Creating a SNOMED CT reference set for common endocrine disorders based on routine clinic correspondence.

BACKGROUND: Routine clinical coding of clinical outcomes in outpatient consultations still lags behind the coding of episodes of inpatient care. Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) offers an opportunity for standardised coding of key clinical information. Identifying the most commonly required SNOMED terms and grouping these into a reference set will aid future adoption in routine clinical care. OBJECTIVE: To create a common endocrinology reference set to standardise the coding for outcomes of outpatient endocrine consultations, using a semi-automated extraction of information from existing clinical correspondence. METHODS: Retrospective review of data from an adult tertiary outpatient endocrine clinic between 2018 and 2019. A total of 1870 patients from postcodes within two regional areas of NHS Grampian (Aberdeen City and Aberdeenshire) attended the clinic. Following consultation, an automated script extracted each problem statement which was manually coded using the 'disorder' concepts from SNOMED CT (UK edition). RESULTS: The review identified 298 relevant endocrine diagnoses, 99 findings and 142 procedures. There were a total of 88 (29.5%) commonly seen endocrine conditions (e.g., Graves' disease, anterior hypopituitarism and Addison's disease) and 210 (70.5%) less commonly seen endocrine conditions. Subsequently, consultant endocrinologists completed a survey regarding the common endocrine conditions; 28 conditions have 100% agreement, 25 have 90%-99% agreement, 31 have 50%-89% agreement and 4 have less than 59% agreement (which were excluded). CONCLUSION: Automated text parsing of structured endocrine correspondence allowed the creation of a SNOMED CT reference set for common endocrine disorders. This will facilitate funding and planning of service provision in endocrinology by allowing more accurate characterisation of the patient cohorts needing specialist endocrine care.

Impact of an outpatient palliative care consultation and symptom clusters in terminal patients at a tertiary care center in Pakistan.

BACKGROUND: Patients with terminal diseases may benefit physically and psychosocially from an outpatient palliative care visit. Palliative care services are limited in Pakistan. An improved understanding of the symptom clusters present in our population is needed. The first outpatient palliative care center in Karachi, Pakistan, was established at our tertiary care institution. The primary aim of this study was to evaluate the impact of a palliative care outpatient consultation on symptom burden in patients with a terminal diagnosis. The secondary aim was to analyze the symptom clusters present in our population. METHODS: Patients with a terminal diagnosis referred to our outpatient palliative department between August 2020-August 2022 were enrolled. The Edmonton Symptom Assessment Scale (ESAS) questionnaire was administered at the initial visit and the first follow-up visit at one month. Change in symptom burden was assessed using a Wilcoxon signed ranks test. A principal component analysis with varimax rotation was performed on the symptoms reported at the initial visit to evaluate symptom clusters. The palliative performance scale (PPS) was used to measure the performance status of palliative care patients. RESULTS: Among the 78 patients included in this study, the average age was 59 ± 16.6 years, 52.6% were males, 99% patients had an oncological diagnosis, and the median duration between two visits was 14 (Q1-Q3: (7.0, 21.0) days. The median PPS level was 60% (Q1-Q3: 50-70). Overall, ESAS scores decreased between the two visits (6.0 (2.8, 11.0), p < 0.001) with statistically significant improvement in pain (5.0 vs. 2.5, p < 0.001), loss of appetite (5.0 vs. 4.0, p = 0.004), depression (2.0 vs. 0.0, p < 0.001), and anxiety (1.5 vs. 0.0, p = 0.032). Based on symptoms at the initial visit, 3 clusters were present in our population. Cluster 1 included anxiety, depression, and wellbeing; cluster 2 included nausea, loss of appetite, tiredness, and shortness of breath; and cluster 3 included drowsiness. CONCLUSION: An outpatient palliative care visit significantly improved symptom burden in patients with a terminal diagnosis. Patients may benefit from further development of outpatient palliative care facilities to improve the quality of life in terminally ill patients.

Correlation between overall survival and quality of life in colon cancer patients with chemotherapy.

