WorldWideScience

Sample records for ambulatory urban patient

  1. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

    Directory of Open Access Journals (Sweden)

    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  2. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  3. Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

    Science.gov (United States)

    Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena

    2012-07-01

    A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

  4. Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

    Science.gov (United States)

    Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

    2012-01-01

    There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

  5. Ambulatory gait analysis in stroke patients using ultrasound and inertial sensors

    NARCIS (Netherlands)

    Weenk, D.; van Meulen, Fokke; van Beijnum, Bernhard J.F.; Veltink, Petrus H.

    2014-01-01

    Objective ambulatory assessment of movements of patients is important for an optimal recovery. In this study an ambulatory system is used for assessing gait parameters in stroke patients. Ultrasound range estimates are fused with inertial sensors using an extended Kalman filter to estimate 3D

  6. The long-term effect of ambulatory oxygen in normoxaemic COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Martinez, Gerd; Lange, Peter

    2013-01-01

    To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation.......To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation....

  7. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension.

    Science.gov (United States)

    Kiselev, Anton R; Gridnev, Vladimir I; Shvartz, Vladimir A; Posnenkova, Olga M; Dovgalevsky, Pavel Ya

    2012-01-01

    The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P mobile phone improves the quality of ambulatory care of hypertensive patients. Copyright © 2012 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  8. Patient Satisfaction with Kimbrough Ambulatory Care Center

    Science.gov (United States)

    1997-02-01

    few are going to opt to change health plans. 14. SUBJECT TERMS PATIENT SATISFACTION; CONSUMER SATISFACTION; SURVEY 15. NUMBER OF PAGES 57 16...to address is overall patient satisfaction with Kimbrough’s current health care system. I surveyed customers on: how satisfied or dissatisfied they...research project was designed to determine how satisfied customers are with Kimbrough Ambulatory Care Center. A patient satisfaction survey developed by

  9. Ambulatory oral surgery: 1-year experience with 11680 patients from Zagreb district, Croatia.

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-02-01

    To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Sociodemographic and clinical data on 11680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (PZagreb than in patients residing in rural areas. The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients' awareness of the importance of oral health.

  10. [Face-lift surgery in ambulatory].

    Science.gov (United States)

    Soulhiard, F

    2017-10-01

    The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke.

    Science.gov (United States)

    Chon, Seung Chul; Oh, Duck Won; Shim, Jae Hun

    2009-06-01

    This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. All patients showed decreased scores in the TAS and RVGA after Watsu application. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis.

  12. Biofilm antifungal susceptibility of Candida urine isolated from ambulatory patients

    Directory of Open Access Journals (Sweden)

    Débora da Luz Becker

    2016-07-01

    Full Text Available Background and Objectives: the association between the biofilm formations an antifungal resistance has been suggested to be an important factor in the pathogenesis of several Candida species. Besides, studies have included invasive candidiasis from hospitalized patients; however there are few studies that evaluated the species distribution, antifungal susceptibility and biofilm formation of Candida species isolated from ambulatory patients. Thus, the aim of this study was to evaluate whether biofilm producing contributes to antifungal resistance in Candida isolates from urine sample obtained from ambulatory patients. Methods: During one year, 25 urine samples positive for yeast were collected, stored and plated on agar supplemented with chloramphenicol and Sabouread left at room temperature for 5 days for subsequent: 52% (13/25 were C. albicans, 36% (9/25 C. tropicalis, 8% (2/25 C. krusei and 4% (1/25 C. parapsilosis. Results: The ability to form biofilm was detected in 23 (92% of the yeast studied and 15.4% (2/13 of C. albicans were fluconazole (FLU and ketoconazole (KET resistant, while 11.1% (1/9 of C. tropicalis were ketoconazole resistant and were anidulafungin (ANI non-susceptible. Conclusion: our results showed the high capacity for biofilm formation among Candida isolates from ambulatory patients.

