Type Of Referral Research Articles

ONCOPEDS: A mobile application to improve early diagnosis and timely referral in childhood cancer in a low- and middle-income country-A pilot study.

Diagnosis delay in children and adolescents with cancer is a public health problem in Peru that leads to high rates of advanced disease and mortality. We aimed to assess the implementation feasibility and potential utility of ONCOpeds®, a mobile application that provides consultations with pediatric oncologists, in reducing the latency to diagnosis (LD) and referral time (RT) among children and adolescents in Peru diagnosed with cancer. A prospective pilot study was conducted in the region of Callao between November 2017 and April 2018. Primary and secondary care providers were trained on the use of ONCOpeds in five educational sessions. Patients younger than 18 years who resided in Callao and were diagnosed with cancer at four pediatric cancer units in Lima were analyzed by referral type: ONCOpeds facilitated or conventional. ONCOpeds was successfully installed in the smartphones of 78 primary and secondary care providers of Callao. During the study period, 23 new cases of cancer in children and adolescents from the region were diagnosed. Ten patients received ONCOpeds-facilitated referrals and 13 received conventional referrals. The RT decreased among those who received ONCOpeds-facilitated referrals by 66% (P=0.02); however, the LD did not significantly decrease with the use of ONCOpeds. The implementation of ONCOpeds was found to be feasible in this pilot study, having a potential utility in improving early diagnosis and referral in children and adolescents newly diagnosed with cancer. Directions for future research include multicenter studies with a larger population to further test the application's effectiveness.

The impact of education and clinical decision support on the quality of positive antinuclear antibody referrals

To implement and evaluate an intervention using education and clinical decision support (CDS) to improve the quality of positive ANA referrals. We retrospectively reviewed "positive ANA" referrals from April 2017 to May 2019. Demographic data and referring provider's location were recorded. Final diagnoses were categorized into two groups: rheumatic disease (RD) or no RD. We compared pre- and post-intervention groups for each type of referral. The positive predictive value (PPV) of an ANA referral leading to an RD for each referral group was calculated. Our intervention consisted of an educational poster and CDS which included a hard-stop prompt embedded into the electronic ANA order. All internal subgroups received CDS; only the main campus primary care providers (IPCP) received the educational poster. The external (EXT) referral subgroup did not receive either intervention. We found a significant increase in the number of RDs diagnosed post-intervention (p = 0.007). The PPV for all referrals increased from 16% to 26% during this project. All groups demonstrated improvement in PPV except the EXT group, which showed no change. Subgroups which demonstrated significant increase in the diagnosis of RD included total internal (p = 0.0005), internal PCP (p = 0.002), and affiliated primary care providers (p = 0.0002). The IPCP subgroup additionally received the educational intervention and did not demonstrate significant improvement. Implementing an intervention with a CDS component helps improve the quality of positive ANA referrals to rheumatology. Key Points • Clinical decision support improves the quality of positive ANA referrals. • Incorporating clinical decision support within the ANA order of an EHR is an effective way to deliver information to impact ordering at the "point of care."

The Influence of Word-Of-Mouth Referral on Consumers’ Purchase Intention: Experimental Evidence from WeChat

Based on the perspective of dual-system information processing, this article explores how word-of-mouth (WOM) referral affects the purchase intentions of consumers with different types of self-construal. Two experimental studies, using WeChat as a research setting, tested the interactive influence of type of WOM referral (economic vs. public welfare) and type of self-construal (independent vs. interdependent) on consumers’ purchase intention toward the referred product and its intermediary mechanism. The results showed that economic (vs. public welfare) WOM referrals, which emphasize a product’s economic benefits, increased the purchase intention of consumers with an independent (vs. interdependent) self-construal, who typically take an individualistic perspective. In contrast, public welfare (vs. economic) WOM referrals, which emphasize the social benefits connected to a company for the community at large, increased the purchase intention of consumers with an interdependent (vs. independent) self-construal, who take a more collectivistic perspective. The results also shed light on the underlying mechanism by showing that different types of self-construal activate different information processing systems in consumers, which mediate consumers’ reaction to different types of WOM referrals. Specifically, economic WOM referrals can inspire consumers with an independent self-construal to engage in more emotional processing, thereby generating higher purchase intentions; in contrast, public welfare WOM referrals can stimulate consumers with an interdependent self-construal to get involved in more cognitive processing, thereby generating higher purchase intentions. These findings contribute to WOM literature and provide practical implications for companies adopting societal marketing strategy and implementing sustainable promotional plans.

