"Haematologic home care in Modena: an operating model involving hospital, community health services and fundraising organisation". Abstract presented at the 10th Congress of the Italian Association of Medical Oncology AIOM (Verona, 2008).
The 2005 National French Adverse Event Study: ENEIS. Anne Farge – Broyart. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
06 acute coronary syndromes is there a place for a real pre hospital treatmen...NPSAIC
1) The management of acute coronary syndrome (ACS) patients requires close collaboration between emergency physicians and cardiologists according to simplified protocols.
2) Key challenges for pre-hospital ACS management include precise knowledge of new drugs, developing regional hospital cooperation, organizing the healthcare network, and regularly analyzing practices.
3) The emergency physician must adapt strategies to international guidelines and the patient's needs, routing high-risk patients directly to catheterization facilities within recommended time limits.
Aortic dissection after ramucirumab infusion dz 2019Davide Zenoni
The endothelial dysfunction associated with vascular endothelial
growth factor pathway inhibitors (VPIs) would seem
to be the most plausible explanation for such events:
it causes thromboembolic events and cardiovascular
complications.
"Clinical management of elderly patients with acute myeloid leukemia referred to the A.I.L. hematology home care service in Modena". Abstract presented at the 42nd Congress of the Italian Society of Hematology SIE (Milan, 2009).
"Use of palliative prognostic score (PaP-score) in terminally ill elderly patients with acute myeloid leukaemia referred to a domiciliary program of supportive and palliative care". Poster presented at the 10th Congress of the Italian Society of Experimental Hematology SIES (Bari, 2008).
"Home care for unfit elderly patients with myelodisplastic syndromes:an Italian single-center experience. "Poster presented at the 14th Congress of EHA (Berlin, 2009)".
The 2005 National French Adverse Event Study: ENEIS. Anne Farge – Broyart. Presentation of the National Study of Adverse Events (Madrid, Ministry of Health and Consumer Affairs, 2006)
06 acute coronary syndromes is there a place for a real pre hospital treatmen...NPSAIC
1) The management of acute coronary syndrome (ACS) patients requires close collaboration between emergency physicians and cardiologists according to simplified protocols.
2) Key challenges for pre-hospital ACS management include precise knowledge of new drugs, developing regional hospital cooperation, organizing the healthcare network, and regularly analyzing practices.
3) The emergency physician must adapt strategies to international guidelines and the patient's needs, routing high-risk patients directly to catheterization facilities within recommended time limits.
Aortic dissection after ramucirumab infusion dz 2019Davide Zenoni
The endothelial dysfunction associated with vascular endothelial
growth factor pathway inhibitors (VPIs) would seem
to be the most plausible explanation for such events:
it causes thromboembolic events and cardiovascular
complications.
"Clinical management of elderly patients with acute myeloid leukemia referred to the A.I.L. hematology home care service in Modena". Abstract presented at the 42nd Congress of the Italian Society of Hematology SIE (Milan, 2009).
"Use of palliative prognostic score (PaP-score) in terminally ill elderly patients with acute myeloid leukaemia referred to a domiciliary program of supportive and palliative care". Poster presented at the 10th Congress of the Italian Society of Experimental Hematology SIES (Bari, 2008).
"Home care for unfit elderly patients with myelodisplastic syndromes:an Italian single-center experience. "Poster presented at the 14th Congress of EHA (Berlin, 2009)".
Personalised Medicine in European HospitalsEuroBioForum
HOPE, the European Hospital and Healthcare Federation
PwC’s Global Healthcare practice
(http://www.pwc.com/global-health
www.hope.be)
Hospitals and providers have a clear opportunity to adapt to the new healthcare paradigm and provide services that are targeted to the individual patient.
European clinical practice guideline on diagnosis hiponatremiaJaime dehais
1. Hyponatraemia, defined as a serum sodium concentration less than 135 mmol/l, is common in clinical practice and associated with increased mortality, morbidity, and length of hospital stay.
2. Despite this, management of patients with hyponatraemia remains problematic due to diverse approaches across institutions and specialties.
3. The European Society of Intensive Care Medicine, European Society of Endocrinology, and European Renal Association developed this joint clinical practice guideline to provide a standardized approach to diagnosis and treatment of hyponatraemia.
