Unregistered Patients Research Articles

Correlation of Serum Uric Acid With Cardiovascular Risk in Nigerian Patients.

Studies exploring the relationship between serum uric acid (sUA) and cardiovascular risk in the Nigerian population remain sparse. The study aimed to assess the association between sUA levels and two measures of cardiovascular risk, namely the Framingham 10-year Cardiovascular Risk Score (FRS) and the Atherogenic Index of Plasma (AIP). This retrospective study used data from clinical records of new, previously unregistered patients presenting at a private cardiac hospital over one year from November 2022 to October 2023. In total, 428 patients presented newly to the hospital in that period. The records of 138 patients were included in the project after various exclusions were made including for incomplete anthropometric and laboratory data. Statistical tests of association were used to determine the significance of the relationship between sUA levels and the measures of cardiovascular risk. Two-tailed p <0.05 was deemed statistically significant. Hyperuricemia was more prevalent in individuals with central obesity, i.e., waist circumference ≥94cm in males or 80cm in females (93.4% vs 6.6%; p=0.03). Serum uric acid also positively correlated with FRS (correlation coefficient: 0.190; p<0.05) and serum triglyceride levels and AIP (correlation coefficient: 0.259 and 0.294, respectively; p<0.001 for both). After multivariate analyses, uric acid was significantly and independently associated with high FRS and AIP after adjusting for age, smoking and diabetes history, blood pressure, total and high-density lipoprotein cholesterol, serum triglyceridesand waist circumference (p<0.001). The results emphasize the emergence of sUA as a pertinent cardiovascular risk factor in clinical settings. More research is needed to deduce the relationship, if any, between cardiovascular risk reduction and pharmacological reduction of sUA levels.

Trends of the COVID-19 dynamics in 2022 and 2023 vs. the population age, testing and vaccination levels.

The population, governments, and researchers show much less interest in the COVID-19 pandemic. However, many questions still need to be answered: why the much less vaccinated African continent has accumulated 15 times less deaths per capita than Europe? or why in 2023 the global value of the case fatality risk is almost twice higher than in 2022 and the UK figure is four times higher than the global one? The averaged daily numbers of cases DCC and death DDC per million, case fatality risks DDC/DCC were calculated for 34 countries and regions with the use of John Hopkins University (JHU) datasets. Possible linear and non-linear correlations with the averaged daily numbers of tests per thousand DTC, median age of population A, and percentages of vaccinations VC and boosters BC were investigated. Strong correlations between age and DCC and DDC values were revealed. One-year increment in the median age yielded 39.8 increase in DCC values and 0.0799 DDC increase in 2022 (in 2023 these figures are 5.8 and 0.0263, respectively). With decreasing of testing level DTC, the case fatality risk can increase drastically. DCC and DDC values increase with increasing the percentages of fully vaccinated people and boosters, which definitely increase for greater A. After removing the influence of age, no correlations between vaccinations and DCC and DDC values were revealed. The presented analysis demonstrates that age is a pivot factor of visible (registered) part of the COVID-19 pandemic dynamics. Much younger Africa has registered less numbers of cases and death per capita due to many unregistered asymptomatic patients. Of great concern is the fact that COVID-19 mortality in 2023 in the UK is still at least 4 times higher than the global value caused by seasonal flu.

Evaluation of family physicians’ attitude towards primary healthcare consultations