BACKGROUND: Patients presenting with inoperable colon cancer at first onset (ICF) or at time of relapse (ICR) are considered in unrecoverable. The therapeutic goal for unrecoverable cancer is to prolong overall survival (OS) and maintain a high quality of life (QOL). As data on objective indicators of QOL in cancer patients, such as length of hospitalisation (LOH), outpatient consultation times (OCT), and hospital-free survival (HFS), is limited, this study compared ICF and ICR with respect to OS and QOL over the entire clinical course. METHODS: We retrospectively evaluated 90 inoperable colon cancer patients with chemotherapy and compared ICF and ICR in terms of OS, LOH, OCT, and HFS. RESULTS: Patients with ICF had a worse OS than those with ICR. In patients with ICF and ICR, OS and LOH were not correlated but OS and OCT and OS and HFS were strongly correlated. In patients with ICF and ICR, OCT and HFS accounted for approximately 8% and 90% of their OS, respectively. CONCLUSIONS: The LOH, OCT, and HFS are important factors for evaluating objective QOL of patients with inoperable colon cancer and should be considered when making treatment decisions.

Treatment decision making in psychiatry: Formulating patients' perspectives in outpatient psychiatric consultations.

Seeking and understanding patients' values and preferences is one of the essential elements in shared decision making, which is associated with treatment adherence in psychiatry. However, negotiating treatment in psychiatric contexts can be challenging with patients whose ability to evaluate treatment recommendations rationally may be impaired. This article attempts to examine a conversational practice that psychiatrists use to deal with patients' views and perspectives by formulating what the patients have said related to treatment. Taking the naturally occurring, face-to-face outpatient psychiatric consultations as the data, the present study uses conversation analysis (CA) as a method to demonstrate in a fine-grained detail what functions formulations of patients' perspectives serve in psychiatric contexts. We found that by eliciting patients' views and perspectives toward treatment, this type of formulation is not only used to achieve mutual understanding and establish the grounds for treatment decisions, but may also be used to challenge the legitimacy of patients' position, steering treatment decision to the direction preferred by the psychiatrists. We argue that in the process of treatment decision making, psychiatrists do not simply impose their perspectives upon the patients, instead, they attempt to achieve consensus with patients by balancing their institutional authority and orientation to the patients' perspectives. Data are in Chinese with English translation.

Actividad asistencial neurológica en Manzanillo / Neurological care activity in Manzanillo / Atividade de cuidados neurológicos em Manzanillo

RESUMEN Las enfermedades neurológicas se han convertido en una preocupación creciente, considerándose causa importante de morbimortalidad tanto en países desarrollados como en aquellos en desarrollo. Se realizó esta investigación con el objetivo de caracterizar la actividad asistencial del servicio de Neurología del Hospital Clínico-Quirúrgico Celia Sánchez Manduley. Se realizó un estudio observacional, descriptivo en el servicio de Neurología del Hospital Clínico-Quirúrgico Celia Sánchez Manduley, en el periodo de enero a diciembre de 2019. El universo estuvo constituido por 3968 pacientes, atendidos en consulta externa y hospitalización. Los resultados obtenidos se distribuyeron en frecuencias absolutas y por cientos. Se tomaron en cuenta las siguientes variables: edad, sexo, municipio, grupo diagnóstico y origen de la interconsulta. Predominó el sexo femenino (57,7 %) y el grupo de edad de 60 años y más (37,2 %). La mayoría de los pacientes fueron manzanilleros (36,4 %). La cefalea fue el grupo diagnóstico más representativo (23,9 %), y la epilepsia fue el principal diagnóstico con que ingresaron los pacientes (32,8 %). El servicio que aportó mayores solicitudes de interconsultas para un 66,8 % fue Medicina Interna. Los motivos de consulta y las características de los pacientes hospitalizados no difieren en gran medida de los presentados por otros autores. Los motivos de consulta más frecuentes fueron la cefalea y la epilepsia. El grupo de edad con mayor demanda de asistencia neurológica fueron pacientes mayores de 60 años, con predominio del sexo femenino. El mayor número de hospitalizaciones correspondió a la epilepsia y la enfermedad de Parkinson.