This document summarizes a policy brief on increasing day surgery (ambulatory surgery where patients are discharged the same day). It discusses the history and growth of day surgery as a cost-effective alternative to inpatient surgery. While day surgery accounts for nearly 90% of surgeries in some countries, rates vary widely between countries and hospitals. The brief examines how expanding day surgery could benefit healthcare systems by increasing throughput, reducing costs and wait times. However, barriers still exist in some countries that prevent day surgery from reaching its full potential. Overcoming these barriers may require changes to policies, regulations, healthcare facilities and staffing.
This clinical trial evaluated the effectiveness of prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO) for refractory mandibular osteoradionecrosis (ORN) in 54 patients. PENTOCLO treatment for a mean of 16 months resulted in:
1) A significant and progressive reduction in exposed bone, with complete mucosal and bone healing in all patients.
2) Significant improvement in pain and symptoms.
3) No safety issues were observed.
4) PENTOCLO appears to be an effective and safe treatment for refractory ORN, though a randomized controlled trial is still needed.
The document summarizes criteria for admission to intensive care units. It outlines that intensive care is appropriate for patients requiring advanced organ system support, such as mechanical ventilation or multiple organ support. The key factors in determining admission are the diagnosis, severity of illness, physiological reserve, prognosis, availability of treatment, and the patient's wishes. Patients should be admitted early before their condition deteriorates irreversibly. Clear referral criteria can help identify at-risk patients and trigger calls for intensive care team assistance.
1) Treatment of malnutrition leads to better clinical outcomes for patients. Evidence from meta-analyses of clinical trials shows that nutritional support improves outcomes like complications and mortality.
2) Screening studies in Denmark found high prevalences of malnutrition in hospitals, especially in orthopedic surgery, gastroenterology, and internal medicine. However, most malnourished patients did not receive nutritional treatment or monitoring.
3) Malnutrition in hospitals results in increased costs due to longer hospital stays and higher rates of complications. Treating malnutrition can reduce these costs. Applying UK cost estimates to Danish healthcare spending suggests that treating malnutrition could save over 140 million pounds.
This article summarizes the use of a patient group direction (PGD) at a hospital to provide pre-operative Staphylococcus aureus decolonization treatment to patients undergoing spinal surgery to reduce their risk of surgical site infection. Staff were trained to distribute the PGD in pre-operative clinics and patients self-administered the treatment at home for 5 days before surgery. An audit found that over 50% of eligible patients received the PGD, and infection rates decreased from 2.4% to 0.6% after implementation. Both staff and patients reported that the PGD was well-explained and adhered to.
Avoidng disruption of timely surgical management of genitourinary cancers ...Valentina Corona
This article describes the experience of a large cancer center in Southern Italy in continuing timely surgical treatment of genitourinary cancers during the early phase of the COVID-19 pandemic. The center established a multidisciplinary team to prioritize urgent cancer cases and implemented screening, safety protocols, and transfer agreements to identify and manage any COVID-19 positive patients while maintaining surgical volume. Through regional healthcare reorganization designating the center as "COVID-free" and other measures, the hospital was able to safely perform a similar number and mix of cancer surgeries compared to the previous year without major disruption of care.
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
New technologies have the potential to improve clinical outcomes in toxicology and poisoning situations. The literature review identified several technologies that could help, such as expert systems to manage emergency drug stocks and antidote programs. Studies found that most hospitals have inadequate stocks of important antidotes. Guidelines and collaboration between hospitals, including formal stock sharing agreements, could help address shortages. The implementation of a computerized pharmacy cabinet system in one hospital reduced costs by 75,000 euros over 5 years while still covering 99% of emergency needs. New technologies, if properly managed by clinical staff, may lead to more effective antidote availability and improved patient outcomes in toxicology emergencies.