The Heterogeneous Impact of Referrals on Labor Market Outcomes

We document a new set of facts regarding the impact of referrals on labor market outcomes. Our results highlight the importance of distinguishing between different types of referrals—those from family and friends and those from business contacts—and different occupations. Then we develop an on-the-job search model that incorporates referrals and calibrate the model to key moments in the data. The calibrated model yields new insights into the roles played by different types of referrals in the match formation process and provides quantitative estimates of the effects of referrals on employment, earnings, output, and inequality.

Patrones de derivación estomatológica y demora en el diagnóstico. Estudio descriptivo

Objective: The aim of this study is to analyze and describe the referral patterns of two groups of patients who consulted the Oral Medicine Department “A”, FOUNC during the year 2019. Materials and methods: A retrospective descriptive study of the analysis of clinical records of two groups of patients of the Oral Medicine Department “A” (2019). Four students, supervised by two professors, carried out the examination. There were registered the following variables: gender, age, type of referral (spontaneous demand, by students, by dentists, by other professionals), pre-referral treatments, evolution (from first symptoms at the time of the stomatological consultation), and kind of lesion (cancer / pre-cancer and other injuries) and prescription of biopsies. Results: 67 clinical records were registered. The average age was 49 years (48 years for men and 50 for women). The stomatological referral by dentists was the most frequent. In 56% of the registered clinical records, the patient consulted with inefficient previous treatments (without a diagnosis) and in the remaining 44%, referrals were made without the prescription of previous treatments, noting a difference of 3 months in the average evolution of the lesions in both situations. 66% of the cases required biopsies. Discussion: When the referral is not appropriate, delays of oral lesions diagnosis are generated. Regarding these cases, the initial clinical scenario is modified, and therefore, the treatment and prognosis of the lesions. Practices must be carried out for postgraduate professional training in Oral Medicine, the promotion of early referral and awareness of self-medication risks.

A Comprehensive Examination of Factors Impacting Collegiate Athletes' Utilization of Psychological Assessment and Intervention Services.

Although collegiate athletes underutilize mental health programming, investigators have rarely examined factors that may influence their participation in such programs. The current study examined how structured interviews and demographic factors influence collegiate athletes to use psychological programming. Two-hundred and eighty-nine collegiate athletes were referred to the study. They were screened for mental health and randomly assigned to one of two semi-structured interviews based on experimental phase. Participants in Phase I received standard engagement (SE; N = 35) or SE+discussion of mental health (DMH; N = 44). Phase II participants received SE+DMH (N = 82) or SE+DMH + discussion of personal ambitions (DPA; N = 66). Phase III participants received SE+DMH+discussion about their culture of choice (DCC) (N = 25) or SE+DMH+discussion of sport culture (DSC) (N = 37). After receiving the respective interview participants were offered psychological assessment and intervention. Chi squared analyses revealed class standing, mental health symptom severity, referral type, and type of engagement interview influenced program commitment/utilization. Logistic regression analyses indicated SE+DMH+DPA and SE+DMH+DSC uniquely improved assessment attendance whereas referrals from the athletic department and coaches/teammates, participation in sport performance workshops, and senior status uniquely improved assessment and intervention attendance.

Aliyatu Al-Tamasuki Al-Nashyi fi Al-Qurani Al-Karimi Wa Dalalutuha fi Tafsiri Al-Kassyafi

