Weeks For Appointment Research Articles

How the COVID-19 pandemic affected infant vaccination trends in rural and urban communities in Ibadan, Nigeria: a cross-sectional study

ObjectivesThis study compared the infant vaccination trends a year before and a year after the onset of the COVID-19 pandemic in selected urban and rural communities in Ibadan, Nigeria.DesignThis was...

Implementing Lean Six Sigma Concepts in Audiology Practices

Implementing Lean Six Sigma Concepts in Audiology Practices

Cancer among syrian refugees living in Konya Province, Turkey

BackgroundWith more than 3.6 million Syrian refugees Turkey hosts the world's largest number of Syrians. Considering the morbidity, mortality, and healthcare spending, cancer is one of the leading health and economic burden for patients and healthcare systems. However, very limited information available in the scientific literature to understand the burden and characteristics of cancer in countries hosting Syrian refugees. The aim of the present study is to evaluate the demographic and clinical characteristics, treatment outcome of Syrian cancer patients living in Konya, Turkey.MethodsWe retrospectively reviewed medical records of Syrian cancer patients at three major institutions from 2005 to 2020. The information regarding demographic and clinical characteristics of patients were identified. The number of days between the first symptom and diagnosis was considered as the “diagnostic interval”. Patients who failed to attend clinics within four weeks of appointment were assumed abandoned treatment. Survival curves were estimated using the Kaplan–Meier method.ResultsWe identified 230 adult and 38 children refugee diagnosed with cancer during the study period. With regards to adult patients, there were 114 (49.6%) male and 116 (50.4%) female. The median age at diagnosis was 52.4, 47.3 years for male, female respectively. The five most common cancer by site among all were; breast (24.8%), colorectal (10.9%), lung (7.4%), central nervous system (CNS) (7.0%), and stomach (5.2%). 93 (40.4%) had metastatic disease at diagnosis. The overall survival probability was 37.5% at five years for the adult population. Data were extracted for 20 boys and 18 girls with childhood cancer. Their median age at diagnosis was 5.8 and 6.0 years respectively. The three most common childhood cancer were; leukemias (21.1%), lymphomas (21.1%), and CNS (13.2%). Excluding leukemia, 13 (43.3%) of childhood cancer cases had the advanced disease at diagnosis. Three year survival probality was 69.5%. The median diagnostic interval for adult and childhood cancer was 96.5 (IQR = 53–165) and 23 (IQR = 13.5–59) days respectively. Twenty-one adults and four children had treatment abandonment.ConclusionThis study contributes to understanding the burden of cancer among Syrian refugees living in Konya, growing health issue for refugees. Larger and prospective studies will help to measure the real burden and compare the difference in cancer risk factors, care, and outcomes among the refugee and host populations.

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

P672 The escalation of therapy or intervention (ETI) calculator for ulcerative colitis: does it have the potential to help outpatient capacity meet demand?

Abstract Background Demand for outpatient clinic appointments for ulcerative colitis (UC) often exceeds capacity, since spaces are frequently assigned to routine follow-up of patients who are well. Demand might better be managed by targeting appointments for patients in need of therapeutic decisions. The TrueColours UC (TCUC) Escalation of Therapy or Intervention (ETI) calculator is a potential enabling tool. Methods TCUC is a web-based programme based on email prompts linked to validated, disease-specific indices. The ETI Calculator was created after logistic regression showed that patient-reported symptoms (Simple Clinical Colitis Activity Index) and quality of life (IBD Control-8) could calculate the probability of therapy escalation or an urgent intervention during an outpatient appointment (OPA, Figure 1). From June 2018 to August 2019, all OPA for 650 patients using TCUC and under standard OPA follow-up were examined. The probability of escalation at each OPA was calculated using the most recent prior SCCAI and IBD-Control scores (within 2 weeks of appointment). Clinic letters were assessed to determine whether treatment escalation or intervention had occurred during the OPA. Results Of 650 patients, 236 had a total of 403 OPAs. 210/403 (52%) of these OPAs resulted in no treatment escalation; 159/403 (40%) had escalation and 34/410 (8%) had de-escalation. An ETI calculator threshold set at 5% estimated probability of treatment escalation would have correctly identified 143/159 (90%) escalation events. 16/159 (10%) escalations were not correctly predicted: 12/16 were escalations of medication (oral 5-aminosalicylic acid, n = 3), azathioprine (2), methotrexate (1), increase infliximab dose (2), adalimumab (3), tofacitinib (1). Other escalations were endoscopy requests (2), dermatology/rheumatology referrals (2). Importantly, 6/16 (38%) had taken steroids within 1 month of data collection. 143/403 (35%) of OPAs could have been deferred using a 5% ETI threshold. In contrast, increasing the ETI threshold to 25% would have allowed 274/403 (68%) OPAs to be deferred but would have resulted in missing an additional 53 escalations. Conclusion A model that predicts the likelihood of treatment escalation or intervention during an OPA, based on real-time data entered by patients, has the potential to improve outpatient clinic resource utilisation. The calculator may not be valid to triage patients recently on steroids.

