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[PMID]:28604501
[Au] Autor:Rebeiro PF; Bakoyannis G; Musick BS; Braithwaite RS; Wools-Kaloustian KK; Nyandiko W; Some F; Braitstein P; Yiannoutsos CT
[Ad] Endereço:*Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN; †Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, IN; ‡Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN; Department of Population Health and Department of Medicine; §New York University School of Medicine, New York City, NY; Departments of ‖Child Health and Paediatrics; ¶Medicine, Moi University School of Medicine, Eldoret, Kenya; and #Epidemiology Division, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.
[Ti] Título:Observational Study of the Effect of Patient Outreach on Return to Care: The Earlier the Better.
[So] Source:J Acquir Immune Defic Syndr;76(2):141-148, 2017 Oct 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The burden of HIV remains heaviest in resource-limited settings, where problems of losses to care, silent transfers, gaps in care, and incomplete mortality ascertainment have been recognized. METHODS: Patients in care at Academic Model Providing Access to Healthcare (AMPATH) clinics from 2001-2011 were included in this retrospective observational study. Patients missing an appointment were traced by trained staff; those found alive were counseled to return to care (RTC). Relative hazards of RTC were estimated among those having a true gap: missing a clinic appointment and confirmed as neither dead nor receiving care elsewhere. Sample-based multiple imputation accounted for missing vital status. RESULTS: Among 34,522 patients lost to clinic, 15,331 (44.4%) had a true gap per outreach, 2754 (8.0%) were deceased, and 837 (2.4%) had documented transfers. Of 15,600 (45.2%) remaining without active ascertainment, 8762 (56.2%) with later RTC were assumed to have a true gap. Adjusted cause-specific hazard ratios (aHRs) showed early outreach (a ≤8-day window, defined by grid-search approach) had twice the hazard for RTC vs. those without (aHR = 2.06; P < 0.001). HRs for RTC were lower the later the outreach effort after disengagement (aHR = 0.86 per unit increase in time; P < 0.001). Older age, female sex (vs. male), antiretroviral therapy use (vs. none), and HIV status disclosure (vs. none) were also associated with greater likelihood of RTC, and higher enrollment CD4 count with lower likelihood of RTC. CONCLUSION: Patient outreach efforts have a positive impact on patient RTC, regardless of when undertaken, but particularly soon after the patient misses an appointment.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Infecções por HIV/tratamento farmacológico
Pacientes não Comparecentes
Pacientes Desistentes do Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Terapia Antirretroviral de Alta Atividade
Contagem de Linfócito CD4
Feminino
Seres Humanos
Perda de Seguimento
Masculino
Meia-Idade
Cooperação do Paciente
Estudos Retrospectivos
Sensibilidade e Especificidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE
[do] DOI:10.1097/QAI.0000000000001474


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[PMID]:28427444
[Au] Autor:Ansell D; Crispo JAG; Simard B; Bjerre LM
[Ad] Endereço:Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada. danse088@uottawa.ca.
[Ti] Título:Interventions to reduce wait times for primary care appointments: a systematic review.
[So] Source:BMC Health Serv Res;17(1):295, 2017 Apr 20.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Accessibility and availability are important characteristics of efficient and effective primary healthcare systems. Currently, timely access to a family physician is a concern in Canada. Adverse outcomes are associated with longer wait times for primary care appointments and often leave individuals to rely on urgent care. When wait times for appointments are too long patients may experience worse health outcomes and are often left to use emergency department resources. The primary objective of our study was to systematically review the literature to identify interventions designed to reduce wait times for primary care appointments. Secondary objectives were to assess patient satisfaction and reduction of no-show rates. METHODS: We searched multiple databases, including: Medline via Ovid SP (1947 to present), Embase (from 1980 to present), PsychINFO (from 1806 to present), Cochrane Central Register of Controlled Trials (CENTRAL; all dates), Cumulative Index to Nursing and Allied Health (CINAHL; 1937 to present), and Pubmed (all dates) to identify studies that reported outcomes associated with interventions designed to reduce wait times for primary care appointments. Two independent reviewers assessed all identified studies for inclusion using pre-defined inclusion/exclusion criteria and a multi-level screening approach. Our study methods were guided by the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Our search identified 3,960 articles that were eligible for inclusion, eleven of which satisfied all inclusion/exclusion criteria. Data abstraction of included studies revealed that open access scheduling is the most commonly used intervention to reduce wait times for primary care appointments. Additionally, included studies demonstrated that dedicated telephone calls for follow-up consultation, presence of nurse practitioners on staff, nurse and general practitioner triage, and email consultations were effective at reducing wait times. CONCLUSIONS: To our knowledge, this is the first study to systematically review and identify interventions designed to reduce wait times for primary care appointments. Our findings suggest that open access scheduling and other patient-centred interventions may reduce wait times for primary care appointments. Our review may inform policy makers and family healthcare providers about interventions that are effective in offering timely access to primary healthcare.
[Mh] Termos MeSH primário: Agendamento de Consultas
Medicina de Família e Comunidade/organização & administração
Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Canadá
Correio Eletrônico
Serviço Hospitalar de Emergência/utilização
Clínicos Gerais/provisão & distribuição
Acesso aos Serviços de Saúde
Seres Humanos
Pacientes não Comparecentes
Profissionais de Enfermagem/provisão & distribuição
Satisfação do Paciente
Encaminhamento e Consulta
Tempo para o Tratamento
Triagem/organização & administração
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2219-y


