Mccainfranklin8142

The results indicate that HT seems to be a more patient-centred alternative to inpatient treatment and might close a gap in the psychiatric care of patients who preferred not to use inpatient services but needed higher treatment intensity than outpatient treatment.

The results indicate that HT seems to be a more patient-centred alternative to inpatient treatment and might close a gap in the psychiatric care of patients who preferred not to use inpatient services but needed higher treatment intensity than outpatient treatment.

To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care.

Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3.

Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital.

GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer.

Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of

(csPC) (Gleason Score ≥7) and

(cnsPC) (Gleason Score 6), in needle biopsies. Monomethyl auristatin E Estimation of direct healthcare costs.

Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Riduction in number of men referred for urological prostate cancer work-up -an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% -an estimated reduction in direct health care costs between 23 and 28%.The objective of this study was to compare implementation of a psychotropic medication reduction project across two types of residential long-term care settings nursing homes (NH) and assisted living (AL) facilities. Fifteen NHs and 14 AL facilities from within a single corporate chain participated in the psychotropic medication reduction project. Using a comparative case study approach, we conducted in-person and telephone interviews with 62 staff members from participating NH and AL facilities to investigate the experience of project implementation. Project implementation within the more institutional NH model produced dramatic changes in residents' lives and medication use. Conversely, changes made in the AL environment appeared to have less impact on resident medication use and resident-centric narratives, and AL staff identified numerous barriers to implementation. Identifying methods to monitor processes and outcomes of care without increasing the regulatory burden of AL facilities may increase transferability of quality improvement efforts across settings.

Only a few studies have described the impacts, strengths and needs for further development of national licensing exams (NLE). To gain such insights regarding the Swiss NLE, which includes a multiple-choice and a standardised clinical skills exam, we explored the perceptions of involved experts and stakeholders.

We explored participants' perceptions in four focus group discussions. The interviews were recorded, transcribed verbatim and qualitatively analysed using a thematic analysis approach.

The analysis resulted in five perceived impacts, two strengths and two needs for further developments of the NLE. Perceived impacts were (1) steering students' learning behaviour, (2) supporting teachers and assessors to align teaching to competencies, (3) elevating the importance of the Swiss Catalogue of Learning Objectives, (4) setting incentives for the further development of curricula, and (5) fostering the collaboration between the faculties of medicine. Perceived strengths were the blend of assessment formats, including their competency-based orientation, and the collaborative development approach. Perceived needs lay in the NLE's further development to sustain its fit for purpose and in incentives for people involved.

According to our study, this NLE had, and has, notable impacts on medical education in Switzerland. Our insights can be useful for others planning a similar undertaking.

According to our study, this NLE had, and has, notable impacts on medical education in Switzerland. Our insights can be useful for others planning a similar undertaking.

Oesophageal perforations and post-oesophagectomy anastomotic leaks are associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a novel treatment strategy with the potential to promote healing and ameliorate sepsis. Only two cases of its use have been reported in the UK in the management of oesophageal wall defects, representing a limited aetiological and demographic spectrum.

From May to December 2019, 7 patients aged 27-85 years underwent EVT for disparate oesophageal wall defects. Data regarding technical success and feasibility were analysed.

Complete defect resolution was achieved in six cases (86%), requiring median of 13 days of treatment (range 6-23), and necessitating three replacement procedures (range 1-4). Significant improvement in C-reactive protein was achieved in all patients undergoing treatment (

 = .015). No severe complications occurred that resulted directly from sponge placement, however two individuals (33%) developed oesophageal stricture necessitating endoscopic balloon dilatation, and one died whilst undergoing treatment.

In selected patients EVT is a safe, valuable tool for the management of a spectrum of oesophageal wall defects, with the potential to reduce associated morbidity and mortality. While this work significantly expands upon the UK reported experience of EVT, we outline the requirement for a national, prospective registry of EVT use in oesophageal leaks and perforations.

AL anastomotic leak; CRP C-reactive protein; CT computed tomography; EVT endoscopic vacuum therapy; HES hospital episode statistics; OGD oesophago-gastro-duodenoscopy; SEMS oesophageal stenting with self-expanding stents; UK United Kingdom.

AL anastomotic leak; CRP C-reactive protein; CT computed tomography; EVT endoscopic vacuum therapy; HES hospital episode statistics; OGD oesophago-gastro-duodenoscopy; SEMS oesophageal stenting with self-expanding stents; UK United Kingdom.