Objective: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI). Methods: A 3‐month retrospective chart review was performed in an urban teaching hospital ED (>70,000 visits/year). Women aged 12–45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included. Patient complaints, physical findings, and laboratory results were reviewed. Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas. Results: Of the 94 women who met study criteria, 53% had proven STDs (19% N. gonorrhoeae 22% C. trachornaris 33% Trichomonas). There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05). Conclusions: Women undergoing pelvic examinations who are subsequently released, from this urban ED with the diagnosis of UTI have a high (>50%) prevalence of occult STDs. No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD. Consideration should be given to empirical antibiotic therapy in similar urban populations.
In 1996, the St. John's region had a population of 8,435 > or = 75 years, with 996 nursing home (NH) beds and 550 supervised care (SC) beds. A single entry system to these institutions was implemented in 1995. To determine the impact of the single entry system, the demographic and clinical characteristics of NH residents were assessed in 1997 (N = 1,044) and in 2003 (N = 963). To determine the efficiency of placement and the need for long-term care beds, two incident cohorts requesting placement were studied in 1995/96 (N = 467) and in 1999/2000 (N = 464). Degree of disability was determined using the Residents Utilization Groups III classification (RUG-III) and the Alberta Resident Classification Score (ARCS), and time to placement and to death was measured. In prevalent NH residents, the percentage without RUGS-III disability decreased from 18.5% in 1997 and to 9.9% in 2003. The proportion recommended for NH was 75% in 1995/96 and 72% in 1999/2000, despite the fact that the proportion with RUGS-III disability was 64% in both periods. Using a decision tree, optimal placement for the 1999/2000 cohort was 36% to SC, 20% to SC for the cognitively impaired, and 44% to NH. Predicted need for long-term care beds in 2004 matched poorly with current provision of NH and SC beds, and the mismatch will be worse in 2014. It was concluded that the single entry system was associated with improved appropriateness of NH bed utilization. However, there was a mismatch in need for and provision of institutional long-term care. Investment in the reconfiguration of long-term care beds by case mix and by geography is necessary.
Restructuring of institutional long-term care was undertaken using predictions of future bed need with assumptions made on incidence rates of clients defined by type of disability, survival, and demographic changes. Recent substantial increase in the population rate of clients seeking placement across all degrees of disability, coincident with new facilities for those with modest disability, occurred. Consequently, more appropriate housing and supervised care beds, and more limited downsizing of nursing homes will be required.
The demand for long-term care (LTC) services in Canada is increasing because the population is aging. In Newfoundland and Labrador (NL) nursing homes (NHs) and supervised care (SC) facilities provide long-term care. There may be a mismatch between the provision of LTC beds and the needs of clients. To compare the type and annual rate of clients seeking placement to LTC, incident annual cohorts (N=l496) in five provincial health regions within Newfoundland and Labrador were compared using objective measures of disability, the Alberta Resident Classification Scores (ARCS) and the Resource Utilization Groups (RUGs lll). Client's need was assessed using a decision tree and optimal distribution of LTC beds determined. Regional incidence rates by disability of clients were compared, and whether these differences were associated with differences in the rate of supervised care (SC) or nursing home (NH) beds provided.. Within the four regions of Newfoundland little difference was observed in degree of disability, but Labrador clients differed from the island regions in age, degree and type of disability. Annual rate of presentation for LTC differed by region, with the highest incidence rate of LTC clients in regions with highest rates of supervised care (SC) beds and lowest rates of nursing home (NH) beds.Thirty four% of applicants for LTC were referred for supervised care placement and sixty six %for nursing home. However, seven % had no functional disability being independent for activities of daily living, were continent and without cognitive