Emergence of oscillatory coexistence with exponentially decayed waiting times in a coupled cyclic competition system

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

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Cotton farmers' adaptation to arid climates: Waiting times to adopt water-saving technology

Agricultural Water Management ◽

10.1016/j.agwat.2020.106596 ◽

2021 ◽

Vol 244 ◽

pp. 106596

Author(s):

Qiao Mi ◽

Xiandong Li ◽

Xianmei Li ◽

Guoxin Yu ◽

Jianzhong Gao

Keyword(s):

Waiting Times ◽

Water Saving ◽

Cotton Farmers

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Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia

Saudi Journal of Health Systems Research ◽

10.1159/000517487 ◽

2021 ◽

pp. 1-6

Author(s):

Khalid Alabbasi ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Health Care ◽

Primary Health Care ◽

Public Hospital ◽

Waiting Times ◽

Care Centre ◽

Health Care Centre ◽

Transfer Policy ◽

Primary Health ◽

Before And After ◽

Ed Visits

Purpose: Excessive delays and emergency department (ED) overcrowding have become an increasingly major problem for public health worldwide. This study was to assess the key strategies adopted by an ED, at a public hospital in Jeddah, to reduce delays and streamline patient flow. Materials and Methods: This study was a service evaluation for a Saudi patient population of all age-groups who attended the ED of a public hospital for the period between June 2016 and July 2019. The Saudi initiative to reduce the ED visits at the King Abdullah Medical Complex hospital has started on August 7, 2018. The initiative was to apply an urgency transfer policy which outlines the procedures to follow when patients arrive to the ED where they are reviewed based on the Canadian Triage and Acuity Scale (CTAS). Patients with less-urgent conditions (category 4 and 5) are referred to a primary health-care practice (where a family medicine consultant is available). Patients with urgent conditions (category 1–3) are referred to a specialized health-care centre if the service is not currently provided. To test the effectiveness of ED initiative on reducing the overcrowd, data were categorized into before and after the initiative. The bivariate analysis χ2 tests and 2 sample t-tests were run to explore the relationship of gender and age with dependent variable emergency. Results: A total of 233,998 patients were included in this study, 61.8% of them were males and the average age of ED patients were 35.5 ± 18.6 years. The majority of cases were those classified as “less urgent” (CTAS 4), which accounted for 65.4%. Number of ED visits before and after the initiative was 67 and 33%, respectively. ED waiting times after the initiative have statistically significantly decreased across all acuity levels compared to ED waiting times before the initiative. Conclusion and Implication: The findings suggest that the majority of patients arrive to the ED with less-urgent conditions and arrived by walking-in. The number of cases attending the ED significantly decreased following the introduction of the urgency transfer policy. Referral for less-urgent patients to primary health-care centre may be an important front-end operational strategy to relieve congestion.

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Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience

Global Spine Journal ◽

10.1177/2192568220988272 ◽

2021 ◽

pp. 219256822098827

Author(s):

Giorgio Lofrese ◽

Alba Scerrati ◽

Massimo Balsano ◽

Roberto Bassani ◽

Michele Cappuccio ◽

...

Keyword(s):

Cervical Spine ◽

Clinical Outcome ◽

Waiting Times ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Surgical Techniques ◽

Rare Condition ◽

Surgical Strategies ◽

Bone Removal ◽

Mild Dysphagia

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( P = 0.12) to the burr ( P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( P = 0.15). Use of curved chisel reduced the surgical times ( P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( P = 0.04) and shorter waiting times for surgery ( P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

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