Journal of evaluation in clinical practice
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Observational Study
Implementation of an Early Referral Programme for Patients With Hand Arthralgia.
Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease. According to the European League Against Rheumatism (EULAR), the stages of RA progression include pre-RA, preclinical RA, inflammatory arthralgia, arthralgia with positive antibodies, arthralgia suspected of progressing to RA, undifferentiated arthritis and finally established RA. According to the Community Oriented Program for Control of Rheumatic Diseases (COPCORD), the prevalence of RA in Mexico is 1.6% [2], with approximately 10% of health problems addressed at the primary care level. ⋯ The implementation of this early referral programme significantly reduced the time in months for patients to access rheumatologic care.
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This study aimed to investigate the influential factors of adherence to inhalation drug therapy (IDT) in patients with stable chronic obstructive pulmonary disease (COPD). ⋯ Dose adherence was predominantly influenced by COPD health literacy, mMRC grading, duration of COPD, utilisation of support and marital status. Inhalation technical standardisation was substantially limited by age, mMRC grading, social support, mode of residence, number of acute exacerbations in the past year and literacy.
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Responses to experimental pain have suggested central and peripheral sensitisation in adult patients with sickle cell disease (SCD). Recent studies have proposed an algometry-derived dynamic measure of pain sensitisation, slowly repeated evoked pain (SREP), which is useful in the discrimination of painful conditions related to central sensitisation. Pain and fatigue are two symptoms that affect the general functioning of patients with SCD most significantly, however, research about experimental dynamic pain measures and their relation to the main symptoms of SCD (pain and fatigue) is still scarce. ⋯ Pain threshold and tolerance did not discriminate between patients and healthy individuals, but were useful for predicting fatigue severity in SCD. The SREP protocol provides a useful dynamic measure of pain for the discrimination and detection of enhanced pain sensitisation in patients with SCD, which could contribute to more personalised pain evaluations and treatment for these patients.
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Pneumonia is the primary cause of pediatric hospitalization and the most frequent cause of death among children under the age of five in China. The parental discharge teaching quality and discharge readiness have a significant impact on children's health outcomes and readmission. ⋯ Pediatricians are encouraged to consider this outcome to develop targeted interventions that improve parental discharge teaching, discharge readiness and post-discharge outcomes for children with pneumonia.
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Individuals experiencing homelessness (IEH) tend to have increased length of stay (LOS) in acute care settings, which negatively impacts health care costs and resource utilisation. It is unclear however, what specific factors account for this increased LOS. This study attempts to define which diagnoses most impact LOS for IEH and if there are differences based on their demographics. ⋯ Homelessness significantly increases the LOS of individuals within both ED and inpatient settings. We have identified several diagnoses that are associated with increased LOS in IE; these should inform the prioritisation and development of targeted interventions to improve the health of IEH.