T his research aims to highlight the importance of context and its role in the coherence of the text and describe the coherence mechanisms revealed by Al-Zamakhshari during his interpretations. Al-Zamakhshari is considered one of the first who follow this aspect. The context is in its fate, giving it multiple meanings or limiting it to one meaning, and among the mechanisms mentioned by Al-Zamakhshari is the referral listing types and indicating its importance. The mechanisms are repetition and sympathy, and all of this will become clear during the research. The research followed a descriptive approach, but it did not remain a captive to it, but tried to benefit from other approaches as much as possible. The research has drawn conclusions from them; First: Although al-Zamakhshari mention the word context only a few times, he used it a lot during his interpretation, as he deal with most contextual phenomena in an approach that reveals Zamakhshari's awareness of the importance of context in understanding the meaning. Second: Al-Zamakhshari realized the importance of text cohesion, and what repetition and referral bring about linking the text to each other. He took care of the assignee and the multiplicity of the assignee, which leads to the coherence of the text, this does not mean that he left it unchecked or restricted as he stresses the importance of taking into account the internal context and taking into account the Qur’anic systems. And its linguistic function, and its usefulness for the addresses, as Zamakhshari believes that repetition is rhetorical unless it benefits the reader, or the speaker wants to deliver a message to the reader through him. Third: Al-Zamakhshari paid great attention to conjunctions, and al-Zamakhshari showed the ability of conjunctions to connect parts of the text. يهدف هذا البحث إلى إبراز أهمية السياق ودوره في ترابط النص وتناسقه ووصف آليات التماسك التي كشف عنها الزمخشري أثناء تفسيره، ويعد الزمخشري من السباقين إلى تتبع هذا الجانب، فقد أولى هذا التماسك عناية فائقة، إذ ذهب إلى إبراز روابط النص، ودلالة هذه الروابط ومدى تأثير السياق في مآلاتها، وإعطائها معانٍ متعددة أو قصرها على معنى واحد، ومن الآليات التي ذكرها الزمخشري الإحالة معددا أنواعها ومبينا أهميتها ومن الآليات التكرار والعطف وسيتضح كل ذلك أثناء البحث. وقد اتبع البحث منهجا وصفيا، ولكنه لم يبق أسيرًا له، بل حاول الإفادة من المناهج الآخرى قدر الإمكان. لقد توصل البحث إلى نتائج منها؛ أولا: على الرغم من أن الزمخشري لم يذكر لفظ السياق إلا بضع مرات، إلا أنه استخدمه كثيرًا أثناء تفسيره، فقد تناول معظم الظواهر السياقية تناولًا يكشف عن إدراك الزمخشري لأهمية السياق في فهم المعنى. ثانيا: أدرك الزمخشري أهمية تماسك النص، وما يحدثه التكرار والإحالة من ربط النص بعضه ببعض. وقد اعتنى بالمحال والمحال إليه وبتعدد المحال إليه، والذي يؤدي إلى ترابط النص، فهذا لا يعني أنه قد تركه دون ضابط أو قيد إذ يشدد على أهمية مراعاة السياق الداخلي، ومراعاة النظم القرآني، ولكن الباحث لاحظ أن الزمخشري حينما تناول ظاهرة التكرار تناوله من جانب المعنى، ووظيفته اللغوية، وفائدته بالنسبة للمخاطب، إذ يرى الزمخشري أن التكرار يعد لغوًا إلا إذا أفاد فائدة للقارئ، أو أراد المتكلم إيصال رسالة للقارئ من خلاله. ثالثا: اهتم الزمخشري اهتمامًا كبيرًا بالعطف، وبين الزمخشري قدرة العطف على ربط أجزاء النص، ولم يكتف بذلك بل إنه كان يحدد دلالة حروف العطف وأسباب اختيارها.

Assessing and Addressing Family Caregivers' Needs and Risks in Primary Care.

To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. Cross-sectional, national mail-based survey. American Medical Association Masterfile database. U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62). Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments. Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type. Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.

Program evaluation of a recuperative care pilot project.

ObjectiveA program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.DesignThe study is a descriptive postprogram evaluation.SampleA total of 73 referrals were made to the project with 23 admissions.MeasureData regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected.InterventionA case management care model was used. The project staff included a public health nurse and an outreach worker.ResultsOne local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day.ConclusionsThe project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost‐effective manner. Challenges and recommendations of the program going forward were identified.

Factors related to length of stay, referral on discharge and hospital readmission for children and adolescents with anorexia nervosa.