Feature determination from powered wheelchair user joystick input characteristics for adapting driving assistance.

Background: Many powered wheelchair users find their medical condition and their ability to drive the wheelchair will change over time. In order to maintain their independent mobility, the powered chair will require adjustment over time to suit the user's needs, thus regular input from healthcare professionals is required. These limited resources can result in the user having to wait weeks for appointments, resulting in the user losing independent mobility, consequently affecting their quality of life and that of their family and carers. In order to provide an adaptive assistive driving system, a range of features need to be identified which are suitable for initial system setup and can automatically provide data for re-calibration over the long term. Methods: A questionnaire was designed to collect information from powered wheelchair users with regard to their symptoms and how they changed over time. Another group of volunteer participants were asked to drive a test platform and complete a course which represented manoeuvring in a very confined space as quickly as possible. Two of those participants were also monitored over a longer period in their normal home daily environment. Features, thought to be suitable, were examined using pattern recognition classifiers to determine their suitability for identifying the changing user input over time. Results: The results are not designed to provide absolute insight into the individual user behaviour, as no ground truth of their ability has been determined, they do nevertheless demonstrate the utility of the measured features to provide evidence of the users' changing ability over time whilst driving a powered wheelchair. Conclusions: Determining the driving features and adjustable elements provides the initial step towards developing an adaptable assistive technology for the user when the ground truths of the individual and their machine have been learned by a smart pattern recognition system.

Feature determination from powered wheelchair user joystick input characteristics for adapting driving assistance

Background: Many powered wheelchair users find their medical condition and their ability to drive the wheelchair will change over time. In order to maintain their independent mobility, the powered chair will require adjustment over time to suit the user's needs, thus regular input from healthcare professionals is required. These limited resources can result in the user having to wait weeks for appointments, resulting in the user losing independent mobility, consequently affecting their quality of life and that of their family and carers. In order to provide an adaptive assistive driving system, a range of features need to be identified which are suitable for initial system setup and can automatically provide data for re-calibration over the long term. Methods: A questionnaire was designed to collect information from powered wheelchair users with regard to their symptoms and how they changed over time. Another group of volunteer participants were asked to drive a test platform and complete a course which represented manoeuvring in a very confined space as quickly as possible. Two of those participants were also monitored over a longer period in their normal home daily environment. Features, thought to be suitable, were examined using pattern recognition classifiers to determine their suitability for identifying the changing user input over time. Results: The results are not designed to provide absolute insight into the individual user behaviour, as no ground truth of their ability has been determined, they do nevertheless demonstrate the utility of the measured features to provide evidence of the users’ changing ability over time whilst driving a powered wheelchair. Conclusions: Determining the driving features and adjustable elements provides the initial step towards developing an adaptable assistive technology for the user when the ground truths of the individual and their machine have been learned by a smart pattern recognition system.

Feature determination from powered wheelchair user joystick input characteristics for adapting driving assistance

Background: Many powered wheelchair users find their medical condition and their ability to drive the wheelchair will change over time. In order to maintain their independent mobility, the powered chair will require adjustment over time to suit the user's needs, thus regular input from healthcare professionals is required. These limited resources can result in the user having to wait weeks for appointments, resulting in the user losing independent mobility, consequently affecting their quality of life and that of their family and carers. In order to provide an adaptive assistive driving system, a range of features need to be identified which are suitable for initial system setup and can automatically provide data for re-calibration over the long term. Methods: A questionnaire was designed to collect information from powered wheelchair users with regard to their symptoms and how they changed over time. Another group of volunteer participants were asked to drive a test platform and complete a course which represented manoeuvring in a very confined space as quickly as possible. Two of those participants were also monitored over a longer period in their normal home daily environment. Features, thought to be suitable, were examined using pattern recognition classifiers to determine their suitability for identifying the changing user input over time. Results: The results are not designed to provide absolute insight into the individual user behaviour, as no ground truth of their ability has been determined, they do nevertheless demonstrate the utility of the measured features to provide evidence of the users’ changing ability over time whilst driving a powered wheelchair. Conclusions: Determining the driving features and adjustable elements provides the initial step towards developing an adaptable assistive technology for the user when the ground truths of the individual and their machine have been learned by a smart pattern recognition system.

Evaluating the impact of integrated change initiatives on wait time for outpatient primary care physiotherapy service

Evaluating the impact of integrated change initiatives on wait time for outpatient primary care physiotherapy service

Feature determination from powered wheelchair user joystick input characteristics for adapting driving assistance

Background: Many powered wheelchair users find their medical condition and their ability to drive the wheelchair will change over time. In order to maintain their independent mobility, the powered chair will require adjustment over time to suit the user's needs, thus regular input from healthcare professionals is required. These limited resources can result in the user having to wait weeks for appointments, resulting in the user losing independent mobility, consequently affecting their quality of life and that of their family and carers. In order to provide an adaptive assistive driving system, a range of features need to be identified which are suitable for initial system setup and can automatically provide data for re-calibration over the long term. Methods: A questionnaire was designed to collect information from powered wheelchair users with regard to their symptoms and how they changed over time. Another group of volunteer participants were asked to drive a test platform and complete a course which represented manoeuvring in a very confined space as quickly as possible. Two of those participants were also monitored over a longer period in their normal home daily environment. Features, thought to be suitable, were examined using pattern recognition classifiers to determine their suitability for identifying the changing user input over time. Results: The results are not designed to provide absolute insight into the individual user behaviour, as no ground truth of their ability has been determined, they do nevertheless demonstrate the utility of the measured features to provide evidence of the users’ changing ability over time whilst driving a powered wheelchair. Conclusions: Determining the driving features and adjustable elements provides the initial step towards developing an adaptable assistive technology for the user when the ground truths of the individual and their machine have been learned by a smart pattern recognition system.