Abstract Background The quality of services in the health care system is very important for both patients’ health and health care providers. In the past decade, good service ratings from the patient's perspective have become crucial in evaluating the work of medical professionals and health care institutions. However, it is also important to consider the opinions of health care specialists, especially when it comes to medical consultation, which is one of the most important components of primary health care (PHC) chain. Aim To evaluate the attitude of family physicians (FP) towards consultations provided in PHC. Methods The study was conducted in 2022. December - 2023 in February. The research contingent is FP of Lithuania. Research method - quantitative momentary research, anonymous questionnaire survey, 206 subjects were interviewed. Calculated chi-square (χ2) and z-criterion. Results The majority of FP indicated that they involve the patient in the decision-making process (68.0%), those working in private institutions said so more often than those working in public institutions (p &amp;lt; 0.05). 89.3% of the subjects stated that the consultation time with the patient is not enough, and 70.4% respondents receive many unregistered patient visits per day. E-health makes it difficult for 81.1%, 86.4% of the respondents indicated that there is too much of a workload and this was mostly said by respondents working in public institutions (p &amp;lt; 0.05). Remote consultations facilitate the workflow (76.2%). The older age of the respondents and greater work experience lead to lower self-confidence during remote consultation, longer consultation time and less belief in the benefits of remote consultation (p &amp;lt; 0.05). Conclusions Most FP positively evaluate the consultation they provide, but they also said that the consultation time is insufficient, they must consult a number of unregistered patients, e-health complicates the work. Remote consultations facilitate the workflow. Key messages • The consultation time is insufficient. • Remote consultations facilitate the workflow.

An exploration of under-registration of chronic kidney disease stages 3-5 in Belgian general practices using logistic regression.

Early detection and treatment of chronic kidney disease (CKD) can prevent further deterioration and complications. Previous studies suggested that the diagnosis is often made when advanced renal failure occurs. The aims of this study were to describe the prevalence of unregistered CKD stages 3-5 in a Belgian General Practitioner population, to determine risk factors for under-registration and to investigate the diagnostic delay. The analyses were carried out in the INTEGO database, a Flanders general practice-based morbidity registration network. The study used INTEGO data from the year 2018 for all patients ≥18 years old. CKD was defined as two consecutive eGFR laboratory measurements (eGFR <60 mL/min/1.73m2) at least three months apart during the baseline period. Registered CKD was characterised by a documented diagnosis of CKD (ICPC2 U99) during the ≥12-month lookback period before the first eGFR measurement and up to six months after the second eGFR in the EHR. The prevalence of unregistered CKD and the median time of diagnostic delay were estimated. Baseline characteristics were described. A multivariate cross-sectional logistic regression analysis was conducted to identify determinants of unregistered CKD. We estimated the odds ratios and their 95% confidence interval. Among included patients, there were 10 551 patients (5.5%) meeting the criteria of CKD. The prevalence of unregistered CKD was 68%. The mean diagnostic delay was 1.94 years (Standard deviation 0.93). Being a male, a concurrent diagnosis of diabetes, stroke, heart failure and hypertension, and more severe CKD (stages 3b, 4 and 5) independently increased the chance on registered CKD. The proportion of patients who had no registered CKD code in the EHR was substantial. The differences between registered and unregistered patients make thinking about solutions to facilitate registration in the EHR imperative.

Assessment of Knowledge, Attitudes, and Practices (KAP): Public Health and Economic Burden of Tuberculosis in Jarso District of West Wollega Zone, Oromia, Western Ethiopia.

Tuberculosis is a communicable mycobacterial disease of humans and animals caused by members of Mycobacterium tuberculosis complex, highly impacting the public health and economy of the country in endemic areas. Retrospective and cross-sectional study was conducted between March and August 2021. For knowledge, attitude, and practices study, five villages were randomly selected using simple random sampling. To quantify the public health burden, one-year data were collected from Jarso Health Center, and unregistered patients were identified using snowball method, and the estimation was based on disability-adjusted life years. Younger age groups (18-40 years) had shown 105.8 times more odds of knowledge towards tuberculosis than the older (>60 years). Moreover, tertiary levels of education had 9395.1 times more odds of knowledge towards tuberculosis compared to illiterates. The estimated economic burden was 7,731.25US$. Of the 51 tuberculosis patients, two died from the disease, resulting in 45.03 disability-adjusted life years. Communities of the study district were heard about tuberculosis, however, unaware of the cause and sources of the infection. Therefore, further strategic and continuous community-based health education and awareness should be given for effective control and prevention of tuberculosis in the study area.