ABSTRACT Neurological diseases have become a growing concern, being considered a major cause of morbidity and mortality in both developed and developing countries. This research was carried out with the aim of characterizing the care activity of the Neurology service of the Celia Sánchez Manduley Clinical-Surgical Hospital. An observational, descriptive study was conducted in the Neurology service of the Celia Sánchez Manduley Clinical-Surgical Hospital, in the period from January to December 2019. The universe consisted of 3968 patients, treated in outpatient consultation and hospitalization. The results obtained were distributed in absolute frequencies and by hundreds. The following variables were taken into account: age, sex, municipality, diagnostic group and origin of the interconsultation. Female sex (57.7%) and the age group of 60 years and over (37.2%) predominated. The majority of patients were manzanilleros (36.4 %). Headache was the most representative diagnostic group (23.9%), and epilepsy was the main diagnosis with which patients were admitted (32.8%). The service that provided the highest requests for interconsultations for 66.8% was Internal Medicine. The reasons for consultation and the characteristics of hospitalized patients do not differ greatly from those presented by other authors. The most frequent reasons for consultation were headache and epilepsy. The age group with the highest demand for neurological assistance were patients over 60 years of age, with a predominance of the female sex. The highest number of hospitalizations corresponded to epilepsy and Parkinson's disease.

RESUMO As doenças neurológicas tornaram-se uma preocupação crescente, sendo consideradas uma das principais causas de morbidade e mortalidade nos países desenvolvidos e em desenvolvimento. Esta pesquisa foi realizada como objetivo de caracterizar a atividade assistencial do serviço de Neurologia do Hospital Clínico-Cirúrgico Célia Sánchez Manduley. Um estudo observacional e descritivo foi realizado no serviço de Neurologia do Hospital Clínico-CirúrgicoCélia Sánchez Manduley, no período de janeiro a dezembro de 2019. O universo era composto por 3.968 pacientes, tratados em consulta ambulatorial e internação. Os resultados obtidos foram distribuídos em frequências absolutas e por centenas. Foram levadas em consideração as seguintes variáveis: idade, sexo, município, grupo diagnóstico e origem da interconsulção. Predominaram o sexo feminino (57,7%) e a faixa etária de 60 anos ou mais (37,2%) predominaram. A maioria dos pacientes foi manzanilleros (36,4 %). A dor de cabeça foi o grupo diagnóstico mais representativo (23,9%), e a epilepsia foi o principal diagnóstico com o qual os pacientes foram internados (32,8%). O serviço que atendeu mais pedidos de interconsultações para 66,8% foi a Medicina Interna. As razões para a consulta e as características dos pacientes internados não diferem muito das apresentadas por outros autores. Os motivos mais frequentes para a consulta foramdor de cabeça e epilepsia. A faixa etária com maior demanda por assistência neurológica foram pacientes com mais de 60 anos de idade, com predominância do sexo feminino. O maior número de internações correspondeu à epilepsia e doença de Parkinson.

Efectos de la COVID-19 sobre los servicios de salud en Santiago de Cuba, 2020 / Effects of COVID-19 on health services in Santiago de Cuba, 2020

