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100 years after Alzheimer: contemporary neurology practice assessment of referrals for dementia.

https://arctichealth.org/en/permalink/ahliterature153508
Source
Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):516-27
Publication Type
Article
Author
Tiffany W Chow
Carin Binder
Steven Smyth
Sharon Cohen
Alain Robillard
Author Affiliation
Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Source
Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):516-27
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Dementia - diagnosis - psychology - therapy
Humans
Neurology - methods - statistics & numerical data
Physician's Practice Patterns
Practice Guidelines as Topic
Primary Health Care - methods - statistics & numerical data
Psychiatric Status Rating Scales - statistics & numerical data
Questionnaires
Referral and Consultation - standards - statistics & numerical data
Abstract
The prevalence of dementia is placing an increased burden on specialists.
Canadian neurologists responded to a structured questionnaire to assess reasons for referral and services provided as well as to compare the neurologists' perceptions of their practice characteristics against cases seen over a 3-month period.
The audit confirmed the participants' perception that family practitioners are the main referral source (358/453, 79%). Sixty-two percent of patients had undergone clinical investigation for dementia prior to being seen by the neurologist; 39% (177/453) were on pharmacotherapy at the time of referral, 68% were initiated on pharmacotherapy by the neurologist. A fifth of the referrals did not meet clinical criteria for dementia, which may be directly related to the prevalence of prior workup that did not include mental status testing.
Neurologists currently treat patients referred for dementia who may already have been adequately evaluated and treated by primary care providers.
Notes
Comment In: Am J Alzheimers Dis Other Demen. 2008 Dec-2009 Jan;23(6):513-519222144
PubMed ID
19106275 View in PubMed
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AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons.

https://arctichealth.org/en/permalink/ahliterature161050
Source
J Am Coll Cardiol. 2007 Oct 2;50(14):1400-33
Publication Type
Article
Date
Oct-2-2007

[Access to general practitioners in a county in Troms]

https://arctichealth.org/en/permalink/ahliterature70574
Source
Tidsskr Nor Laegeforen. 2005 Aug 25;125(16):2210-2
Publication Type
Article
Date
Aug-25-2005
Author
Anne Helen Hansen
Ivar J Aaraas
Jorun Støvne Pettersen
Gerd Ersdal
Author Affiliation
Tromsø kommune, Rådhuset, 9299 Tromsø. anne.helen.hansen@tromso.kommune.no
Source
Tidsskr Nor Laegeforen. 2005 Aug 25;125(16):2210-2
Date
Aug-25-2005
Language
Norwegian
Publication Type
Article
Keywords
Comparative Study
Emergency Medical Services - standards - statistics & numerical data
English Abstract
Family Practice - standards - statistics & numerical data
Female
Health Services Accessibility - standards - statistics & numerical data
Humans
Interviews
Male
Norway
Physicians, Family
Physicians, Women
Referral and Consultation - standards - statistics & numerical data
Rural Health Services - standards - statistics & numerical data
Telephone
Urban Health Services - standards - statistics & numerical data
Abstract
BACKGROUND: In 2002 the Norwegian Board of Health made a survey of the accessibility of general practitioners in Troms county in North Norway. MATERIAL AND METHODS: In a telephone interview one secretary in each surgery informed about telephone response time, planned time for telephone consultations, recorded numbers of urgent consultations, and waiting time to obtain a routine consultation. RESULTS: On average, the planned telephone time was two hours per week. Telephone time was in inverse proportion to the number of patients on the doctor's list. Rural doctors spent twice as much time as urban colleagues on the telephone with their patients. Doctors with lists between 500 and 1500 patients had a higher proportion of urgent consultations compared with doctors with shorter or longer lists. INTERPRETATION: Telephone response time below two minutes and waiting times for routine consultations below 20 days appear to be within acceptable norms. When patient lists are above 1500, doctors' capacity to offer telephone contact and emergency services to their patients seems reduced.
PubMed ID
16138139 View in PubMed
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Access to palliative care services in hospital: a matter of being in the right hospital. Hospital charts study in a Canadian city.