The document provides updated guidelines from the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. It summarizes the evidence from systematic reviews on various topics related to opioid use. The guidelines consist of 16 evidence-based recommendations developed using the GRADE system. Some of the key recommendations include: (1) For patients with mild to moderate pain, starting with a step II opioid or low-dose step III opioid is recommended; (2) Morphine, oxycodone, and hydromorphone are recommended as first-choice step III opioids as they showed no important differences in efficacy or tolerability; (3) Immediate-release oral morphine administered every 4 hours
Using asynchronous telemedicine in rural primary care settings in the Catalon...Josep Vidal-Alaball
Asynchronous telemedicine is used in rural primary care settings in Catalonia to provide better access to specialists. Store-and-forward telemedicine allows clinical data like photos and test results to be collected and interpreted remotely without needing the patient and clinician to be in the same place. This approach has reduced dermatology waiting times from 30 to 16 days and enabled teleconsultations for ulcers, eye screenings for diabetes, and audiology services. Photos, scans and patient histories are uploaded for specialists to review and provide diagnoses and treatment plans to improve efficiency and access to care.
Rui Maio Portugal - Monday 28 - ICU and Organ Donationincucai_isodp
Close cooperation between intensive care unit (ICU) staff and transplant coordinators (TCs) is key to the organ donation process. The profile of professionals involved in transplant coordination has changed, with more medical professionals from ICU and emergency backgrounds. All steps of the donation process must be managed in the ICU by ICU staff and TCs to increase organ donation and quality. As populations age and diseases increase, intensive care needs are growing, requiring preparation to face these challenges.
Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DA...haha haha
This clinical trial investigated the safety and efficacy of combining intravitreal aflibercept injections with micropulse laser treatment for diabetic macular edema. Thirty patients were randomized to receive either injections with sham laser (Group 1) or injections with micropulse laser (Group 2). Both groups showed improvements in visual acuity and macular thickness after 48 weeks, with no significant differences between groups. While micropulse laser did not reduce the number of injections needed or further improve outcomes, it also did not cause any adverse effects when combined with anti-VEGF therapy.
1) Peritoneal dialysis is the most cost-effective form of dialysis treatment for economic sustainability compared to hemodialysis.
2) Studies show that peritoneal dialysis and hemodialysis have similar survival rates long-term, but peritoneal dialysis has better outcomes in the first years and helps preserve residual kidney function.
3) Quality of life is also generally better for patients undergoing peritoneal dialysis compared to hemodialysis, especially regarding factors like hospitalizations and length of hospital stays.
Hospital Medicine around the World- Taiwan ExperienceHung-Bin Tsai
This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
prevencion de la IRA y proteccion de la Funcion renal en la UciResidentes1hun
This expert panel review provides recommendations for preventing acute kidney injury (AKI) in intensive care unit patients. The panel performed a systematic literature search to evaluate potential preventative measures including volume expansion, diuretics, vasopressors, vasodilators, hormones, nutrition, and renal replacement therapy. Based on the available evidence, the panel recommends prompt resuscitation with adequate hydration while avoiding hydroxyethyl starch, maintaining adequate blood pressure with vasopressors in vasodilatory shock, and using vasodilators and sodium bicarbonate under strict hemodynamic control. However, none of the recommendations received the highest evidence grade.
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
Personalised Medicine in European HospitalsEuroBioForum
HOPE, the European Hospital and Healthcare Federation
PwC’s Global Healthcare practice
(http://www.pwc.com/global-health
www.hope.be)
Hospitals and providers have a clear opportunity to adapt to the new healthcare paradigm and provide services that are targeted to the individual patient.
European clinical practice guideline on diagnosis hiponatremiaJaime dehais
1. Hyponatraemia, defined as a serum sodium concentration less than 135 mmol/l, is common in clinical practice and associated with increased mortality, morbidity, and length of hospital stay.
2. Despite this, management of patients with hyponatraemia remains problematic due to diverse approaches across institutions and specialties.
3. The European Society of Intensive Care Medicine, European Society of Endocrinology, and European Renal Association developed this joint clinical practice guideline to provide a standardized approach to diagnosis and treatment of hyponatraemia.
This document summarizes a policy brief on increasing day surgery (ambulatory surgery where patients are discharged the same day). It discusses the history and growth of day surgery as a cost-effective alternative to inpatient surgery. While day surgery accounts for nearly 90% of surgeries in some countries, rates vary widely between countries and hospitals. The brief examines how expanding day surgery could benefit healthcare systems by increasing throughput, reducing costs and wait times. However, barriers still exist in some countries that prevent day surgery from reaching its full potential. Overcoming these barriers may require changes to policies, regulations, healthcare facilities and staffing.