  13. Participation restrictions in ambulatory amyotrophic lateral sclerosis patients: Physical and psychological factors.

    Science.gov (United States)

    Van Groenestijn, Annerieke C; Schröder, Carin D; Kruitwagen-Van Reenen, Esther T; Van Den Berg, Leonard H; Visser-Meily, Johanna M A

    2017-11-01

    The aim of this study was to assess the prevalence of participation restrictions in ambulatory patients with amyotrophic lateral sclerosis (ALS) and to identify physical and psychological contributory factors. In this cross-sectional study, self-reported participation restrictions of 72 ambulatory ALS patients were assessed using the social health status dimension (SIPSOC) of the Sickness Impact Profile (SIP-68). Associations between SIPSOC and physical functioning, psychological factors, and demographic factors were analyzed using hierarchical regression analyses. Ninety-two percent of the patients reported participation restrictions; 54.9% could be explained by physical functioning; psychological factors accounted for 8.1% of the variance. Lung capacity, functional mobility, fatigue, and helplessness were independently associated with participation restrictions. Ambulatory ALS patients have participation restrictions, which may be influenced if early ALS care is directed toward lung capacity, functional mobility, fatigue, and feelings of helplessness. Muscle Nerve 56: 912-918, 2017. © 2017 Wiley Periodicals, Inc.

  14. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Directory of Open Access Journals (Sweden)

    Fenwick Angela

    2011-02-01

    Full Text Available Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge; were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development

  15. Ambulatory surgery for the patient with breast cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Pek CH

    2016-08-01

    Full Text Available Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to

  16. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted. Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening

  17. Unanticipated hospital admission in pediatric patients with congenital heart disease undergoing ambulatory noncardiac surgical procedures.

    Science.gov (United States)

    Yuki, Koichi; Koutsogiannaki, Sophia; Lee, Sandra; DiNardo, James A

    2018-05-18

    An increasing number of surgical and nonsurgical procedures are being performed on an ambulatory basis in children. Analysis of a large group of pediatric patients with congenital heart disease undergoing ambulatory procedures has not been undertaken. The objective of this study was to characterize the profile of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis at our institution, to determine the incidence of adverse cardiovascular and respiratory adverse events, and to determine the risk factors for unscheduled hospital admission. This is a retrospective study of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis in a single center. Using the electronic preoperative anesthesia evaluation form, we identified 3010 patients with congenital heart disease who underwent noncardiac procedures of which 1028 (34.1%) were scheduled to occur on an ambulatory basis. Demographic, echocardiographic and functional status data, cardiovascular and respiratory adverse events, and reasons for postprocedure admission were recorded. Univariable analysis was conducted. The unplanned hospital admission was 2.7% and univariable analysis demonstrated that performance of an echocardiogram within 6 mo of the procedure and procedures performed in radiology were associated with postoperative admission. Cardiovascular adverse event incidence was 3.9%. Respiratory adverse event incidence was 1.8%. Ambulatory, noncomplex procedures can be performed in pediatric patients with congenital heart disease and good functional status with a relatively low unanticipated hospital admission rate. © 2018 John Wiley & Sons Ltd.

  18. The Use of the Ambulatory Arterial Stiffness Index in Patients Suspected of Secondary Hypertension

    NARCIS (Netherlands)

    Verbakel, J.R.; Adiyaman, A.; Kraayvanger, N.; Dechering, D.G.; Postma, C.T.

    2016-01-01

    The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness and is derived from ambulatory 24-h blood pressure registration. We studied whether the AASI could be used as a predictive factor for the presence of renal artery stenosis (RAS) in patients with a suspicion of secondary

  19. quality of glycaemic control in ambulatory diabetics at the out-patient

    African Journals Online (AJOL)

    hi-tech

    2003-08-08

    Aug 8, 2003 ... Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin ...

  20. Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-01-01

    Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

  1. The effects of the spleen tyrosine kinase inhibitor fostamatinib on ambulatory blood pressure in patients with active rheumatoid arthritis: results of the OSKIRA-ABPM (ambulatory blood pressure monitoring) randomized trial.

    Science.gov (United States)

    Kitas, George D; Abreu, Gabriel; Jedrychowicz-Rosiak, Krystyna; Miller, Jeffrey L; Nakov, Roumen; Panfilov, Seva; Vencovsky, Jiri; Wang, Millie; Weinblatt, Michael E; White, William B

