“They really hear you out”: Lessons on providing contraceptive care from a community-based sexual health clinic

Individuals in Canada may obtain prescription contraception from a family doctor, a walk-in clinic, or sexual health clinic. While there are guidelines for best practice in contraceptive care, the quality of this care varies widely. Access to any contraceptive care is also a concern, partly due to increasing pressures on physicians’ time. These issues have led to calls to expand contraceptive care into the purview of nurses and other qualified health professionals, a ‘task-sharing’ approach. Here, we use data from semi-structured interviews with providers and patients at a sexual health clinic in British Columbia to examine the benefits of such an approach as implemented in this particular clinic. We conducted semi-structured interviews with physicians, nurses, volunteer peer contraceptive educators, and patients about their experience providing or obtaining care at the clinic, and thematically analyzed the resulting data. Interviewees identified four key benefits in the clinic’s approach: the value of a specialized sexual health clinic where providers had a wealth of experience providing sexual health care; the time and attention given by providers relative to practitioners at other types of clinics; the increased efficiency facilitated by a task-sharing approach; and the inclusive and supportive environment. Although some aspects of this clinic’s strategy are not transferrable to all settings, implementing elements of this model in other settings could increase access to quality contraceptive care.

2020 ANCC Pathway Award® winner.

2020 ANCC Pathway Award® winner.

COVID pandemic as an incubator for a renewed vision of pediatric value-based healthcare

COVID-19 has stressed primary care pediatric practices. In addition, other market pressures that began before the pandemic make this an optimal time to re-examine pediatric payment models. CMS is encouraging changes in the Medicare market toward alternative payment models. However, success is limited for older adults, and while components of these models can work for pediatricians, the needs of children, young adults and their families are different from older adults. The rapid evolution of telemedicine, and the incursion of retail clinics and urgent care centers are eroding same day office visits and at the same time practices are merging or being acquired by larger organizations including hospitals and insurance companies. All of these changes will require a change in culture and approach in pediatric practice, and modified payment models must incentivize the best care for patients and families and create the opportunity for pediatricians to succeed.

Clinical presentation, diagnosis, and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation.

Atrioesophageal fistula (AEF) is a worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. The digital search retrieved 150 studies containing 257 cases, 238 (92.6%) of which with a confirmed diagnosis of AEF and 19 (7.4%) of pericardioesophageal fistula. The median time from ablation to symptom onset was 21 days (interquartile range [IQR]: 11-28). Neurological abnormalities were documented in 75% of patients. Compared to patients seen by a specialist, those evaluated at a walk-in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission (median: 2.5 day [IQR: 1-8] vs. 1 day [IQR: 1-5); p = .03). Overall, 198 patients underwent a chest scan (computed tomography [CT]: 192 patients and magnetic resonance imaging [MRI]: 6 patients), 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan (p < .001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course, as well as an early contact with the treating electrophysiologist for a coordinated interdisciplinary medical effort, are pivotal to prevent diagnostic delays and reduce mortality.

B-PO03-083 CLINICAL PRESENTATION, DIAGNOSIS, AND TREATMENT OF ATRIOESOPHAGEAL FISTULA RESULTING FROM ATRIAL FIBRILLATION ABLATION

Atrioesophageal fistula (AEF) is a rare but worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. Our search retrieved 149 studies containing 238 cases, 220 (92.4%) of which with a confirmed diagnosis of AEF and 18 (7.6%) of pericardio-esophageal fistula. The median time from ablation to symptom onset was 21 days [IQR: 11-28]. Neurological abnormalities were documented in 78% of patients. Compared to patients seen by a specialist, those evaluated at a walk-in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission [median: 2.5day (IQR:1-8) vs 1day (IQR:1-5); p=0.03]. Overall, 198 patients underwent a chest scan [(computed tomography (CT): 192 and magnetic resonance imaging (MRI): 6], 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan (p<0.001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course and promotion of an interdisciplinary medical effort are pivotal to prevent diagnostic delays and reduce mortality.

