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

Which communication strategies for the next influenza pandemic?

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Systems metabolomics: from metabolomic snapshots to design principles

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Análise de aprendizagem expansiva em intervenção formativa: a inclusão de alunos com deficiência nas séries finais do ensino fundamental em foco

This study analyzed a formative intervention with a group of teachers that were dealing with the inclusion of students with disabilities for the first time and facing difficulties. The intervention’s aim was to expand the understanding of inclusion and, consequently, change the pedagogical practices related to the included students. It was comprised of ten sessions (March to December 2014) planned according to Engeström’s expansive learning proposition. The analysis was organized according to the cycle of expansive learning: questioning, analysis, modeling and testing of the new solution, the implementation of the new model, reflection of the process, and consolidation of the new practice. There were three attempts of expansive learning during the intervention: a protocol to organize the process of inclusion, the development of a school diary to be used by the included students, and an attempt to coordinate the work of the teachers from the regular classes and the resource room. At the end of the intervention, none of the three attempts was consolidated. Finally, the development of the agency would be paramount to allow transformation, which did not happen.  El artículo examina una intervención formativa en una escuela, en la cual un grupo de profesores tenía dificultades con la inclusión de alumnos con discapacidad en las aulas. La intervención buscó expandir la comprensión sobre inclusión y el cambio de las prácticas en relación con los alumnos incluidos. Partiendo de la propuesta de aprendizaje expansivo, definida por Engeström, se planearon diez sesiones, de marzo a diciembre de 2014. Se organizaron análisis a partir de acciones del ciclo de aprendizaje expansivo: cuestionamiento, análisis, modelado de la nueva solución, examen del nuevo modelo, implementación del nuevo modelo, reflexión sobre el proceso y consolidación de la nueva práctica. Se desarrollaron tres intentos de aprendizaje expansivo: el protocolo de organización de la inclusión en la escuela, la agenda para los alumnos incluidos y el establecimiento de un trabajo coordinado entre profesores de clases regulares y de clases especiales. Al final de la intervención, se constató que ninguna de estas se consolidó. Por consiguiente, se concluyó que mientras no hubiera el desarrollo de agency por parte de los sujetos involucrados, no habría transformación.O artigo examina uma intervenção formativa, realizada em uma escola, com um grupo de professores que estreava na inclusão de alunos com deficiência em suas turmas e estava apresentando dificuldades. A intervenção buscou ampliar a compreensão sobre inclusão e, consequentemente, a mudança das práticas em relação aos alunos incluídos. Foram realizadas 10 sessões, de março a dezembro de 2014, planejadas a partir da proposta de aprendizagem expansiva, definida por Engeström. A análise foi organizada com base nas ações do ciclo de aprendizagem expansiva: questionamento, análise, modelagem da nova solução, exame do novo modelo, implementação do novomodelo, reflexão sobre o processo e consolidação da nova prática. Foram desenvolvidas, durante a intervenção, três ações capazes de produzir a aprendizagem expansiva: protocolo de organização da inclusão na escola, agenda para os alunos incluídos e estabelecimento de trabalho coordenado entre professores da sala regular e da sala de recursos. Ao final da intervenção, constatou-se que nenhuma das três consolidou-se. Concluiu-se que, para haver transformação, seria necessário desenvolvimento de agency, de engajamento dos sujeitos no processo de mudança, o que não aconteceu

The Effectiveness of Coping Strategies in the Latent First Stage of Labour: A Systematic Review

The latent phase of labour is defined as a period of time marked by painful uterine contractions and variable changes of the cervix, including some degree of cervical effacement and a slow dilatation up to 5 cm [1]..

Infliximab treatment for steroid-refractory acute graft-versus-host disease

Background and Objectives. Tumor necrosis factor \u3b1 is one of the principal cytokines involved in the pathogenesis of acute graft-versus-host- disease (GVHD). Infliximab is an antibody to this cytokine. Design and Methods. We performed a retrospective analysis to evaluate the activity of infliximab in 32 patients with severe steroid-refractory acute GVHD. The patients received a median of 3 weekly courses of infliximab. The main organs involved in the patients were skin (n=2) liver (n=1), bowel (n=19), liver and bowel at the same stage (n=10). Results. Nineteen out 32 patients (59%) responded to infliximab with 6 (19%) complete and 13 (40%) partial responses. Age younger than 35 years, intestinal involvement and a longer time between hematopoietic stem cell transplantation and infliximab administration were factors predicting a favorable response. Infective episodes developed in 23/32 (72%) patients. All the 13 unresponsive patients died of GVHD shortly after infliximab. Thirteen of 19 responsive patients were alive at a median follow-up of 449 days (range 155-842) after infliximab, with no signs of chronic GVHD (n=5), limited (n=5) or extensive involvement (n=3). Six patients who responded subsequently died, one of chronic lung GVHD, the others of vascular complications or infections (2 fungal diseases). Interpretation and Conclusions. We conclude that infliximab is active in the treatment of severe steroid-refractory acute GVHD, particularly when the intestine is involved. Infections commonly followed its administration. The clinical activity of infliximab and the possibility that it increases the risk of infections are worth investigating in prospective trials