The optimal means of initiating warfarin therapy for acute venous thromboembolism in the outpatient setting remains controversial. We have previously demonstrated the efficacy of a 10 mg initiation nomogram in a randomized controlled trial; however, some clinicians remain reluctant to use this nomogram due to a fear of potential increased bleeding. To review the safety and efficacy of a 10 mg warfarin nomogram we conducted a retrospective cohort study of patients prospectively treated for venous thromboembolism according to a 10 mg nomogram in an outpatient thrombosis clinic. All patients received standard treatment with low molecular weight heparin for 5 to 7 days and warfarin for at least 3 months. Four-hundred and fourteen patients were included in the analysis, of whom 295 (71%) fully adhered to the nomogram. In the whole cohort, 8 patients (1.9%) experienced recurrent thrombosis, 4 (0.97%) suffered a major bleeding event, and 3 (0.72%) suffered a minor bleeding event. There were no deaths related to thrombosis or bleeding. Four patients (0.97%) died from unrelated causes. Twenty-two (5.3%) patients experienced an INR > or =5.0 in the first 8 days of therapy, and none of these patients experienced a bleeding event. Eighty-four percent of patients achieved a therapeutic INR by day 5. In outpatients, a 10 mg nomogram results in timely achievement of a therapeutic INR with an acceptable incidence of bleeding and recurrent thromboembolism.
The national strategy for treatment of chronic diseases - including MS - and changes in the Swedish welfare system, call for analyses of the use of, and patient satisfaction with, care in a long-term perspective. The aim was therefore to explore the use of care and the predictive value of personal factors, disease-specific factors and functioning on the use of care and to explore patient satisfaction with care in a 10-year perspective.
Information regarding personal factors, disease-specific factors, functioning and satisfaction with care was collected by home-visits; use of care was collected from the Stockholm County Council computerised register.
Data from 121 people with MS (PwMS) was collected. Primary care accounted for the majority of all care. Neurology and Rehabilitation Departments together accounted for two-thirds of all hospital outpatient care. Rehabilitation Departments accounted for one-third of the total number of inpatient days. Lower coping capacity, impaired manual dexterity and activity of daily living dependency at baseline, together with progress in MS disability predicted a higher use of care. Overall, patient satisfaction with care was stable over time.
The extensive use of care offers challenges to care coordination. Implementation of person-centred care could be a strategy to increase efficacy/outcome of care.
The Sexual Information Clinic in Oslo was founded more than 20 years ago. The clinic is the largest family planning centre in Norway, treating 4,000-6,000 patients per year. In recent years the treatment of venereal diseases has become the major component of the daily work. The authors describe the different groups of patients who visit the clinic. The meanage of the patients is 21 years. The high number of legal abortions among younger women and the rising incidence of sexually transmitted diseases prove the continued existence of a need for family planning centres. The authors discuss the situation of family planning centres in Norway in general and stress the importance of their work. They argue that all venereal diseases should be treated free of charge.
The article is devoted to the anniversary of Consultation-and-diagnostic outpatient hospital of 442nd District military clinical hospital in Saint-Petersburg. This outpatient hospital was founded in on the 20th March 1938. Work of garrison outpatient hospital was especially difficult during the Great Patriotic War. Employees of this hospital heroically fulfilled their duties in conditions of severe blocade winter 1941-1942. The outpatient hospital was nominally garrison, in fact this hospital operated units of Leningrad front-line. In 1993 the garrison outpatient hospital was renamed as 104th Consultation-and-diagnostic. The main branch of activity is health maintenance of participants in the rectification of the consequences of the accident at the Chernobyl Atomic Electric Power Station and veterans (case follow up) belonging to special risk subunits. Nowadays there are 30 treatment-and-diagnostic departments including staff military physician board.