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Impact of the '2 week wait' directive for suspected cancer on service provision in a symptomatic breast clinic

BRITISH JOURNAL OF SURGERY 2000年第8期87卷 1082-1086页

作者： Cant, PJ Yu, DSL Rotherham Gen Hosp Trust Combined Breast Clin Rotherham S60 2UD S Yorkshire England

Background: The '2 week wait' directive (Health Service Circular (HSC 1998/242) guaranteeing that 'everyone with suspected breast cancer will be able to see a specialist within two weeks of their general practitioner (GP) deciding they need to be seen urgently' is a unique audited approach to access for the British National Health Service, the effects of which have been assessed in a non-academic symptomatic breast clinic. Methods: New GP referrals (n = 607) were reviewed prospectively in two comparable 3-month intervals, beginning 1 April 1998 and 1 April 1999, to determine the probability of a breast cancer diagnosis from the referral letter and the effects of the directive on waiting times for appointments and utilization of clinics. Results: The urgency of referral was not specified in 53 per cent of GP referrals. For the 'urgent' cases (25 per cent of all new referrals) the probability of a final diagnosis of breast cancer was 0.19. The breast specialists prospectively achieved a rate of 0.26 from 99 per cent of the same referral letters. 'Urgent' referrals did not wait significantly longer in 1999 (median 9 versus 10 days) but waiting times for new appointments overall increased (13 versus 16 days;P < 0.01), and this was greatest for 'routine' referrals (14 versus 21 days;P < 0.001). These changes were caused by an increase in the number of clinic appointments, due to significant increases in median number of visits to diagnosis or discharge and clinic non-attendance in 1999, resulting in overbooking. Telephonic communications were associated with faster median access times (fax 8 days;telephone 2 days), relative to mailed referrals (19 days) (P < 0.01). Conclusion: Breast specialists were better overall at assessing the probability of a breast cancer diagnosis. The waiting time for 'urgent' appointments was unchanged following HSC 1998/242, but there was an increased wait for other patients, especially those assessed as having a lower probability of cancer.

关键词：乳腺肿瘤/诊断大不列颠卫生服务易得程度/组织和管理卫生服务易得程度/标准前瞻性研究卫生保健质量转诊和会诊/标准公费医疗时间因素预约名单女(雌)性人类

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Integrating oral health into primary health care - experiences in Bangladesh, Indonesia, Nepal and Tanzania

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INTERNATIONAL DENTAL JOURNAL 1999年第4期49卷 240-248页

作者： Helderman, WV Mikx, F Begum, A Adyatmaka, A Bajracharya, M Kikwilu, E Rugarabamu, P Nijmegen The Netherlands Dhaka Bangladesh Jakarta Indonesia Kathmandu Nepal Dar es Salaam Tanzania [*]WHO Collaborating Centre Dentistry 117 Postbus 9101 6500 HB Nijmegen The Netherlands

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

关键词：孟加拉国社区卫生服务/组织和管理卫生保健提供联合牙科医疗/分类牙科医疗/经济学牙科医疗/组织和管理牙科保健服务/组织和管理发展中国家/经济学财政支持健康教育牙科健康计划健康促进卫生资源/经济学卫生资源/组织和管理卫生服务易得程度/组织和管理印度尼西亚口腔疾病/预防和控制国家卫生规划/组织和管理尼泊尔口腔保健初级卫生保健/经济学初级卫生保健/组织和管理乡村卫生服务/组织和管理坦桑尼亚人类

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A conceptual model of emergency department crowding

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ANNALS OF EMERGENCY MEDICINE 2003年第2期42卷 173-180页

作者： Asplin, BR Magid, DJ Rhodes, KV Solberg, LI Lurie, N Camargo, CA Reg Hosp Dept Emergency Med St Paul MN 55101 USA HealthPartners Res Fdn St Paul MN 55101 USA Univ Minnesota Sch Med Dept Emergency Med Minneapolis MN 55455 USA Univ Colorado Hlth Sci Ctr Div Emergency Med Denver CO USA Univ Colorado Hlth Sci Ctr Dept Prevent Med & Biometr Denver CO 80262 USA Univ Colorado Hlth Sci Ctr Clin Res Unit Colorado Permanente Med Grp Denver CO 80262 USA Univ Chicago Hosp Sect Emergency Med Chicago IL 60637 USA HealthPartners Res Fdn Minneapolis MN USA RAND Corp Arlington VA USA Harvard Univ Sch Med Channing Lab Dept Med Boston MA 02115 USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA

Emergency department (ED) crowding has become a major barrier to receiving timely emergency care in the United States. Despite widespread recognition of the problem, the research and policy agendas needed to understand and address ED crowding are just beginning to unfold. We present a conceptual model of ED crowding to help researchers, administrators, and policymakers understand its causes and develop potential solutions. The conceptual model partitions ED crowding into 3 interdependent components: input, throughput, and output. These components exist within an acute care system that is characterized by the delivery of unscheduled care. The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

关键词：急性病/治疗病床利用率/统计学和数值数据拥挤效率组织急诊室医院/组织和管理健康计划/组织和管理卫生政策卫生服务易得程度/组织和管理卫生服务研究住院时间/统计学和数值数据模型组织管理需求估价/组织和管理运筹学结果与过程评价(卫生保健)/组织和管理病人入院/统计学和数值数据病人出院/统计学和数值数据研究设计全面质量管理/组织和管理伤病员分拣/组织和管理美国

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A questionnaire for the assessment of patients' impressions of the risks and benefits of home telecare

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第5期6卷 278-284页

作者： Demiris, G Speedie, S Finkelstein, S Univ Minnesota Dept Lab Med & Pathol Minneapolis MN 55455 USA

Home telecare is a promising method of improving access to care for rural and urban populations. It requires, however, that patients accept the installation and use of equipment in their home. How patients perceive home telecare may influence its acceptability and diffusion. We developed a questionnaire to assess patients' impressions of the risks and benefits of home telecare. A preliminary 20-item questionnaire was developed and tested on 32 subjects. It proved to be of acceptable reliability (Cronbach's alpha of 0.8) and validity, but three items appeared to be redundant. The final 17-item version was tested twice on 10 more subjects and was found to have high test-retest reliability. Most subjects showed an overall positive attitude towards home telecare and agreed it could improve their health. Many were concerned about being able to trust the equipment. The questionnaire can be used to investigate the acceptance of telemedicine and to improve the design of applications.

关键词：健康态度机密卫生服务易得程度/组织和管理家庭医疗保健服务/组织和管理家庭医疗保健服务/标准病人接受卫生保健的程度问卷调查可重复性结果危险因素远程医学人类

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Plastic surgery in the new millennium

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BRITISH JOURNAL OF PLASTIC SURGERY 2000年第4期53卷 271-278页

作者： Hurren, J W Norwich Hosp Norwich NR2 3TU Norfolk England

The end of centuries, and especially millennia, have always been a time for soothsayers. Such times offer rich pickings, especially for the prophets of doom! The last 50 years have seen a meteoric development in the specialty of Plastic Surgery. However, as the end of the century and millennium approaches, the voice of disquiet can be increasingly heard amongst Plastic Surgeons, The cause of this anxiety is the increasing number of Plastic Surgery techniques that are being performed by non Plastic Surgeons, Some even speak of the demise of Plastic Surgery as a specialty, or at least its marginalisation to cosmetic surgery. Has the specialty of Plastic Surgery really been a star which has burned too brightly? Is it really in danger of burning out? My central thesis is that the specialty of Plastic Surgery is unique and has an important contribution to make into the future. Plastic Surgery differs around the world such that some of what I say is specific to conditions in Britain. I will start by considering what is meant by the term 'Plastic Surgery'. After a brief look at the past I will review the likely future changes in the techniques of Plastic Surgery. Then I will move on to explore the future of the specialty and the factors that will determine its future. Finally I will offer some immediate priorities.

关键词：培养技术/方法预测卫生服务易得程度/组织和管理外科整形/教育外科整形/组织和管理外科整形/发展趋势伤口愈合/遗传学人类

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Out-of-hours dental services: a survey of current provision in the United Kingdom

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BRITISH DENTAL JOURNAL 2000年第5期188卷 269-274页

作者： Anderson, R Thomas, DW Univ Wales Coll Cardiff Coll Med Dept Oral Surg Cardiff CF4 4XY S Glam Wales