    2014-11-01

    Clinical trials of fostamatinib in patients with rheumatoid arthritis showed blood pressure (BP) elevation using clinic measurements. The OSKIRA-ambulatory BP monitoring trial assessed the effect of fostamatinib on 24-hour ambulatory systolic BP (SBP) in patients with active rheumatoid arthritis. One hundred thirty-five patients were randomized to fostamatinib 100 mg twice daily (bid; n = 68) or placebo bid (n = 67) for 28 days. Ambulatory, clinic, and home BPs were measured at baseline and after 28 days of therapy. Primary end point was change from baseline in 24-hour mean SBP. Fostamatinib increased 24-hour mean SBP by 2.9 mm Hg (P = .023) and diastolic BP (DBP) by 3.5 mm Hg (P < .001) versus placebo. Clinic/home-measured BPs were similar to those observed with ambulatory BP monitoring. After treatment discontinuation (1 week), clinic BP values returned to baseline levels. Fostamatinib induced elevations in 24-hour mean ambulatory SBP and DBP. BP elevations resolved with fostamatinib discontinuation. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  2. Ambulatory percutaneous nephrolithotomy: initial series.

    Science.gov (United States)

    Shahrour, Walid; Andonian, Sero

    2010-12-01

    To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL). PCNL is the gold standard for the management of large renal stones. Although tubeless PCNL has been previously described, no case series have been published of ambulatory PCNL. The criteria for ambulatory PCNL were: single tract, stone-free status documented by flexible nephroscopy, adequate pain control, and satisfactory postoperative hematocrit level and chest radiographic findings. Patient information, including operating room and fluoroscopy times, stone size and Hounsfield units, and number of needle punctures, were collected prospectively. The time spent in the recovery room, in addition to the amount of narcotics used in the recovery room and at home, was documented. Of 10 patients, 8 had nephrostomy tracts established intraoperatively by the urologist and 2 had preoperative nephrostomy tubes placed. The median operating and fluoroscopy time was 83.5 and 4.45 minutes, respectively. The median stone diameter was 20 mm (800 Hounsfield units) in addition to a patient with a staghorn calculus. The patients spent a median of 240 minutes in the recovery room and had received a median of 19.25 mg of morphine equivalents. Only 3 patients (30%) used narcotics at home. No intraoperative complications occurred, and none of the patients required transfusions. Two postoperative complications developed: a deep vein thrombosis requiring outpatient anticoagulation and multiresistant Escherichia coli infection requiring intravenous antibiotics. In highly selected patients, ambulatory PCNL is safe and feasible. More patients are needed to verify the criteria for patients undergoing the ambulatory approach. Copyright © 2010 Elsevier Inc. All rights reserved.

  3. Antroduodenal manometry: 24-hour ambulatory monitoring versus short-term stationary manometry in patients with functional dyspepsia

    NARCIS (Netherlands)

    Jebbink, R. J.; vanBerge-Henegouwen, G. P.; Akkermans, L. M.; Smout, A. J.

    1995-01-01

    OBJECTIVES: To examine the interdigestive and postprandial antroduodenal motility patterns of patients with functional dyspepsia using prolonged ambulatory antroduodenal manometry and to compare these findings with conventional stationary manometry. METHODS: Prolonged ambulatory and short-term

  4. [Considerations on local-regional anesthesia for ambulatory tooth extractions in patients with heart disease].

    Science.gov (United States)

    Debernardi, G; Borgogna, E

    1975-01-01

    Ambulatory dental extraction was performed on 150 patients with various forms of heart disease. No serious complications were noted with an anaesthetic without vasoconstriction (plain 3% carbocaine). The prior history was carefully studied and pressure values were determined. It is felt that heart disease does not form an absolute contraindication to ambulatory dental extraction.

  5. Ambulatory phlebectomy at radiologic outpatient clinic

    International Nuclear Information System (INIS)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic

  6. Ambulatory phlebectomy at radiologic outpatient clinic

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University, Medical College, Seoul (Korea, Republic of)

    2007-03-15

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic.

  7. Patient satisfaction and acceptability: a journey through an ambulatory gynaecology clinic in the West of Ireland

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

    Ambulatory Gynaecology allows a “see-and-treat” approach to managing gynaecological conditions, providing a more streamlined, integrated care pathway than the traditional gynaecology clinic and inpatient care model. This study was designed to assess patient satisfaction and acceptability of Ambulatory Gynaecology services in Mayo University Hospital, Castlebar, Ireland. It also provided for feedback from patients as to how the service might be improved. \\r\

  8. The features of 24-hour ambulatory blood pressure in patients with diabetes mellitus depending on endothelial dysfunction

    Directory of Open Access Journals (Sweden)