This study examined factors related to hospital length of stay (LOS), reported referral on discharge, and hospital readmission, for children and adolescents (C&A) admitted to public hospitals for anorexia nervosa (AN), in a large health jurisdiction in Australia. Sociodemographic, illness, treatment, and hospital factors associated with LOS, reported referral to post-hospital treatment, and readmission within 28 days were analyzed for C&A with AN admitted to all New South Wales public hospitals in 2017, using median, multinomial logit and logit models. The sample comprised 289 admissions by 200 C&A aged 9-18 years with a primary or secondary diagnosis of AN. AN as a primary diagnosis and the presence of some physical and mental co-occurring conditions (e.g., malnutrition and obsessive-compulsive disorders) conferred a longer LOS. The majority of admissions were recorded being referred to primary care physicians (59.86%) and relatively small numbers to outpatient mental health services (5.54%) or outpatient eating disorder services (8.30%), with age, area socioeconomic status, and illness factors related to referral type. Male, low socioeconomic status, the presence of some co-occurring illnesses (e.g., adjustment disorder and viral infection), and rural or remote locations increased the likelihood of readmission. The findings have implications for service design, in particular the pathway to care from hospital into community for AN. Targeted interventions should consider recognizing and treating physical co-occurring illnesses at presentation to the health system, ensuring appropriate referral to community services, and providing services in socioeconomically disadvantaged and rural or remote areas.

Long-term mental health services use in children referred to a clinical intervention

BackgroundRecent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear. ObjectiveThe study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants. Participants and settingParticipants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent–child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county. MethodSymptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling. ResultsResults indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs. ConclusionsFindings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.

A Multidisciplinary Hand Clinic Using Physiatrists for the Evaluation of Non-Operative Pathologies.

The purpose of this study was to describe the impact of using a multidisciplinary hand clinic on (1) hand clinic waitlists for urgent operative pathologies and (2) the volume of urgent operative referrals seen by plastic surgery. A retrospective data analysis of all new referrals to the Peter Lougheed Centre hand clinic in Calgary, Alberta, was performed. Data were collected from 6 months before and after the introduction of the multidisciplinary model (ie, between January 2017 and January 2018). Demographics for all new referrals were collected from the clinic database, including wait times, triage type, and volume of referrals triaged to each discipline. Prior to using a multidisciplinary model, 81% (n = 591) of new patient referrals were triaged directly to plastic surgery, 4% (n = 28) to physiotherapy, and 6% (n = 43) to minor surgery (N = 728). However, following the addition of physiatry to the clinic, 62% (n = 451) of new patient referrals were triaged directly to plastic surgery, 24% (n = 173) to physiatry, 2% (n = 17) to physiotherapy, and 4% (n = 31) to minor surgery (N = 730). Overall, the number of urgent operative referrals triaged to plastic surgery proportionally increased by 7%, from 67% to 74%. Mean wait times for urgent referrals to plastic surgery decreased by 1.7 ± 1.0 months (P = .09). Applying a multidisciplinary model to a hand clinic can allow non-operative cases to be triaged directly to physiotherapy and physiatry, allowing plastic surgeons to manage a higher volume of urgent and operative referrals. Implementing a multidisciplinary hand clinic can, therefore, decrease waitlist volumes and shorten the time to assessment by a plastic surgeon. Level II Prognostic Study.

Práticas fisioterapêuticas para o tratamento das disfunções temporomandibulares: avaliação do conhecimento de cirurgiões-dentistas

Introdução: A disfunção temporomandibular (DTM) é uma das condições orofaciais mais prevalentes e por ser multifatorial, necessita de tratamento multidisciplinar. É frequente o número de pessoas que apresentam sinais ou sintomas de DTM, porém, poucas são conhecedoras desta disfunção e buscam por tratamento. A falta de comunicação multidisciplinar ou a ausência de conhecimento por parte dos cirurgiões-dentistas em relação aos fisioterapeutas, muitas vezes impedem o tratamento multidisciplinar. O objetivo da presente pesquisa foi investigar o conhecimento dos cirurgiões-dentistas sobre a atuação da Fisioterapia no tratamento das DTM. Metodologia: Trata-se de um estudo quantitativo, do tipo analítico transversal. Foram investigados 29 cirurgiões-dentistas que trabalhavam no setor privado e/ou público, com idades entre 25 e 60 anos, de ambos os gêneros. Resultados: Os resultados da pesquisa mostraram que não existe um encaminhamento eficiente dos pacientes com DTM por parte dos cirurgiões-dentistas aos fisioterapeutas, para que assim ocorra um tratamento mais eficaz. Foi constatado que essa situação não ocorria por falta de conhecimento dos cirurgiões-dentistas (83,0%), sobre a atuação da Fisioterapia. Apenas 38% já tinham feito esse tipo de encaminhamento. Entre os mesmos 97% acreditam na importância do tratamento multidisciplinar. No entanto, os entrevistados ressaltaram a sua opinião sobre a importância da comunicação entre as áreas envolvidas, porém não manifestaram a razão da falta de encaminhamentos e da integração entre os profissionais. Entre os participantes 48% afirmaram ter sido na graduação o primeiro contato com esse tipo de informação interdisciplinar. Conclusão: Poucos cirurgiões-dentistas encaminham os pacientes com DTM para os fisioterapeutas, portanto faz-se necessário divulgar mais resultados das evoluções de casos clínicos para a área da Odontologia, além de realizar pesquisas mais focadas em concretizar pensamentos e atitudes interdisciplinares entre os profissionais da saúde de forma geral dentro do tratamento da DTM.

