A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Memòria Practicum II : Gestió de Serveis Sanitaris, Hospital de Sta Maria de Lleida, Unitat d'Aguts, Servei de Psiquiatria

Memòria del Practicum II realitzat a la Unitat d'aguts del Servei de Psiquiatria de l'Hospital de Santa Maria a Lleida.

El temps del mal: l’experiència i la gestió de la cronicitat en adults

El temps del mal. L’experiència i la gestió de la cronicitat en adults. El principal objectiu d’aquesta recerca és l’estudi de l’experiència i la gestió diària de la cronicitat, entenent-la com a categoria analítica que engloba els processos de malalties i/o malestars crònics, biomèdicament diagnosticats o no, que perduren en el temps. La recerca es centra en adults entre 30 i 50 anys amb problemes crònics de salut que impliquin algun tipus de discapacitat i/o dependència (a nivell moderat), i s’ubica en l’àmbit urbà i en la comunitat autònoma de Catalunya (dins del context de l’estat Espanyol). L’estudi analitzarà la gestió individual i social de la cronicitat a través dels itineraris terapèutics i pràctiques assistencials dels processos de salut/malaltia/atenció prenent l’autoatenció com a principal categoria analítica. Per altra banda, es descriurà el rol dels serveis assistencials de la sanitat pública i dels serveis socials, per veure com es duu a terme la gestió – polítiques públiques - de la cronicitat en un país amb estat del benestar com Espanya. L’experiència de la cronicitat s’explorarà a través de les narratives de la vivència de la malaltia/malestar tan com a representació cultural – que dóna compte de les relacions, interaccions i respostes socials – i des d’una perspectiva fenomenològica que ens permet comprendre la naturalesa del patiment en l’experiència viscuda del cos malalt. Aquesta recerca espera poder fer aportacions pertinents que contribueixin des de l’antropologia però amb la intenció d’obrir un diàleg públic i interdisciplinar – professionals de la salut, experts en polítiques públiques i públic en general - a la resolució de l’actual problema de salut pública d’increment de cronicitat. El model públic d’atenció a la salut espanyol es va dissenyar per resoldre problemes de salut aguts, malgrat la major part dels usuaris actuals presentes problemes de salut crònics. L’actual crisi econòmica que amenaça aquest pilar de l’estat del benestar és, alhora, una oportunitat per replantejar-ho.

Outpatient Quick Diagnosis Units for the evaluation of suspected severe diseases: an observational, descriptive study

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.

Vaginal hysterectomy with the autosuture stapler

Our objective was to assess the applicability of hysterectomy by the vaginal route completely performed with Autosuture staples. Between January 1992 and September 1993, 5 vaginal hysterectomies using Autosuture staplers were performed by the authors. Five vaginal hysterectomies matched for age, parity, and uterine size performed by the same surgeons using reabsorbable sutures during the same period were used as case controls. No febrile morbidity, cuff infections, thrombophlebitis, bladder injury, or hemorrhage complications were observed in the 10 women who entered the study. In summary, vaginal hysterectomy can be performed with Autosutures easily, probably faster with experience, and with less oozing from the operative field, thus providing a safe procedure.

Posterior vaginal wall repair with synthetic absorbable mesh: A new technique for and old procedure

The objective of this study was to assess the applicability of posterior wall repair with a synthetic absorbable mesh. Between January and September 1996, five posterior repairs using absorbable synthetic meshes were performed. Five posterior wall repairs in patients matched for age, parity, and rectocele degree were performed according to usual procedures during the same period, and were used as controls. No febrile morbidity, cuff or posterior vaginal wall infections, thrombophlebitis, rectal injury, or hemorrhagic complications were observed in the 10 women who entered the study. In summary, posterior wall repair can be easily performed with an absorbable soft tissue patch, theoretically preserving sexual activity, and probably offers better functional results with longer experience, thus providing a safe and useful procedure in sexually active women.

