961 research outputs found
The impact of co-located NHS walk-in centres on emergency departments
Objectives:
To determine the impact of establishing walk-in centres alongside emergency departments
on attendance rates, visit duration, process, costs and outcome of care.
Methods:
Eight hospitals with co-located emergency departments and walk-in centres were compared
with eight matched emergency departments without walk-in centres. Site visits were
conducted. Routine data about attendance numbers and use of resources were analysed. A
random sample of records of patients attending before and after walk-in centres opened
were also assessed. Patients who had not been admitted to hospital were sent a postal
questionnaire.
Results:
In most sites, the walk-in centres did not have a distinct identity and there were few
differences in the way services were provided compared with control sites. Overall, there
was no evidence of an increase in attendance at sites with walk-in centres, but considerable
variability across sites. The proportion of patients managed within the four-hour NHS target
improved at sites both with and without walk-in centres. There was no evidence of any
difference in re-consultation rates, costs of care or patient outcomes at sites with or without
walk-in centres.
Conclusions:
Most hospitals in this study implemented the walk-in centre concept to a very limited extent.
Consequently there was no evidence of any impact on attendance rates, process, costs or
outcome of care
Comparing care at walk-in centres and at accident and emergency departments: an exploration of patient choice, preference and satisfaction
Objectives:
To explore the impact of establishing walk-in centres alongside emergency departments on
patient choice, preference and satisfaction.
Methods:
A controlled, mixed-method study comparing eight emergency departments with co-located
walk-in centres with the same number of ‘traditional’ emergency departments. This paper
focuses on the results of a cross-sectional questionnaire survey of users.
Results:
Survey data demonstrated that patients were frequently unable to distinguish between being
treated at a walk-in centre or an A&E department, and even where this was the case,
opportunities to exercise choice about their preferred care provider were often limited. Few
made an active choice to attend a co-located walk-in centre. Patients attending walk-in
centres were just as likely to be satisfied overall with the care they received as their
counterparts who were treated in the co-located A&E facility, although a small proportion of
walk-in centre users did report greater satisfaction with some specific aspects of their care
and consultation.
Conclusions:
Whilst one of the key policy goals underpinning the co-location of walk-in centres next to an
A&E department was to provide patients with more options for accessing healthcare and
greater choice, leading in turn to increased satisfaction, this evaluation was able to provide
little evidence to support this. The high percentage of patients expressing a preference for
care in an established emergency department compared to a new walk-in centre facility
raises questions for future policy development. Further consideration should therefore be
given to the role that A&E focused walk-in centres play in the Department of Health’s
current policy agenda, as far as patient choice is concerned
Policy Recommendations for Meeting the Grand Challenge to Eradicate Social Isolation
This brief was created forSocial Innovation for America’s Renewal, a policy conference organized by the Center for Social Development in collaboration with the American Academy of Social Work & Social Welfare, which is leading theGrand Challenges for Social Work initiative to champion social progress. The conference site includes links to speeches, presentations, and a full list of the policy briefs
CYP1B1 copy number variation is not a major contributor to primary congenital glaucoma
This article is published under a Creative Commons Attribution-NonCommercial-NoDerivatives License 3.0, or CC BY-NC-ND 3.0 (see http://creativecommons.org/licenses/by-nc-nd/3.0/ for license terms). The authors retain copyright and grant Molecular Vision an irrevocable, royalty-free, perpetual license to publish and distribute the article, in all formats now known or later developed, and to identify Molecular Vision as the original publisher.Purpose: To evaluate the prevalence and the diagnostic utility of testing for CYP1B1 copy number variation (CNV) in primary congenital glaucoma (PCG) cases unexplained by CYP1B1 point mutations in The Australian and New Zealand Registry of Advanced Glaucoma.
Methods: In total, 50 PCG cases either heterozygous for disease-causing variants or with no CYP1B1 sequence variants were included in the study. CYP1B1 CNV was analyzed by Multiplex Ligation-dependent Probe Amplification (MLPA).
Results: No deletions or duplications were found in any of the cases.
Conclusion: This is the first study to report on CYP1B1 CNV in PCG cases. Our findings show that this mechanism is not a major contributor to the phenotype and is of limited diagnostic utility
Perceptions on diversity in cardiology: A survey of cardiology fellowship training program directors
Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors\u27 perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief that diversity is a driver of excellence in health care, only 26% could quote 1 to 2 references to support this statement. Sixty-three percent of respondents agreed that our program is diverse already so diversity does not need to be increased. Only 6% of respondents listed diversity as a top 3 priority when creating the cardiovascular fellowship rank list. Conclusions These findings suggest that while program directors generally believe that diversity enhances quality, they are less familiar with the literature that supports that contention and they may not share a unified definition of diversity. This may result in diversity enhancement having a low priority. The authors propose several strategies to engage fellowship training program directors in efforts to diversify cardiology fellowship training programs
embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice
APP1155125.
Publisher Copyright:
© 2022 Author(s) (or their employer(s)).Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.publishersversionpublishe
Which resources help young people to prevent and overcome mental distress in deprived urban areas in Latin America? A protocol for a prospective cohort study
Introduction Improving the mental health of young people is a global public health priority. In Latin America, young people living in deprived urban areas face various risk factors for mental distress. However, most either do not develop mental distress in the form of depression and anxiety, or recover within a year without treatment from mental health services. This research programme seeks to identify the personal and social resources that help young people to prevent and recover from mental distress. Methods and analysis A cross-sectional study will compare personal and social resources used by 1020 young people (aged 15-16 and 20-24 years) with symptoms of depression and/or anxiety and 1020 without. A longitudinal cohort study will follow-up young people with mental distress after 6 months and 1 year and compare resource use in those who do and do not recover. An experience sampling method study will intensively assess activities, experiences and mental distress in subgroups over short time periods. Finally, we will develop case studies highlighting existing initiatives that effectively support young people to prevent and recover from mental distress. The analysis will assess differences between young people with and without distress at baseline using t-tests and χ 2 tests. Within the groups with mental distress, multivariate logistic regression analyses using a random effects model will assess the relationship between predictor variables and recovery. Ethics and dissemination Ethics approvals are received from Ethics Committee in Biomedical Research, Faculty of Medicine, University of Buenos Aires; Faculty of Medicine-Research and Ethics Committee of the Pontificia Universidad Javeriana, Bogotá; Institutional Ethics Committee of Research of the Universidad Peruana Cayetano Heredia and Queen Mary Ethics of Research Committee. Dissemination will include arts-based methods and target different audiences such as national stakeholders, researchers from different disciplines and the general public. Trial registration number ISRCTN72241383
The state of the Martian climate
60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes
Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial
Background
Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy
Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context
Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts
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