The impact of incomplete registration on survival rate of children with very rare tumors

Pediatric very rare tumors (VRTs) represent a heterogeneous subset of childhood cancers, with reliable survival estimates depending dramatically on each (un)registered case. The current study aimed to evaluate the number of VRTs among Lithuanian children, to assess the impact of the registration status on survival rates and to track changes in treatment outcomes over the 16-year study period. We performed a population-based retrospective study across children below 18 years old diagnosed with VRTs in Lithuania between the years 2000 and 2015. The identified cases were cross-checked with the Lithuanian Cancer Registry—a population-based epidemiology cancer registry—for the fact of registration and survival status. The overall survival was calculated in relation to the registration status and treatment period. Thirty-seven children with VRTs were identified within the defined time frame. Six of them (16.2%) were not reported to the Lithuanian Cancer Registry at diagnosis. The probability of overall survival at 5 years (OS5y) differed significantly between the registered (n = 31) and unregistered (n = 6) cohorts: 51.6% versus 100%, respectively (p = 0.049). A 5-year survival estimate for children diagnosed with a VRT at the age of 0–14 years differed by 10 percentage points according to the registration completeness: 52.1% calculated for the entire cohort versus 42.1% for registered patients only. The OS5y has not improved over the analyzed period: 61.1% in 2000–2007 versus 57.9% in 2008–2015 (p = 0.805). The survival continued to decline beyond 5 years post-diagnosis due to late cancer-related adverse events: 59.5% of patients were alive at 5 years as compared to 44.3% at 10 years. The OS5y of children affected by VRT was lower than in more common childhood cancers. The survival rate of the unregistered patients may lead to misinterpretation of treatment outcomes. Meticulous registration of VRTs is crucial for correct evaluation of treatment outcomes, especially across small countries with few cases.

Estimation of unregistered patients who left without being seen: At an urban mid-sized Canadian community emergency department.

To determine whether changes to the appearance of an emergency department (ED) waiting room influenced the number of patients who left without being seen (LWBS). Retrospective analysis using National Ambulatory Care Reporting System data collected at the time of patient registration. The ED of Belleville General Hospital, a mid-sized secondary care community hospital in Ontario with a catchment population of 125 000. All unscheduled patients registering at the hospital to be seen in the ED from July 1 to December 31, 2016 (control period), and from July 1 to December 31, 2017 (study period). The volume of patients registering by Canadian Triage and Acuity Scale (CTAS) level to be seen in the ED during the study period compared with the volume of patients registering during the control period, and the number of LWBS during the 2 time periods. The average number of patients registered per month was significantly greater in the study period than in the control period (t 10 = -5.53, P < .01). A total increase of 1881 registrations was recorded in the study period, or 10.47% (increase per month ranged from 9.59% to 11.66%). The proportion of patients with less acute triage scores decreased in the study period; however, the differences in CTAS levels between the 2 years was not statistically significant (χ 2 = 1.05, P = .90). The number of LWBS according to CTAS level was lower in all categories in the study period, including those in the less acute levels, decreasing from 60 in CTAS 5 in 2016 to 45 in 2017, and 585 in CTAS 4 in 2016 to 330 in 2017. Overall, the distribution of LWBS by CTAS level was significantly different between the control and study periods (P < .01). The number of patients registering is influenced by the apparent high or low occupancy of the waiting area at the time of registration.