Maternal mental healthcare needs of refugee women in a State Registration and Reception Centre in Germany: A descriptive study

Pregnant refugees and new mothers are at high risk of developing mental health problems. Previous research has highlighted an increase in adverse pre-, peri- and postpartum outcomes in refugee women and their newborns. This descriptive study aimed to present the characteristics and needs of refugee women who attended a psychosocial walk-in clinic addressing pregnant refugees' and new mothers' maternity mental healthcare needs in a state registration and reception centre in Germany. We assessed all patients that consulted the clinic and received interventions during the first 28weeks after it opened, collecting information on symptoms, diagnoses, attitudes towards and experience of pregnancy, birth, obstetric care and applied psychosocial interventions during consultations. Between November 2017 and May 2018, N=120 pregnant refugees and new mothers attended the clinic. Most patients were diagnosed with post-traumatic stress-, adjustment- or depressive disorder. While 69.6% of the women reported physical and mental health problems during pregnancy, 87.4% experienced obstetric complications. Trauma-informed and psychoeducational interventions were primarily used during counselling sessions. Our data underpin the glaring disparities in refugee maternal healthcare in Germany. Maternal care designed to meet the specific needs of pregnant refugees and mothers is essential. More targeted, evidence-based and cost-effective interventions are needed. Our psychosocial walk-in clinic is a first step towards ensuring primary care delivery for refugee women during the particularly vulnerable period of pregnancy and early motherhood.

Predictors of aetiology and outcomes of acute gastrointestinal illness in returning travellers: a retrospective cohort analysis

BackgroundGastrointestinal illness is a major cause of morbidity in travellers and is a common reason for presentation to healthcare services on return. Whilst the aetiology of imported gastrointestinal disease is predominantly infectious, outcomes are variable due to a range of phenomena such as post-infectious irritable bowel syndrome, drug resistance and occult pathology (both infectious and non-infectious). Previous studies have focussed on predictors of aetiology of gastrointestinal disease in travellers; we present a retrospective study combining both aetiological and early outcome data in a large cohort of returned travellers.MethodWe identified 1450 patients who attended our post-travel walk-in clinic with gastrointestinal symptoms between 2010 and 2016. Demographic, travel, clinical and laboratory data was collected through case note review. Logistic regression analysis to examine correlates of aetiology and outcome were performed in R (CRAN Project 2017).ResultsOf 1450 patients in our cohort 153 reported bloody diarrhoea and 1081 (74.6%) reported non-bloody diarrhoea. A definitive microbiological diagnosis was made in 310 (20.8%) of which 137 (9.4%) had a parasite identified and 111 (7.7%) had a bacterial cause identified. Factors associated with a parasitological diagnosis included history of travel to South Asia (aOR = 2.55; 95%CI 1.75–3.70, p < 0.0001) and absence of bloody diarrhoea (aOR = 0.22; 95%CI 0.066–0.53, p < 0.005). Factors associated with a bacteriological diagnosis included male gender (aOR = 1.69; 95%CI 1.10–2.62, p < 0.05), an age < 37 years on presentation (aOR = 2.04; 95%CI 1.25–3.43, p < 0.01), white cells on stool microscopy (aOR = 3.52; 95%CI 2.09–5.86, p < 0.0001) and a C-reactive protein level of >5iu/dL (aOR = 4.68; 95%CI 2.91–7.72, p < 0.0001). The majority (1235/1450, 82.6%) reported full symptomatic resolution by the first follow up visit; factors associated with lack of symptomatic resolution included female gender (aOR = 1.45 95%CI 1.06–1.99, p < 0.05), dysenteric diarrhoea (aOR = 2.14 (95%CI 1.38–3.25, p < 0.0005) and elevated peripheral leukocyte count (aOR = 1.58 95%CI 1.02–2.40, p < 0.05).ConclusionsIn a cohort of returned travellers, we were able to identify multiple factors that are correlated with both aetiology and outcome of imported gastrointestinal syndromes. We predict these data will be valuable in the development of diagnostic and therapeutic pathways for patients with imported gastrointestinal infections.