Influència de l’estrès en els resultats acadèmics en relació a la pràctica esportiva

University students which are in exams period tend to modify their habits; physical activity, diet, rest, etc. This means a lesser physical and academical performance. “Tal situación les puede hacer experimentar agotamiento, poco interés frente al estudio, y autocrítica (Caballero, Abello & Palacios, 2007)”(13) Because of that, the goal of this investigation is to observe if practising physical activity during exams period affects the stress level and the academical marks. Students which took part in this investigation had been distributed in two groups: one group which does physical activity minimum 2 days per week (from 5 to 15 hours) and another group which doesn’t practise, or maybe just do less hours than the first group. The sampling is performed by 18 students of Universitat de Vic (9 in each group). During 3 months, they had to answer some questionnaires, first of all, to know the characteristics of all the students (physical activity level, what kind of physical activity they did, average academical marks, etc). Then, they had to do 2 tests to go further in the stress topic (STAI and Escala Estrès Percebut), and finally, the last questionnaire was useful to know if they have been ill after exams period or during it. This 3 months period has been divided in 3 phases: 1st phase at the end of November to choose the participants and learn their characteristics, 2nd phase to do the stress tests (from December until January), and the 3rd phase to collect the data from the questionnaires and tests (end of January).While the groups were being analysed, it was clear to see that the students which practise physical activity tend to suffer less stress in both periods (with and without exams), compared to the sedentary group. Apparently, due to the questionnaires results, the sedentary students suffered more illnesses during or after the stressing period. Therefore, even there are significative differences between both groups in connection with stress level (even from STAI or Escala Estrès Percebut), there isn’t any association towards the academical results, because after all, the sedentary group tends to have better marks than the other group.

Functional remediation for bipolar disorder

Neurocognitive impairment constitutes a core feature of bipolar illness. The main domains affected are verbal memory, attention, and executive functions. Deficits in these areas as well as difficulties to get functional remission seem to be increased associated with illness progression. Several studies have found a strong relationship between neurocognitive impairment and low functioning in bipolar disorder, as previously reported in other illnesses such as schizophrenia. Cognitive remediation strategies, adapted from work conducted with traumatic brain injury patients and applied to patients with schizophrenia, also need to be adapted to individuals with bipolar disorders. Early intervention using functional remediation, involves neurocognitive techniques and training, but also psychoeducation on cognition-related issues and problem-solving within an ecological framework.

Memòria Practicum II : Gestió de Serveis Sanitaris, Hospital de Sta Maria de Lleida, Unitat d'Aguts, Servei de Psiquiatria

Memòria del Practicum II realitzat a la Unitat d'aguts del Servei de Psiquiatria de l'Hospital de Santa Maria a Lleida.

Niños "vergonzantes" y "pequeños rojos". La población marginal infantil en la Cataluña interior del primer franquismo

En el imaginario colectivo de la sociedad de posguerra siempre están presentes las duras condiciones de la vida cotidiana. La población infantil fue especialmente sensible a esta situación debido al alto índice de enfermedades infecciosas, el racionamiento dietético y las angustias derivadas del conflicto bélico. En estas condiciones, el Auxilio Social de la Falange fue el encargado de administrar la beneficencia y, a su vez, resocializar la población, en este caso, la infantil, dentro de los valores nacionalsindicalistas y nacionalcatólicos. Ello le permitió no sólo controlar la política social sino también criminalizar a los vencidos en el momento de administrarla. En definitiva, fue uno de los pilares fundamentales en el proceso de construcción del edificio franquista.

The ‘Dys-Appearing’ Body in Doris Lessing’s The Diary of a Good Neighbour and Margaret Forster’s Have the Men Had Enough?

If the old body is usually read as a synonym of fragility and upcoming illness, even though not the case for most elderly citizens, the reality is that the longer we live, the increased probability of being affected by different illnesses cannot be eluded or denied. In Doris Lessing’s The Diary of a Good Neighbour and Margaret Forster’s Have the Men Had Enough? the reader is invited to participate in the day-to-day routines of two aged female protagonists, as well as to empathize with their inner feelings as they go through their last life stage. In fact, their ‘dys-appearing’ bodies, marked by their respective terminal illnesses, force these characters to grow closer to those around them and to accept the help of their families and friends, despite their desire to keep their free will and independence until the very end. The analysis of the two novels within the framework of ageing studies aims to show the contradictions existing between a growing ageing society and the negative cultural connotations of old age in Western society and the need to revise them.