This clinical trial evaluated the effectiveness of prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO) for refractory mandibular osteoradionecrosis (ORN) in 54 patients. PENTOCLO treatment for a mean of 16 months resulted in:
1) A significant and progressive reduction in exposed bone, with complete mucosal and bone healing in all patients.
2) Significant improvement in pain and symptoms.
3) No safety issues were observed.
4) PENTOCLO appears to be an effective and safe treatment for refractory ORN, though a randomized controlled trial is still needed.
The document summarizes criteria for admission to intensive care units. It outlines that intensive care is appropriate for patients requiring advanced organ system support, such as mechanical ventilation or multiple organ support. The key factors in determining admission are the diagnosis, severity of illness, physiological reserve, prognosis, availability of treatment, and the patient's wishes. Patients should be admitted early before their condition deteriorates irreversibly. Clear referral criteria can help identify at-risk patients and trigger calls for intensive care team assistance.
1) Treatment of malnutrition leads to better clinical outcomes for patients. Evidence from meta-analyses of clinical trials shows that nutritional support improves outcomes like complications and mortality.
2) Screening studies in Denmark found high prevalences of malnutrition in hospitals, especially in orthopedic surgery, gastroenterology, and internal medicine. However, most malnourished patients did not receive nutritional treatment or monitoring.
3) Malnutrition in hospitals results in increased costs due to longer hospital stays and higher rates of complications. Treating malnutrition can reduce these costs. Applying UK cost estimates to Danish healthcare spending suggests that treating malnutrition could save over 140 million pounds.
This article summarizes the use of a patient group direction (PGD) at a hospital to provide pre-operative Staphylococcus aureus decolonization treatment to patients undergoing spinal surgery to reduce their risk of surgical site infection. Staff were trained to distribute the PGD in pre-operative clinics and patients self-administered the treatment at home for 5 days before surgery. An audit found that over 50% of eligible patients received the PGD, and infection rates decreased from 2.4% to 0.6% after implementation. Both staff and patients reported that the PGD was well-explained and adhered to.
Avoidng disruption of timely surgical management of genitourinary cancers ...Valentina Corona
This article describes the experience of a large cancer center in Southern Italy in continuing timely surgical treatment of genitourinary cancers during the early phase of the COVID-19 pandemic. The center established a multidisciplinary team to prioritize urgent cancer cases and implemented screening, safety protocols, and transfer agreements to identify and manage any COVID-19 positive patients while maintaining surgical volume. Through regional healthcare reorganization designating the center as "COVID-free" and other measures, the hospital was able to safely perform a similar number and mix of cancer surgeries compared to the previous year without major disruption of care.
Presentazione a cura della Dottoressa Rosella Pasqualoni e del dottor Gregorio Reda - "TIROIDE 2018 Nuovi approcci diagnostici e terapeutici" - Roma 24/11/2018
New technologies have the potential to improve clinical outcomes in toxicology and poisoning situations. The literature review identified several technologies that could help, such as expert systems to manage emergency drug stocks and antidote programs. Studies found that most hospitals have inadequate stocks of important antidotes. Guidelines and collaboration between hospitals, including formal stock sharing agreements, could help address shortages. The implementation of a computerized pharmacy cabinet system in one hospital reduced costs by 75,000 euros over 5 years while still covering 99% of emergency needs. New technologies, if properly managed by clinical staff, may lead to more effective antidote availability and improved patient outcomes in toxicology emergencies.
The document provides updated guidelines from the European Association for Palliative Care (EAPC) on the use of opioids for the treatment of cancer pain. It summarizes the evidence from systematic reviews on various topics related to opioid use. The guidelines consist of 16 evidence-based recommendations developed using the GRADE system. Some of the key recommendations include: (1) For patients with mild to moderate pain, starting with a step II opioid or low-dose step III opioid is recommended; (2) Morphine, oxycodone, and hydromorphone are recommended as first-choice step III opioids as they showed no important differences in efficacy or tolerability; (3) Immediate-release oral morphine administered every 4 hours
Using asynchronous telemedicine in rural primary care settings in the Catalon...Josep Vidal-Alaball
Asynchronous telemedicine is used in rural primary care settings in Catalonia to provide better access to specialists. Store-and-forward telemedicine allows clinical data like photos and test results to be collected and interpreted remotely without needing the patient and clinician to be in the same place. This approach has reduced dermatology waiting times from 30 to 16 days and enabled teleconsultations for ulcers, eye screenings for diabetes, and audiology services. Photos, scans and patient histories are uploaded for specialists to review and provide diagnoses and treatment plans to improve efficiency and access to care.