Evaluation of effect of vitamin D supplementation on vitamin D levels and pregnancy outcome

Introduction: Vitamin D is a fat-soluble vitamin which comes primarily from exposure to sunlight, and only few foods acts as a source of it. Vitamin D deficiency is a preventable health problem. Research shows that during pregnancy, adequate vitamin D intake is necessary for maternal, fetal and child health. This study was conducted to determine prevalence of vitamin D deficiency in pregnant women and neonates and will also help us to determine if 400IU daily recommended dose is sufficient to treat hypovitaminosis D. Materials and Methods: The study was carried out for 1 ½ years on 100 pregnant, divided in two groups in which one group was given supplementation and 2nd group was of unregistered patients. Results: The prevalence of Vitamin D deficiency was observed as 82% in present study. On supplementing the subjects with 400IU vitamin D with calcium 1000 mg daily, the prevalence reduced to 14% while normal levels were achieved in 58% as compared to 8% during the first trim which was significant with p value of Conclusion: We recommend evaluation of the status of vitamin D in all pregnant women along with D3 supplementation. Routine supplementation of pregnant mothers with 400IU vitamin D with calcium 1000 mg daily resulted in significant improvement of vitamin D levels in study group, but sufficient levels were reached in just over half of the females. We thus propose further research on the daily dosage recommendations along with other factors affecting vitamin D levels in pregnant females like eating pattern, compliance to prescribed drugs and sun light exposure. Keywords: Vitamin D levels, Vitamin D deficiency in pregnancy.

Frequency of AIDS in District Dera Ghazi Khan

According to the survey conducted in Dera Ghazi Khan district in 2017, there are around 20,000 HIV/AIDS patients in south Punjab districts. Dera Ghazi Khan alone has 1,650 patients registered with the Punjab AIDS Control Programme and, the number of unregistered patients in the district may be over 9,000. There has been a 40 per cent increase in the number of AIDS patients reported in 2017, The reason behind the increase was a lack of awareness. There are more than 200 HIV/AIDS patients living in Dera Ghazi Khan’s rural areas like Sakhi Sarwar, Kot Mubarak, Kaala, Saddaruddin, Yaaru Khosa and the tribal belt.The situation is very alarming.

Analysis of Oral Hypoglycemic Drugs Consumption in Ukraine in 2015

Diabetes is a global medical and social problem in the world, influence the quality and duration of patients life. According to official statistics in Ukraine in 2015 the number of patients with diabetes covered 2.81% of the total number of residents. For every registered patient there are 2.5 patients with unidentified diabetes. Based on these data, we can assume that in Ukraine there are about 3.6 million patients with diabetes (8.45% of population), of which 90% (3.24 million) are patients with type 2 diabetes (7.6% of population). The main method of treatment of patients with type 2 diabetes is the use of oral hypoglycemic drugs (OHDs). Most OHDs have high clinical efficacy, their use increases the duration and quality of patients life. The objective - determining the consumption of the OHDs in Ukraine in 2015. Calculation of OHDs consumption was carried out on the basis of the ATC/DDD-methodology. In Ukraine in 2015 total consumption of OHDs was 11.14 DIDs. This means that 1.1% of the population of Ukraine from the total number of residents received 1 DDD of oral hypoglycemic drugs daily. Taking into account the official statistics, the consumption of OHDs for patients with diabetes should cover 2.81% of the population, but real consumption of OHDs 2.6 times less than is necessary for all officially registered patients. When recalculating the consumption of OHDs, taking into account unregistered patients with type 2 diabetes in Ukraine (7.6% of the population), their consumption was 6.9 times less than the required amount. Thus, the calculated indicator of the consumption of OHDs in Ukraine is 2.6 to 6.9 times lower than necessary for the treatment of patients with diabetes. The incidence of diabetes in Ukraine in 2015 was significantly higher than the consumption of OHDs, which indicates an insufficient level of OHDs consumption.

An epidemiological study of mortality among mothers admitted in a rural tertiary hospital of West Bengal.

