A single-entry model and wait time for hip and knee replacement in eastern health region of Newfoundland and Labrador 2011–2019

Background A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. Method The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. Result After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. Conclusion Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

Refractory hyperactive delirium in the dying: pharmacological management

BackgroundDelirium is a prevalent clinical presentation in advanced illness. The hyperactive phase can cause severe symptoms at the end of life. There is no published study of the pharmacological management of this symptom in Australian palliative medicine practice.ObjectivesTo describe the pharmacological management of hyperactive delirium at the end of life in an Australian inpatient palliative care setting.MethodsRetrospective audit of deaths from October 2019 where a medication of interest (MOI) was used following admission to the palliative care unit (PCU) of Eastern Health. The clinical notes of those included were reviewed to further describe the clinical details surrounding the use of the MOI.ResultsForty patients were included. Midazolam was the most common medication used (57.5%). The most common dual agent combination was midazolam plus levomepromazine.ConclusionsThis audit is the first description of pharmacological management of severe hyperactive delirium at the end of life requiring sedation in an Australian PCU.

883Discharge Prescribing in Older Adults with Type 2 Diabetes Hospitalised for Diabetes-related Complications

Background Intensive therapy is often required to reach glycated haemoglobin targets in people with Type 2 Diabetes (T2D), however, aggressive treatment in people >80 years, frail individuals and people with dementia may be harmful. We aimed to determine whether these factors predict the intensity of anti-hyperglycaemic therapies prescribed for older hospitalised patients with T2D. Methods A cohort study was completed using discharge prescribing data from Melbourne’s Eastern Health hospital network. We identified 3,067 patients, aged 65-99 years, with T2D, at least one diabetes related complication and an index discharge between 2012 and 2016. Multinomial Logistic Regression was used to estimate adjusted Odds Ratios (ORs) with 95% confidence intervals (CI) for being prescribed insulin-only (IO), non-insulin anti-hyperglycaemics only (NIO) or a combination of those two (CT) compared to no anti-hyperglycaemics (NA). Results At discharge, 23% of patients were prescribed NA, 19% IO, 39% NIO and 20% CT. People aged >80 were less likely than those aged 65-80 to be discharged with IO (OR = 0.53; 95%CI [0.42-0.68]) or CT (OR = 0.37; 95%CI [0.30-0.47]), compared to NA. Frailty was negatively associated with being prescribed IO (OR 0.64; 95%CI [0.43-0.94]) or NIO (OR 0.64; 95%CI [0.46-0.89], compared to NA. People with dementia were less likely to be discharged with CT (OR 0.56; 95%CI [0.34-0.92]) compared to NA. Conclusions Prescribers recognise advancing age, frailty and dementia as factors which necessitate less intensive T2D treatment in hospitalised older adults. Key messages Frailty, independent of chronological age, is associated with receiving less intensive T2D therapy in older hospitalised patients.

Performance of Health Caregivers in the Eastern Health Center of Ahvaz, Iran, in the Self-Care Program

Background: Human factor has currently become the source of change in organizations. The evaluation of human performance is a practical issue in human resources management and the best way to obtain information for organizational decision-making. Objectives: The current study aimed to monitor the performance of health caregivers in the eastern health center of Ahvaz, Iran, in the self-care program. Methods: This cross-sectional descriptive study was conducted on 72 health caregivers in 20 affiliated and 31 non-affiliated health posts in the eastern health center of Ahvaz in 2018. The census sampling method and ministerial checklist were the tools of assessment for the performance measurement of the health caregivers. The checklist consisted of two parts for personal information and technical performance evaluation. The data were analyzed using the t-test and analysis of variance in SPSS software (version 22). Results: All the participants were female health caregivers. The results showed that there was notanysignificantdifferencebetweenthestudy dimensions with the participants’fieldofstudy (P = 0.798;F = 0.226), academic degree (P value =0.957; t = 0.003), age (P = 0.419; F = 0.955), and work experience (P-value = 0.537; F = 0.627). The health caregiversofthe eastern Ahvaz health center of Ahvaz scored 767.35 out of the total 1,000, indicating that their performance was generally at an acceptable level. Conclusions: The findings of this study can assist the managers and experts of the health sector in evaluating the performance of health caregivers in their self-care program. For the enhancement of the performance of health caregivers, not only health ambassadors should be identified and trained, but also the dimension of organizational self-care should be reinforced.