Independent or employed? There is a third way. . .

General practice is in crisis. Many posts lie empty and large numbers of older doctors are due to retire soon. The current system is failing, with patients waiting weeks for appointments. Something radical has to be done. Currently we are small groups of self employed doctors with limited career progression, a blank cheque of responsibility, and seeing in excess of 30 patients a day in 10 minute appointments.1 The combination of acute and routine work required means that GPs often finish surgeries then do house calls over lunchtime. Paperwork is done in the margins of the day. Increasing pressure is making general practices dysfunctional, chaotic, unhappy, and lonely places. A sickness absence can …

Effect of vertical oscillatory pressure on disability of patients with chronic mechanical low back pain using Roland Morris Disability questionnaire

Prevalence of low back pain (LBP) among Africans is rising. Many adults in any given year experience low back pain at one time or the other, this should be of concern. It is then imperative to research into how to reduce the disability caused by LBP. The objective of this study was to assess the effect of Vertical Oscillatory Pressure (VOP) on the pain and disability of patients with mechanical low back pain. A total of 84 patients (34 males and 50 females) diagnosed with mechanical low back pain were purposely selected to participate in the study after obtaining their consent. The pain intensity of all the patients was assessed individually using Present Pain Intensity (PPI) on the first day of their appointment in addition to other examinations. Roland-Morris Disability Questionnaire (RMDQ) was also administered to all patients individually on the first day of report to the clinic. This is pre test record. VOP was then administered to each patient twice in a week for 6 weeks making 12 treatment sessions. Pain intensity and disability were assessed regularly every week of appointment for the 6-week period using PPI and RMDQ (post-test) by another physiotherapist in order to avoid bias. The difference between the first week score of RMDQ and the 6th week score was calculated and the percentage of improvement was determined. Dependent t-test was used to compare the pre and post test values and an alpha level of 0.05 was set as level of significance. An independent t-test was used to analyse the difference between male and female values. Result revealed that the maximum complaint of patients using RMDQ showed a significant disability for males but not for females, and the rate of improvement of male was higher than that of females. There were significant differences (P<.00 1) between the pre-test and post test measurements of PPI and RMDQ, respectively. The rate of improvement in males was significantly higher than that of females. The study concluded that VOP can be useful in ameliorating pain and disability of patients with low back pain.

Coping strategies for adaptation to new teacher appointments: Intervention for retention

Findings are presented from a qualitative longitudinal collective case study of 29 teachers newly appointed to rural or remote schools in Western Australia. All participants experienced stress and articulated coping strategies in response: direct-action, palliative and avoidant strategies. Where protective structures and processes existed in environments, teachers employed direct-action problem-solving strategies. Avoidant strategies were more common in young and mature-aged novices, rather than experienced teachers. Three critical times were identified to support adaptation: first weeks of appointment for information, first semester for assistance, support, feedback for development of competence and three months before the year-end for stability and certainty.

Kaiser-Permanente: a model American health maintenance organization.

The Kaiser-Permanente medical care program, a prepaid group practice that has been operating in California for over 30 years, is one of the most successful Health Maintenance Organizations (HMOs) in the United States. Kaiser's membership in California, Portland, Hawaii, Denver, and Cleveland exceeds 2.5 million. The main success that HMOs can claim is cost reduction. Kaiser can provide a package of services at lower cost than identical services would cost in “mainstream” medicine. The way in which an HMO reduces cost is by lowering the use of services by its members. Kaiser members spend half as many days in the hospital as a similar population of Blue Cross/Blue Shield subscribers. But Kaiser also tends to lower the availability of services that are not presently performed in excess. Ambulatory care is not easily accessible-large numbers of patients complain of waiting several weeks for appointments, of receiving rushed impersonal treatment, and of being unable to find and keep a personal physician. Thus Kaiser cost reduction goes hand-in-hand with a general inaccessibility of services. The reason for this is the working of the profit motive. Whether for-profit or technically “nonprofit,” private corporations have always committed themselves to maximizing their income, reducing their expenditures, and using the surplus for expansion. The profit incentive leads private HMOs to limit services by hiring an inadequate number of physicians and other personnel so that patients will be discouraged from seeking care. In this way, expenses go down and surplus goes up. This is a revision of an article, “Kaiser Plan,” that appeared in the Health-PAC Bulletin, No. 55, pp. 1-18, November 1973.