A Closer Examination of the Patient Experience in the Ambulatory Space: A Retrospective Qualitative Comparison of Specialty Care to Primary Care Experiences

With the advent of consumerism in one of the most complex and fragmented industries in the United States, the healthcare space now has a collective interest to further understand its consumers and help to shape their experiences. In this qualitative research study, we explore the key patient experience impressions responsible for driving quality. Differences between primary care patient perspectives and specialty care patient perspectives were analyzed using a mixed methods design in high, median and low quality performing practices. We found that primary care patients highly value (a) provider listening, (b) time spent with provider, and (c) consistent and effective coordination of care (i.e. provider handoffs, referrals, prescription refills, etc.). Specialty care patients were found to highly value (a) provider clinical skill acumen and outcomes, (b) being kept informed with timely updates and care instructions, and (c) a stress and pain-free experience. Both patient types also highly value a patient- and family- centered care team approach. We did find a direct association between patient experience quantitative scores and patient comments ratings. We conclude that differing patient types attach greater value to different elements of their health care experiences

Confidence intervals for performance estimates in 3D medical image segmentation

Medical segmentation models are evaluated empirically. As such an evaluation is based on a limited set of example images, it is unavoidably noisy. Beyond a mean performance measure, reporting confidence intervals is thus crucial. However, this is rarely done in medical image segmentation. The width of the confidence interval depends on the test set size and on the spread of the performance measure (its standard-deviation across of the test set). For classification, many test images are needed to avoid wide confidence intervals. Segmentation, however, has not been studied, and it differs by the amount of information brought by a given test image. In this paper, we study the typical confidence intervals in medical image segmentation. We carry experiments on 3D image segmentation using the standard nnU-net framework, two datasets from the Medical Decathlon challenge and two performance measures: the Dice accuracy and the Hausdorff distance. We show that the parametric confidence intervals are reasonable approximations of the bootstrap estimates for varying test set sizes and spread of the performance metric. Importantly, we show that the test size needed to achieve a given precision is often much lower than for classification tasks. Typically, a 1% wide confidence interval requires about 100-200 test samples when the spread is low (standard-deviation around 3%). More difficult segmentation tasks may lead to higher spreads and require over 1000 samples.Comment: 10 page

Um olhar para a clínica de crianças e adolescentes - relato de experiência

The purpose of this article is to demonstrate, through a study case, the clinic developed by ELT. In order to produce health, we believe that this clinic must offer more than just a simple therapeutical treatment. It should go over its limits and add to its knowledge other knowledgement, building up a new form of looking at and thinking about the handicapped infants and teenagers. As we report about this case, we point out that the clinic of infants and teenagers has its own peculiarities and lead us to a differentiated kind of work, which goes through the daily life of this community, the partnerships and interactions with other institutions, performing a interdisciplinary work.Este artigo se propõe a relatar, através de um estudo de caso, a clínica desenvolvida pelo Espaço Lúdico Terapêutico. Partimos do princípio que para produzir saúde, esta clínica deve oferecer mais que o atendimento terapêutico. Ela deve ultrapassar seus limites e agregar ao seu conhecimento outros saberes, construindo um novo modo de olhar e pensar sobre a infância e a adolescência com deficiência. Ao relatar este caso ressaltamos que a clínica de crianças e adolescentes tem peculiaridades e nos leva a um trabalho diferenciado, que percorre o cotidiano dessa população, as parcerias e intervenções em outras instituições, realizando um trabalho interdisciplinar

Policies for care during the third stage of labour: a survey of maternity units in Syria

<p>Abstract</p> <p>Background</p> <p>Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction.</p> <p>Methods</p> <p>To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births.</p> <p>Results</p> <p>Responses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined.</p> <p>One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine^®(oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births.</p> <p>68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour.</p> <p>Conclusion</p> <p>Most maternity units report using Syntometrine^®, usually given after delivery of the placenta, clamping the cord within 20 seconds, and using controlled cord traction.</p

Consanguinity and reproductive health among Arabs

Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity