Journal of clinical medicine
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In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. ⋯ The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20-33) regarding specialised consultation, 47 days (95% CI: 17-74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.
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Evidence on whether habitual sleep duration and sleep quality are associated with increased insulin resistance is inconsistent. Here, we investigated the associations between different measures of habitual sleep with glycemic traits through cross-sectional and Mendelian randomization (MR) analyses. We assessed the associations of sleep duration and sleep quality with glycemic traits using multivariable linear regression models adjusted for potential confounders in 4672 middle-aged (45-65 years; 48% men) nondiabetic participants of the Netherlands Epidemiology of Obesity (NEO) study. ⋯ All these associations disappeared after adjustment for BMI and the risk of sleep apnea. MR analyses did not indicate a causal association between total, short or long sleep duration and glycemic traits. Therefore, our used measures of habitual sleep duration and sleep quality are unlikely to directly associate with insulin resistance.
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In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter "conversion") during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. ⋯ Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248-3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167-4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.
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Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. ⋯ Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention.
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The best intramedullary nail for the treatment of unstable AO/OTA 31. A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. ⋯ The only significant change in follow-up using Parker's ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.