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[PMID]:28336027
[Au] Autor:Lee CM; Rodgers C; Oh AK; Muckler VC
[Ti] Título:Reducing Surgery Cancellations at a Pediatric Ambulatory Surgery Center.
[So] Source:AORN J;105(4):384-391, 2017 Apr.
[Is] ISSN:1878-0369
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Surgery cancellations are costly and can be frustrating for patients, their families, and the surgical team. Because of the inherent nature of an ambulatory surgery center, which only performs scheduled elective procedures, surgical cancellations typically result in wasted time and resources. Pediatric surgery cancellations can be mitigated with proper preoperative screening and communication between nurses and patients' guardians. To reduce the rate of cancellation at our pediatric ambulatory surgery center, we implemented a Nurse-Patient Preoperative Call Log. Preoperative nurses called patients or their guardians on two separate occasions during the two weeks before surgery to review health history and instructions and answer questions about the upcoming surgery. Three months after implementing the call log, surgery cancellation rates significantly decreased from 16.8% to 8.8% (P < .05). Nurses used the call log for all patients, with 85.6% of patients receiving two calls in the two weeks before their surgery.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos
Agendamento de Consultas
Comunicação
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos
Pacientes não Comparecentes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Criança
Seres Humanos
Relações Enfermeiro-Paciente
Cuidados Pré-Operatórios/métodos
Telefone/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE


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[PMID]:28222306
[Au] Autor:Puliti D; Bucchi L; Mancini S; Paci E; Baracco S; Campari C; Canuti D; Cirilli C; Collina N; Conti GM; Di Felice E; Falcini F; Michiara M; Negri R; Ravaioli A; Sassoli De' Bianchi P; Serafini M; Zorzi M; Caldarella A; Cataliotti L; Zappa M; IMPACT COHORT Working Group
[Ad] Endereço:ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy.
[Ti] Título:Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy.
[So] Source:Eur J Cancer;75:109-116, 2017 Apr.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. METHODS: The cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. RESULTS: Overall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06-1.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01-1.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57-0.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76-0.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68-0.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. CONCLUSIONS: Comparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+.
[Mh] Termos MeSH primário: Neoplasias da Mama/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Neoplasias da Mama/prevenção & controle
Neoplasias da Mama/psicologia
Estudos de Coortes
Detecção Precoce de Câncer/psicologia
Detecção Precoce de Câncer/estatística & dados numéricos
Feminino
Seres Humanos
Incidência
Itália/epidemiologia
Mamografia/psicologia
Mamografia/estatística & dados numéricos
Programas de Rastreamento/psicologia
Programas de Rastreamento/estatística & dados numéricos
Meia-Idade
Pacientes não Comparecentes/psicologia
Pacientes não Comparecentes/estatística & dados numéricos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Fatores Socioeconômicos
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE


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[PMID]:28067678
[Au] Autor:Drewek R; Mirea L; Adelson PD
[Ad] Endereço:Author Affiliations: Sleep Disorders Center, Department of Pediatric Pulmonology (Dr Drewek), and Department of Research (Dr Mirea), and Barrow Neurological Institute and Neurosurgery, (Dr Adelson) Phoenix Children's Hospital, Arizona.
[Ti] Título:Lead Time to Appointment and No-Show Rates for New and Follow-up Patients in an Ambulatory Clinic.
[So] Source:Health Care Manag (Frederick);36(1):4-9, 2017 Jan/Mar.
[Is] ISSN:1550-512X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:High rates of no-shows in outpatient clinics are problematic for revenue and for quality of patient care. Longer lead time to appointment has variably been implicated as a risk factor for no-shows, but the evidence within pediatric clinics is inconclusive. The goal of this study was to estimate no-show rates and test for association between appointment lead time and no-show rates for new and follow-up patients. Analyses included 534 new and 1920 follow-up patients from pulmonology and gastroenterology clinics at a freestanding children's hospital. The overall rate of no-shows was lower for visits scheduled within 0 to 30 days compared with 30 days or more (23% compared with 47%, P < .0001). Patient type significantly modified the association of appointment lead time; the rate of no-shows was higher (30%) among new patients compared with (21%) follow-up patients with appointments scheduled within 30 days (P = .004). For appointments scheduled 30 or more days' lead time, no-show rates were statistically similar for new patients (46%) and follow-up patients (0.48%). Time to appointment is a risk factor associated with no-shows, and further study is needed to identify and implement effective approaches to reduce appointment lead time, especially for new patients in pediatric subspecialties.
[Mh] Termos MeSH primário: Assistência ao Convalescente/estatística & dados numéricos
Instituições de Assistência Ambulatorial/economia
Agendamento de Consultas
Pacientes não Comparecentes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Instituições de Assistência Ambulatorial/organização & administração
Estudos Transversais
Seres Humanos
Pacientes não Comparecentes/economia
Cooperação do Paciente/estatística & dados numéricos
Pediatria
Sistemas de Alerta/utilização
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170110
[St] Status:MEDLINE
[do] DOI:10.1097/HCM.0000000000000148


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[PMID]:27603225
[Au] Autor:Valsangkar NP; Eppstein AC; Lawson RA; Taylor AN
[Ad] Endereço:Section of General Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis.
[Ti] Título:Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.
[So] Source:JAMA Surg;152(1):42-47, 2017 Jan 01.
[Is] ISSN:2168-6262
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. Objective: To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Design, Setting, and Participants: Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. Exposures: The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Main Outcomes and Measures: Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Results: Following rapid process improvement workshop project rollouts, mean (SD) patient wait times for elective general surgical procedures decreased from 33.4 (8.3) days in FY 2012 to 26.0 (9.5) days in FY 2013 (P = .02). In FY 2014, mean (SD) wait times were half the value of the previous FY at 12.0 (2.1) days (P = .07). This was a 3-fold decrease from wait times in FY 2012 (P = .02). Operative volume increased from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3131 in FY 2012 to 3460 in FY 2013 and 3517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014 (P = .02). Conclusions and Relevance: Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos
Cirurgia Geral/organização & administração
Administração Hospitalar/métodos
Centro Cirúrgico Hospitalar/organização & administração
Gestão da Qualidade Total
United States Department of Veterans Affairs/organização & administração
[Mh] Termos MeSH secundário: Agendamento de Consultas
Eficiência Organizacional
Cirurgia Geral/estatística & dados numéricos
Seres Humanos
Pacientes não Comparecentes/estatística & dados numéricos
Salas Cirúrgicas/organização & administração
Projetos Piloto
Avaliação de Processos (Cuidados de Saúde)
Encaminhamento e Consulta/estatística & dados numéricos
Centro Cirúrgico Hospitalar/estatística & dados numéricos
Telemedicina/estatística & dados numéricos
Fatores de Tempo
Triagem/organização & administração
Estados Unidos
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160908
[St] Status:MEDLINE
[do] DOI:10.1001/jamasurg.2016.2808


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[PMID]:27477580
[Au] Autor:Mayer JE; Fontelo P
[Ad] Endereço:a Department of Medicine , Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA.
[Ti] Título:Meta-analysis on the effect of text message reminders for HIV-related compliance.
[So] Source:AIDS Care;29(4):409-417, 2017 Apr.
[Is] ISSN:1360-0451
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:For the treatment of HIV, compliance in regard to appointment attendance and medication usage is critical. Various methods have been attempted to increased HIV care compliance, and a method that has inspired many published studies is text message reminders. We conducted a meta-analysis of the literature from inception through May 2016 using the following databases: Pubmed, Embase, CINAHL, Web of Science, and Cochrane. Examples of terms used in the search included exploded versions of "HIV, "AIDS", "cell phone", "SMS", "text message", "reminder". After abstract and manuscript review, articles were discussed with co-author and included based on consensus. We excluded qualitative analyses, observational studies without an intervention, and studies without a control or pre-intervention group. We used random-effects models to calculate odds ratios (OR) and standardized mean differences (SMDs) for the text message intervention. Thirty-four unique studies were found and included in the meta-analysis. For the seven articles relating to non-attendance, text message reminders significantly reduced the rates of non-attendance (OR, 0.66; 95% CI, 0.48-0.92; P = .01; I = 52%). For the 20 articles on drug adherence, text message reminders significantly increased adherence (SMD, 0.87; 95% CI, 0.06-1.68; P = .04; I = 99%). For the 11 articles with physiologic measures (CD4 count or viral load), text message reminders led to significant improvement (SMD, 1.53; 95% CI, 0.52-2.55; P = .003; I = 99%). This meta-analysis reveals that text message reminders are a promising intervention that can be used to increase HIV care compliance when logistically feasible. Further study should focus on which populations benefit the most from this intervention, and successful implementers could create an established technological infrastructure for other clinics to adopt when seeking to boost compliance.
[Mh] Termos MeSH primário: Agendamento de Consultas
Infecções por HIV/tratamento farmacológico
Adesão à Medicação/estatística & dados numéricos
Pacientes não Comparecentes/estatística & dados numéricos
Sistemas de Alerta
Mensagem de Texto
[Mh] Termos MeSH secundário: Contagem de Linfócito CD4
Infecções por HIV/imunologia
Infecções por HIV/virologia
Seres Humanos
Razão de Chances
Carga Viral
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170624
[Lr] Data última revisão:
170624
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:160802
[St] Status:MEDLINE
[do] DOI:10.1080/09540121.2016.1214674