impairment (CI). Fifteen % of clients recommended for nursing home had no indicators for nursing home. A decision tree suggested that optimal placement was seven % to 11 supportive hou ing, thirty four% to supervi ed care, 17% to upervi ed care for cognitive impairment, and 42% to nursing home.In NL, a large component of institutional LTC is nursing home , whereas the major need is for appropriate supervised care for those with mode t di ability, with or without cognitive impairment. Different approaches to restructuring of long term care in each region are necessary because of differences in rates of presentation for LTC and availability of nursing home and appropriate supervised care beds.111
No abstract
En 1996 la région de St. John's comptait une population de 8 435 personnes âgées de plus de 75 ans, 996 lits dans des foyers de soins infirmiers (FSI) et 550 lits de soins sous surveillance (SSS). Un système d'admission à point unique à ces établissements a été mis en œuvre en 1995. Afin de déterminer l'incidence du système d'admission à point unique, les caractéristiques démographiques et cliniques des résidents de FSI ont été évaluées en 1997 (N = 1 044) et en 2003 (N = 963). Afin de déterminer l'efficacité du placement et le besoin de lits de soins de longue durée, deux cohortes d'incidents nécessitant un placement ont été étudiées en 1995–1996 (N = 467) et en 1999–2000 (N = 464). Le niveau de déficience a été déterminé à l'aide de la classification des Resource Utilization Groups III (RUG-III) et l'Alberta Resident Classification Score (ARCS), puis le temps écoulé entre le placement et le décès a été mesuré. Chez les résidents courants des FSI le pourcentage de clients ne souffrant d'aucune déficience aux termes de la classification RUGS-III a diminué de 18,5 % en 1997 et de 9,9 % en 2003. La proportion recommandée de ces clients dans les FSI était de 75 % en 1995–1996 et de 72 % en 1999–2000, malgré le fait que la proportion de résidents atteints d'une déficience aux termes de la classification RUGS-III était de 64 % au cours des deux périodes. À l'aide d'un arbre de décision, un placement optimal pour la cohorte de 1999–2000 a été établi à 36 % dans les établissements de SSS, à 20 % pour les résidents de SSS souffrant de facultés cognitives altérées et à 44 % dans les FSI. Le besoin prévu de lits de soins de longue durée en 2004 ne correspondait que faiblement à l'inventaire actuel de lits de FSI et de SSS et ce manque à gagner sera bien pire en 2014. Nous avons conclu que le système d'admission à point unique était associé à une utilisation améliorée des lits en FSI de façon appropriée. Cependant, il y avait un manque à combler dans le besoin de lits de soins de longue durée en établissement et l'inventaire de ces lits. Un investissement dans la reconfiguration des lits de soins de longue durée par composition de la clientèle et par géographie est nécessaire.
La population canadienne est vieillissante. À Terre-Neuve-et-Labrador, les maisons de soins infirmiers et les centres de santé supervisés offrent des soins de longue durée (SLD). Il peut y avoir une disparité entre l'offre de lits pour soins de longue durée et les besoins des clients. Afin de comparer le genre et le taux annuel de clients à la recherche d'un placement en SLD, les cohortes annuelles (N = 1 496) de cinq régions des services de santé provinciaux de Terre-Neuve-et-Labrador ont été comparées en utilisant des mesures objectives d'invalidité. Les besoins des clients ont été évalués à l'aide d'un arbre de décision et la répartition optimale des lits de SLD a été déterminée. Dans les quatre régions, une petite différence a été observée en ce qui concerne le niveau d'invalidité. Toutefois, les clients du Labrador différaient de ceux des régions insulaires en âge, en intensité et en genre d'invalidité. Un arbre de décision a suggéré que le placement optimal était de 7% pour l'hébergement, de 34% pour les soins supervisés, de 17% pour les soins supervisés pour les déficiences cognitives et de 42% pour les soins infirmiers à domicile. À Terre-Neuve-et-Labrador, les SLD en centre hospitalier reposent sur les maisons de soins infirmiers, alors que le principal besoin se situe sur le plan des soins supervisés destinés aux personnes souffrant d'une légère invalidité, avec ou sans déficience cognitive. Afin de restructurer les soins de longue durée, diverses approches sont nécessaires en raison de l'incidence de SLD et des disparités en ce qui a trait à la disponibilité des maisons de soins infirmiers et de lits de soins supervisés appropriés.
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