Introducción: En Santiago de Cuba las acciones aplicadas para el control de la epidemia en el 2020 ocasionaron cambios y efectos negativos sobre muchos de los servicios de salud que se brindan de manera habitual en el territorio. Objetivo: Identificar el efecto de la epidemia de COVID-19 sobre los servicios de salud en la provincia Santiago de Cuba durante el año 2020. Métodos: Se realizó un estudio ecológico retrospectivo con series temporales como unidades de análisis comparadas en la provincia de Santiago de Cuba como único territorio geográfico para evaluar los efectos que tuvo la COVID-19 sobre la prestación de los servicios de salud durante el año 2020. Se seleccionaron algunos indicadores de servicios de salud de la serie de tiempo de 2015 a 2019. La fuente de datos fueron las estadísticas oficiales. Se estimó el porcentaje de cambio y se propuso una clasificación de los efectos de la COVID-19 según su magnitud y sentido. Resultados: Se produjeron cambios en la cantidad y tipos de servicios de salud en cuanto a las consultas médicas externas y de urgencia, los ingresos hospitalarios y promedio de estadía de las actividades de cardiología relacionados con ingresos, coronariografías realizadas, marcapasos implantados y operaciones ejecutadas, de las actividades quirúrgicas operaciones electivas y de urgencia, así como las ambulatorias y por mínimo acceso, los tratamientos rehabilitadores, los estudios para el diagnóstico mediante el uso de los laboratorios clínicos y de microbiología, estudios imagenológicos, en general, y los más afectados fueron los relacionados con la Estomatología, trasplantes renales y de córnea. Conclusiones: La epidemia de COVID-19 tuvo un efecto negativo en el funcionamiento de los servicios de salud al producirse cambios desfavorables en la cantidad de servicios prestados en los niveles de atención primario y secundario, lo que puede impactar en la salud de personas vulnerables si no se establecen estrategias alternativas(AU)

Introduction: In Santiago de Cuba province, the actions applied to control the epidemic in 2020 caused changes and negative effects on many of the health services that are usually provided in the territory. Objective: To identify the effect of the COVID-19 epidemic on health services in Santiago de Cuba province during 2020. Methods: A retrospective ecological study was conducted with time series as units of comparative analysis in Santiago de Cuba province as the only geographical territory to evaluate the effects of COVID-19 on the provision of health services during 2020. Some health service indicators from the time series from 2015 to 2019 were selected. The data source was official statistics. The percentage of change was estimated and a classification of the effects of COVID-19 according to its magnitude and meaning was proposed. Results: There were changes in the number and types of health services in terms of outpatient and emergency medical consultations, hospital admissions and average stay of cardiology activities related to admissions, coronary angiographies performed, pacemakers implanted and operations performed, elective surgical activities and emergency operations, as well as outpatient and minimal access ones, rehabilitative treatments, studies for diagnosis through the use of clinical and microbiology laboratories, imaging studies in general, and the most affected were those related to Stomatology, and kidney and corneal transplants. Conclusions: The COVID-19 epidemic had a negative effect on the functioning of health services as there were unfavorable changes in the number of services provided at the primary and secondary care levels, which can impact on the health of vulnerable people if alternative strategies are not established(AU)

Child Psychiatry Consultation Clinic for Pediatricians: Long-Term Outcomes.

There is an urgent need for new clinical models to improve access to child mental health care. Pediatricians are tasked to care for youth with mild to moderate mental health problems, but require additional training. This article describes an outpatient child psychiatry consultation clinic (CPC) designed to empower pediatricians to care for youth with depression, anxiety, and attention deficit/hyperactivity disorder. Over a 2-year period, 40 primary care physicians (PCPs) referred 159 patients to the CPC. The most common primary diagnoses of patients seen for consultation were generalized anxiety disorder (35%), major depressive disorder (24%), and attention deficit/hyperactivity disorder (20%). Most patients (89%) had at least 2 psychiatric diagnoses. Nearly four fifths (79%) of these patients successfully returned to their PCP for ongoing care. PCPs reported that the CPC enhanced their skills and improved access to mental health care. Similar models are needed to facilitate early intervention for the millions of youth with mental health problems.

Validación de instrumento para evaluación del rol docente de los profesionales de enfermería de consulta externa / Validation of the instrument for the evaluation of the teaching role of external consultation nursing professionals