Abortion Referral Practices among a National Sample of Obstetrician-Gynecologists.

Obstetrician-gynecologists (ob-gyns) play a critical role in improving access to timely abortion care. This cross-sectional study estimates the proportion of ob-gyns providing abortion referral in the prior year and identifies predictors of direct (facilitated) referral compared with indirect referral (providing contact information). In 2016-2017, we invited a national sample of 2,500 ob-gyns to complete a survey. We restricted the final sample of 1,280 respondents (52% response rate) to participants who had abortion-seeking patients in the last 12months (n=868, 68% of the sample). We calculated descriptive statistics by referral type and conducted logistic regression analyses to examine associations between physician and practice setting characteristics and abortion referral type (direct vs. indirect). Eighty-eight percent of ob-gyns provided abortion referral (479 [55%] indirect referrals; 287 [33%] direct referrals). Abortion provision in the prior year (adjusted odds ratio, 2.82; 95% confidence interval, 1.80-4.42) was a significant predictor of direct referrals. Compared with ob-gyns practicing in the Northeast, ob-gyns in the South had lower odds of direct referrals (adjusted odds ratio, 0.39; 95% confidence interval, 0.24-0.62), whereas those in the West had higher odds (adjusted odds ratio, 1.91; 95% confidence interval, 1.14-3.23). Ob-gyns providing direct referrals were more likely to practice within 25 miles of an abortion facility compared with those who provided indirect referrals (25% vs. 5%, respectively; p<.001). Although the majority of ob-gyns refer patients for abortion care, most offer indirect referrals, only providing contact information for an abortion provider. Ob-gyns should facilitate referrals as access becomes more constrained, especially in regions where abortion facilities are limited.

Programmatic determinants of successful referral to health and social services for orphans and vulnerable children: A longitudinal study in Tanzania.

BackgroundTrained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system.MethodsData for this secondary analysis come from the first two years (2017–2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations.ResultsDuring the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26–49 versus 18–25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively.ConclusionCW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.

Late Referral of Eisenmenger Syndrome in Pregnancy at Dr. Soetomo Hospital Surabaya

Background: Pregnancy with Eisenmenger syndrome is an obstetric problem which numbers keep rising every year. The cases require specific,decisive,and multidisciplinary approach.The unavailability of accurate diagnostic procedures, as well as the national consensus that has not been agreed on, all contributes to the increasing number of late referral that cause morbidity and the high risk of mortality. Purpose: To know number and cause of late referral cases with Eisenmenger syndrome at Dr. Soetomo General Hospital, Surabaya in 2018-2019. Methods: Retrospective study by using medical records data of Dr. Soetomo General Hospital, Surabaya on January 2018- December 2019. Result: There are 18 cases of Eisenmenger syndrome from January 2018 to December 2019. Approximately 3 cases are timely referral while 15 cases are late referral cases. From those 15 late referral cases, about 12 cases (80%) are pregnant. Based on the risk factors, 73% of the patients have a congenital heart disease (Atrial septal defect) and severe pulmonary hypertension. In the postpartum referral cases group, 3 cases were referred because of suspected heart disease postpartum. Nearly all of the late referred cases have a bad prognosis those maternal deaths. There were 7 maternal deaths caused by cardiogenic shock. Regarding the source of referral, the majority of referred pregnant patient comes from out of Surabaya (73%), while for the postpartum patient, 13 % was referred from out of Surabaya. According to the referral types, the majority of the late referral cases are emergency referral (73%), as for the postpartum referral, 20% are emergency referral. Conclusion: The number of late referral in Eisenmenger syndrome in Dr. Soetomo general hospital is still high. Further socialization and trainings regarding the early detection and management of Eisenmenger syndrome is still very much needed.