Objective To describe the variety of arrangements for providing out-of-hours dental care in the UK. Design A telephone interview survey of health authorities and health boards. Setting United Kingdom. Subjects 104 health authority contacts, usually consultants in dental public health, dental advisers or others in a position to describe the local dental service arrangements. Results At weekends, 25 authorities have no formal dental care arrangements for unregistered patients, 55 have separate arrangements for registered and unregistered patients, and 44 have 'universal access' arrangements - for anyone in an area, regardless of their registration status. On weekday nights over two-thirds (82/124) of UK health authorities have no formal arrangements for unregistered patients. Where there are separate 'safety-net' services intended for unregistered patients only they are usually (in 48 of 55 authorities) emergency treatment sessions. A fifth of authorities reported planned changes to their local out-of-hours arrangements, including the introduction of telephone triage, and moves to make care available at more times, to more people or from centralised premises. Conclusions There is extremely wide geographical variation in the organisation of out-of-hours dental services provided in the United Kingdom. In many parts of the UK there are no formal out-of-hours care arrangements for unregistered patients, even at weekends. This unequal provision will mean inequitable access for many unregistered patients. With increasing demands from a growing unregistered population, and various government initiatives to make primary care services more integrated and accessible, the highly fragmented pattern of provision in many areas may no longer be acceptable.

关键词：卫生服务范围社区牙科学牙科保健服务/组织和管理急救医疗服务/组织和管理开业医生牙科/组织和管理健康计划卫生服务易得程度/组织和管理卫生服务需求采访(主题) 初级卫生保健/组织和管理转诊和会诊登记公费医疗/组织和管理电话伤病员分拣人类

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A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第3期6卷 172-176页

作者： Ostojic, V Stipic-Markovic, A Tudman, Z Zivkovic, N Cvoriscec, B Trajbar, T Donnelly, CL Grgic, M Matek, P Lusic, M Iskra, M Univ Zagreb Gen Hosp Sveti Duh Dept Clin Immunol & Pulmonol Zagreb 10000 Croatia Ambulance Selca Brac Isl Croatia Dartmouth Hitchcock Med Ctr Dept Child Psychiat Lebanon NH 03766 USA Croatian Inst Brain Res Zagreb Croatia

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brac. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.

关键词：克罗地亚卫生服务易得程度/经济学卫生服务易得程度/组织和管理因特网病人满意度远程医学/经济学远程医学/方法远程医学/标准青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类男(雄)性中年人

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Heart failure now on the palliative care agenda

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PALLIATIVE MEDICINE 2000年第5期14卷 361-362页

作者： Addington-Hall, JM Gibbs, JSR Univ London Imperial Coll Sci Technol & Med Natl Heart & Lung Inst St Christophers HospiceGKT Sch Med Dept Palliat Care & Policy London England

Comments on the April 2000 publication of National Service Frameworks (NSF) for coronary heart disease (CHD), as part of the modernization program of Great Britain's National Health Service. Commendation of the NSF authors for recognizing that palliative care may benefit CHD patients; Value of the NSF in CHD for patients; Challenges involved in palliative care for CHD.

关键词：心排血量低/治疗慢性病大不列颠卫生计划方针卫生服务易得程度/组织和管理姑息疗法/组织和管理公费医疗/标准人类

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Expanding contraceptive choice:: Findings from Brazil

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STUDIES IN FAMILY PLANNING 1999年第1期30卷 1-16页

作者： Díaz, M Simmons, R Díaz, J Gonzalez, C Makuch, MY Bossemeyer, D CEMICAMP Dept Educ Training & Commun BR-13081970 Campinas SP Brazil Univ Michigan Sch Publ Hlth Dept Hlth Behav & Hlth Educ Ann Arbor MI 48109 USA Populat Council Campinas Brazil

This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.

关键词：巴西选择行为计划生育服务/组织和管理集中研讨小组健康知识态度实践卫生服务易得程度/组织和管理卫生服务研究整体保健需求估价方案评价卫生保健质量问卷调查妇女/心理学青少年成年人女(雌)性人类男(雄)性中年人

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Overview of bioterrorism readiness plan: A template for health care facilities

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第6期27卷 468-469页

作者： English, JF Natl Naval Med Ctr Infect Control Branch Div Infect Dis Bethesda MD 20889 USA

The Association for professionals in Infection control andEpidemiology, Inc (APIC), recognized that most health care facilitiesare ill prepared to deal with a bioterrorist event. Thisdetermination led APIC, in cooperation with the Centers for DiseaseControl and prevention (CDC), to devise the "Bioterrorism ReadinessPlan: A Template for Healthcare Facilities" to Serve as a referencedocument and initial template to Facilitate preparation ofbioterrorism readiness plans For diverse health care facilities.

关键词：生物战/预防和控制救灾计划/组织和管理卫生设施卫生服务易得程度/组织和管理规划制订危险性评估美国暴力/预防和控制人类

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