Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

open7PURPOSE: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. SETTING: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). METHOD: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. RESULTS: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. CONCLUSION: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.Purpose: The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. Setting: A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). Method: A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. Results: OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. Conclusion: Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.openBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, VincenzoBuja, Alessandra; Toffanin, R; Rigon, S; Sandona', Paolo; Carraro, D; Damiani, G; Baldo, Vincenz

Adult Onset Vitiligo: Multivariate Analysis Suggests the Need for a Thyroid Screening.

Background. There are limited epidemiological studies evaluating the effect of age at onset on disease features in vitiligo. Objectives. To identify factors associated with adult onset vitiligo in comparison with childhood onset vitiligo. Patients and Methods. We retrospectively collected medical records of 191 patients. Such records included clinical examination, personal and familial medical history, laboratory evaluations, concomitant vitiligo treatment and drug assumption. Results. 123 patients with a disease onset after the age of 40 (adult onset vitiligo) were compared with 68 patients who developed vitiligo before the age of 12 (childhood onset vitiligo). Multivariate analysis revealed that personal history of thyroid diseases (P=0.04; OR 0.4), stress at onset (P=0.002; OR = 0.34), personal history of autoimmune thyroid disease (ATD) (P=0.003; OR = 0.23), and thyroid nodules (P=0.001; OR 0.90) were independently associated with adult onset vitiligo, whereas family history of dermatological diseases (P=0.003; OR = 2.87) and Koebner phenomenon (P<0.001; OR = 4.73) with childhood onset vitiligo. Moreover, in the adult onset group, concomitant thyroid disease preceded vitiligo in a statistically significant number of patients (P=0.014). Conclusions. Childhood onset and adult onset vitiligo have different clinical features. In particular, ATD and thyroid nodules were significantly associated with adult onset vitiligo, suggesting that a thyroid screening should be recommended in this group of patients

Use of biological drugs in patients with psoriasis and psoriatic arthritis in italy: Results from the PSONG survey

This Italian multicenter retrospective study compared the drug survival and efficacy of differentanti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsApatients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 wasanalyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug sur-vival rate and probability of maintaining PASI response were evaluated. The impact of dependentvariables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients wereincluded, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumabfollowed by etanercept and infliximab in PsO and PsA patients. The probability of maintainingPASI response was significantly higher for adalimumab followed by infliximab. For PsO patients,the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2–15.6,p<.001) or infliximab (OR: 6.6; 95% CI: 2.6–16.3,p<.001) vs. adalimumab. Likewise, for PsApatients the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 2.3; 95% CI:1.4–3.8,p5.01) or infliximab (OR: 2.2; 95% CI: 1.1–4.1,p5.018) vs. adalimumab. Adalimumabcould be the best therapeutic option over other anti-TNF agents for the treatment of PsO and PsApatients

Dermatological conditions during TNF-α-blocking therapy in patients with rheumatoid arthritis: a prospective study

Various dermatological conditions have been reported during tumor necrosis factor (TNF)-α-blocking therapy, but until now no prospective studies have been focused on this aspect. The present study was set up to investigate the number and nature of clinically important dermatological conditions during TNF-α-blocking therapy in patients with rheumatoid arthritis (RA). RA patients starting on TNF-α-blocking therapy were prospectively followed up. The numbers and natures of dermatological events giving rise to a dermatological consultation were recorded. The patients with a dermatological event were compared with a group of prospectively followed up RA control patients, naive to TNF-α-blocking therapy and matched for follow-up period. 289 RA patients started TNF-α-blocking therapy. 128 dermatological events were recorded in 72 patients (25%) during 911 patient-years of follow-up. TNF-α-blocking therapy was stopped in 19 (26%) of these 72 patients because of the dermatological event. More of the RA patients given TNF-α-blocking therapy (25%) than of the anti-TNF-α-naive patients (13%) visited a dermatologist during follow-up (P < 0.0005). Events were recorded more often during active treatment (0.16 events per patient-year) than during the period of withdrawal of TNF-α-blocking therapy (0.09 events per patient-year, P < 0.0005). The events recorded most frequently were skin infections (n = 33), eczema (n = 20), and drug-related eruptions (n = 15). Other events with a possible relation to TNF-α-blocking therapy included vasculitis, psoriasis, drug-induced systemic lupus erythematosus, dermatomyositis, and a lymphomatoid-papulosis-like eruption. This study is the first large prospective study focusing on dermatological conditions during TNF-α-blocking therapy. It shows that dermatological conditions are a significant and clinically important problem in RA patients receiving TNF-α-blocking therapy

A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use

Multivariate-Stepwise Gaussian Classifier (MSGC): A New Classification Algorithm Tested Over Real Disease Data Sets

In data mining, classification is the process of assigning one amongst previously known classes to a new observation. Mathematical algorithms are intensively used for classification. In these, a generalization is inferred from the data, so as to classify new cases, or individuals. The algorithm may misclassify an individual if the inference machine is not able to sufficiently discriminate it. Therefore, it is necessary to go further into the analysis of the information provided by the individual, until it can be sufficiently identified as belonging to a class. This chapter developed this idea for the improvement of a certain class of classifiers, using medical data sets to validate the new algorithm proposed here: The Multivariate-Stepwise Gaussian Classifier (MSGC). The results showed that MSGC is at least as competitive as the Gaussian Maximum Likelihood Classifier. MSGC attained the greatest accuracy rate in two of the data sets, and obtained identical results in the two remaining data sets. Concerning medical applications, once a classification method has been successfully validated considering a particular scope of data, the recommendable would be its use for the best diagnosis. Meanwhile, other algorithms could be tested until they proved to be effective enough to be put into practice

Risk factors for surgical site infection after minor dermatological surgery: a systematic review

Objective: Antibiotics can be prescribed as prophylaxis against surgical site infection (SSI) in dermatological surgery. In accordance with antibiotic stewardship, clinical evidence should inform judicious antibiotic prescribing. This review aimed to identify patient and procedure related risk factors for SSI following minor dermatological surgery. Data sources: MEDLINE, CINAHL, Informit and Scopus databases were searched for relevant literature on patient populations receiving minor surgery, where risk factors for SSI were explicitly stated. Study Selection: Studies involving major dermatological surgery were excluded. The preliminary search yielded 820 studies after removing duplicates. 210 abstracts were screened, and 42 full texts were assessed for eligibility. A total of 13 papers were included. Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale. Data Extraction: An electronic data collection tool was constructed to extract information from the eligible studies, and distributed to participating authors. Data synthesis: Risk factors identified included age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anti-hypertensive and corticosteroid use, smoking, surgery on the lower or upper extremities, excision of non-melanocytic skin cancers (NMSC), large skin excisions and complex surgical techniques. A maximum of two studies agreed on any one risk factor and there were insufficient studies for meta-analysis. Conclusions: Re-excision of skin cancer, below knee excisions and intra-operative haemorrhagic complications were predictive for infection in more than one study. More high-quality studies are required to accurately identify risk factors so they can be reliably used in clinical guidelines

Effectiveness, Tolerability, and Drug Survival of Risankizumab in a Real-World Setting: A Three-Year Retrospective Multicenter Study—IL PSO (ITALIAN LANDSCAPE PSORIASIS)

Background: Risankizumab is a humanized monoclonal antibody that selectively inhibits interleukin-23. It has been approved for moderate-to-severe plaque psoriasis and has shown efficacy and safety in clinical trials and real-world experiences. This study aimed to evaluate the long-term effectiveness, safety, and drug survival of risankizumab in a real-life setting. Materials and Methods: We included patients treated with risankizumab from January 2019 to February 2023. A Psoriasis Area and Severity Index score (PASI) was collected at weeks 0, 16, 28, 52, 104, and 156, when available. The occurrence of any adverse events was recorded at each visit. Results: We enrolled 1047 patients. At week 52, a ≥90% improvement in PASI was observed in 81.44% of patients, with a continuous improvement throughout the study (88.99% and 99.07% at weeks 104 and 156, respectively). After three years of treatment, all patients involving the scalp, palms/soles, and genitalia and 95% of patients with nail psoriasis achieved a complete or almost complete skin clearance. No significant safety findings were observed, and 90.73% of the patients were still on treatment after 36 months. Conclusions: This study supports the long-term effectiveness and safety of risankizumab in a real- world setting, even in patients involving difficult-to-treat areas

The prevalence of psychiatric disorders in patients attending dermatology outpatient clinics at Barau Dikko Teaching Hospital (BDTH), Kaduna State University, Nigeria

Although psychiatric disorders are frequent among dermatological patients, a few studies have formally assessed the performance of any psychiatric screening questionnaire in dermatological practice. This study tested the ability of the 12-item General Health Questionnaire (GHQ-12) to identify psychiatric morbidity in dermatological patients. A sample of 125 outpatients attending dermatology clinics at Barau Dikko Teaching Hospital (BDTH) Kaduna Nigeria, completed a sociodemographic questionnaire, a GHQ-12 and were administered the Structured Clinical Interview for WHO International Classification of Diseases (ICD-10) by a trained mental health professional. Patients that scored “two” and above on GHQ-12 were selected for the stage two interview. Out of all dermatological patients who visited the health facility, 125 were recruited and consented to participate in the study giving a response rate of 100%, which makes up to 104% of the initial proposed sample size (n=120). Of the 125 participants, 48 (38.4%) were men and 76(60.8%) were women. The mean age was 27 years (SD, ±15 years; range, 18-55 years). The psychiatric morbidity was significant in our dermatological patients, thus indicating the use of GHQ 12 in assisting to formulate psychiatric interventions and possible reduction in morbidity and cost of treatment

Actinic Cheilitis prevalence and risk factors: a cross-sectional, multicentre study in a population aged 45 years and over in north-west Spain

Actinic cheilitis is thought to be a premalignant lesion or a superficial squamous cell carcinoma. The prevalence of actinic cheilitis in Europe is unknown. The aim of this study was to determine the prevalence of actinic cheilitis in the Galicia region (north-west Spain). Secondary objectives were the description of risk factors of actinic cheilitis. A cross-sectional multicentre study in patients ≥ 45 years of age was performed in 8 dermatology departments in Galicia region during a 1-year period. The prevalence of actinic cheilitis was 31.3%. Significant and independent risk factors of actinic cheilitis after multivariate analysis were age ≥ 60 years, Fitzpatrick skin phototype II, outdoor working for more than 25 years, and previous history of non-melanoma skin cancer. This is the first cross-sectional multicentre study of the prevalence of actinic cheilitis in Europe. Actinic cheilitis was present in almost one-third of the screened patients. Lip examination should be performed in all patients with chronic actinic damageS