No / Wound healing remains a largely overlooked area despite the perceived large numbers of people with wounds and the high costs of treatment. The lack of visibility for wounds and wound healing may in part stem from the fragmented nature of the available data on wound occurrence often limited to descriptions of specific wound types within single care settings. A survey was undertaken across all care providers serving the population of Bradford, UK to identify the number of people with wounds, the characteristics of their wounds and the allocated interventions used to prevent and heal wounds. In March 2007, 1735 completed questionnaires were returned each marking the most severe wound experienced by a patient. The overall prevalence of wounds was 3.55 people with wounds per 1000 population (prevalence 0.355% 95% CI 0.33–0.37%). Almost one third (n = 556) of the people with wounds were located in acute care settings with the remainder spread across several community locations including residential and nursing homes. The most prevalent forms of wound were acute wounds (n = 826) followed by leg ulcers (n = 482) and pressure ulcers (n = 363). A previous survey with broadly similar methodology had shown a lower prevalence of wounds (0.279% 95% CI 0.26–0.29%) with this difference perhaps explained by different data collection methodologies within the nursing home sector that resulted in a 100% return compared with 50% in the earlier survey.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Emergency Medicine Johannesburg, 2015 / Background: There has always been anecdotal reports that the ED is busier during the holidays and this increase in utilization is due to an increased incidence of trauma. Methods The retrospective data was collected from the Study Hospital’s Database and from the billing records of the doctor practice managing the ED. The data included all patients attending the Study Hospital ED during November 2011 (Non-holiday Period) and between the 10th December 2011 and 8th January 2012 (Holiday Period). Results: It was noted that the age, gender and racial profile of the patients attending the ED during the Holiday and Non-holiday Periods were similar. However there was a 39.9% increase in ED utilization during the Holiday Period. The Holiday Period was also associated with increased utilization by tourists (29.9% vs. 8.2%); with a slightly lower incidence of trauma (23.4% vs. 24.6%); with patients presenting with less urgent Triage Scores; fewer patients arriving at the ED via ambulance (3.2% vs. 7.2%) and a lower admission rate (10% vs. 17.5%). Conclusions: There was a significant increase in the utilization of the Study Hospital ED during the Holiday Period. This increased utilization was due to an increase in visitors to the Umhlanga area during the Holiday Period and was associated with an increased presentation to the ED of low acuity patients probably as a result of a lack of availability of their GP.

Base Teórica: Apesar dos avanços alcançados na última década por meio das ações de controle da tuberculose, esta endemia permanece um problema no Brasil. Atraso no diagnóstico e tratamento dos casos de tuberculose é o fator de maior impedimento no controle da tuberculose. Os objetivos desse estudo foram descrever a trajetória dos pacientes com diagnóstico de tuberculose antes do início do tratamento em unidade de referência, analisando a demora do paciente e o número de unidades de saúde visitadas antes do início do tratamento para tuberculose. Método: Estudo transversal realizado em dois serviços de tisiologia. Pacientes com idade ≥18 anos e com diagnóstico de tuberculose pulmonar responderam um questionário que avaliava: trajetória até o diagnóstico, tempo até o diagnóstico e fatores associados com o atraso no diagnóstico. Resultados: A média de idade dos pacientes foi de 40,4 ± 16,1. Foi encontrada uma mediana de 20 dias no atraso dos pacientes. Os fatores associados negativamente com atraso do paciente em um modelo de análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. Também foi encontrado que 44,8% relataram incorretamente o modo de transmissão tuberculose. Além disso, o local de primeiro atendimento para 37,3% dos pacientes foi uma emergência de hospital público. Conclusão: Foi encontrada uma mediana de 20 dias no atraso dos pacientes até o diagnóstico da tuberculose em dois serviços de saúde e em uma região com alta prevalência da doença, os fatores associados a este atraso na análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. / Background: Despite the advances in the last decade through the actions of tuberculosis control, this remains a problem endemic in Brazil. Delays in diagnosis and treatment of tuberculosis cases are major impeding factors in the control of tuberculosis. The objectives of this study were to describe the health care seeking behavior of tuberculosis patients, assessing patient delay and the number of health care facilities visited before the start of tuberculosis treatment. Methods: Cross-sectional study in two tuberculosis services. Patients aged ≥18 years old and diagnosed with pulmonary tuberculosis answered a questionnaire that evaluated: path to diagnosis, time to diagnosis and factors associated with delay in diagnosis. Results: The mean age of all patients was 40.4 ± 16.1 years. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of tuberculosis. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. Conclusions: We demonstrated that the median patient delay in tuberculosis diagnosis in two tuberculosis services in a region with a high prevalence of tuberculosis was 20 days, and the factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

