Follow-up after unsatisfactory cervical cytology in a county hospital setting

2022 ◽  
Vol 164 (1) ◽  
pp. 31-32
Author(s):  
Sanchala Sehgal ◽  
Syem Barakzai ◽  
Ailene Nguyen ◽  
Brian Gordon
Keyword(s):  
Hospital Setting ◽  
Cervical Cytology ◽  
County Hospital

Validation of a model for the prediction of retinopathy in persons with type 1 diabetes

2019 ◽  
pp. bjophthalmol-2018-313539
Author(s):  
Vivian Schreur ◽  
Heijan Ng ◽  
Giels Nijpels ◽  
Einar Stefánsson ◽  
Cees J Tack ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Hospital Setting ◽  
Predictive Performance ◽  
Individual Risk ◽  
Screening Interval ◽  
C Statistic ◽  
Onset Of Diabetes ◽  
Screening Frequency

Background/AimTo validate a previously developed model for prediction of diabetic retinopathy (DR) for personalised retinopathy screening in persons with type 1 diabetes.MethodsRetrospective medical data of persons with type 1 diabetes treated in an academic hospital setting were used for analysis. Sight-threatening retinopathy (STR) was defined as the presence of severe non-proliferative DR, proliferative DR or macular oedema. The presence and grade of retinopathy, onset of diabetes, systolic blood pressure, and levels of haemoglobin A1c were used to calculate an individual risk estimate and personalised screening interval. In persons with STR, the occurrence was compared with the calculated date of screening. The model’s predictive performance was measured using calibration and discrimination techniques.ResultsOf the 268 persons included in our study, 24 (9.0%) developed STR during a mean follow-up of 4.6 years. All incidences of STR occurred after the calculated screening date. By applying the model, the mean calculated screening interval was 30.5 months, which is a reduction in screening frequency of 61% compared with annual screening and 21% compared with biennial screening. The discriminatory ability was good (Harrell’s C-statistic=0.82, 95% CI 0.74 to 0.90), and calibration showed an overestimation of risk in persons who were assigned to a higher risk for STR.ConclusionThis validation study suggests that a screening programme based on the previously developed prediction model is safe and efficient. The use of a personalised screening frequency could improve cost-effectiveness of diabetic eye care.

Evaluating a bereavement support group

2008 ◽  
Vol 6 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Nancy C. Maruyama ◽  
Clarisa V. Atencio
Keyword(s):  
General Hospital ◽  
Support Group ◽  
Negative Emotions ◽  
Hospital Setting ◽  
Bereavement Support ◽  
Men And Women ◽  
Before And After ◽  
Bereavement Support Group

ABSTRACTObjective:To assess the feasibility of an 8-week bereavement support group in a general hospital setting.Methods:We assessed grief and mood before and after an 8-week bereavement support group and compared dropouts to completers. Forty-seven participants filled out mood and grief questionnaires. Scores were compared with norms, then baseline and follow-up scores were analyzed by paired t tests. Fifteen dropouts' scores were compared with completers' baseline scores.Results:Participants' grief improved, as did depression in women but not men. Women dropouts scored significantly higher on Anger, Tension/Anxiety.Significance of results:Findings suggest men and women respond differently to bereavement groups. Bereaved individuals with high anger and tension may require interventions addressing their particular needs, with a focus on acceptance of negative emotions.

scholarly journals Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

2021 ◽  
Vol 13 (01) ◽  
pp. e51-e56
Author(s):  
Lauren Hennein ◽  
Kimberly A. Spaulding ◽  
Veronika Karlegan ◽  
Ogonna N. Nnamani Silva ◽  
Alejandra G. de Alba Campomanes
Keyword(s):  
High School ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Nonprofit Organization ◽  
County Hospital ◽  
Categorical Variables ◽  
Homeless Shelter ◽  
High School Diploma

Abstract Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

Attitudes Regarding Transitions of Care of Obstetric and Gynecology Patients in a County Hospital Setting [20I]

2017 ◽  
Vol 129 ◽  
pp. 98S
Author(s):  
Angalene Jackson ◽  
Hayley Marshall ◽  
Christine Hoang ◽  
Timothy Kremer
Keyword(s):  
Hospital Setting ◽  
Transitions Of Care ◽  
County Hospital

scholarly journals After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial

2011 ◽  
Vol 61 (587) ◽  
pp. e333-e339 ◽  
Author(s):  
Seonaidh Cotton ◽  
Linda Sharp ◽  
Claire Cochran ◽  
Nicola Gray ◽  
Maggie Cruickshank ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Cervical Cytology ◽  
After Effects

scholarly journals A call to action for delirium research: Meta-analysis and regression of delirium associated mortality

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
May Zin Aung Thein ◽  
Jarett V. Pereira ◽  
Anita Nitchingham ◽  
Gideon A. Caplan
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
A Priori ◽  
Group Analysis ◽  
Hospital Setting ◽  
Mortality Data ◽  
Mixed Effect ◽  
Elderly Inpatients ◽  
Registration Number

Abstract Background Delirium is an extremely common hospital complication. No study to date has assessed whether a priori defined covariates; type of hospital setting and year of study publication, influence the relationship between delirium and mortality. This is also the first study to examine the longitudinal trend of delirium-associated mortality over recent decades, to analyse the trajectory of our efforts in combating this disease. Methods MEDLINE, EMBASE and PsycINFO, were searched from January 1981 to May 2018 for English-language primary articles. Rigorous title and abstract screen and full-text screen were conducted independently by two reviewers. This paper adhered to MOOSE guidelines. Data was extracted independently by one reviewer using standardised data-collection sheets, with a separate reviewer verifying for accuracy. The quality of included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Unadjusted effect sizes and event counts were analysed with a random effects model in primary meta-analysis and meta-regression, whereas a mixed effect model was used in secondary sub-group analysis. Mortality data at longest follow-up and cumulative mortality (hospital mortality combined with mortality at longest follow-up) data were analysed. Results As part of a larger project, 446 of 6790 articles were retrieved, including 71 studies that measured mortality. Our results demonstrate that elderly inpatients with delirium had significantly greater odds of mortality (OR 3.18 [95%CI: 2.73, 3.70]) compared to non-delirious controls. Patients with delirium in the ICU had the highest odds for mortality (OR: 7.09 [95%CI: 3.60, 14.0]); double the risk compared to the average. Curiously, despite advancements in delirium research, delirium associated in-hospital odds of mortality has not changed in 30 years. Conclusion This is the largest meta-analysis to confirm the association between delirium and mortality, in older (age ≥ 65) hospital inpatients. The current meta-analysis highlights the significant odds of mortality after an episode of delirium, and these odds are much higher for ICU patients. However, in contrast to other medical conditions that have seen a decrease in associated mortality over the past few decades, delirium associated mortality remains unchanged. These findings underscore the urgent need for better delirium treatments. PROSPERO Registration Number: CRD42018098627, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=98627

scholarly journals Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

2019 ◽  
Vol 81 (01) ◽  
pp. 017-027
Author(s):  
Michael Bender ◽  
Carolin Gramsch ◽  
Lukas Herrmann ◽  
Seong Woong Kim ◽  
Eberhard Uhl ◽  
...  
Keyword(s):  
Blood Loss ◽  
Pain Score ◽  
Hospital Setting ◽  
University Hospital ◽  
Disk Herniation ◽  
Training Requirements ◽  
Lumbar Disk ◽  
Duration Of Surgery ◽  
Lumbar Disk Herniations

Abstract Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

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