https://arctichealth.org/en/permalink/ahliterature133654
Source
Palliat Med. 2012 Jan;26(1):89-94
Publication Type
Article
Date
Jan-2012
Author
Joachim Cohen
Donna M Wilson
Amy Thurston
Rod MacLeod
Luc Deliens
Author Affiliation
Ghent University & Vrije Universiteit Brussel, End-of-Life Care Research Group, Brussels, Belgium. jcohen@vub.ac.be
Source
Palliat Med. 2012 Jan;26(1):89-94
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada
Child
Child, Preschool
Female
Health Services Accessibility - standards
Health Services Research
Hospital Planning
Hospitals, Urban - organization & administration
Humans
Infant
Male
Medical Records
Middle Aged
Palliative Care - organization & administration - standards
Referral and Consultation - standards
Young Adult
Abstract
Access to palliative care (PC) is a major need worldwide. Using hospital charts of all patients who died over one year (April 2008-March 2009) in two mid-sized hospitals of a large Canadian city, similar in size and function and operated by the same administrative group, this study examined which patients who could benefit from PC services actually received these services and which ones did not, and compared their care characteristics. A significantly lower proportion (29%) of patients dying in hospital 2 (without a PC unit and reliant on a visiting PC team) was referred to PC services as compared to in hospital 1 (with a PC unit; 68%). This lower referral likelihood was found for all patient groups, even among cancer patients, and remained after controlling for patient mix. Referral was strongly associated with having cancer and younger age. Referral to PC thus seems to depend, at least in part, on the coincidence of being admitted to the right hospital. This finding suggests that establishing PC units or a team of committed PC providers in every hospital could increase referral rates and equity of access to PC services. The relatively lower access for older and non-cancer patients and technology use in hospital PC services require further attention.
PubMed ID
21680750 View in PubMed
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Access to treatment and educational inequalities in cancer survival.

https://arctichealth.org/en/permalink/ahliterature266954
Source
J Health Econ. 2014 Jul;36:98-111
Publication Type
Article
Date
Jul-2014
Author
Jon H Fiva
Torbjørn Hægeland
Marte Rønning
Astri Syse
Source
J Health Econ. 2014 Jul;36:98-111
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cancer Care Facilities - utilization
Educational Status
Female
Geography
Health Behavior
Health Services Accessibility
Health Status Disparities
Healthcare Disparities
Humans
Male
Middle Aged
Neoplasms - mortality
Norway - epidemiology
Physician-Patient Relations
Quality of Health Care
Referral and Consultation - standards - statistics & numerical data
Registries - statistics & numerical data
Socioeconomic Factors
Specialization - standards - statistics & numerical data
Survival Analysis
Travel
Abstract
The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by differential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that (i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and (ii) the use of such treatment improved these patients' survival.
PubMed ID
24780404 View in PubMed
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[Analysis of the state-of-the-art of consulting medical care to patients with glucocorticoid-induced osteoporosis or its risk according to the data of a questionnaire survey (GLUCOST study)].

https://arctichealth.org/en/permalink/ahliterature265347
Source
Ter Arkh. 2015;87(5):58-64
Publication Type
Article
Date
2015
Author
I A Baranova
O B Ershova
E Kh Anaev
T N Anokhina
O N Anoshenkova
S Z Batyn
E A Belyaeva
T Yu Bolshakova
I A Volkorezov
L N Eliseeva
E V Kashnazarova
M F Kinyaikin
M N Kirpikova
E P Klyuchnikova
M A Korolev
I V Kuneevskaya
L V Masneva
A A Muradyants
E N Otteva
T N Petrachkova
L K Peshekhonova
A S Povzun
T A Raskina
M L Smirnova
N V Toroptsova
R B Khasanova
N G Shamsutdinova
N L Shaporova
N S Shitova
S Yu Shkireeva
N A Shostak
O M Lesnyak
Source
Ter Arkh. 2015;87(5):58-64
Date
2015
Language
Russian
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Fractures, Bone - chemically induced - epidemiology - prevention & control
Glucocorticoids - adverse effects
Health Services - standards - statistics & numerical data
Health Surveys - statistics & numerical data
Humans
Male
Middle Aged
Osteoporosis - chemically induced - epidemiology - therapy
Referral and Consultation - standards - statistics & numerical data
Russia - epidemiology
Young Adult
Abstract
To analyze the state-of-the-art of consulting medical care to Russian patients with glucocorticoid-induced osteoporosis (GCOP) or its risk.
This GLUCOST study was organized and conducted by the Russian Association of Osteoporosis. A total of 1129 patients with chronic inflammatory diseases, who had been taking oral glucocorticosteroids (OGCSs) a long time (3 months or more), were examined. The patients filled out an anonymous questionnaire on their own. Whether the measures taken to diagnose, prevent, and treat GCOP complied with the main points of Russian clinical guidelines was assessed.
61.8% of the patients knew that the long-term treatment of GCOP might cause osteoporosis. 48.1% of the respondents confirmed the results of bone densitometry; 78.1% of the patients reported that they had been prescribed calcium and vitamin D supplements by their physician, but their regular intake was confirmed by only 43.4%; 25.4% of the patients had sustained one low-energy fracture or more. Treatment for GCOP was prescribed for 50.8% of the patients at high risk for fractures, but was actually received by 40.2%. Therapeutic and diagnostic measures were implemented in men less frequently than in women. When the patient was aware of GCOP, the probability that he/she would take calcium and vitamin D supplements rose 2.7-fold (95% Cl; 2.1 to 3.5; p = 0.001) and that he/she would follow treatment recommendations did 3.5-fold (95% Cl; 2.3 to 5.3; p = 0.001). Bone densitometry increased the prescription rate for antiosteoporotic medication and patient compliance.
According to the data of Russia's large-scale GLUCOST survey, every four patients with chronic inflammatory disease who are on long-term OGCS therapy have one low-energy fracture or more. Due to inadequate counseling, the patients are little aware of their health and do not get the care required to prevent the disease. Less than 50% of patients who have GCOP and a high risk for fractures undergo examination and necessary treatment aimed at preventing fractures.
PubMed ID
26155620 View in PubMed
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An evaluation of sources of information on health and travel.