    N.O. Pertseva

    2018-03-01

    Full Text Available Background. Arterial hypertension in patients with diabetes mellitus (DM plays a main role in the earlier formation of diabetic kidney disease (DKD. Endothelial dysfunction is considered to be a process based on the development of diabetic complications. It is important to study the markers, which gives the opportunity to identify DKD in early stage. Objective: to evaluate 24-h ambulatory blood pressure data in patients with DM and its correlation with estimated glomerular filtration rate and endothelial dysfunction. Materials and methods. The endothelial function was determined by the levels of transforming growth factor-beta 1 (TGF-b1 and vascular cell adhesion molecule 1 (VCAM-1. There were 124 patients with DM (66 with type 1 and 58 with type 2 under observation. Results. Levels of endothelial function (TGF-b1 and VCAM-1 indexes in patients with type 1 and type 2 DM depended on glomerular filtration rate. Between the indexes of endothelial function (TGF-b1, VCAM-1 and the 24-hour ambulatory blood pressure, there is strong and average correlation, therefore, parameters of 24-hour ambulatory blood pressure and presence of endothelial dysfunction can be considered as early signs of DKD progression in patients with DM. Conclusions. 24-hour ambulatory blood pressure in patients with DM on the early stages of diabetic nephropathy is characterized by significant circadian rhythm disorders. The insufficient night decline of blood pressure in patients with type 1 and type 2 DM characterizes the presence of diabetic nephropathy progression according to the indexes of 24-h ambulatory blood pressure.

  9. Patient care delivery and integration: stimulating advancement of ambulatory care pharmacy practice in an era of healthcare reform.

    Science.gov (United States)

    Epplen, Kelly T

    2014-08-15

    This article discusses how to plan and implement an ambulatory care pharmacist service, how to integrate a hospital- or health-system-based service with the mission and operations of the institution, and how to help the institution meet its challenges related to quality improvement, continuity of care, and financial sustainability. The steps in implementing an ambulatory care pharmacist service include (1) conducting a needs assessment, (2) aligning plans for the service with the mission and goals of the parent institution, (3) collaborating with patients and physicians, (4) standardizing the patient care process, (5) proposing the service, (6) attaining the necessary resources, (7) identifying stakeholders, (8) identifying applicable quality standards, (9) defining competency standards, (10) planning for service payment, and (11) monitoring outcomes. Ambulatory care pharmacists have current opportunities to become engaged with patient-centered medical homes, accountable care organizations, preventive and wellness programs, and continuity of care initiatives. Common barriers to the advancement of ambulatory care pharmacist services include lack of complete access to patient information, inadequate information technology, and lack of payment. Ambulatory care pharmacy practitioners must assertively promote appropriate medication use, provide patient-centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  10. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni

    2013-01-01

    Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

  11. Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

    Science.gov (United States)

    Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

    1997-01-01

    The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

  12. [Travel times of patients to ambulatory care physicians in Germany].

    Science.gov (United States)

    Schang, Laura; Kopetsch, Thomas; Sundmacher, Leonie

    2017-12-01

    The time needed by patients to get to a doctor's office represents an important indicator of realised access to care. In Germany, findings on travel times are only available from surveys or for some regions. For the first time, this study examines nationwide and physician group-specific travel times in the ambulatory care sector in Germany and describes demographic, supply-side and spatial determinants of variations. Using a full review of patient consultations in the statutory health insurance system from 2009/2010 for 14 physician groups (approximately 518 million cases), case-related travel times by car between patients' places of residence and physician's practices were estimated at the municipal level. Physicians were reached in less than 30 min in 90.8% of cases for primary care physicians and up to 63% of cases for radiologists. Patients between 18 and under 30 years of age travel longer to get to the doctor than other age groups. The average travel time at the county level systematically differs between urban and rural planning areas. In the case of gynecologists, dermatologists and ophthalmologists, the average journey time decreases with increasing physician density at the county level, but remains approximately constant from a recognisable point of inflection. There is no association between primary care physician density and travel time at the district level. Spatial analyses show physician group-specific patterns of regional concentrations with an increased proportion of cases with very long travel times. Patients' travel times are influenced by supply- and demand-side determinants. Interactions between influential determinants should be analysed in depth to examine the extent to which the time travelled is an expression of regional under- or over-supply rather than an expression of patient preferences.

  13. Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre.

    Science.gov (United States)

    Teh, Benjamin W; Brown, Christine; Joyce, Trish; Worth, Leon J; Slavin, Monica A; Thursky, Karin A

    2018-03-01

    Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period. Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons. Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported. Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.