An Environmental Scan of Virtual "Walk-In" Clinics in Canada: Comparative Study.

BackgroundCanada has been slow to implement virtual care relative to other countries. However, in recent years, the availability of on-demand, “walk-in” virtual clinics has increased, with the COVID-19 pandemic contributing to the increased demand and provision of virtual care nationwide. Although virtual care facilitates access to physicians while maintaining physical distancing, there are concerns regarding the continuity and quality of care as well as equitable access. There is a paucity of research documenting the availability of virtual care in Canada, thus hampering the efforts to evaluate the impacts of its relatively rapid emergence on the broader health care system and on individual health.ObjectiveWe conducted a national environmental scan to determine the availability and scope of virtual walk-in clinics, cataloging the services they offer and whether they are operating through public or private payment.MethodsWe developed a power term and implemented a structured Google search to identify relevant clinics. From each clinic meeting our inclusion criteria, we abstracted data on the payment model, region of operation, services offered, and continuity of care. We compared clinics operating under different payment models using Fisher exact tests.ResultsWe identified 18 virtual walk-in clinics. Of the 18 clinics, 10 (56%) provided some services under provincial public insurance, although 44% (8/18) operated on a fully private payment model while an additional 39% (7/18) charged patients out of pocket for some services. The most common supplemental services offered included dermatology (15/18, 83%), mental health services (14/18, 78%), and sexual health (11/18, 61%). Continuity, information sharing, or communication with the consumers’ existing primary care providers were mentioned by 22% (4/18) of the clinics.ConclusionsVirtual walk-in clinics have proliferated; however, concerns about equitable access, continuity of care, and diversion of physician workforce within these models highlight the importance of supporting virtual care options within the context of longitudinal primary care. More research is needed to support quality virtual care and understand its effects on patient and provider experiences and the overall health system utilization and costs.

Audit of physical health monitoring in a forensic psychiatric community caseload

AimsAdherence to Cumbria Northumberland Tyne and Wear NHS Foundation (CNTW) Trust physical health monitoring guidelines for a caseload of community forensic psychiatry patients residing at Westbridge supported accommodation was audited to identify areas for improvement in practice. It was also our aim to highlight the delay in obtaining non-urgent investigations due to the need to minimize COVID infection transmission risks.MethodData were collected from mental health and acute trust electronic records (Rio and ICE) of all patients taking antipsychotic medications currently care coordinated by the Westbridge Forensic Community Mental Health Team (FCMHT) between January 2020 and January 2021 (8 patients). Analysis of compliance with standards set by Trust guidelines was made.ResultIn the chosen audit period, compliance with physical health monitoring standards was below target of 100% (80% compliance for bloods, 50% for ECG). Reasons for non-compliance were unexpected restrictions in service availability (e.g. temporary closure of walk-in ECG clinic) and one omission of sending a prolactin levels request.ConclusionThe need for practice adaptation and advance planning by team in anticipation of potential delays was identified. Request for routine bloods and ECGs will now be made two months before the annual due dates to compensate for delays in the new process with plan to continue re-audit yearly.

Post COVID-19 Reimbursement Parity for Nurse Practitioners

Reimbursement parity of nurse practitioners (NPs) and physicians is appropriate now more than ever. Studies have demonstrated that NPs provide the same quality of care as physicians, yet they do not receive the same reimbursement. The rise in full practice authority states, as well as nurse managed clinics and retail clinics, has led to more NPs practicing independently. The COVID-19 pandemic opened a need for NPs to provide a greater amount of care in more settings, and thus led to temporary removals of practice restrictions to increase access to care. This article offers a review of the issues, such as “incident to” billing; direct and indirect reimbursement; and quality of care. We consider MedPAC and reimbursement policy, post COVID-19 policy solutions, and action steps to move forward to seek reimbursement parity. The COVID-19 pandemic serendipitously led to the removal of many restrictions on NP practice, offering an opportunity for NPs to work with MedPAC to achieve full reimbursement for care provided.