Base Teórica: Apesar dos avanços alcançados na última década por meio das ações de controle da tuberculose, esta endemia permanece um problema no Brasil. Atraso no diagnóstico e tratamento dos casos de tuberculose é o fator de maior impedimento no controle da tuberculose. Os objetivos desse estudo foram descrever a trajetória dos pacientes com diagnóstico de tuberculose antes do início do tratamento em unidade de referência, analisando a demora do paciente e o número de unidades de saúde visitadas antes do início do tratamento para tuberculose. Método: Estudo transversal realizado em dois serviços de tisiologia. Pacientes com idade ≥18 anos e com diagnóstico de tuberculose pulmonar responderam um questionário que avaliava: trajetória até o diagnóstico, tempo até o diagnóstico e fatores associados com o atraso no diagnóstico. Resultados: A média de idade dos pacientes foi de 40,4 ± 16,1. Foi encontrada uma mediana de 20 dias no atraso dos pacientes. Os fatores associados negativamente com atraso do paciente em um modelo de análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. Também foi encontrado que 44,8% relataram incorretamente o modo de transmissão tuberculose. Além disso, o local de primeiro atendimento para 37,3% dos pacientes foi uma emergência de hospital público. Conclusão: Foi encontrada uma mediana de 20 dias no atraso dos pacientes até o diagnóstico da tuberculose em dois serviços de saúde e em uma região com alta prevalência da doença, os fatores associados a este atraso na análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. / Background: Despite the advances in the last decade through the actions of tuberculosis control, this remains a problem endemic in Brazil. Delays in diagnosis and treatment of tuberculosis cases are major impeding factors in the control of tuberculosis. The objectives of this study were to describe the health care seeking behavior of tuberculosis patients, assessing patient delay and the number of health care facilities visited before the start of tuberculosis treatment. Methods: Cross-sectional study in two tuberculosis services. Patients aged ≥18 years old and diagnosed with pulmonary tuberculosis answered a questionnaire that evaluated: path to diagnosis, time to diagnosis and factors associated with delay in diagnosis. Results: The mean age of all patients was 40.4 ± 16.1 years. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of tuberculosis. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. Conclusions: We demonstrated that the median patient delay in tuberculosis diagnosis in two tuberculosis services in a region with a high prevalence of tuberculosis was 20 days, and the factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