  14. Ambulatory cleft lip surgery: A value analysis.

    Science.gov (United States)

    Arneja, Jugpal S; Mitton, Craig

    2013-01-01

    Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory cleft surgery enhances overall health care value.

  15. A pilot audit of a protocol for ambulatory investigation of predicted low-risk patients with possible pulmonary embolism.

    Science.gov (United States)

    McDonald, A H; Murphy, R

    2011-09-01

    Patients with possible pulmonary embolism (PE) commonly present to acute medical services. Research has led to the identification of low-risk patients suitable for ambulatory management. We report on a protocol designed to select low-risk patients for ambulatory investigation if confirmatory imaging is not available that day. The protocol was piloted in the Emergency Department and Medical Assessment Area at the Royal Infirmary of Edinburgh. We retrospectively analysed electronic patient records in an open observational audit of all patients managed in the ambulatory arm over five months of use. We analysed 45 patients' records. Of these, 91.1% required imaging to confirm or refute PE, 62.2% received a computed tomography pulmonary angiogram (CTPA). In 25% of patients, PE was confirmed with musculoskeletal pain (22.7%), and respiratory tract infection (15.9%) the next most prevalent diagnoses. Alternative diagnoses was provided by CTPA in 32% of cases. We identified no adverse events or readmissions but individualised follow-up was not attempted. The data from this audit suggests this protocol can be applied to select and manage low-risk patients suitable for ambulatory investigation of possible PE. A larger prospective comparative study would be required to accurately define the safety and effectiveness of this protocol.

  16. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

  17. Diagnostic accuracy of manual office blood pressure measurement in ambulatory hypertensive patients in Korea.

    Science.gov (United States)

    Kim, Sehun; Park, Jin Joo; Lee, Seung-Ah; Cho, Youngjin; Yoon, Yeonyee E; Oh, Il-Young; Yoon, Chang-Hwan; Suh, Jung-Won; Cho, Young-Seok; Youn, Tae-Jin; Cho, Goo-Yeong; Chae, In-Ho; Lee, Hae-Young; Shin, Jinho; Park, Sungha; Choi, Dong-Ju

    2018-01-01

    Currently, office blood pressure (OBP) is the most widely used method of measuring blood pressure (BP) in daily clinical practice. However, data on the diagnostic accuracy of OBP in reference to ambulatory blood pressure (ABP) are scarce in Korea. In retrospective and prospective cohorts, manual OBP and ABP measurements were compared among ambulatory hypertensive patients. Hypertension was defined as systolic OBP ≥ 140 mmHg and/or diastolic OBP ≥ 90 mmHg, and systolic ABP ≥ 130 mmHg and/or diastolic ABP ≥ 80 mmHg. In the retrospective cohort (n = 903), the mean OBP1 (before ABP measurement) was higher than ABP in both systolic (138 ± 17 mmHg vs. 123 ± 13 mmHg, p ABP ( r 2 = 0.038, p ABP, which is the reference method for measuring BP, was 43.9%. The prospective cohort (n = 57) showed similar results. In a subgroup analysis, male patients had higher false negative results (masked or under-treated hypertension) than did female patients (26.1% vs. 17.8%, p = 0.003), whereas female patients had a higher false positive rate (white-coat or over-treated hypertension) than did male patients (28.7% vs. 15.2%, p ABP. Men and women have different patterns of discordance. These findings indicate that management of hypertensive patients with manual OBP measurements may be suboptimal and encourages the use of ABP in ambulatory hypertensive patients.

  18. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin (Eilish)

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  19. Risk Factors for new accidental falls in elderly patients at traumatology ambulatory center.

