Impact of a referral management “gateway” on the quality of referral letters; a retrospective time series cross sectional review

Background Referral management centres (RMC) for elective referrals are designed to facilitate the primary to secondary care referral path, by improving quality of referrals and easing pressures on finite secondary care services, without inadvertently compromising patient care. This study aimed to evaluate whether the introduction of a RMC which includes triage and feedback improved the quality of elective outpatient referral letters. Methods Retrospective, time-series, cross-sectional review involving 47 general practices in one primary care trust (PCT) in South-East England. Comparison of a random sample of referral letters at baseline (n = 301) and after seven months of referral management (n = 280). Letters were assessed for inclusion of four core pieces of information which are used locally to monitor referral quality (blood pressure, body mass index, past medical history, medication history) and against research-based quality criteria for referral letters (provision of clinical information and clarity of reason for referral). Results Following introduction of the RMC, the proportion of letters containing each of the core items increased compared to baseline. Statistically significant increases in the recording of ‘past medical history’ (from 71% to 84%, p < 0.001) and ‘medication history’ (78% to 87%, p = 0.006) were observed. Forty four percent of letters met the research-based quality criteria at baseline but there was no significant change in quality of referral letters judged on these criteria across the two time periods. Conclusion Introduction of RMC has improved the inclusion of past medical history and medication history in referral letters, but not other measures of quality. In approximately half of letters there remains room for further improvement

Meanings attributed by family members in pediatrics regarding their interactions with nursing professionals

Abstract OBJECTIVE Understanding the meanings attributed by family caregivers of children in hospital environments about their interactions with nursing professionals. METHODS This qualitative study used Symbolic Interactionism as a theoretical reference and Grounded Theory as the methodological framework. It was carried out in a Pediatrics Center in southern Brazil, in the first half of 2013. Participants were 15 family caregivers of hospitalized children. Data were collected through interviews and submitted to open and axial analysis. RESULTS Interactions with the nursing team enable family to trust or distrust in the provided child care and to positively evaluate the care received. CONCLUSION Interactions between family members and the nursing team contribute to the significance attributed by the family to the nursing care received by the child. Nurses should be aware of the attitudes of the nursing team regarding the child and their family, prioritizing humanized care

Immunogenicity and efficacy of one and two doses of Ad26.COV2.S COVID vaccine in adult and aged NHP

Safe and effective coronavirus disease-19 (COVID-19) vaccines are urgently needed to control the ongoing pandemic. While single-dose vaccine regimens would provide multiple advantages, two doses may improve the magnitude and durability of immunity and protective efficacy. We assessed one-and two-dose regimens of the Ad26.COV2.S vaccine candidate in adult and aged nonhuman primates (NHPs). A two-dose Ad26.COV2.S regimen induced higher peak binding and neutralizing antibody responses compared with a single dose. In one-dose regimens, neutralizing antibody responses were stable for at least 14 wk, providing an early indication of durability. Ad26.COV2.S induced humoral immunity and T helper cell (Th cell) 1-skewed cellular responses in aged NHPs that were comparable to those in adult animals. Aged Ad26.COV2.S-vaccinated animals challenged 3 mo after dose 1 with a SARS-CoV-2 spike G614 variant showed near complete lower and substantial upper respiratory tract protection for both regimens. Neutralization of variants of concern by NHP sera was reduced for B.1.351 lineages while maintained for the B.1.1.7 lineage independent of Ad26.COV2.S vaccine regimen.Molecular basis of virus replication, viral pathogenesis and antiviral strategie

Psychosocial issues in elderly

Third age is the period in which the person is withdrawn from the daily activities, such as workplace, resulting in the different psycho-social problems, such as dementia, agitation, anxiety, loneliness and social exclusion. These problems lead to people's psychological depression with its subsequent effects on their health. Exploring the psycho-social problems is of great importance, as this age is characterized by feelings of loneliness, fear, depression and isolation from themselves, unpleasant thoughts but it is also dominated by negative feelings

Nutrition and peritoneal dialysis patients – a review

Introduction: The Peritoneal Dialysis (PD) is a preferable treatment option of the renal replacement in patients with chronic renal failure (CRF) end stage. Purpose: The purpose of this study was to review of articles published related to the contribution of nutrition to health promotion of patients undergoing haemodialysis.Materials and methods: A review of the Greek and international literature on the subject was Performed through the electronic databases Medline, Google Scholar, Scopus and the Association of Greek Academic Libraries Link (Heal-Link), using as key words the following terms:haemodialysis, renal failure, peritoneal dialysis, nutrition.Most of the articles used in this literature review were recently published. Only few old - dated articles were included in the study and the reason was their significant contribution to the field. The exclusion criteria for the articles were the languages except from English and Greek.Results:Patient’s diet must contain 1.3 g of protein per kilogram of body weight per day. Consumption of foods rich in carbohydrates should be limited. Patients should consume foods with the adequate quantity of phosphorus and potassium. Finally, they should have their sodium levels and fluid intake checked because sodium causes severe thirst that can lead to excessive fluid intake. As a result, the patient experiences swelling, shortness of breath and high blood pressure.Conclusion: Patients who undergo peritoneal dialysis must be checked regularly and pay special attention to their diets

