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
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