Background:Maternal mortality reflects the quality of obstetric services given to pregnant women in the community.Objectives:The objectives of this study were to calculate the maternal mortality rate in a teaching institution, to assess the epidemiological aspects of maternal mortality, and to assess the different causes of maternal mortality.Materials and Methods:This was a retrospective study where individual records of all maternal deaths occurring in our hospital during the past 6 years from 2009 to 2014 were studied. The cause of death and the factors which led to death in each individual case were analyzed.Results:A total of 105 maternal deaths occurred during the study period. The mean maternal mortality ratio in the study period was 233/100,000 live births. Most maternal deaths (37.14%) occurred in the age group of 20–24 years, multiparous women (74.28%) and in women from rural areas (70.47%). Most of the women were unbooked or unregistered patients (64.76%), and 40.95% cases were referred cases. Direct causes accounted for 90.47% of maternal deaths whereas 9.52% of maternal deaths were due to indirect causes. Hemorrhage (26.6%) and eclampsia (27.6%) were the major direct causes of maternal deaths.Conclusion:There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers, and proper transport system is the need of the hour.

Is diabetes mellitus correctly registered and classified in primary care? A population-based study in Catalonia, Spain

ObjectiveTo assess the prevalence of miscoding, misclassification, misdiagnosis and under-registration of diabetes mellitus (DM) in primary health care in Catalonia (Spain), and to explore use of automated algorithms to identify them. MethodsIn this cross-sectional, retrospective study using an anonymized electronic general practice database, data were collected from patients or users with a diabetes-related code or from patients with no DM or prediabetes code but treated with antidiabetic drugs (unregistered DM). Decision algorithms were designed to classify the true diagnosis of type 1 DM (T1DM), type 2 DM (T2DM), and undetermined DM (UDM), and to classify unregistered DM patients treated with antidiabetic drugs. ResultsData were collected from a total of 376,278 subjects with a DM ICD-10 code, and from 8707 patients with no DM or prediabetes code but treated with antidiabetic drugs. After application of the algorithms, 13.9% of patients with T1DM were identified as misclassified, and were probably T2DM; 80.9% of patients with UDM were reclassified as T2DM, and 19.1% of them were misdiagnosed as DM when they probably had prediabetes. The overall prevalence of miscoding (multiple codes or UDM) was 2.2%. Finally, 55.2% of subjects with unregistered DM were classified as prediabetes, 35.7% as T2DM, 8.5% as UDM treated with insulin, and 0.6% as T1DM. ConclusionsThe prevalence of inappropriate codification or classification and under-registration of DM is relevant in primary care. Implementation of algorithms could automatically flag cases that need review and would substantially decrease the risk of inappropriate registration or coding.

Is diabetes mellitus correctly registered and classified in primary care? A population-based study in Catalonia, Spain

ObjectiveTo assess the prevalence of miscoding, misclassification, misdiagnosis and under-registration of diabetes mellitus (DM) in primary health care in Catalonia (Spain), and to explore use of automated algorithms to identify them. MethodsIn this cross-sectional, retrospective study using an anonymized electronic general practice database, data were collected from patients or users with a diabetes-related code or from patients with no DM or prediabetes code but treated with antidiabetic drugs (unregistered DM). Decision algorithms were designed to classify the true diagnosis of type 1 DM (T1DM), type 2 DM (T2DM), and undetermined DM (UDM), and to classify unregistered DM patients treated with antidiabetic drugs. ResultsData were collected from a total of 376,278 subjects with a DM ICD-10 code, and from 8707 patients with no DM or prediabetes code but treated with antidiabetic drugs. After application of the algorithms, 13.9% of patients with T1DM were identified as misclassified, and were probably T2DM; 80.9% of patients with UDM were reclassified as T2DM, and 19.1% of them were misdiagnosed as DM when they probably had prediabetes. The overall prevalence of miscoding (multiple codes or UDM) was 2.2%. Finally, 55.2% of subjects with unregistered DM were classified as prediabetes, 35.7% as T2DM, 8.5% as UDM treated with insulin, and 0.6% as T1DM. ConclusionsThe prevalence of inappropriate codification or classification and under-registration of DM is relevant in primary care. Implementation of algorithms could automatically flag cases that need review and would substantially decrease the risk of inappropriate registration or coding.