El rol educativo de enfermería es conveniente para comprender e interpretar la percepción de los profesionales de enfermería y pacientes sobre su experiencia educativa. La educación es un componente esencial en la profesión de enfermería. Es concebida como una función sustantiva del rol enfermero, pues hace parte central del cuidado que este profesional brinda a las personas en los diferentes ámbitos de actuación. Objetivo: validar un instrumento para la evaluación del rol docente de los profesionales de enfermería en pacientes atendidos en consulta externa. Metodología: el paradigma bajo el cual se construyó esta investigación fue de corte cuantitativo, de tipo hipotético deductivo. La evaluación del instrumento se realizó a través del juicio de experto. Para la prueba piloto participaron 248 pacientes atendidos en consulta externa del hospital General IESS Ceibos- Guayaquil, 2019. Resultado: en la calificación obtenida en la evaluación del juicio de experto arrojo que el instrumento tiene una fiabilidad de 89.90% que según la escala, lo hace altamente con-fiable para mediar el rol docente en los profesionales de enfermería en pacientes atendidos en consulta externa. Conclusiones: el instrumento es apto para evaluar el rol docente de los profesionales de enfermería en pacientes atendidos en consulta externa(AU)

The nursing educational role is convenient to understand and in-terpret the nursing professionals and pa-tients perception about their educational experience. Education is an essential component in the nursing profession. The nursing role is conceived as a substan-tive function, since it is a central part of the care that this professional provides to people in different areas of action. Objec-tive: to validate an instrument for evalua-ting the teaching role of external consul-tation nursing professionals with patients seen in outpatient clinics. Methodology: the paradigm under which this research was built is quantitative, of a hypothe-tical deductive type. The evaluation of the instrument was carried out through expert judgment. For the pilot test, 248 patients attended in an outpatient clinic of the General IESS Ceibos-Guayaquil hospital, 2019 participated. Result: in the qualification obtained in the evaluation of the expert judgment, it was found that the instrument has a reliability of 89.90%, which according to the scale, makes it hi-ghly reliable to mediate the teaching role of nursing professionals in patients seen in outpatient clinics. Conclusions: the instrument is suitable for evaluating the teaching role of nursing professionals in patients seen in outpatient clinics

Rapid implementation of an evidence-based remote triaging system for assessment of suspected referrals and patients with head and neck cancer on follow-up after treatment during the COVID-19 pandemic: Model for international collaboration.

BACKGROUND: Outpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation. METHODS: For suspected referrals with cancer, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10 244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value, and area under the curve of 0.89. For follow-up patients, a symptom inventory generated from 5123 follow-up consultations was used. A customized Excel Data Tool was created, trialed across professional groups and made freely available for download at www.entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol, and registration link for the project. Stakeholder support was obtained from national bodies. RESULTS: No remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centers show that 77.1% of patients were discharged directly or have had their appointments deferred. DISCUSSION: Significant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC-V.2 is feasible and the authors welcome international collaboration.

Follow-up results in a specialised consultation after discharge for heart failure. / Resultados del seguimiento en una consulta monográfica tras el alta por insuficiencia cardiaca.

BACKGROUND: Despite advances in the diagnosis and treatment of heart failure (HF), the condition still has high morbidity and mortality. Health education and the treatment of comorbidities have been shown to be effective, as has multidisciplinary care in specialised units, although this involves organisational and structural efforts that are not always feasible. We present the results of a simple outpatient consultation, focused on the specialised care of HF. PATIENTS AND METHODS: The consultation included patients discharged after hospitalisation (index hospitalisation) for decompensated HF from an internal medicine department. The follow-up was conducted by internists especially dedicated (not exclusively) to HF and a nurse partially dedicated to HF. The follow-up consisted of fixed visits 1, 3, 6 and 12 months after the discharge, with more visits on demand if needed. RESULTS: A total of 250 patients were included with a minimum follow-up of 1 year. The reduction in hospitalisations and emergency department visits was 56% and 61% (P<.05), respectively, for HF and 46% and 40% (P<.05), respectively, for any cause. Treatment optimisation was also achieved, with a significant increase in the evidence-based drug prescription rate and the reduction of other drugs, such as calcium antagonists. CONCLUSION: A simple model based on a specialised care consultation for HF is effective in reducing readmissions and optimising the treatment. The lack of healthcare resources should not be an obstacle for specialised care for patients with HF.

[Special treatment in rheumatology-cross-sectoral quality-oriented selective contracts]. / Vertragsentwicklung der Selektivverträge in der Versorgungslandschaft Rheuma.

