Compliance With Surgical Oncology Specialty Care at a Safety Net Facility

2021 ◽  
pp. 000313482110249
Author(s):  
Trevor Silva ◽  
Nikita Kadakia ◽  
Chade Aribo ◽  
Andrea Gochi ◽  
Gi Yoon Kim ◽  
...  
Keyword(s):  
At Risk ◽  
Significant Proportion ◽  
Surgical Oncology ◽  
Safety Net ◽  
Lessons Learned ◽  
Definitive Treatment ◽  
Patient Portal ◽  
Risk Patients ◽  
Race Ethnicity ◽  
Malignant Diagnosis

Background Social determinants of health challenge in at-risk patients seen in safety net facilities. Study design We performed a retrospective review of surgical oncology specialty clinic referrals at a safety net institution evaluating referral compliance and times to first appointment and initiation of definitive treatment. Main outcomes measured included completion of initial visit, initiation of definitive treatment, time from referral to first appointment, and time from first appointment to initiation of definitive treatment. Results Of 189 new referrals, English was not spoken by 52.4% and 69.4% were Hispanic. Patients presented without insurance in 39.2% of cases. Electronic patient portal was accessed by 31.6% of patients. Of all new referrals, 55.0% arrived for initial consultation and 53.4% initiated definitive treatment. Malignant diagnosis ( P < .0001) and lack of insurance ( P = .01) were associated with completing initial consultation. Initiation of definitive treatment was associated with not speaking English ( P = .03), malignant diagnosis ( P < .0001), and lack of insurance ( P = .03). Times to first appointment and initiation of definitive treatment were not significantly affected by race/ethnicity, language, insurance, treatment recommended, or electronic patient portal access. Conclusion Access to surgical oncology care for at-risk patients at a safety net facility is not adversely affected by lack of insurance, primary spoken language, or race/ethnicity. However, a significant proportion of all patients fail to complete the initial consultation and definitive treatment. Lessons learned from safety net facilities may help to inform disparities in health care found elsewhere.

scholarly journals Neuroactive Molecules in the Etiology of Postpartum Depression. An overview

2019 ◽  
Vol 70 (8) ◽  
pp. 2885-2888
Author(s):  
Mihaela Gabriela Stefan ◽  
Carmen Elena Condrat ◽  
Lavinia Gusa ◽  
Oana Daniela Toader ◽  
Andrei-Dennis Voichitoiu ◽  
...  
Keyword(s):  
At Risk ◽  
Postpartum Depression ◽  
Significant Proportion ◽  
Developed Countries ◽  
New Mothers ◽  
New Methods ◽  
High Prevalence ◽  
Mother And Child ◽  
Risk Patients

Postpartum depression is a serious and frequent condition that affects a significant proportion of new mothers in developed countries. Despite its high prevalence and proven deleterious outcomes for both mother and child, there remains an increasing need to expand our knowledge regarding new methods that ensure the discovery of at-risk patients. Many theories have been developed over the years, mainly focusing on hormonal imbalances that occur after childbirth. This review has the purpose to analyze the existing literature and to summarize the latest findings on neuroactive molecules which may predict postpartum depression in new mothers.

scholarly journals Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics

2021 ◽  
Vol 2 ◽  
Author(s):  
Ingrid Glurich ◽  
Richard Berg ◽  
Aloksagar Panny ◽  
Neel Shimpi ◽  
Annie Steinmetz ◽  
...  
Keyword(s):  
At Risk ◽  
Community Health ◽  
Health Center ◽  
Integrated Care ◽  
Point Of Care ◽  
Community Health Center ◽  
Safety Net ◽  
Risk Patients ◽  
Dental Appointments

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

Information-Seeking on the Internet

Crisis ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Vinod Singaravelu ◽  
Anne Stewart ◽  
Joanna Adams ◽  
Sue Simkin ◽  
Keith Hawton
Keyword(s):  
At Risk ◽  
Young People ◽  
Information Seeking ◽  
Significant Proportion ◽  
The Internet ◽  
Search Terms ◽  
Specific Advice ◽  
Restriction Sites ◽  
Self Harm ◽  
Negative Tone

Abstract. Background: The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. Aims: We aimed to identify and analyze websites potentially accessed by these young people. Method: Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. Results: In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Conclusion: Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

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