Rui Maio Portugal - Monday 28 - ICU and Organ Donationincucai_isodp
Close cooperation between intensive care unit (ICU) staff and transplant coordinators (TCs) is key to the organ donation process. The profile of professionals involved in transplant coordination has changed, with more medical professionals from ICU and emergency backgrounds. All steps of the donation process must be managed in the ICU by ICU staff and TCs to increase organ donation and quality. As populations age and diseases increase, intensive care needs are growing, requiring preparation to face these challenges.
Treatment of Diabetic Macular Edema with Aflibercept and Micropulse Laser (DA...haha haha
This clinical trial investigated the safety and efficacy of combining intravitreal aflibercept injections with micropulse laser treatment for diabetic macular edema. Thirty patients were randomized to receive either injections with sham laser (Group 1) or injections with micropulse laser (Group 2). Both groups showed improvements in visual acuity and macular thickness after 48 weeks, with no significant differences between groups. While micropulse laser did not reduce the number of injections needed or further improve outcomes, it also did not cause any adverse effects when combined with anti-VEGF therapy.
1) Peritoneal dialysis is the most cost-effective form of dialysis treatment for economic sustainability compared to hemodialysis.
2) Studies show that peritoneal dialysis and hemodialysis have similar survival rates long-term, but peritoneal dialysis has better outcomes in the first years and helps preserve residual kidney function.
3) Quality of life is also generally better for patients undergoing peritoneal dialysis compared to hemodialysis, especially regarding factors like hospitalizations and length of hospital stays.
Hospital Medicine around the World- Taiwan ExperienceHung-Bin Tsai
This is the presentation by Dr. Hung-Bin Tsai to introduce the hospitalist program in National Taiwan University Hospital at International Hospital Medicine Forum of Hospital Medicine 2014.
prevencion de la IRA y proteccion de la Funcion renal en la UciResidentes1hun
This expert panel review provides recommendations for preventing acute kidney injury (AKI) in intensive care unit patients. The panel performed a systematic literature search to evaluate potential preventative measures including volume expansion, diuretics, vasopressors, vasodilators, hormones, nutrition, and renal replacement therapy. Based on the available evidence, the panel recommends prompt resuscitation with adequate hydration while avoiding hydroxyethyl starch, maintaining adequate blood pressure with vasopressors in vasodilatory shock, and using vasodilators and sodium bicarbonate under strict hemodynamic control. However, none of the recommendations received the highest evidence grade.
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
AIOM 2008
1. session P Annals of Oncology
P26 SECOND-LINE TREATMENT FOR NON-SMALL-CELL LUNG P28 IMPROVING EFFICIENCY OF A MEDICAL ONCOLOGY IN-
CANCER: ARE THE COSTS AFFORDABLE? PATIENT UNIT
Bearz A, Vaccher E, Spina M, Lleshi A, Schioppa O, Giacalone A, Tirelli U Ucci G, Anghilieri M, Villa S, Plebani D, Ferraioli L, Colli A
CRO-IRCCS, Aviano UO Oncologia Medica, Dipartimento di Area Medica e Dipartimento Oncologico,
Azienda Ospedaliera di Lecco. Lecco – Italy
Introduction: Advanced non-small-cell lung cancer (NSCLC) is a major health
problem in Western countries. Overall about 20% of all patients affected by NSCLC Background: Most italian hospitals are organized to fullfill routine diagnostic and
receive second-line chemotherapy. Single agent Docetaxel and Pemetrexed, and the clinical requirements only during week days. This limitation is not usually taken into
tyrosine kinase inhibitor Erlotinib are approved as second-line treatment options by account for admission of elective cases and often patients stay in hospital on the week-
Regulatory Agency in Italy. Moreover, expensive new compounds will be upcoming end waiting for completion of diagnostic/therapeutic procedures. This report
available, in first or further-line setting. summarizes the experience of the medical oncology (MO) of the Lecco Hospital with
We analyzed the costs related to second-line chemotherapy in NSCLC patients treated a flexible organization of admission and discharge of elective cases.