https://arctichealth.org/en/permalink/ahliterature231638
Source
Can J Public Health. 1989 Jan-Feb;80(1):20-2
Publication Type
Article
Author
S J Demeter
Source
Can J Public Health. 1989 Jan-Feb;80(1):20-2
Language
English
Publication Type
Article
Keywords
Commerce
Data Collection
Evaluation Studies as Topic
Government Agencies
Health Education - standards
Humans
Information Services - standards
Physicians, Family
Referral and Consultation - standards
Saskatchewan
Travel
United States
Abstract
I surveyed by telephone 108 potential sources of information on health and travel. I posed as a traveler, and evaluated the information and referrals elicited by comparison to current standards set out by the World Health Organization (WHO) and the U.S. Public Health Service. Only 7.4% potential sources gave correct information, 30.6% gave incorrect information, and 62% gave no information. 74.1% of those surveyed gave correct referrals, 22.2% gave incorrect referrals, and 3.7% gave no referrals.
PubMed ID
2702539 View in PubMed
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An internist's role in perioperative medicine: a survey of surgeons' opinions.

https://arctichealth.org/en/permalink/ahliterature159268
Source
BMC Fam Pract. 2008;9:4
Publication Type
Article
Date
2008
Author
Lisa Pausjenssen
Heather A Ward
Sharon E Card
Author Affiliation
Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada. lisa.pj@usask.ca
Source
BMC Fam Pract. 2008;9:4
Date
2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cooperative Behavior
General Surgery - statistics & numerical data
Health Care Surveys
Heart Diseases - surgery
Humans
Internal Medicine - standards
Interprofessional Relations
Perioperative Care - methods - standards
Physician's Role
Physician-Patient Relations
Preoperative Care - methods - standards
Questionnaires
Referral and Consultation - standards
Saskatchewan
Surgery Department, Hospital - manpower
Abstract
Literature exists regarding the perioperative role of internists. Internists rely on this literature assuming it meets the needs of surgeons without actually knowing their perspective. We sought to understand why surgeons ask for preoperative consultations and their view on the internist's role in perioperative medicine.
Survey of surgeons in Saskatoon, Saskatchewan, Canada regarding an internist's potential role in perioperative care.
Fifty-nine percent responded. The majority request a preoperative consultation for a difficult case (83%) or specific problem (81%). While almost half feel that a preoperative consultation is to "clear" a patient for surgery, 33% disagree with this statement. The majority believe the internist should discuss risk with the patient. Aspects of the preoperative consultation deemed most important are cardiac medication optimization (93%), cardiac risk stratification (83%), addition of beta-blockers (76%), and diabetes management (74%).
Surgeons perceive the most important roles for the internist as cardiac risk stratification and medication management. Areas of controversy identified amongst the surgeons included who should inform the patient of their operative risk, and whether the internist should follow the patient daily postoperatively. Unclear expectations have the potential to impact on patient safety and informed consent unless acknowledged and acted on by all. We recommend that internists performing perioperative consults communicate directly with the consulting physician to ensure that all parties are in accordance as to each others duties. We also recommend that the teaching of perioperative consults emphasizes the interdisciplinary communication needed to ensure that patient needs are not neglected when one specialty assumes the other will perform a function.
Notes
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PubMed ID
18208614 View in PubMed
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Assessing quality of care in a trauma referral center: benchmarking performance by TRISS-based statistics or by analysis of stratified ISS data?