    Science.gov (United States)

    Porto Gautério, Daiane; Zortea, Bruna; Costa Santos, Silvana Sidney; da Silva Tarouco, Bárbara; Lopes, Manoel José; João Fonseca, Cesar

    2015-01-01

    To identify the risks factors for new accidental falls in elderly patients attended in the Traumatology Ambulatory of a University hospital in Rio Grande do Sul, Brazil. Quantitative study of the type of multiple cases. Performed at the traumatology ambulatory, amongst fifteen elders that attended the inclusion criteria: age of sixty or more; patient at the traumatology ambulatory because of a fall motivated by accident, oriented and in conditions of answer an interview of data collectors. The data collection was made between April and June, 2013, with the Elderly Nursing Core Set scale (Lopes & Fonseca). The data analysis was made by a descriptive structure, which helped identify the existence of relation patterns among the cases. The risk factors for new accidental falls identified with larger incidence amongst the elders studied were: impaired balance (15/15), age above 65 (11/15), use of antihypertensive drugs (9/15), absence of non-slip material at home environment (7/15), in seven cases; rugs scattered at the floor of the house (6/15). The combination of intrinsic and extrinsic factors that include the environmental risks is considered a much more relevant cause to occur the new falls. The minimization of the home dangers, allied to the control of the elder intrinsic factors, may reduce the risks of causes. In that sense, is necessary that the nursing team make available more attention to the elderly assisted at the ambulatories, mainly those with sequelae due to fall accidents.

  20. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo

    2011-10-01

    Full Text Available Abstract The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI. This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all

  1. Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study.

    Science.gov (United States)

    Gaillard, M; Tranchart, H; Lainas, P; Tzanis, D; Franco, D; Dagher, I

    2015-11-01

    Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. The Åstrand-Ryhming Test is not a Feasible Measure in Ambulatory Patients with Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    van Groenestijn, Annerieke C; Verschuren, Olaf; Schröder, Carin D; van den Berg, Leonard H; Visser-Meily, Johanna M A

    2016-11-29

    Ambulatory patients with Amyotrophic Lateral Sclerosis (ALS) show a decreased aerobic capacity which may hamper the ability to perform activities of daily living. A standardized measure, however, for assessing aerobic capacity in patients with ALS during the disease course, is lacking. To examine the feasibility of the Åstrand-Ryhming (ÅR) test protocol longitudinally in ambulatory patients with amyotrophic lateral sclerosis (ALS). Seven ambulatory male patients with spinal ALS onset were assessed at baseline and at 4, 7 and 10 months' follow-up. Feasibility of the ÅR test protocol was analysed using percentage of: a) completed ÅR tests; b) achieved steady states; and c) predefined heart rates. Test completion decreased from 7/7 at baseline to 10/21 at follow-up due to ALS-related symptoms as fatigue, muscle weakness and cramps. Steady states and predefined heart rates were achieved in 12/17 and 17/17 of the completed tests, respectively. Overall, the feasibility of the ÅR test protocol declines from 5/7 at baseline to 7/21 at follow-up. The results suggest that changes in aerobic capacity in ambulatory patients with ALS could not be successfully monitored due to a diminished feasibility of the ÅR test protocol.

  3. Is there an overprescription of proton pump inhibitors in oncohematologic patients undergoing ambulatory oncospecific treatment?

    Directory of Open Access Journals (Sweden)

    Meritxell Pujal Herranz

    2016-09-01

    Full Text Available Objective: The aim of this study is to evaluate the prevalence of proton pump inhibitors (PPIs prescription, and the level of adequacy of the indication of these drugs in oncohematologic patients under ambulatory oncoespecific treatment. Method: An observational descriptive study in oncohematologic patients under ambulatory oncoespecific treatment. A protocol for the rational use of PPI targeted to oncohematologic patients based on the PPI protocol of our hospital was designed. Patients under active treatment with PPIs were quantified and the appropriateness of their indications evaluated. Results: 111 patients (71 oncologic and 40 hematologic were included. 56% of all oncologic patients and 63% of all hematologic patients were under active treatment with PPIs. After reviewing the indications for PPI in all patients, 72% of oncologic and 12% of hematologic patients did not present evidence justifying treatment with these drugs. Conclusion: It is important the pharmacist to detect unappropriated prescriptions of PPIs, especially among oncologic patients, and to promote a deprescription of these drugs

  4. Risk Factors for new accidental falls in elderly patients at traumatology ambulatory center

    Directory of Open Access Journals (Sweden)