In the last 4 years selective contracts according to §140a of the German Social Code Book V (SGB V) with three different health insurers were signed by the Professional Association of German Rheumatologists (BDRh) and from the beginning of the year 2018 by the management company of the association. The contracts were rolled out in five regions of Germany (Bavaria, Hesse, Mecklenburg-Western Pomerania, North Rhine and Saxony). Up to the end of 2018, 12,000 patients with chronic inflammatory rheumatic diseases were treated within the managed care of these contracts. The interface and the treatment pathways were initially consented with the associations of rheumatologists and general practitioners. The aim of the managed care was to provide the optimal quality in diagnostics and treatment and to improve management of rheumatic diseases. Quality indicators, such as treat-to-target principles, tight control, delegation to specially trained assistance personnel, patient education in rheumatoid arthritis (StruPi) and early arthritis consultation, are part of the managed care and are successfully promoted with incentive payments. Thus approximately 20% of the patients were enrolled for the first time in rheumatological care. The BDRh wants to promote the nationwide roll-out of this managed care in Germany with more participating health insurance funds.

[Improved early diagnostics of rheumatic diseases : Monocentric experiences with an open rheumatological specialist consultation]. / Verbesserte Frühdiagnostik rheumatischer Erkrankungen : Monozentrische Erfahrungen mit einer offenen fachärztlich rheumatologischen Sprechstunde.

AIM OF THE PROJECT: To establish an open rheumatological outpatient consultation service for early diagnosis of inflammatory rheumatic diseases and initiation of further diagnostics and treatment. METHODS: In 2015 an open consultation service was initiated for patients with signs of an early rheumatic disease after referral by primary care physicians. Patients could attend once a week without the need for a prior appointment if they fulfilled at least one of the following criteria: positive rheumatoid factor, increased CRP, anti-CCP antibody or antinuclear antibody, joint pain or back pain for over 3 months, swollen joints, fever of unknown origin or acute muscle pain with or without headache of unknown origin. This article presents the results of the retrospective descriptive data analysis of the first 2 years of this project. RESULTS: A total of 1262 patients were treated with an average of approximately 20 patients per consultation. In nearly half of the patients an inflammatory rheumatological disease could be diagnosed and immediate diagnostic and treatment measures could be initiated. The diagnostic delay for patients with rheumatoid arthritis was 12 weeks, for patients with polymyalgia rheumatica 11 weeks and for patients with psoriatic arthritis or axial spondylarthritis 18 and 44 weeks, respectively. The time expenditure was a total of 4-5 h per week for an experienced rheumatologist and a specialized rheumatology nurse. CONCLUSION: Through this open rheumatological outpatient consultation a low threshold opportunity for the early diagnosis of rheumatologic diseases could be established. The diagnostic delay for many rheumatological diseases could be considerably shortened. Cooperation with rheumatologists in private practice guaranteed the subsequent specialized rheumatological care of the identified patients in the early stages of their illness.

Cost of Trauma Care in Secondary- and Tertiary-Care Public Sector Hospitals in North India.

BACKGROUND: Several initiatives to provide trauma care, including ambulance services, creation of a network of trauma hospitals and insurance schemes for cashless treatment, are currently being implemented in India. However, lack of information on the cost of trauma care is an impediment to the evidence-based planning for such initiatives. In this study, we aim to bridge this gap in evidence by estimating the unit cost of an outpatient consultation, inpatient bed-day of hospitalization, surgical procedure and diagnostics for providing trauma care through secondary- and tertiary-level hospitals in India. METHODS: We undertook an economic costing of trauma care in a secondary-care district hospital and a tertiary-level teaching and research hospital in North India. Cost analysis was undertaken using a health system perspective, employing a bottom-up costing methodology. Data on all resources-capital or recurrent-on delivery of trauma care during the period of April 2014 to March 2015 were collected. Standardized unit costs were estimated after adjusting for bed occupancy rates. Sensitivity analysis was performed to account for the uncertainties due to differences in prices and other assumptions. RESULTS: The cost of trauma care in the tertiary care hospital was INR 9585 (US$147.4) per day-care consultation; INR 2470 (US$37.7) per bed-day hospitalization (excluding ICU), INR 12,905 (US$198.5) per bed day in ICU and INR 21,499 (US$330.8) per surgery. Similarly, in the secondary-care hospital, the cost of trauma care was INR 482 (US$7.4) per outpatient consultation, INR 791 (US$12.2) per bed day of hospitalization, INR 186 (US$2.9) per minor surgery and INR 6505 (US$100.1) per major surgery. CONCLUSION: The estimates generated can be used for planning and managing trauma care services in India. The findings may also be used for undertaking future research in estimating the cost effectiveness of trauma care services or models of care.