in the context of the Italian health system. Methods: From January to December 2007, in-patient elective and emergent cases were
Patients and Methods: We evaluated the costs as if sustained in Aviano, North-Eastern allowed to reach a total occupancy of 16 beds from Monday to Friday, while only 12
Italy, for a patient with NSCLC in second-line treatment for the three available drugs patients were allowed on the week-end. Oncologic emergencies on the week-end were
respectively. Considering a patient with an average body-surface area of 1.8 m2, we admitted either by MO unit or, temporarily, by the Internal Medicine unit. Patients
compared the costs among the three treatments; Pemetrexed and Docetaxel are usually needs were discussed before admission and diagnostic and therapeutic procedures were
administered in the outpatient setting. strictly programmed; special emphasis was given to agree appropriate protocols for
Results: The table shows the costs in Euro (C) per month of treatment for the three
= patients discharge with house doctors and home care services in order to reassure
available drugs in second-line treatment for NSCLC. patients and their families and ensure continuation of treatment or follow-up within or
outside the hospital. The experimental period was compared to the same period of
2006, when no action was taken in order to allow for the reduced hospital activity on
Docetaxel Pemetrexed Erlotinib the week-end and 16 in-patients were eventually allowed for the whole week.
Drug cost (1 month) 945 2250 1730 (865) Results: Results are summarized in the table below:
Antiemetics 2.50 2.50 À
Chemotherapy daycare Mean pts Total nr. Total Mean duration Mean Total
Nursing 10.7 0.70 À allowed/ of pts days of of admission DRG turnover
Physician 9 9 9 day managed in-patients (days) weight (Eurox1000)
Complication costs
Hospitalization 448 156 À 2006 15,2 781 5468 7,85 1,214 2.463
G-CSF 26 4.20 À 2007 14,8 839 5059 7,01 1,216 2.529
Total 1440.70 2422.40 1730 (865) % À3 +7,4 À7,5 À11 +0,2 +2,6
*In Italy there is an agreement between the pharmaceutical company (Roche), and the
Government for the reimbursement of half the costs of Erlotinib for the first two In addition, a total of 40 nursing hours per week were saved for other offices.
months of treatment only (shown in brackets). Conclusions: Flexible admission and discharge of elective cases to the inpatient ward of
Conclusion: It is difficult to believe that a public health system may afford such a MO unit may improve efficiency and save costs. A motivated staff and compliant
expensive treatments. The costs related to second-line treatment for NSCLC may not territorial services are important.
be affordable, due to the high incidence of NSCLC and the palliative role of those
treatments. In a population of cancer patients with poor prognosis, cost-utility
analyses, or the inclusion of quality indicators in the calculation of costs, would be P29 AN AUDIT OF NON-URGENT ATTENDANCES OF CANCER
important to a better understanding of costs and benefits. PATIENTS (PTS) TO THE EMERGENCY DEPARTMENT (ED) OF A
DISTRICT GENERAL HOSPITAL IN NORTH-EASTERN ITALY
P27 HAEMATOLOGIC HOME CARE IN MODENA: AN OPERATING
MODEL INVOLVING HOSPITAL, COMMUNITY HEALTH SERVICES Follador A1, Fanzutti M2, Adami G2, Merlo V1, Rijavec E1, Belvedere O3,
AND FUNDRAISING ORGANISATION Rizzato S1, Pertoldi F4, Piga A1
1
Dipartimento di Oncologia Azienda Ospedaliero - Universitaria di Udine, Italy;
2
Alfieri Pierluigi, Favale Enzo Day Hospital Oncologico - Dipartimento di Medicina, Ospedale San Daniele del
Servizio di assistenza domiciliare ematologica AIL Modena ONLUS - Divisione di Friuli (Ud), Italy; 3Leeds Institute of Molecular Medicine, St. James’s University
Ematologia - Policlinico di Modena Hospital Leeds, UK; 4Dipartimento di Emergenza Ospedale San Daniele del Friuli
(Ud), Italy
Home care has achieved a relevant role in the global management of cancer patients
improving quality of life and reducing health care costs. In the last decade many efforts Background: Many pts with cancer present to ED at some point during their disease.