    Daiane Porto Gautério

    2015-04-01

    Full Text Available Objective. To identify the risks factors for new accidental falls in elderly patients attended in the Traumatology Ambulatory of a University hospital in Rio Grande do Sul, Brazil. Methodology. Quantitative study of the type of multiple cases. Performed at the traumatology ambulatory, amongst fifteen elders that attended the inclusion criteria: age of sixty or more; patient at the traumatology ambulatory because of a fall motivated by accident, oriented and in conditions of answer an interview of data collectors. The data collection was made between April and June, 2013, with the Elderly Nursing Core Set scale (Lopes & Fonseca. The data analysis was made by a descriptive structure, which helped identify the existence of relation patterns among the cases. Results. The risk factors for new accidental falls identified with larger incidence amongst the elders studied were: impaired balance (15/15, age above 65 (11/15, use of antihypertensive drugs (9/15, absence of non-slip material at home environment (7/15, in seven cases; rugs scattered at the floor of the house (6/15. Conclusion. The combination of intrinsic and extrinsic factors that include the environmental risks is considered a much more relevant cause to occur the new falls. The minimization of the home dangers, allied to the control of the elder intrinsic factors, may reduce the risks of causes. In that sense, is necessary that the nursing team make available more attention to the elderly assisted at the ambulatories, mainly those with sequelae due to fall accidents.

  5. Side effects after ambulatory lumbar iohexol myelography

    International Nuclear Information System (INIS)

    Sand, T.; Myhr, G.; Stovner, L.J.; Dale, L.G.; Tangerud, A.

    1989-01-01

    Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography. (orig.)

  6. Achieving the AAAs of Ambulatory Care: Aptitude, Appeal, and Appreciation

    Science.gov (United States)

    Rybolt, Ann H.; Staton, Lisa J.; Panda, Mukta; Jones, Roger C.

    2009-01-01

    Background In the current health care environment more patient care has moved from in-hospital care to the ambulatory primary care settings; however, fewer internal medicine residents are pursuing primary care careers. Barriers to residents developing a sense of competency and enjoyment in ambulatory medicine include the complexity of practice-based systems, patients with multiple chronic diseases, and the limited time that residents spend in the outpatient setting. Objective In an effort to accelerate residents' ambulatory care competence and enhance their satisfaction with ambulatory practice, we sought to change the learning environment. Interns were provided a series of intensive, focused, ambulatory training sessions prior to beginning their own continuity clinic sessions. The sessions were designed to enable them to work confidently and effectively in their continuity clinic from the beginning of the internship year, and it was hoped this would have a positive impact on their perception of the desirability of ambulatory practice. Methods Improvement needs assessment after a performance, so we developed a structured, competency-based, multidisciplinary curriculum for initiation into ambulatory practice. The curriculum focused on systems-based practice, patient safety, quality improvement, and collaborative work while emphasizing the importance of continuity of care and long-term doctor-patient relationships. Direct observation of patient encounters was done by an attending physician to evaluate communication and physical examination skills. Systems of care commonly used in the clinic were demonstrated. Resources for practice-based learning were used. Conclusion The immersion of interns in an intensive, hands-on experience using a structured ambulatory care orientation curriculum early in training may prepare the intern to be a successful provider and learner in the primary care ambulatory setting. PMID:21975724

  7. Medication-related problem type and appearance rate in ambulatory hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Drayer Debra K

    2003-12-01

    Full Text Available Abstract Background Hemodialysis (HD patients are at risk for medication-related problems (MRP. The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: {[(number of patients × (mean number of medications]/(number of months of study} /number of MRP identified. Results were expressed as mean ± standard deviation or percentages. Results Patients were 62.6 ± 15.9 years old, had 6.4 ± 2.0 comorbid conditions, were taking 12.5 ± 4.2 medications, and 15.7 ± 7.2 doses per day at baseline. Medication-dosing problems (33.5%, adverse drug reactions (20.7%, and an indication that was not currently being treated (13.5% were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 ± 0.46 per patient per month. Conclusion MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics.

  8. An analysis of risk factors and adverse events in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Kent C

    2014-06-01

    Full Text Available Christopher Kent, Julia Metzner, Laurent BollagDepartment of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USAAbstract: Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more

  9. Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000–2007

    Directory of Open Access Journals (Sweden)

    Sudeep Karve

    2012-01-01

    Full Text Available Objective. Study objectives were to assess temporal trends and identify patient- and practice-level predictors of the prescription of antiplatelet medications in a national sample of ischemic stroke (IS patients seeking ambulatory care. Methods. IS-related outpatient visits by adults were identified using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the years 2000–2007. We assessed prescribing of antiplatelet medications using the generic drug code and drug entry codes in these data. Temporal trends in antiplatelet prescribing were assessed using the Cochran-Mantel-Haenszel test for trend. Results. We identified 9.5 million IS-related ambulatory visits. Antiplatelet medications were prescribed at 35.5% of visits. Physician office prescribing of the clopidogrel-aspirin combination increased significantly from 0.5% in 2000 to 22.0% in 2007 (P=0.05, whereas prescribing of aspirin decreased from 17.9% to 7.0% (P=0.50 during the same period. Conclusion. We observed a continued increase in prescription of the aspirin-clopidogrel combination from 2000 to 2007. Clinical trial evidence suggests that the aspirin-clopidogrel combination does not provide any additional benefit compared with clopidogrel alone; however, our study findings indicate that even with lack of adequate clinical evidence physician prescribing of this combination has increased in real-world community settings.