Impact of joint consultation by a clinical pharmacist and a clinical geriatrician to improve inappropriate prescribing for elderly patients.

OBJECTIVE: Appropriate prescribing is a key quality element in medication safety. It is unclear if therapeutic interventions resulting from medication review lead to clinically relevant improvements. The effect of medication review on prescribing appropriateness was evaluated in the setting of an outpatient consultation team, consisting of a clinical pharmacist and a clinical geriatrician, in a large non-academic teaching hospital in the Netherlands. METHOD: A group of 49 elderly patients with polypharmacy was included after referral by their general practitioner for drug related problems. After a regular assessment by a clinical geriatrician and medication record review by a clinical pharmacist, a treatment plan was implemented based on the recommended interventions. The main outcome measure was the change in the Medication Appropriateness Index (MAI) before and 3 months after primary consultation. RESULTS: Overall 82% of the recommended interventions of the pharmacist were implemented by the geriatrician of which 63% persisted up to the last visit. Per patient an average of 6.6 interventions were carried out. The interventions showed a reduction of the MAI per patient of 50%. The number of drugs per patient was reduced from 12.1 to 11.0. The number of medications listed on the Beers list decreased from 2.3 to 1.5 and the number of drugs listed on the Hospital Admissions Related to Medication (HARM) Trigger list decreased from 2.1 to 1.5. CONCLUSIONS: Interventions from a multidisciplinary outpatient consultation team were effective in improving appropriate prescribing in elderly outpatients with polypharmacy.

Cuidados prenatales de enfermería proporcionados a adolescentes embarazadas en la consulta externa del CIMIGEN / Prenatal nursing care provided to pregnant adolescents in the external consultation of CIMIGEN / Assistência pré-natal de enfermagem prestada a adolescentes grávidas em consulta externa ao CIMIGENN

"El embarazo en adolescentes está expuesto a consecuencias, no sólo orgánicas sino también psicológicas, sociales, económicas, educativas y laborales. Por ello, se debe de pensar al embarazo en adolescentes en varios contextos y como fenómeno social. Sin embargo, los procedimientos de enfermería para la atención prenatal son los mismos que para toda la población de mujeres embarazadas, sin importar su edad. Objetivo: Identificar los tipos de cuidado que el personal de enfermería proporciona a las adolescentes embarazadas, es decir, los biológicos, psicológicos y sociales. Metodología: Se realizaron sesiones de observación participante, al personal de enfermería cuando brinda atención a gestantes menores de 20 años, y entrevistas semi-estructuradas a este personal. Resultados: En las consultas de enfermería los cuidados prenatales se centraron en los aspectos físicos y biológicos. Incluyeron el pesaje, la elaboración de la historia clínica prenatal, el interrogatorio sobre el desarrollo del embarazo, la toma de presión arterial, la exploración gineco-obstétrica y eventualmente, el Papanicolaou. Además, en las consultas se presentaron episodios de verificación de hábitos alimenticios y de detección de infecciones génito-urinarias, contracciones uterinas y síntomas de alarma para la prevención de riesgos y complicaciones en la salud. A pesar de que los aspectos psicosociales fueron poco evidentes en los cuidados dados por las enfermeras, sí los tomaron en cuenta: tranquilizaban a las adolescentes, les demostraban comprensión acerca de su conducta, las recriminaban por su alimentación inadecuada o por no tomar en tiempo y forma los medicamentos. Conclusión: El cuidado prenatal de enfermería a gestantes adolescentes tiene un énfasis curativo y preventivo en torno a lo físico y biológico. Aunque las enfermeras tienen potencial para realizar un cuidado prenatal más integral y de mayor calidad, los aspectos psicosociales en éste son débiles. Por ello, se recomienda fortalecerlos, mediante la formación profesional, la capacitación del personal y la modificación de algunas políticas y normas de la institución de salud, y así poder responder mejor a las necesidades de este grupo."