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[PMID]:27449558
[Au] Autor:Matlosz B; Firlag-Burkacka E; Horban A; Kowalska JD
[Ad] Endereço:a Hospital for Infectious Diseases , HIV Out-Patient Clinic , Warsaw , Poland.
[Ti] Título:Nephrology consultations incorporated into HIV care - non-compliance is an important issue.
[So] Source:AIDS Care;29(2):226-230, 2017 Feb.
[Is] ISSN:1360-0451
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Although infrequent, kidney disease is a potentially serious co-morbidity among human immunodeficiency virus (HIV)-infected patients. The spectrum of renal impairment is very wide from clinically insignificant to end stage renal disease and often requires nephrologist's consultation. Therefore, we established combined renal and HIV care in the HIV Out-Patient Clinic in Warsaw. Medical records of patients consulted by nephrologist from March 2014 to March 2015 were included in analyses. Patients changing medication without consulting the physician or persistently not coming for follow-up visits were defined as non-compliant. In statistical analyses, non-parametric tests and logistic regression models were used as appropriate. In total, 100 patients were consulted by a nephrologist during the study period. All patients were white Europeans, 88 (88%) male, 42 (42%) infected through men having sex with men and 16 (16%) through intravenous drug users. Fifteen (15%) patients had hepatitis C virus (HCV) infections and 11 (11%) confirmed with positive HCV RNA. The most common reasons for referral were proteinuria and increased serum creatinine. In 6 out of 31 patients (19.3% of those referred for increased creatinine level) elevated serum creatinine was due to illegal substances or diet supplements use. Fifty-seven (57%) of patients were non-compliant. In univariate logistic regression models, all tested factors were non-significant. In most cases, patients were referred to nephrologist due to possible link between laboratory abnormalities and antiretroviral treatment. In one out of five cases, elevated creatinine level was linked with substance/dietary abuse. Poor compliance is an important problem in integrated nephrological care, however we were not able to identify any factors associated with non-compliance.
[Mh] Termos MeSH primário: Infecções por HIV/tratamento farmacológico
Nefrologia
Pacientes não Comparecentes
Encaminhamento e Consulta
Insuficiência Renal/etiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Instituições de Assistência Ambulatorial
Fármacos Anti-HIV/efeitos adversos
Coinfecção/virologia
Creatinina/sangue
Suplementos Nutricionais/efeitos adversos
Feminino
Infecções por HIV/complicações
Hepatite C/complicações
Seres Humanos
Masculino
Meia-Idade
Proteinúria/etiologia
Insuficiência Renal/sangue
Insuficiência Renal/urina
Transtornos Relacionados ao Uso de Substâncias/complicações
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:160725
[St] Status:MEDLINE


