Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations

Stroke patients with spasticity usually require long-lasting care and interventions but frequently report that outpatient and community treatment is limited, reflecting a significant unmet need in health and social care provision. Rehabilitation and spasticity management services are essential for patient recovery, with improvements in both activity and participation reducing the burden on patients, family and society. Current clinical guidance provides scope for improvements in both post-stroke management and spasticity prevention. However, access to specialist services can be limited and the patient journey does not always match national recommendations. Identification of spasticity and its predictors and lack of subsequent referral to rehabilitation or specialist spasticity services are key issues in the management of post-stroke spasticity. Implementation of a traffic light classification system prioritises patients at an increased risk of spasticity and promotes early and consistent management across the spectrum of primary and secondary care. The proposed system is based on clinical evidence, expert consensus and recent clinical guidelines. It provides simple and straightforward criteria for management, multidisciplinary consultation and referral to specialist spasticity services, with patients allocated by monitoring requirements and a low (green/periodic monitoring), medium (amber/routine referral) or high risk (red/urgent referral) of spasticity.

Vertigo and Balance Disorders – The Role of Osteopathic Manipulative Treatment: A Systematic Review

<b><i>Background:</i></b> Balance disorders are among the most frequent reasons for consultation and referral to specialist care. Osteopathic Manipulative Treatment (OMT) can influence the proprioceptive system by inducing alterations in the proprioceptive stimuli, hence affecting postural control. <b><i>Objective:</i></b> The present systematic review aimed to explore the effects of OMT in managing patients with vertigo and balance disorders. <b><i>Methods:</i></b> MEDLINE (PubMed), ScienceDirect, and Google Scholar were searched. Clinical trials and prospective observational studies were considered. Only studies that considered OMT as the main intervention, provided alone or combined with other interventions, were included. The methodological quality of the evidence was assessed with a modified version of the Newcastle-Ottawa Scale. <b><i>Results:</i></b> Five studies that enrolled a total of 114 subjects met our inclusion criteria. Overall, it has been observed that there is a positive effect on balance disorders through different outcomes in all of the included studies. Only two studies (9 subjects) mentioned low to moderate adverse events after OMT. <b><i>Conclusions:</i></b> OMT showed weak positive effects on balance function, encouraging the connection of conventional medicine and evidence-based complementary medicine for integrative clinical practice and interprofessional work. However, full-sized adequately powered randomized trials are required to determine the effectiveness of OMT for vertigo and balance disorders.

Cancer care through the fire and flames: Three-year experience in utilizing of oncologic electronic consultation and referral system in the red zone of Thailand.

14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southernmost districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. The chronic terrorism had major affected on cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, financial constraints due to longstanding economic downturn and security concerns during travelling led to high loss to follow-up rate and treatment delay. We, an oncology service team working at Songklanagarind hospital, the only one cancer center served this area together with primary doctors and nurses in the Red Zone created a network and utilized an oncology-specific electronic consultation and referral system to make more efficient care. We reported its performance in 3 years period. Methods: Electronic consultation system (E-consult) was a web-based program developed to provide advice and facilitate the referral process in cancer care. Since October 2015, we prospectively surveyed the impact of this pilot project on the quality of service by counting waiting time, number of center visit until treatment, unnecessary referral avoidance, patient and potential cost saving compared to normal referral system. Results: E-consult reached out to 7 hospitals and 589 cancer patients successfully referred through E-consult. Among patients from the Red Zone, without E-consult, their average waiting time was 56.4 days, number of visit was 6.5 visits. The estimated financial burden was $758.8 per patient. After implementation of E-consult in 259 patients, average time to treatment was 41.5 days (p = 0.006) and a number of the counter visit was 2.3 visits (p < 0.001). Estimated financial burden could be reduced to $358.7(p < 0.001). Ultimately, we prevented 28 patients from unnecessary referral. Conclusions: In this special context the electronic referral system was helpful to improve medical access, timeliness to specialist care, saving the patients’ family time and resources. This model is widely applicable to oncology referral chain.