AIDS and nutrition in patients

Introduction: AIDS is a viral infection that particularly affects the nutritional status of patients by complicating the absorption of nutrients and their metabolism. Purpose: The purpose of this retrospective study is to highlight the contribution of nutrition to the wellness of people with HIV in all stages of the disease. Review Methods: The methodology used to select the information used in this study includes review studies and research in leading databases such as PUBMED, MEDLINE, and IATROTEK. The selection criterion of the articles was the Greek and English language.Results: The real goal of the nutritional assessment of patients with AIDS is to improve their ability to consume a sufficient quantity and variety of foods in order to meet their nutritional needs. The evaluation of dietary intake assesses the adequacy of food and nutrients consumed. It includes assessing the dietary patterns, frequency of meals, and the factors that affect food choice. Conclusions: Maintaining a good nutritional status has a significant impact on the functioning of the immune system and the overall health of people living with HIV / AIDS

Ulcerative colitis: effect on fertility and pregnancy

Introduction: Ulcerative colitis is one of the most interesting nosological entities of gastroenterology and internal medicine. This chronic autoimmune disorder of the digestive system, along with Crohn's disease, is a type of idiopathic inflammatory bowel disease. It mainly affects people during their peak reproductive age, i.e., 15 to 30 years old. It is characterized by diffuse mucosal inflammation of the large intestine, which is limited to the colon and shows alternating periods of exacerbations and remissions. Purpose: To review the world literature regarding the impact of the disease on fertility, the course of pregnancy, and consecutively, the outcome of pregnancy.Materials and methods: An extensive review of the recent national and international literature in electronic databases (Pubmed, Google Scholar) and in scientific journals was accomplished through the use of appropriate keywords. Results: The majority of women will have a chance of conceiving. For about 25% of them, conception will be achieved in the course of the disease and it will progress normally, resulting in a healthy fetal outcome. Infertility only occurs among men while they are taking medicines, whereas among women it occurs after surgery for ileoanal anastomosis. During periods of flare-ups, there is a possibility of spontaneous abortion, premature labor and birth of an infant with low birth weight. The majority of pharmaceutical formulations can be used safely both before and after pregnancy without causing any birth defects

The contribution of dance on children's health

Introduction: Dance is a kind of art therapy involving the psychotherapeutic use of expressive movement through which children can engage creatively in the process of personal development. Purpose: To highlight the contribution of dance to children psychophysical development and their self-expression of personality. Materials and methods: The research method consisted of reviewing articles addressing dance's role in children's psychophysical development and self-expression of personality found mostly via Medline, the Hellenic Academic Libraries Link and Google Scholar. A search of classic scientific literature and studies in libraries was also conducted. All articles had to be written in either Greek or English and refer to dance. Results: Dance is a treatment procedure commonly used at schools as an educational means. It is an important effective tool for children who suffer from emotional disorders and learning disabilities and aims to increase children's self-esteem, emotional expression, and ability to complete tasks relaxation, social interaction and coherence of the group in which they participate. Dance also helps children both to manage emotions that impede learning and to improve their adaptability in school. Conclusions: Dance develops children's the expressive ability and help them to express themselves not only verbally but also bodily

Anorexia nervosa: A literature review

Introduction: Anorexia nervosa is a food intake disorder characterized by acute weight loss that it could cause severe psychosomatic problems. Purpose: To present the data and information as well as the treatment related to Anorexia nervosa. Materials and methods: The study material consisted of reviewed articles on the topic found in Greek and globally accepted electronic databases, Pubmed, Scopus, Medline, Google Scholar, regarding the effects of Anorexia nervosa on health and its treatment. Results: Initial symptoms of Anorexia nervosa and Bulimia Nervosa may be characterised by body-related negative interpretation bias, distorted body image and pronounced body dissatisfaction. Anorexic patients refuse to eat with their family or in public places. They lose weight by drastically reducing their total food intake, with a disproportionate reduction in the amount of meals containing carbohydrates and fats. The term Anorexia is unfortunate, because a decrease in appetite does not occur. Patients are constantly hungry and they are constantly thinking about food, but they refuse it. An indication of their way of thinking is that they often collect recipes or prepare complex meals for others. Conclusions: Anorexia nervosa is a disease that connects the physical with the mental dimension of health. A person's disharmonious relationship with oneself, which may have its roots in a dysfunctional family context or in a demanding and competitive social environment, finds the way to be manifested through the individual's reflection on food