Exploring Predictors of Treatment Engagement in Urban Integrated Primary Care.

Integrated primary care (IPC) is intended to address the gap in access to behavioral health care. This may be particularly true in urban settings; however, there is a paucity of research on treatment engagement in urban IPC. This study explored factors associated with treatment engagement. Data were collected via retrospective chart review for 410 patients of diverse backgrounds who received an IPC referral in an urban primary care site. Patient-related factors included having multiple types of referral concerns, patient primary care show rate, and number of visits with referring clinician. Service-related factors included referral type (warm handoff/ electronic), number of days between referral and intake, and average number of days between IPC treatment sessions. Engagement outcomes included attendance at IPC intake, total IPC sessions attended, overall IPC show rate, and IPC treatment attrition. Of referred patients, 348 (84.9%) were encouraged to or scheduled an intake. Of those, 289 (83.1%) scheduled and 57.2% attended; the average number of sessions attended was 1.73. Patients who had more primary care office visits and higher primary care show rates were more likely to attend an IPC intake. Shorter average duration between follow-up sessions was associated with higher overall IPC show rates for those who initiated IPC follow-up care. Supporting engagement in primary care broadly and building scheduling capacity for IPC treatment may increase IPC service engagement in an urban primary care context.

AN EVALUATION OF SWALLOWING FUNCTION AFTER CANCER TREATMENT IN HEAD AND NECK CANCER PATIENTS

Purpose: Evaluation of swallowing and feeding types are essential in patients with head and neck cancer (HNC). This study aimed to evaluate the swallowing function of patients treated for HNC. Methods: One hundred fifty-seven patients with HNC who were referred for swallowing disorder were included. Descriptive information including age, gender, weight, height, diagnosis, and feeding type was recorded. Videofluoroscopic swallowing study (VFSS) was performed to assess swallowing function. Penetration and aspiration severity was determined using the Penetration and Aspiration Scale (PAS). Results: The mean age was 54.16±12.90 years, of which 66.9% was male. The 23.6% of patients were treated for oropharyngeal cancer, 17.2% for nasopharyngeal cancer, and 59.2% for hypopharyngeal cancer. The 26.75% of patients underwent surgery, and 25.5% received chemoradiotherapy, and 45.9% underwent surgery combined with chemoradiotherapy. The mean PAS score for liquid was 4.96±2.93, and the mean PAS score for pudding was 3.76±3.05 according to the VFSS. While only liquid aspiration was 70.1%, aspiration in liquid and pudding was 37.2%. A significant difference was found between referral and recommended feeding types (p=0.003). No difference was detected in terms of PAS score for liquids, PAS score for pudding, and recommended feeding type according to received treatment types (p&amp;gt;0.05). Conclusion: More than half of the patients had airway aspiration, and their referral feeding type was not appropriate. Therefore, swallowing function should be evaluated in patients with HNC, and appropriate feeding type should be determined in an early period.

Effect of the COVID-19 Pandemic on Surgical Breast Cancer Care in the Netherlands: A Multicenter Retrospective Cohort Study

BackgroundCoronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. In the Netherlands, the national screening programs, including for breast cancer, were halted temporarily. This posed a challenge to breast cancer care, because ∼40% of cases are detected through national screening. Therefore, the aim of the present study was to evaluate the effects of the COVID-19 pandemic on the surgical care of patients with breast cancer in the Netherlands. Materials and MethodsThe present multicenter retrospective cohort study investigated the effects of COVID-19 on patients with breast cancer who had undergone surgery from March 9 to May 17, 2020. The primary endpoints were the number of surgical procedures performed during the study period, tumor characteristics, surgery type, and route of referral. The secondary endpoint was the incidence of postoperative complications during the study period. ResultsA total of 217 consecutive patients with breast cancer requiring surgery were included. We found an overall decrease in the number of patients with breast cancer who were undergoing surgery. The most significant decline was seen in surgery for T1-T2 and N0 tumors. A decline in the number of referrals from both the national screening program and general practitioners was observed. The incidence of postoperative complications remained stable during the study period. ConclusionsThe temporary halt of the national screening program for breast cancer resulted in fewer surgical procedures during the study period and a pronounced decrease in surgery of the lower tumor stages.

Hospital referrals of patients with acute poisoning by the Belgian Poison Centre: analysis of characteristics, associated factors, compliance and costs

ObjectiveAims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2)...