https://arctichealth.org/en/permalink/ahliterature70415
Source
J Trauma. 2006 Mar;60(3):538-47
Publication Type
Article
Date
Mar-2006
Author
Nils O Skaga
Torsten Eken
Petter A Steen
Author Affiliation
Department of Anesthesiology, Ulleval University Hospital, Oslo, Norway. nilsoddvar@ulleval.no
Source
J Trauma. 2006 Mar;60(3):538-47
Date
Mar-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Benchmarking - statistics & numerical data
Comparative Study
Female
Glasgow Outcome Scale
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Multiple Trauma - mortality
Norway
Outcome Assessment (Health Care) - statistics & numerical data
Prospective Studies
Quality Assurance, Health Care - standards
Referral and Consultation - standards
Reproducibility of Results
Risk Adjustment
Survival Rate
Trauma Centers - standards
Trauma Severity Indices
Wounds, Nonpenetrating - mortality
Wounds, Penetrating - mortality
Abstract
BACKGROUND: Using prospectively collected data from Ulleval University Hospital in Norway, standard TRISS-based methods with case mix correction were compared with analysis based on ISS stratified data. METHODS: Reference data were The Major Trauma Outcome Study (MTOS) controlled sites, used for calculation of AIS 90 based TRISS coefficients. Present TRISS convention requires RTS scoring on hospital admission, excluding many severely injured patients intubated before arrival. Therefore, all Ulleval patients were RTS scored using prehospital data if needed. RESULTS: There was 6.6% of MTOS controlled sites patients (mortality rate 26.7%) that had been excluded before estimation of TRISS coefficients because of lack of data for Ps calculation. Analyses based on ISS stratified data included these patients and indicated significant better performance at Ulleval for blunt, but not for penetrating trauma. No TRISS-based analysis detected this difference. CONCLUSIONS: The RTS convention should be changed to reduce patient exclusion. Presently, stratified ISS based data should also be analyzed.
PubMed ID
16531851 View in PubMed
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Assessment of decision-making capacity: views and experiences of consultation psychiatrists.

https://arctichealth.org/en/permalink/ahliterature118544
Source
Psychosomatics. 2013 Mar-Apr;54(2):115-23
Publication Type
Article
Author
Lisa Seyfried
Kerry A Ryan
Scott Y H Kim
Author Affiliation
Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-2800, USA.
Source
Psychosomatics. 2013 Mar-Apr;54(2):115-23
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Canada
Clinical Competence - standards
Data Collection
Decision Making
Evidence-Based Medicine - standards
Female
Humans
Informed Consent - psychology
Male
Mental Competency - psychology
Middle Aged
Psychosomatic Medicine - standards
Referral and Consultation - standards
Regression Analysis
Societies, Medical
United States
Abstract
Decision-making capacity (DMC) assessments can have profound consequences for patients. With an aging population, an increasing emphasis on shared decision-making, and a rising number of potential medical interventions, the need for such assessments will continue to grow.
To assess psychosomatic medicine clinicians' training, experiences, and views about DMC assessments.
Online survey of members of the Academy of Psychosomatic Medicine (APM). Of 780 eligible members, 288 responded to the survey (36.9% response rate).
Approximately 1 in 6 psychiatric consultations are DMC assessments. Ninety percent of respondents reported that at least half of their capacity assessments involve patients older than 60 years. DMC assessments were seen as more challenging and time-consuming than other types of consultations; yet training in capacity evaluations was seen as suboptimal and half of respondents felt the evidence-base guiding DMC assessment is somewhat or much weaker than for other types of psychiatric consultations. In addition, the practice of capacity assessment seems to vary widely with no consistent approach among respondents. Respondents strongly endorsed multiple areas and topics for potential future research, indicating a desire for a stronger evidence-base.
Members of the APM perceive capacity assessments as common and challenging. Yet they perceive having received subpar training with relatively weak evidence to guide their current practice. Future research should address these potential deficiencies, given the likelihood that DMC assessments will only become more common.
PubMed ID
23194935 View in PubMed
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103 records – page 1 of 11.