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[PMID]:27984257
[Au] Autor:Perez DL; Young SS; King JN; Guarino AJ; Dworetzky BA; Flaherty A; Chemali Z; Caplan D; Dickerson BC
[Ad] Endereço:*Cognitive Behavioral Neurology Unit ∥Movement Disorders Unit ¶Frontotemporal Disorders Unit, Department of Neurology †Neuropsychiatry Unit, Department of Psychiatry ‡Institute of Health Professions, Massachusetts General Hospital §Edward B. Bromfield Epilepsy Program, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Preliminary Predictors of Initial Attendance, Symptom Burden, and Motor Subtype in a US Functional Neurological Disorders Clinic Population.
[So] Source:Cogn Behav Neurol;29(4):197-205, 2016 Dec.
[Is] ISSN:1543-3641
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: Although many patients present with functional neurological symptoms (FNS), few US clinics offer specialized FNS care, and data on clinic attendees remain limited. We determined predictors of initial attendance, symptom burden, and FNS subtype in the first patients referred to our Functional Neurological Disorders Clinic for suspected FNS. METHODS: We reviewed the charts of 62 consecutive patients (46 women, 16 men). Regression analyses investigated predictors of keeping the first scheduled clinic appointment. For the 49 patients who did keep that appointment, regression analyses examined neuropsychiatric factors associated with symptom burden and motor FNS subtypes. RESULTS: The odds of not keeping the first appointment were 10.4 times greater for patients referred from the emergency department than from other sources. The patients who kept their appointment reported a symptom burden that was significantly associated with a past FNS-related emergency department visit and a diagnosis of another medically unexplained somatic syndrome. The number of FNS findings on neurological examination also correlated with a history of an FNS-related emergency department visit. Patients with psychogenic non-epileptic seizures reported cognitive complaints and prior psychiatric hospitalizations significantly more often than did patients with other FNS. One fourth of all patients had two or more motor FNS. CONCLUSIONS: In our FNS cohort, patients were less likely to keep an initial clinic appointment if they were referred from the emergency department than from other sources. Patients with psychogenic non-epileptic seizures were more likely to report cognitive symptoms and past psychiatric hospitalizations than patients with other FNS.
[Mh] Termos MeSH primário: Transtornos Motores/etiologia
Doenças do Sistema Nervoso/diagnóstico
Pacientes não Comparecentes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Serviço Hospitalar de Emergência
Feminino
Seres Humanos
Masculino
Meia-Idade
Transtornos Motores/diagnóstico
Doenças do Sistema Nervoso/fisiopatologia
Encaminhamento e Consulta/estatística & dados numéricos
Estudos Retrospectivos
Transtornos Somatoformes/etiologia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170208
[Lr] Data última revisão:
170208
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161217
[St] Status:MEDLINE


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[PMID]:27905957
[Au] Autor:O AlRowaili M; Ahmed AE; Areabi HA
[Ad] Endereço:King Abdullah International Medical Research Center (KAIMRC), College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
[Ti] Título:Factors associated with No-Shows and rescheduling MRI appointments.
[So] Source:BMC Health Serv Res;16(1):679, 2016 Dec 01.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: One of the major challenges facing global radiology services comes from delays connected to long waiting lists for magnetic resonance imaging (MRI) procedures. Such delays in diagnostic procedures could lead to poorer patient care outcomes. This study intended to estimate the rate of "No-Shows" or "Reschedule" MRI appointments. We also investigated the factors correlating No-Shows and Reschedule MRI appointments. METHODS: A cross-sectional study was conducted in Saudi Arabia using data obtained via MRI schedule reviews and self-administrated questionnaires. Clinical and demographic data were also collected from the study participants. Stepwise binary logistic regression was used to analyze the data. RESULTS: A total of 904 outpatients were asked to participate in the study, and we enrolled 121 outpatients who agreed to complete the study questionnaire. Of the 904 outpatients, the rate of No-Shows or Reschedule was 34.8% (95% Confidence Interval: 31.7-38.1%). Of the 121 outpatients studied, the rate of No-Shows or Reschedule was 49.6% (95% CI: 40.4-58.8%). Those of the female gender (OR = 6.238; 95% CI: 2.674-14.551, p-value = 0.001) and lack of education (OR = 2.799; 95% CI: 1.121-6.986, p-value = 0.027) were highly associated with No-Shows for the MRI appointments. There was no clarification of the MRI instructions (OR = 31.396; 95% CI: 3.427-287.644; p-value = 0.002), and family member drivers (OR = 15.530; 95% CI: 2.637-91.446, p-value = 0.002) were highly associated with rescheduling the MRI appointments. CONCLUSIONS: We noted higher rates of No-Shows and Rescheduling of MRI appointments in females, those with a lack of formal education, those who had not received the procedure instructions, and those who lacked transportation. We recommend setting targets and developing strategies and policies to improve more timely access to MRI, and thus reduce the waiting time.
[Mh] Termos MeSH primário: Agendamento de Consultas
Imagem por Ressonância Magnética/estatística & dados numéricos
Pacientes não Comparecentes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Assistência Ambulatorial/estatística & dados numéricos
Estudos Transversais
Família
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Pacientes Ambulatoriais/estatística & dados numéricos
Arábia Saudita
Inquéritos e Questionários
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161202
[St] Status:MEDLINE



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