Hospital activity and cost incurred because of unregistered patients in England: considerations for current and new commissioners

Commissioners are responsible for providing health care for defined geographical areas. A lack of comprehensive national and local information on health needs of unregistered populations makes health service planning difficult. A cross-sectional study using Hospital Episode Statistics to quantify the level of inpatient and outpatient activity, and associated cost by patients not registered in primary care in English NHS hospitals. Unregistered patients were defined as those without a valid GP registration, prisoners, military personnel, asylum seekers/immigrants and the homeless. Unregistered patients accounted for 99 615 inpatient admissions and 370 504 outpatient attendances in 2009/10, at a total cost of £242 m. Mental health accounted for 30% of all inpatient costs. The majority of unregistered patients were male and aged 20-39 years. There were high levels of activity and cost in urban local authorities (LAs) (Birmingham and London) and LAs with links to military services (Salisbury, Richmondshire, Southampton). A high total inpatient cost was attributed to trauma, general medicine and mental health specialties. A high total outpatient cost was attributed to genitourinary medicine and trauma specialties. Health care use by unregistered populations is an important consideration for resource allocation and planning health care services at national and local levels.

A Survey of General Dental Practitioners in Merseyside regarding Urgent Appointments and Suspected Cancer Referrals

The aims of this study were to investigate the current situation regarding unregistered patients in the Mersey region who seek an urgent dental appointment, and to gather information on suspected oral cancer cases seen by dentists in the previous two years and about how such cases are referred. The survey took the form of a short questionnaire sent in May 2006 to all general dental practitioners (GDPs) in the Mersey region who were registered with the regional postgraduate dental office. A total of 904 GDPs were identified and 572 (63%) returned completed survey responses. Half (276/572; 48%) reported that they could see new patients urgently under the National Health Service (NHS) and two-thirds (365/571; 64%) that they could see them either under the NHS or privately. Nineteen per cent reported that they would not see any new patients. Those in the most deprived areas were more likely to see a patient on the NHS. The waiting time for an urgent appointment, if it was offered, was over one week for nearly one-third (32%) of the dentists offering NHS care. Most dentists (84%) said that a patient suspected of having oral cancer would be referred the same day as the decision had been made to refer. Access to dental care has been a high-profile issue over the past few years. This survey indicated that in Merseyside, just under half of the dentists who responded were willing to see new patients with urgent problems under the NHS. It is suggested that this difficulty in access, together with some reported delays in obtaining appointments and the methods of onward referral, may cause additional barriers to early detection of oral cancer, especially for those in the most at-risk groups, who are also very frequently hard to reach.

A Survey of Users of a Dental Access Centre Situated in an Area of Mixed Socioeconomic Affluence and Deprivation

To describe the users of a Dental Access Centre (DAC) situated in an area of England with a mixed socioeconomic profile, their pattern of use, and their perception of the role of the service. A sample of users was drawn from a DAC in Cheshire's clinical database. A postal questionnaire was sent to these users via a three-stage mailing, using a prize draw incentive to promote response. After the third mailing stage, non-responders were also contacted by telephone. A high proportion of users lived relatively near the DAC. Over 80% of respondents were unregistered with a dentist in Cheshire. The centre appeared to be used for symptomatic care only, with no respondents reporting using the centre for routine care (including check-ups). The role of DACs was originally envisaged as providing a service for unregistered patients wanting convenient, accessible, emergency care, and as providing routine National Health Service (NHS) care, including check-ups in geographical areas where there is limited availability of NHS care in general dental practice. In a geographical area with low dental need, one might expect the DAC to fulfil the second of these roles. However, this study suggests that even in this type of area, users of the DAC who responded to the questionnaire viewed it as a source of emergency care and not as a provider of routine care.