"A gravidez na adolescência está exposta a consequências, não apenas orgânicas, mas também psicológicas, sociais, econômicas, educacionais e trabalhistas. Portanto, a gravidez deve ser considerada em adolescentes em vários contextos e como um fenômeno social. No entanto, os procedimentos de enfermagem para o pré-natal são os mesmos de toda a população de gestantes, independentemente da idade. Objetivo: Identificar os tipos de cuidados que os enfermeiros prestam às adolescentes grávidas, isto é, biológicas, psicológicas e sociais. Metodologia: Foram realizadas sessões de observação dos participantes com a equipe de enfermagem no atendimento a gestantes menores de 20 anos e entrevistas semiestruturadas com essas equipes. Resultados: nas consultas de enfermagem, o pré-natal focado nos aspectos físicos e biológicos. Eles incluíram pesagem, preparação da história clínica pré-natal, interrogatório sobre o desenvolvimento da gravidez, aferição da pressão arterial, o exame gineco-obstétrico e, eventualmente, o exame de Papanicolaou. Além disso, as consultas apresentaram episódios de verificação dos hábitos alimentares e detecção de infecções genito-urinárias, contrações uterinas e sintomas de alarme para a prevenção de riscos e complicações à saúde. Embora os aspectos psicossociais não fossem muito evidentes nos cuidados prestados pelos enfermeiros, eles os levaram em consideração: tranquilizaram os adolescentes, mostraram compreensão sobre seu comportamento, os recriminaram por sua alimentação inadequada ou por não levá-los a tempo e a tempo. formar os medicamentos. Conclusão: A assistência pré-natal de enfermagem às adolescentes grávidas tem ênfase curativa e preventiva nos aspectos físicos e biológicos. Embora os enfermeiros tenham potencial para realizar um pré-natal mais abrangente e de maior qualidade, os aspectos psicossociais nele são fracos. Portanto, recomenda-se fortalecê-los, por meio de treinamento profissional, treinamento de pessoal e modificação de algumas políticas e padrões da instituição de saúde, para poder responder melhor às necessidades desse grupo."

"Teen pregnancy is exposed to consequences, not only organic but also psychological, social, economic, educational and labor. Therefore, pregnancy should be considered in adolescents in various contexts and as a social phenomenon. However, the nursing procedures for prenatal care are the same as for the entire population of pregnant women, regardless of their age. Objective: To identify the types of care that nurses provide to pregnant adolescents, that is, biological, psychological and social. Methodology: Participant observation sessions were held to the nursing staff when providing care to pregnant women under 20 years of age, and semi-structured interviews with these staff. Results: In nursing consultations, prenatal care focused on physical and biological aspects. They included weighing, the preparation of the prenatal clinical history, the interrogation on the development of pregnancy, the taking of blood pressure, the gyneco-obstetric examination and, eventually, the Pap smear. In addition, the consultations presented episodes of verification of eating habits and detection of genitourinary infections, uterine contractions and alarm symptoms for the prevention of health risks and complications. Although the psychosocial aspects were not very evident in the care given by the nurses, they did take them into account: they reassured the adolescents, showed them understanding about their behavior, recriminated them for their inadequate feeding or for not taking them in time and form the medications. Conclusion: Prenatal nursing care for pregnant teenagers has a curative and preventive emphasis on the physical and biological aspects. Although nurses have the potential to perform a more comprehensive and higher quality prenatal care, the psychosocial aspects in it are weak. Therefore, it is recommended to strengthen them, through professional training, staff training and the modification of some policies and standards of the health institution, and thus be able to better respond to the needs of this group."