Evaluation of a Preventative Health Consultation Service for Patients at Student-Run Walk-In Health Clinics

Background: Preventative health services are often underutilized by under-resourced populations. This study aimed to evaluate the utility of a student-run preventative health consultation (PHC) service at free walk-in clinics.&#x0D; Methods: This prospective cohort study recruited adult participants from student-run free walk-in clinics at a Spanish-language church and a homeless shelter. During the PHCs, recommendations from the United States Preventative Services Task Force and Centers for Disease Control and Prevention immunization schedule were discussed with participants. The top three recommendations for each participant were prioritized using shared decision-making. Participants completed a post-PHC survey and were contacted within three months about recommendation completion status. Recommendations were grouped into categories and analyzed using descriptive statistics.&#x0D; Results: Of the 29 people enrolled in the study, 48% (n=14) were Spanish-speaking, and 45% (n=13) were homeless/displaced. There were 87 recommendations made and categorized as health behaviors (29.9%, n=26), vaccinations (18.4%, n=16), chronic disease screenings (18.4%, n=16), communicable disease screenings (17.2%, n=15), cancer screenings (11.5%, n=10), and other (4.6%, n=4). The most common completed recommendations were changes in health behaviors (46.2%, n=12) and chronic disease screenings (37.5%, n=6). Of the participants who completed the post-PHC survey, 96% (n=27) agreed or strongly agreed they learned new information about their health from the PHC, and 100% (n=29) reported being glad to have engaged in the PHC and that the PHC service should continue at the monthly clinics.&#x0D; Conclusions: Health behaviors, vaccinations, and chronic disease screenings were the most frequently prioritized preventative health needs. Student-run PHC services may offer a way to increase underserved patient knowledge and engagement with preventative healthcare.

A Systematic Review of New Approaches to Sexually Transmitted Infection Screening Framed in the Capability, Opportunity, Motivation, and Behavior Model of Implementation Science.

Chlamydia and gonorrhea are 2 of the most common bacterial sexually transmitted infections (STIs) worldwide. Rising chlamydia and gonorrhea rates along with increased closing of STI clinics has led many to seek STI testing in clinical settings such as urgent cares and walk-in clinics. However, with competing priorities, providing effective and efficient STI care can be difficult in these settings. This has left a growing need for the implementation of novel STI screening programs in other clinical settings. This review summarizes previous studies that have evaluated the clinical implementation of chlamydia and gonorrhea screening programs in these settings. Literature from January 2015 to February 2020 regarding the implementation or evaluation of STI screening programs in clinical settings was reviewed. Constructs from the Capability, Opportunity, Motivation, and Behavior model were used to organize results, as this model can aid in identifying specific strategies for behavior/process change interventions. We found that multiple STI screening programs have been implemented and evaluated in 5 different countries and multiple health care facilities including sexual health clinics, urgent cares, walk-in clinics, and university health clinics. When implementing new STI screening programs, sample-first, test-and-go services and molecular point-of-care (POC) testing approaches were found to be effective in increasing screening and reducing costs and time to treatment. At the health care systems level, these programs can help reduce STI screening costs and generate additional revenue for clinics. At the provider level, clear communication and guidance can help clinical and administrative staff in adopting new screening programs. Finally, at the patient level, new programs can reduce time to treatment and travel costs in visiting clinics multiple times for testing and treatment services.

Workload and patterns of care in the Timmins Family Health Team in Ontario.