Physical Therapy Management of Low-Back Pain: A Survey of Physiotherapists’ Current Assessment and Treatment Practices

Purpose: The purpose of this study was to determine current physiotherapy practice for managing chronic low back pain (LBP). Method: We administered a cross-sectional survey to all physiotherapists working in Eastern Health (EH) Regional Health Authority, Newfoundland and Labrador, by email. To ascertain how physiotherapists assessed and treated patients with LBP, the survey included multiple-choice and open-ended questions, along with case vignettes. We explored the respondents’ confidence about implementing all aspects of guideline-based care, as well as their use of treatment outcome measures. Results: A total of 76 physiotherapists responded to the survey (84% response rate); 56 (74%) reported that they treated patients with LBP as part of their regular practice. More than half had managed LBP for more than 10 years. The most frequently used treatments were self-management advice, followed by home and supervised exercise. The majority of respondents lacked confidence about implementing cognitive–behavioural treatment techniques. The Numeric Pain Rating Scale was the most commonly used outcome measure; disability outcome measures were not frequently used. Conclusions: The majority of LBP management in EH aligns with guideline recommendations. Increased uptake of guidelines recommending assessment and management of LBP using a bio-psychosocial approach will require training and support.

Nitrogen-siliceous thermal waters in the therapy of patients with psoriasis (On the 155th anniversary of the Annenskie Vody sanatorium)

In 2021 the sanatorium "Annenskie Vody" will be 155 years old. This is the oldest balneological institution in the Khabarovsk Territory, a Far Eastern health resort that helps restore health to the population using natural factors. Annenskie Vody sanatorium receives more than three thousand patients annually, and almost 7 % of the patients are patients with skin diseases. The main healing factor in the Annenskie Vody sanatorium is mineral water. The spring water is thermal (t 52 ºC), slightly mineralized (0.2–0.3 g/l), hydrocarbonate-sulphate-sodium, alkaline, with a high content of silicic acid. There were 560 psoriasis patients aged from 18 to 70 years under observation. Of these, 360 are women and 200 are men. To assess the severity and effectiveness of the therapy in patients with psoriasis, the PASI index was used, which decreased by 4 times during therapy. Biochemical parameters improved under the influence of AKTW. The effectiveness of therapy increased with the use of complex methods of exposure (mud therapy, physiotherapy).

Assessment of a Pharmacist-Led Direct Oral Anticoagulant Monitoring Clinic

Background: Direct oral anticoagulants (DOACs) are recommended as first-line therapy for treatment and prevention of venous thromboembolism (VTE) and prevention of stroke related to nonvalvular atrial fibrillation. Recent publications have suggested incorporating DOAC monitoring into anticoagulant management clinics. The Eastern Health Adult Outpatient Thrombosis Service (Newfoundland and Labrador) includes a pharmacist-led DOAC monitoring clinic that uses standardized evidence-based care processes. Objectives: To describe a new pharmacist-led DOAC monitoring clinic and to assess patients’ adherence to medication therapy, adherence to guideline-recommended frequencies for blood work, and adverse and non-adverse events. Methods: This retrospective chart review involved patients who attended their first visit to the DOAC clinic between October 10, 2017, and May 31, 2018. Patients were followed until November 30, 2018. Data were abstracted from electronic hospital records and the provincial pharmacy network. Descriptive statistics were used to analyze the data: categorical variables were presented as frequencies and percentages; continuous variables were analyzed and presented as means with standard deviations and, where applicable, as medians with interquartile ranges. Results: Forty-seven patients, who attended a total of 74 clinic visits, were included. Twenty-eight patients (60%) were adherent to their DOAC therapy. All patients had blood work completed before each clinic appointment. The mean time between the first and second sets of blood tests was 6.2 (standard deviation [SD] 1.4) months and between the second and third sets of blood tests was 5.1 (SD 1.0) months. There were no episodes of VTE or major bleeding. There was 1 cerebrovascular accident (3.2 events per 100 person-years, 95% confidence interval [CI] 0.2–15.7) and 5 episodes of clinically relevant non-major bleeding (12.8 events per 100 person-years, 95% CI 4.1–30.1). Pharmacists identified 51 issues at the clinic appointments, of which 48 were medication-related. Referral to the Thrombosis Service physician was required to resolve 8 (16%) of the issues identified. A brief discussion between the Thrombosis Service physician and pharmacist was required to resolve 30 (59%) of the issues, with 13 (25%) resolved by the pharmacist alone. Conclusions: This study described the implementation and outcomes of a novel pharmacist-led DOAC clinic. Clinic patients underwent blood work at recommended intervals and received guidance on adherence and adverse events; as such, patients had follow-up that aligned with guideline recommendations. RÉSUMÉ Contexte : Les anticoagulants oraux directs (AOD) sont recommandés comme thérapie de première ligne pour le traitement et la prévention de la thromboembolie veineuse (TEV) et la prévention des AVC liés à la fibrillation auriculaire non valvulaire. Des publications récentes ont proposé d’incorporer le contrôle des AOD dans les cliniques des anticoagulants. L’Eastern Health Adult Outpatient Thrombosis Service (St John’s, Terre-Neuve-et-Labrador) comprend une clinique de surveillance des AOD, dirigée par des pharmaciens qui utilisent des processus de soins standardisés basés sur des éléments de preuve. Objectifs : Décrire une nouvelle clinique de surveillance des AOD dirigée par des pharmaciens et évaluer l’adhésion des patients à la pharmacothérapie, le respect de la fréquence des analyses sanguines recommandées dans les lignes directrices ainsi que les effets indésirables et ceux qui ne le sont pas. Méthodes : Cet examen rétrospectif des dossiers impliquait des patients ayant effectué leur première visite à la clinique AOD entre le 10 octobre 2017 et le 31 mai 2018. Les patients étaient suivis jusqu’au 30 novembre 2018. Les données analysées provenaient de dossiers d’hospitalisation électroniques et du réseau des pharmacies provinciales. Des statistiques descriptives ont servi à analyser les données : les variables catégorielles ont été présentées sous forme de fréquences et de pourcentages; les variables continues ont été analysées et présentées sous forme de moyennes avec les écarts-types et, le cas échéant, sous forme de moyennes avec les écarts interquartiles. Résultats : Quarante-sept patients, ayant effectué 74 visites en clinique, ont participé à l’étude. Vingt-huit patients (60 %) se conformaient à leur thérapie AOD. Les analyses sanguines de tous les patients ont été effectuées avant chaque rendez-vous en clinique. Le temps moyen entre le premier et le deuxième ensemble de tests sanguins était de 6,2 mois (écart-type standard [ET] 1,4), et de 5,1 mois (ET 1) entre le deuxième et le troisième. Aucun épisode de TEV ou d’hémorragie importante n’a eu lieu. Il y a eu un accident cérébrovasculaire (3,2 événements par 100 années-personnes; intervalle de confiance [IC] à 95 % 0,2–15,7) et 5 épisodes de saignements non majeurs et cliniquement pertinents (12,8 événements par 100 années-personnes, IC 95 % 4,1–30,1). Les pharmaciens ont décelé 51 problèmes lors des rendez-vous en clinique; parmi ceux-ci, 48 étaient liés aux médicaments. Il a fallu faire appel au médecin du service des thromboses pour résoudre 8 (16 %) problèmes. Une brève discussion entre ce médecin et le pharmacien a été nécessaire pour résoudre 30 (59 %) problèmes et 13 (25 %) ont été réglés uniquement par le pharmacien. Conclusions : Cette étude décrivait la mise en place et les résultats d’une nouvelle clinique AOD dirigée par les pharmaciens. Les patients de la clinique ont subi une analyse sanguine aux intervalles recommandés et ont reçu des conseils sur l’adhésion et les effets indésirables; les patients ont donc bénéficié d’un suivi conforme aux lignes directrices.

