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Median Waiting Time (median + waiting_time)
Selected AbstractsDelivery of photocoagulation treatment for diabetic retinopathy at a large Australian ophthalmic hospital: comparisons with national clinical practice guidelinesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2002Parapun Bamroongsuk MD Abstract Objective: To determine if the delivery of photocoagulation for diabetic retinopathy at a large Australian ophthalmic hospital conforms with Australian National Health and Medical Research Council clinical practice guidelines. Methods: A retrospective medical record review was conducted of all patients who had initial laser treatment for diabetic retinopathy at the Royal Victorian Eye and Ear Hospital from January 1997 to December 1998. Results: The study included 322 eyes from 203 patients. The mean age was 65.8 years (range 18,89 years) and the mean duration of diabetes was 14.7 years (range 1,40 years). Panretinal photocoagulation (PRP) alone was performed in 37 eyes over a mean number of 2.6 sessions. The median waiting time for these procedures was 14 days (range 0,146 days) and the median follow-up time was 7.1 weeks (range 1,25 weeks). Focal treatment was performed (without PRP) in 238 eyes and 55.5% of these cases required repeat focal treatment for persistent clinically significant macular oedema. Median waiting time for focal treatment was 20 days (range 0,302 days) and the median follow-up time after treatment was 12.1 weeks (range 1.7,42.0 weeks). Focal and PRP treatment was used in 47 eyes that had maculopathy concurrently with proliferative retinopathy. Focal treatment was applied before (or at the same session as) the PRP wherever possible. Conclusions: The study indicates that the application of photocoagulation and follow up for diabetic retinopathy at this tertiary referral institution conforms closely with Australian clinical practice guidelines. [source] A bird can't fly on one wing: patient views on waiting for hip and knee replacement surgeryHEALTH EXPECTATIONS, Issue 2 2007Barbara L. Conner-Spady PhD Abstract Objectives, To obtain patients' perspectives on acceptable waiting times for hip or knee replacement surgery. Methods, A questionnaire with both open- and close-ended items was mailed to 432 consecutive patients who had hip or knee replacement surgery 3,12 months previously in Saskatchewan, Canada. A content analysis was used to analyse the text data from the open-ended questions. Results, The sample of 303 (response rate 70%) was 59% female with a mean age of 70 years (SD 11). The median waiting time from the decision date to surgery was 17 weeks. Individuals who rated their waiting time very acceptable (48%) had a median waiting time of 13 weeks compared with a median waiting time of 22 weeks for those who rated it unacceptable (23%). The two most common determinants of acceptability were patient expectations and pain and its impact on patient quality of life. The median maximum acceptable waiting time was 13 weeks and median ideal waiting time, 8.6 weeks. Seventy-nine per cent felt that those in greater need (higher severity) should go before them on the waiting list. Patient ratings of maximum acceptable waiting time were based on: pain and loss of mobility, time needed to prepare for surgery, and severity at the time of seeing the surgeon. In consideration of changing their surgeon to one with a shorter waiting list, 68% would not. Conclusions, Patient views on waiting times are not only related to quality of life issues, but also to prior expectations and notions of fairness and priority. Understanding patient views on waiting for surgery has implications for better management of waiting times and experiences for joint replacement. [source] The role and limitation of living donor liver transplantation for hepatocellular carcinomaLIVER TRANSPLANTATION, Issue 3 2004Chung-Mau Lo Liver transplantation for hepatocellular carcinoma (HCC) is restricted by the scarcity of cadaver grafts. Living donor liver transplantation (LDLT) may potentially increase the applicability but its role and limitation are not clear. We studied the outcome of a cohort of 51 patients with unresectable HCC who were accepted on list for both options of deceased donor liver transplantation (DDLT) and LDLT. Twenty-five of 51 (49%) patients had voluntary living donors (group 1) and 26 did not (group 2). Patients in group 1 were younger, and more often had a MELD score more than 20 or blood group other than O. Twenty-one patients of group 1 underwent LDLT after a median waiting time of 24 days (range, 2,126 days), but 4 did not because the donors were not suitable (HBsAg-positive, 2; ABO-incompatible, 1; liver dysfunction, 1). Of the 30 patients who remained on list, only 6 underwent DDLT after a median waiting time of 344 days (range, 22,1359 days, P < .005). Nineteen died before transplantation and 2 were alive but taken off the list because of disease progression (drop-out rate, 70%). One patient was alive on list and 2 had undergone transplantation outside Hong Kong. The 1-, 2-, 3-, and 4-year intention-to-treat survival rates were 88%, 76%, 66%, and 66%, respectively, for group 1 and 72%, 46%, 38%, and 31%, respectively, for group 2 (relative risk of death for group 1, 0.35; 95% CI, 0.14 to 0.90; P = .029). In conclusion, although complicated factors such as donor voluntarism and selection criteria limit the role of LDLT for HCC, LDLT allows more patients to undergo early transplantation and results in a better outcome. (Liver Transpl 2004;10:440,447.) [source] Lung Transplantation in the United States, 1998,2007AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009K. R. McCurry This article highlights trends and changes in lung and heart-lung transplantation in the United States from 1998 to 2007. The most significant change over the last decade was implementation of the Lung Allocation Score (LAS) allocation system in May 2005. Subsequently, the number of active wait-listed lung candidates declined 54% from pre-LAS (2004) levels to the end of 2007; there was also a reduction in median waiting time, from 792 days in 2004 to 141 days in 2007. The number of lung transplants performed yearly increased through the decade to a peak of 1 465 in 2007; the greatest single year increase occurred in 2005. Despite candidates with increasingly higher LAS scores being transplanted in the LAS era, recipient death rates have remained relatively stable since 2003 and better than in previous years. Idiopathic pulmonary fibrosis became the most common diagnosis group to receive a lung transplant in 2007 while emphysema was the most common diagnosis in previous years. The number of retransplants and transplants in those aged ,65 performed yearly have increased significantly since 1998, up 295% and 643%, respectively. A decreasing percentage of lung transplant recipients are children (3.5% in 2007, n = 51). With LAS refinement ongoing, monitoring of future impact is warranted. [source] Emergency nurse practitioner care and emergency department patient flow: Case,control studyEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2006Julie Considine Abstract Objective:, The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods:, A case,control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results:, There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion:, Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes. [source] Geographic Variation in Organ Availability Is Responsible for Disparities in Liver Transplantation between Hispanics and CaucasiansAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009M. L. Volk The aims of this study were to determine whether disparities in waiting list outcomes exist for Hispanics and African Americans during the post-MELD era, and to investigate interactions between disparities and geography. Scientific Registry of Transplant Recipients data were used to compare Hispanics and African Americans to Caucasians listed between 2003 and 2008. Endpoints included (i) receipt of a liver transplant and (ii) death or removal from the waiting list for being too sick or medically unsuitable. Adjustment for possible confounders was performed using multivariate Cox regression, with adjustment for geographic variation using a fixed-effects multilevel model. In multivariate analysis, African Americans have similar hazard of transplantation and death/removal as Caucasians during the post-MELD era. However, Hispanics are less likely to receive a transplant than Caucasians despite adjustment for potential confounders (HR 0.80, 95% CI 0.77,0.83), while having a similar hazard of death/removal. This effect disappeared after adjusting for unequal regional distribution of Hispanics, who represent 8% of patients in donation service areas (DSAs) having median waiting times of ,155 days versus 19% in DSAs with median waiting times of >155 days. In conclusion, disparities in liver transplantation exist for Hispanics during the post-MELD era, caused by geographic variation in organ availability. [source] | ||||||||||