Encaminhamentos aos cuidados paliativos para pacientes com câncer: revisão integrativa

No cenário oncológico atual temos o surgimento de novas drogas e tecnologias para prolongamento de vida.Com isso tivemos a promessa de aumento de sobrevida aliada a dilemas éticos como qual o momento ideal paraencaminhamento aos cuidados paliativos. Objetivo: Analisar as evidências disponíveis na literatura acerca deconsultas e encaminhamentos aos Cuidados Paliativos para pacientes com câncer. Método: Revisão integrativa nasbases de dados LILACS e Medline. Utilizados os descritores e palavras-chave: “consultation and referral”, “palliativecare”, “cancer”, “encaminhamento e consulta” e “câncer” acompanhados do conector “and”. Resultados: Artigosalocados em duas categorias: 1. Artigos sobre Momento dos Encaminhamentos aos Cuidados Paliativos e 2. Artigossobre Características dos encaminhados aos Cuidados Paliativos. Artigos sobre momento do encaminhamentoabordaram encaminhamentos precoce, tardios e encaminhamentos ao hospice. Artigos sobre características dosencaminhamentos abordaram aspectos facilitadores e barreiras aos encaminhamentos. Conclusões: Apesar dosbenefícios apontados pelos encaminhamentos precoces ainda vemos na prática o encaminhamento tardio aoscuidados paliativos. Esforços para conscientização da equipe de saúde e aumento da oferta de serviços de cuidadospaliativos parecem boas estratégias para reverter esta realidade.Palavras-chave: Referência e consulta; Cuidados paliativos; Neoplasias. ABSTRACTIn the current oncology scenario we face the dicovery of new drugs and technologies for prolonging life. Thus wehave the promise of increased survival, ethical dilemmas such as the ideal time for referral to palliative care haveemerged. Aim: To review the evidence available in literature about consultations and referrals to palliative carefor cancer patients. Method: Integrative review in LILACS and Medline databases. The search strategie includedthe use of the terms: “consultation and referral,” “palliative care,” “cancer,” “referral and consultation” and “cancer”accompanied by “and”. Results: Articles were allocated into two categories: 1. Articles about moment of referralsto Palliative care and 2. Articles about Characteristics of referral to palliative care. Articles on the moment ofreferrals addressed early, late and hospice referrals. Articles on characteristics of referrals addressed facilitatingfactors and barriers to referrals. Conclusions: Despite the benefi ts mentioned we still see in practice late referralsto palliative care. Efforts to raise awareness of the health team and increasing the supply of palliative careservices seems as good strategies to reverse this reality.Keywords: Referral and consultation; Palliative care; Neoplasms.