Base Teórica: Apesar dos avanços alcançados na última década por meio das ações de controle da tuberculose, esta endemia permanece um problema no Brasil. Atraso no diagnóstico e tratamento dos casos de tuberculose é o fator de maior impedimento no controle da tuberculose. Os objetivos desse estudo foram descrever a trajetória dos pacientes com diagnóstico de tuberculose antes do início do tratamento em unidade de referência, analisando a demora do paciente e o número de unidades de saúde visitadas antes do início do tratamento para tuberculose. Método: Estudo transversal realizado em dois serviços de tisiologia. Pacientes com idade ≥18 anos e com diagnóstico de tuberculose pulmonar responderam um questionário que avaliava: trajetória até o diagnóstico, tempo até o diagnóstico e fatores associados com o atraso no diagnóstico. Resultados: A média de idade dos pacientes foi de 40,4 ± 16,1. Foi encontrada uma mediana de 20 dias no atraso dos pacientes. Os fatores associados negativamente com atraso do paciente em um modelo de análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. Também foi encontrado que 44,8% relataram incorretamente o modo de transmissão tuberculose. Além disso, o local de primeiro atendimento para 37,3% dos pacientes foi uma emergência de hospital público. Conclusão: Foi encontrada uma mediana de 20 dias no atraso dos pacientes até o diagnóstico da tuberculose em dois serviços de saúde e em uma região com alta prevalência da doença, os fatores associados a este atraso na análise multivariada foram perda de peso e ter procurado tratamento por causa do primeiro sintoma. / Background: Despite the advances in the last decade through the actions of tuberculosis control, this remains a problem endemic in Brazil. Delays in diagnosis and treatment of tuberculosis cases are major impeding factors in the control of tuberculosis. The objectives of this study were to describe the health care seeking behavior of tuberculosis patients, assessing patient delay and the number of health care facilities visited before the start of tuberculosis treatment. Methods: Cross-sectional study in two tuberculosis services. Patients aged ≥18 years old and diagnosed with pulmonary tuberculosis answered a questionnaire that evaluated: path to diagnosis, time to diagnosis and factors associated with delay in diagnosis. Results: The mean age of all patients was 40.4 ± 16.1 years. We found a median patient delay of 20 days. The factors associated negatively with patient delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom. We also demonstrated that 44.8% of patients incorrectly reported the mode of transmission of tuberculosis. In addition, the local of first attendance was an emergency room of public hospitals in 37.3% of patients. Conclusions: We demonstrated that the median patient delay in tuberculosis diagnosis in two tuberculosis services in a region with a high prevalence of tuberculosis was 20 days, and the factors associated with this delay in multivariate analysis were weight loss, and have sought treatment because of the first symptom.

No / 482 people with leg ulcers were identified among those receiving health care in Bradford, UK. Of these wounds 195 (40.4%) were venous leg ulcers. Typically the people who experienced these wounds were elderly Caucasian females however a sub-group of younger males of Asian descent were seen to experience ulcers involving neuropathy. The leg ulcers were typically small in size although 33 people had wounds over 25 cm2 in surface area. The leg ulcers tended to persist with many present for at least 1 year with 4 wounds active for over 5 years. 205 people had experienced previous episodes of leg ulcer occurrence. Of the leg ulcers encountered 18.0% (n = 87) were infected and where wounds were swabbed for their microbial burden MRSA was identified in 8.5% of cases. Use of Doppler ultrasound to assess the aetiology of the wound had been performed in 66.4% of cases and where wounds remained undiagnosed (n = 69) only 8 had been Doppler assessed. While 75% of all venous leg ulcers received compression 48 people with venous leg ulcers did not have compression applied to their wound.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser. År 2005 tilldelat nummer i serien Linköping studies in arts and science.

Thesis (M.P.H.M.)--Mahidol University, 2000.

Thesis (Ph.D.)--University of Missouri-Columbia, 2008. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "December 2008" Includes bibliographical references.

No / To estimate the resource costs of providing wound care for the 488,000 catchment population of the Bradford and Airedale primary care trust (PCT). METHOD: A wound survey was carried out over a one-week period in March 2007 covering three hospitals in two acute trusts, district nurses, nursing homes and residential homes within the geographical area defined by the PCT. The survey included information on the frequency of dressing change, treatment time and district nurse travel time. The resource costs of wound care in the PCT were estimated by combining this information with representative costs for the UK National Health Service and information on dressing spend. RESULTS: Prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. Of these, 11.6% were pressure ulcers, of which 66% were hospital-acquired. The attributable cost of wound care in 2006-2007 was pounds 9.89 million: pounds 2.03 million per 100,000 population and 1.44% of the local health-care budget. Costs included pounds 1.69 million spending on dressings, 45.4 full-time nurses (valued at pounds 3.076 million) and 60-61 acute hospital beds (valued at pounds 5.13 million). CONCLUSION: The cost of wound care is significant. The most important components are the costs of wound-related hospitalisation and the opportunity cost of nurse time. The 32% of patients treated in hospital accounted for 63% of total costs. Putting in place care pathways to avoid hospitalisation and avoiding the development of hospital-acquired pressure ulcers and other wound complications are important ways to reduce costs. DECLARATION OF INTEREST: John Posnett is an employee of Smith & Nephew.