Primary health care for refugees and asylum seekers: A review of the literature and a framework for services

This paper aims to provide a framework for primary health care services to meet the recognized health needs of refugees and asylum seekers that can be used in planning and evaluating services for this group. Primary care services for refugees and asylum seekers are reviewed and presented in terms of a tripartite framework of gateway, core and ancillary services. Gateway services facilitate entry into primary care by identifying unregistered patients and carrying out health assessments. They are typically undertaken by nurse-led outreach services and specialist health visitors. Core services provide full registration and may be provided by dedicated practices or by mainstream practices, with or without additional support. Ancillary services are those that supplement and support core services' ability to meet the additional health needs of this group. They include language and information services, close links with community-based organizations, specialist mental health services and services for survivors of torture and organized violence, as well as targeted health promotion and training of health workers. The framework can be used for education and training, planning and commissioning, and to provide criteria for comparison and evaluation. The paper suggests that a lack of published evaluations and reports about interventions for refugees and asylum seekers constrains further policy development that could build on the strengths of such interventions. It also stresses the importance of ancillary services to successful mainstream provision.

Adjuvant Treatment of High-risk Adult Soft Tissue Sarcomas: A Survey by the Italian Sarcoma Group

After the first adjuvant study on adult soft tissue sarcomas was concluded, the participating institutions continued to select and treat patients according to that protocol. The aim of this study was to test the protocol reproducibility when applied as a standard practice. A call for retrospective data was launched in June 1999 (self-referral of consecutive unregistered patients); thereafter, a prospective follow-up was performed. The treatment regimen consisted of epirubicin (60 mg/m2 days 1 and 2), ifosfamide (3 g/m2/die for 3 days) and equimolar doses of 6-mercapto-ethansulfonate (MESNA), with 300 microg G-CSF administered subcutaneously from day +8 until recovery, every 3 weeks for a total of 5 cycles. From November 1996 to June 1999, 55 high-risk, adult patients were treated. The average median dose intensity was 89% of the planned program. Grade 3-4 toxicities were leukopenia (49%), thrombocytopenia (14%), transfusion requiring anemia in 7 patients (16%), and alopecia in all patients (100%). After a median follow-up of 70 months, 23 patients (41.8%) relapsed and 19 died. Median disease-free, local disease-free and overall survival rates have not yet been reached. The disease-free survival rates at 2 and 4 years were 73% and 57%, respectively; the corresponding overall survival rates were 91% and 70%, respectively. The feasibility and reproducibility of the original protocol were confirmed, since disease-specific overall survival and disease-free survival rates at the same period of observation and with the same prolonged follow-up did not differ.

The effectiveness of out-of-hours dental services: I. pain relief and oral health outcome

To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. Two health authorities in South Wales, UK. A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30-40% and 23-38% respectively). Although the 'rotas for all' - a telephone-access GDP-provided service for both registered and unregistered patients - achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.

Pain relief from out-of-hours dental services?

Objective To compare the effectiveness of four types of out-of-hours emergency dental service, including both 'walk-in' and telephone-access services. Basic design Questionnaire survey of patients attending weekend emergency dental services, with measurement of self-reported oral health status and dental pain (at attendance and follow-up) and retrospective judgements of change in oral health status. Setting and subjects Two health authorities in South Wales, UK. A total of 783 patients who completed questionnaires at attendance, and 423 who completed follow-up questionnaires. Results For patients who saw a dentist there were no consistent differences in the effectiveness of the four services, whether measured as pain relief, oral health gain or using patients' retrospective transition judgements about feeling better after their episode of emergency dental care. The proportion of patients reporting no improvement (transition judgements), either an hour after or the day after seeing the dentist, was surprisingly high (30–40% and 23–38% respectively). Although the 'rotas for all' — a telephone-access GDP-provided service for both registered and unregistered patients — achieved both the highest reductions in pain scores and the greatest improvements in dental health status between attendance and follow-up, this effect may reflect health gains due to care received after the episode of emergency dental care. Conclusions Neither the setting where emergency dental patients are seen, nor the type of dentist who sees them, appear to have any significant effect on patient-reported health outcomes. Although further exploration of the factors that predict poor pain relief or low oral health gain is required, future research on these services should focus on the process of care and accessibility.