To characterize primary care physician and nurse practitioner ("GP") workload and availability, and any relationship with daytime, low-acuity emergency department (ED) and after-hours walk-in clinic (WIC) visit counts. Retrospective database review. Timmins, Ont, with 5 family health team (FHT) office sites, 1 after-hours FHT WIC, and 1 ED. An anonymous data set representing 21 voluntarily enrolled GPs comprising 33 211 office appointments among 15 908 patients, plus 2043 ED visits and 2713 WIC visits, over 18 months. Roster size corrections for inactive ("dormant") patients, nursing supports, and patient complexity (age and sex). Availability of GPs was defined as the corrected number of office visits per patient per year. Linear and nonlinear relationships between GP availability and each roster's chronic disease burden (congestive heart failure, chronic obstructive pulmonary disease, and diabetes); ED visit count per patient; and WIC visit count per patient. Corrections for dormant patients and then for each of relative nursing support and patient complexity changed roster sizes by a mean (SD) of -8.4% (14.5%), -7.1% to 5.6% (median -1.6%), and 32.0% (18.2%), respectively. Combining these corrections increased effective roster size by a mean (SD) of 18.4% (7.3%). Larger rosters were not proportionately more dormant. In the Timmins FHT, GPs saw unique patients about 2.05 times per year (range 1.39 to 3.81). Availability of GPs did not change with increasing numbers of patients with congestive heart failure, chronic obstructive pulmonary disease, or diabetes in the roster. The ED diversion model had low explanatory power and was likely unreliable. The WIC diversion model was more robust, predicting 0.08 fewer WIC visits per patient per year if GP availability increased from 2.0 to 3.0 visits per patient per year (relative risk reduction of 41%). Sampled GPs manage a more complex patient population on average than their uncorrected roster sizes imply. There was no evidence that larger rosters or those with more patients with comorbid conditions reduced GP availability. Increasing physician availability might decrease WIC attendance.

Stressor Combat Strategies and Motivating Factors Among Health Care Service Providers During COVID-19 Pandemic.

ContextSince its inception in December 2019 in Wuhan, China, the severe acute respiratory syndrome coronavirus-2, the etiological agent for coronavirus disease 2019 (COVID-19), is spreading rapidly both locally and internationally, and became certified as a pandemic by the World Health Organization (WHO) in March 2020. Working in an environment of high risk, coupled with adherence to quarantine and stressors related to the job, has been found to exacerbate the psychological health of frontline healthcare workers.AimsTo assess the perceived stressors, combat strategies, and motivating factors among health care service providers during the COVID-19 pandemic.Setting and designA cross-sectional study was conducted among healthcare workers at a tertiary care hospital in the north-central region of India from May to September 2020.Methods and materialsA convenience sample of 150 health care workers was taken. A self-reported pretested structured “COVID 19 staff questionnaire” was used as a study tool. The health care workers (HCWs) included nurses, physicians, laboratory technicians, and radiology technicians who worked in high-risk areas (isolation ward, COVID intensive care unit, emergency department, and outpatient cough outdoor walk-in clinics) during the outbreak constituted our study population. Statistical analysis usedThe varying levels of stress or effectiveness of measures were reported as mean and standard deviation, as appropriate. Descriptive statistics were used for data presentation. A Mann-Whitney U test was used to analyse differences between two groups of non-normally distributed data. A p-value of less than 0.05 was considered statistically significant.ResultsAs compared to doctors, paramedical staffs were more stressed with frequent protocol changes (88%), emotional exhaustion (68%), and conflicts with duties (62.7%). The factors like seeing colleague getting better (78.7%) and hoping for financial compensation (49.3%) were reported as stress busters; family compensation in case of death at the workplace and disability benefits in case of disease-related disability development were more effective motivational factors for paramedical staff in case of future outbreaks (p-value <0.05).ConclusionsIt is needful that secondarily traumatized team members should be always observed, educated, and properly handled. Certain personal coping strategies adopted by health workers should be well addressed and motivated if scientifically sustainable. We have to include psychiatric preparedness and stress monitoring also for health care teams along with emphasizing hygiene, temperature monitoring, and fever management, in planning to fight the pandemic.