have also been made in order to assist patients with blood malignancies who are fragile, Management of non-urgent problems at ED may not be optimal for these pts with
such as elderly and not-self sufficient people, irrespective of disease phase (terminal, estabilished diagnosis of cancer. We report an audit of non-urgent attendances of
chronic, advanced). cancer pts to the ED of San Daniele del Friuli District Hospital in North-Eastern Italy
Here we describe our experience in Modena, where a haematologic home care service is that serves a population of around 50,000 and has a 5-day oncology day unit but not an
active on the basis of a protocol agreed in 1998 by university hospital division inpatient facility.
(Policlinico), community health system (ASL) and the fundraising organisation A.I.L. Methods: To identify non-urgent attendances of cancer pts between January 2004 and
(Italian Association against Leukaemia-Lymphoma-Myeloma). December 2006, we retrospectively searched the ED electronic medical record database
Eligibility criteria are: diagnosis of blood malignancy, age > 18, poor performance using the precoded search strings: ‘‘white code’’ (defined by the Italian 4-level triage
status, distance from university hospital < 15 km, availability of a care-giver, scale as ‘‘non-urgent cases’’), ‘‘common medical problems’’ and ‘‘cancer related
appropriate home logistics. According to the Emilia-Romagna model for integrated problems’’.
domiciliary assistance (ADI) home care team is composed by general practitioner Results: Overall, 315 attendances were identified, accounting for 0.4% of all ED
(therapeutic responsible), community nurses, consultant haematologist and, when attendances. Pts characteristics: M/F 51/49%, median age 71 yrs (range 31-98). Most
needed, by other specialists, psychologist and social assistant. frequent malignancies included gastrointestinal (17%), lung (15%), genitourinary
In the period July 1999 – March 2008 344 patients (median age=75) have been referred (13%), breast (11%) and hepatobiliary/pancreatic (10%) cancers. In all, 74% of pts
to this service (non-Hodgkin’s lymphoma=89, multiple myeloma=65, acute myeloid were judged by ED physicians as having advanced disease. Most frequent symptoms/
leukaemia=56, myelodisplastic syndrome and other anaemias=45, chronic signs included pain (31%); cachexia (31%); gastrointestinal symptoms (20%);
myeloproliferative disorders including chronic myeloid leukaemia=41, chronic respiratory problems (15%); neurological problems (15%); fever (11%); edema/ascites
lymphocytic leukaemia=25, acute lymphocytic leukaemia=11, Hodgkin’s (11%); asthenia (11%); anemia (5%). Most attendances were between 8 am and 8 pm
lymphoma=8, autoimmune thrombocytopenia=4). (78%). While 30% were referred by their general practitioner, 70% of pts self-
Main activity indicators are here reported: median duration of assistance = 190 days; presented. Management/investigation during ED attendance included blood tests
median frequency of haematologist’s visits = 1 every 8 days; total number of blood and (41%); ECG (38%); radiology (30%); 45% received drug therapy and 19% were
platelet transfusions = 2030; median number of hospital admissions = 0.95 per patient; referred for a specialist opinion. Most pts were admitted to hospital, either in the
percentage of patients died at home = 38%. Medical (62%) or Surgical Departments (4%). A further 7% of pts were kept under
This valid integration between hospital and community services is possible thanks to an observation in the ED observation area, 25% were discharged.
efficient operating model, an effective clinical approach and a convenient use of means Conclusion: This audit shows that attendance of cancer pts with non-urgent
and resources. The role of no-profit organisations like A.I.L. is essential to sustain these complaints is not a significant burden on ED. Future prospective studies might help to
programs until a full recognition comes from public health services. identify reasons for the use of ED and to improve medical care sources.
ix124 | session P: organization and pharmacoeconomic aspects, patient care and elderly Volume 19 | Supplement 9 | October 2008