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

Diabetic education in nursing: A Rodgers' evolutionary concept analysis

Aim: This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing.Background: Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging.Design: Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing.Data Source: We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL). MedLine, and Psyclnfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms.Results: The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds. needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes

Efficacy and safety of rituximab in type II mixed cryoglobulinemia

Abstract The best treatment of type II mixed cryoglobulinemia (MC) has still to be defined. Antiviral treatment for the frequent underlying infectious trigger hepatitis C virus (HCV) may be ineffective, contraindicated, or not tolerated in a fraction of cases, whereas current immunosuppressive treatments may lead to relevant complications. Selective B-cell blockade with rituximab was used in this study, based on favorable results in preliminary experience. Fifteen consecutive patients with type II MC (HCV-related in 12 of 15) were treated with rituximab, 375 mg/m2 intravenously weekly for 4 weeks. Only medium- to low-dose steroids were allowed, if already administered at the time of recruitment. All patients had active disease, poorly controlled or difficult to manage with previous treatments, including corticosteroids in all. Efficacy and safety of rituximab therapy were evaluated in the following 6 months. The overall follow-up after rituximab treatment ranged from 9 to 31 months. Rituximab proved effective on skin vasculitis manifestations (ulcers, purpura, or urticaria), subjective symptoms of peripheral neuropathy, low-grade B-cell lymphoma, arthralgias, and fever. Nephritis of recent onset went into remission in one case. Laboratory features, that is, significantly decreased serum rheumatoid factor and cryoglobulins and increased C4, were consistent with the clinical efficacy. Treatment was well tolerated, with no infectious complications. Thrombosis of retinal artery or self-limiting panniculitis occurred in one patient each. Rituximab may represent a safe and effective alternative to standard immunosuppression in type II MC. Controlled studies are needed to better define drug indications and the cost-efficacy profile in the different systemic manifestations