An Evidence-based Protocol to Improve HPV Vaccine Initiation Rates at a County Immunization Clinic

ABSTRACT Human Papillomavirus (HPV) is responsible for 26,900 cancer cases yearly, including genital and oropharyngeal cancers. Despite providing nearly 100% protection against cancer-causing strains of HPV, only 68.9% of teenagers receive even one dose of the HPV9 vaccine. To increase HPV9 vaccine series initiation rates among 11–14 year-olds. Vaccine rates were examined before and after multi-modal protocol implementation at a nurse-run, walk-in immunization clinic. Initiation increased from 17.9% in 2017 to 35.5% in 2018. Use of same way/same day recommendation practices and inclusion of non-clinician staff could improve quality of care and decrease HPV-related disease.

Pre-Implementation of the Age-Friendly Health Systems Evidence-Based 4Ms Framework in a Multi-State Convenient Care Practice.

Quality issues in the delivery of healthcare services to older adults and changes in societal demographics call for a social movement to improve the care of older adults in a variety of healthcare settings, including ambulatory care and convenient care clinics. To describe the pre-implementation phase to integrate the Age-Friendly Health Systems (AFHS) 4Ms (i.e., What Matters, Medication, Mentation, and Mobility) Framework in 1,100 MinuteClinics (the retail medical clinic of CVS Health) using the Consolidated Framework for Implementation Research (CFIR) and RE-AIM (an evaluation implementation framework). The CFIR and RE-AIM models guided data collection. Data were collected from all stakeholders (patients, healthcare providers, managers, educators, informatics staff, communications staff, and implementation consultants) via observations, surveys, interviews, focus groups, organizational readiness assessment, stakeholder assessment, and workflow mapping during a 15-month period to identify potential barriers, facilitators, and other opportunities for implementation. The CFIR and RE-AIM implementation frameworks provided a comprehensive approach to guide the pre-implementation phase of the AFHS 4Ms Framework at the MinuteClinic. The baseline assessments guided by the CFIR revealed important insights in the choice of implementation strategies that were developed and tested in the pre-implementation phase, and the RE-AIM guided meaningful components to the development of the logic model. As more healthcare systems integrate the AFHS 4Ms Framework, the approach reported in this quality improvement project can be used in other settings to facilitate a comprehensive implementation.

Patient and Resource Management of Emergency Walk-In Clinic During a COVID-19 Pandemic State Lockdown.

ObjectiveTo gather data on the most common chief complaints, diagnoses, in-office procedures, and surgeries that presented to the Kresge Eye Institute’s Emergency Clinic in Detroit, Michigan during the COVID-19 state lockdown period to provide data for staff and resource allocation in future waves.DesignRetrospective study.ParticipantsAll patients 18 years or older presenting for ophthalmic consultation to the Kresge Eye Institute Emergency Walk-in Clinic between March 23rd and April 17th, 2020 were included in the study.MethodsAll patients who met the inclusion criteria were indexed based on their initial encounter date and patients were stratified by urgent and non-urgent ophthalmic reasons for evaluation. Patient demographics, medical history, chief complaint, diagnosis, and need for surgical intervention and procedures were obtained from the electronic medical records.ResultsThe most common diagnoses were corneal disease (31.4%), followed by vitreoretinal disease (25.3%), orbit-eyelid pathology (8.8%), and glaucoma-related issues (8.8%). The most common office procedure was intravitreal injections (37.5%) followed by foreign body removal (21.9%), and pan-retinal photocoagulation laser (21.9%). Retina surgery was the most common emergency surgery representing 73.3% of the total, the second most common was keratoplasty (13%).ConclusionFuture implementation of protocols for triaging based on chief complaints can aid in protecting patients and expanding the role of distanced assessment with telemedicine. Suggested management of an emergent clinic requires availability of retina and cornea specialists given the majority of visits, procedures, and surgeries were related to their area of expertise.

Economic evaluation of pharmacists prescribing for minor ailments in Ontario, Canada: a cost-minimization analysis.

The objective of this study was to use a decision-analytic model to examine the potential economic impact of establishing a remunerated programme for pharmacists prescribing for minor ailments (PPMA) in Ontario, Canada. A novel decision tool was developed to assess the economic impact of pharmacists prescribing for upper respiratory tract infections (URTIs), contact dermatitis (CD) and conjunctivitis by performing a cost-minimization analysis from a public payer perspective. Two prescribing strategies were compared: (1) PPMA, where patients may seek care from pharmacists or physicians, and (2) the usual care model (UCM), where all patients receive care from physicians. Two remuneration models for the PPMA strategy were also compared: (1) a prescription-detached scenario (PDS), where pharmacists were remunerated CAD$18.00 for each consultation, and (2) a Prescription-Attached Scenario (PAS), where pharmacists were only remunerated if a decision to prescribe was made. At a service uptake rate of 38% for the PDS, the PPMA model led to savings of $7.51, $4.08 and $5.15 per patient for URTIs, CD and conjunctivitis, respectively. Per 30 000 patients, the PPMA model for these minor ailments was projected to lead to cumulative reductions in visits to the emergency department, family physician and walk-in clinics by 799, 3677 and 5090, respectively. The results of the study strongly suggest that enabling community pharmacists to assess and prescribe for minor ailments could potentially lead to large savings for the government in Ontario, Canada. In 100% of the PAS scenarios simulated, pharmacists as prescribers led to cost savings.

Binge Eating After Bariatric Surgery in Patients Assisted by the Reference Service in a Brazilian Hospital and the Correlation with Weight Loss.

Identify, 18 months after bariatric surgery, the binge eating variation and its relation with weight regain or loss. Cross-sectional, retrospective study with 108 patients, assisted by an obesity walk-in clinic of a specialized hospital in São Paulo (Brazil), who had undergone bariatric surgery a minimum of 18 months previously. The anthropometric and clinic data were collected from medical records, and binge eating symptoms were evaluated with the application of the Binge Eating Scale (BES). Scale outcomes were related to weight regain and loss at the application moment. The average age (standard error) of the sample was 47 years (±0.91) and 93% were female. Patients had lost 52.2% of their body weight and regained 4.7% of their weight 18 months after the surgery. The elapsed surgical time (> 50 months) was associated with a higher gross weight (p<0.0001). Bariatric surgery has been shown to be effective for improving diabetes mellitus as well as for controlling obesity. The variation in binge eating intensity 18 months after bariatric surgery is a factor that interferes in the amount of weight regained. The presence of binge eating symptoms negatively affects the % total weight loss (%TWL).

Anti-Cancer Effects of Huaier on Prostate Cancer; miRNA-Mediated Transcription Control Induced Both Inhibition of Active Progression and Prevention of Relapse

Prostate cancer is classified as mild malignant tumor, since the growth is slow, and also the early detection and monitoring of PSA and other cancer cell-specific markers are available among the target population in walk-in clinic even effect the bones and lymph nodes, it requires long term treatments which significantly decrease the lifespan in patients. Trametes robiniophila Murr (Huaier) has proved broad spectrum anti-cancer effects, which initiates the recovery of damaged bio physiological functions in the end by dose-dependent manner which proved the molecular basis of Huaier effects by total RNA and small non-coding RNA sequencing (“genome-scope” project) and that is based on the rescue of the disrupted transcriptional control based on individual capability and flexibility of genomic potential. Here we focused to show MEGA-DATA genome analysis results on inhibition of active progression in cancer in situ, and also prevents relapse of prostate cancer. Total sequencing of RNAs revealed massive SNP variances (average 89,473SNP variances per individual), however, it is unlikely that specific type variants influenced to the malignancy, process, and prognosis. On the other hand, the significant up-regulation and alteration of major ontogenesis and tumor suppressor genes were detected in transcribed genes, especially in altered (normalized) NFkB, TGFb, BRCA2 and p53 genes and their leading signaling pathways. These genetic alterations in transcriptomes were based on miRNA-mediated transcriptional control as reported drugs have not shown any effect. Thus, the present study provides the safe and effective treatment to prevent and inhibit prostate cancer progression, and also to maintain homeostasis in a long-range of stressful human life without excessive medical treatments.