ABSTRACT
RATIONALE: Changes in the demography of doctors require changes in care practices. OBJECTIVES: The aim of this study was to identify factors associated with doctors' workload in the ophthalmology consultation department of a university hospital, with a view to developing methods to improve the organization of hospital outpatient clinics. METHODS: A 10-day cross-sectional survey was carried out in an ophthalmology outpatient clinic (in- and outpatient consultations, including emergencies) specializing in the uveitis care. Demographic and management data for each patient were collected on a structured form. The doctor's workload was assessed, using a scale taking into account the duration of the consultation and the number of diagnostic tests performed, as a function of management complexity. RESULTS: Of the 861 consultations studied, 39.7% were highly complex. The level of complexity of consultations was correlated with the type of referral (phi = 0.602), consultation duration (phi = 0.545), the number of consultations in the previous year (phi = 0.499), and the number of diagnostic tests performed (phi = 0.445). Consultations were longer and diagnostic tests were more frequently performed if patients had been referred by an ophthalmologist, consulted a faculty doctor or a fellow, or presented with uveitis. Consultations were also more complex for patients with at least four previous consultations in the past year. CONCLUSIONS: Type of referral, status of the attending doctor and number of consultations within the course of 1 year were associated with doctors' workload and could be taken into account to predict the duration of complexity of consultations when scheduling appointments.
Subject(s)
Hospital Departments/organization & administration , Hospitals, University/organization & administration , Ophthalmology/organization & administration , Referral and Consultation/organization & administration , Adolescent , Aged , Appointments and Schedules , Cataract/diagnosis , Child , Cross-Sectional Studies , Diagnostic Techniques, Ophthalmological , Eye Diseases/diagnosis , Female , Humans , Male , Middle Aged , Muscle Hypertonia/diagnosis , Oculomotor Muscles/physiopathology , Outpatient Clinics, Hospital/organization & administration , Refractive Errors/diagnosis , Time Factors , Uveitis/diagnosis , WorkloadABSTRACT
PURPOSE: To ascertain the loco-regional recurrence (LRR) rate and its major prognostic factors in patients younger than 40 and to determine the influence of age on the features of breast cancer and its treatment in two age groups: 35 years and [36-39] years. METHODS AND MATERIALS: Between 1985 and 1995, 209 premenopausal women, younger than 40, were treated for early breast cancers with primary breast conserving surgery followed by radiotherapy+/-chemotherapy. Median age was 37 years with 66 patients (32%) 35 years and 143 older (68%). Median follow-up was 12 years. Tumours' characteristics were: cT1 in 75%, pN0 in 60%. RESULTS: LRR rate was 38% at 10 years, contralateral breast cancer rate 12%. Age was the only prognostic factor for LRR. The relative risk of LRR increased by 7% for every decreasing year of age. The annual risk of local recurrence peaked between 2 and 3 years after the initial diagnosis and returned to the level of contra-lateral breast cancer at 10 years. The younger population had infiltrating carcinomas that were significantly more commonly ductal, less commonly lobular, and of higher grade - they received chemotherapy more often. CONCLUSION: Using conventional methods we could find no explanation as to why age remained the most important prognostic factor for breast cancer LRR. Known prognostic factors such as involved surgical margins seemed erased by adequate radiotherapy doses.
Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Carcinoma, Lobular/surgery , Neoplasm Recurrence, Local/epidemiology , Adult , Age Factors , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Ductal, Breast/radiotherapy , Carcinoma, Lobular/drug therapy , Carcinoma, Lobular/radiotherapy , Combined Modality Therapy , Disease-Free Survival , Female , Follow-Up Studies , Humans , Lymph Node Excision , Mastectomy, Segmental , Prognosis , Survival RateABSTRACT
Reporting of incidents or near incidents because of medical devices in French hospitals relies on procedures following European and national guidelines. The authors intend to evaluate hospital staff knowledge on these surveillance procedures as a marker of appropriate application. A telephone survey is conducted on a sample of Paris University hospital staff (n = 327) using a structured questionnaire. Two-hundred sixteen persons completed the questionnaire. The response rate was lower among physicians, especially surgeons paid on an hourly basis. Rates of correct answers were different according to age, seniority, job, and department categories. Physicians and nurses correctly answered questions on theoretical knowledge more often than the other job categories. However, on questions dealing with actual practice conditions, correct answers depended more on age and seniority with a U-shaped distribution (minimum rates in intermediate categories of age and seniority).