Revista Nº 77 - Abril / Maio / Junho - 2016

O 1º artigo: Inovações tecnológicas em unidade de terapia intensiva: implicações para a saúde do trabalhador de enfermagem é um estudo qualitativo descritivo, realizado em uma unidade de tratamento intensivo de um hospital universitário, cujos objetivos principais foram: analisar a percepção dos trabalhadores de enfermagem sobre a incorporação das tecnologias duras ao trabalho em terapia intensiva e as implicações para a saúde do grupo. O 2º artigo: Dificuldades enfrentadas pelo paciente renal para a realização do tratamento é um estudo de caráter qualitativo, do tipo descritivo exploratório, em que o objetivo principal foi identificar dificuldades enfrentadas pelo paciente renal para a realização do tratamento. O 3º artigo: Detecção precoce do câncer de mama: o direito da mulher à mamografia é um estudo quantitativo, documental, exploratório e retrospectivo, com os objetivos de: apontar o número de mamografias com BI-RADS sugestivos de câncer de mama em mulheres valencianas que estão fora da faixa etária preconizada pelo Ministério da Saúde e suscitar a discussão na atenção básica.O 4º artigo: Conhecimentos, atitudes e práticas dos enfermeiros na central de quimioterapia frente ao risco químico é um estudo descritivo com abordagem quantitativa, do tipo inquérito CAP. Seu principal objetivo foi: apontar Conhecimentos, Atitudes e Práticas (CAP) dos enfermeiros de duas Centrais de Quimioterapia (CQT) a respeito da exposição ao risco químico.O 5º artigo: Riscos para o desenvolvimento de úlceras por pressão em idosos utilizando as subescalas de Braden é um estudo descritivo, com abordagem quantitativa, sendo que objetivo principal foi de analisar os riscos no desenvolvimento de UP em pacientes idosos admitidos em uma Unidade de Terapia Intensiva (UTI), utilizando as subescalas de Braden.O 6º artigo: Eletroterapia em úlceras venosas: uma revisão integrativa é uma revisão integrativa da literatura realizada nas bases de dados Lilacs e Medline, via Pubmed, utilizando os descritores: “terapia por estimulação elétrica”, “úlceras venosas” e “cicatrização”. Os objetivos do estudo foram descrever e analisar as evidências científicas encontradas na literatura sobre o uso da eletroterapia no reparo tecidual de úlceras venosas.O 7º artigo: Encaminhamentos aos cuidados paliativos para pacientes com câncer: revisão integrativa é uma revisão integrativa da literatura realizada nas bases de dados Lilacs e Medline. Foram utilizados os descritores e as palavras-chave: “consultation and referral”, “palliative care”, “cancer”, “encaminhamento e consulta” e “câncer”, acompanhados do conector “and”. O objetivo principal do estudo foi analisar as evidências disponíveis na literatura acerca de consultas e encaminhamentos aos Cuidados Paliativos para pacientes com câncer.O 8º artigo: Os fatores de risco da infecção do trato urinário na gravidez: revisão Integrativa é uma revisão integrativa da literatura realizada nas bases Lilacs, PAHO, Wholys, Biblioteca Cochrane, Medline e CINAHL, no período de 1º de abril a 1º de maio de 2015, baseada na seguinte questão de pesquisa: no que se refere à prevenção deagravos, quais são os fatores de risco relacionados com a infecção urinária na gravidez? O objetivo principal foi analisar os fatores de risco referentes à ocorrência da infecção urinária na gravidez.O 9º artigo: Precarização do trabalho de enfermagem e repercussões na saúde dos trabalhadores brasileiros: revisão integrativa é uma revisão integrativa realizada entre os meses de dezembro de 2012 e janeiro de 2013 na Biblioteca Virtual em Saúde, a qual inclui, entre outras, as bases de dados Lilacs, BDENF e Scielo. Os objetivos foram identificar e caracterizar a produção científica relacionada à precarização do trabalho de enfermagem no Brasil, e avaliar as repercussões da precarização do trabalho na saúde dos trabalhadores de enfermagem.O 10º artigo: Sistematizando o conhecimento acerca da prevenção das lesões do tipo skin tears na pele senil é uma revisão integrativa realizada nas bases de dados da Pubmed (Public Medline - Literatura Internacional em Ciências da Saúde) e na Biblioteca Virtual em Saúde (BVS), com o principal objetivo de identificar as melhores intervenções para prevenção do surgimento das lesões por fricção do tipo skin tears no idoso.

Virtual Reality for Teaching ESP Vocabulary: A Myth or A Possibility

Studies on the effects of various strategies to improve vocabulary have documented the important role of input and output in terms of long-term retention of lexical items. Nowadays, the world is witnessing a growing interest in wearable devices. Considerable attention has been paid specifically to virtual reality (VR) headsets or smart Goggles and their abilities to engage their users. This paper examined whether virtual reality headsets help (N=20) Saudi female ESP postgraduates enrolled in the Didactic Terminologies in English Course to retain vocabulary related to their field. For six weeks, the students interacted with virtual objects through watching 360 degrees videos related to basic skills in counseling and some cases that require consultation and referral. For example, depression, addiction, suicide, autism, violence, domestic violence, bullying, and impulsive behavior. A pre and a post tests scores were compared by a paired sample t-test to examine the effect of the virtual reality videos on their vocabulary retention. The results showed a highly significant difference between the two tests with a (P< 0.001), and the mean scores between a pre and a post-tests pointed out that an alteration in favor to the post-test where students indicated the most improvement. The results demonstrated that virtual reality videos actually helped the postgraduate students to retain ESP vocabulary and therefore develop their competence level. Future work could investigate the perception of using virtual reality headsets to improve ESP vocabulary.