Information system on tuberculosis: data completeness spatial analysis in the state of Paraná, Brazil

ABSTRACT Objective: To analyze the spatiality of completeness of the Information System on Diseases of Compulsory Declaration of tuberculosis in Paraná state, focusing on the border region. Method: A study composed by the notified cases of the disease treated in Paraná between 2008 and 2017. The variable completeness was classified as excellent (<5% of incompleteness), good (5 to <10%), regular (10 to <20%), poor (20% to 50%), and very poor (>50%). Moran global was used for the spatial correlation and local association was analyzed. Logistic regression was employed to assess the spatial association of the variables with the border and, for the significant variables, multiple logistic regression was used. The study abides by the resolution 510/2016 of the National Health Council. Results: There was a “high-high” correlation for education level, 2- and 6-month sputum smear in the Eastern health macroregional and “high-high” correlation in the Northwestern macroregional for 2-month sputum smear and antibiotic sensitivity testing. There was no spatial association with the border. Conclusion: Unsatisfactory completeness was identified in the database and conglomerates, indicating spatial association of incompleteness of some variables, but with no relation with the border. There was no worsening of completeness nor of the case outcomes related to these regions.

Physical Culture and Sports Activities in Self-Preserving Behavior of Students

The purpose of the research is to identify the role of physical culture and sports activities on the practice of students’ self-preservation behavior. The materials: The research was based on an online questionnaire which was held among 2503 students in REU Plekhanov (Moscow) in October 2019 under E. V. Kargapolova leadership. The results: The most common practices of self-preservation behavior are walking outside, physical education classes and regular sports. The most preferable kinds of sports for students were football, basketball and volleyball. The less preferable were Eastern health practices. Nevertheless, only half of students were regularly engaged in physical education activities. Most of respondents consider they are able to make a set of training exercises and a rational diet. Conclusions: There are several contradictions in students’ behavior values of self-preservation and their practices of sport activities. The majority of respondents understand the importance of a healthy lifestyle. Nevertheless, students do not always follow these practices in their daily routine. There is a strong correlation between their health and regular sport assessment, especially. This was due to the presence of a physical education system in higher educational institutions. That’s why universities are the most important platform for sports activities.

Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus

The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations’ average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.