  10. An overview of anesthetic procedures, tools, and techniques in ambulatory care

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

    Full Text Available Zakaria Messieha Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Abstract: Ambulatory surgical and anesthesia care (ASAC, also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care. Keywords: ambulatory anesthesia, out-patient anesthesia, Day-Care anesthesia

  11. Comparison of valsartan and amlodipine on ambulatory blood pressure variability in hypertensive patients.

    Science.gov (United States)

    Eguchi, Kazuo; Imaizumi, Yuki; Kaihara, Toshiki; Hoshide, Satoshi; Kario, Kazuomi

    We tested the hypothesis that calcium channel blockers (CCBs: amlodipine group, n = 38)) are superior to angiotensin receptor blockers (ARBs: valsartan group, n = 38) against ambulatory blood pressure variability (BPV) in untreated Japanese hypertensive patients. Both drugs significantly reduced ambulatory systolic and diastolic BP values. With regard to BPV, standard deviation (SD) in SBP did not change with the administration of either drug, but the ARB significantly increased SD in awake DBP (12 ± 4-14 ± 4 mmHg). The ARB also significantly increased the coefficients of variation (CVs)in awake and 24-h SBP/DBP (all P valsartan, especially in reducing maximum BP levels.

  12. Patient satisfaction with ambulatory care in Germany: effects of patient- and medical practice-related factors.

    Science.gov (United States)

    Auras, Silke; Ostermann, Thomas; de Cruppé, Werner; Bitzer, Eva-Maria; Diel, Franziska; Geraedts, Max

    2016-12-01

    The study aimed to illustrate the effect of the patients' sex, age, self-rated health and medical practice specialization on patient satisfaction. Secondary analysis of patient survey data using multilevel analysis (generalized linear mixed model, medical practice as random effect) using a sequential modelling strategy. We examined the effects of the patients' sex, age, self-rated health and medical practice specialization on four patient satisfaction dimensions: medical practice organization, information, interaction, professional competence. The study was performed in 92 German medical practices providing ambulatory care in general medicine, internal medicine or gynaecology. In total, 9888 adult patients participated in a patient survey using the validated 'questionnaire on satisfaction with ambulatory care-quality from the patient perspective [ZAP]'. We calculated four models for each satisfaction dimension, revealing regression coefficients with 95% confidence intervals (CIs) for all independent variables, and using Wald Chi-Square statistic for each modelling step (model validity) and LR-Tests to compare the models of each step with the previous model. The patients' sex and age had a weak effect (maximum regression coefficient 1.09, CI 0.39; 1.80), and the patients' self-rated health had the strongest positive effect (maximum regression coefficient 7.66, CI 6.69; 8.63) on satisfaction ratings. The effect of medical practice specialization was heterogeneous. All factors studied, specifically the patients' self-rated health, affected patient satisfaction. Adjustment should always be considered because it improves the comparability of patient satisfaction in medical practices with atypically varying patient populations and increases the acceptance of comparisons. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients.

    LENUS (Irish Health Repository)

    Ti, Joanna P

    2010-07-01

    OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.

  14. Ambulatory blood pressure monitoring profile in urban African black and European white untreated hypertensive patients matched for age and sex.

    Science.gov (United States)

    Polónia, Jorge; Madede, Tavares; Silva, José A; Mesquita-Bastos, José; Damasceno, Albertino

    2014-08-01

    The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (Pwhite hypertensive patients showed higher casual blood pressure (BP) 160/104 ± 19/14 versus 149/97 ± 18/12 mmHg, 24-h ABP 146/92 ± 16/13 versus 139/85 ± 11/10 mmHg, daytime ABP 150/95 ± 16/13 versus 143/88 ± 13/11 mmHg, night-time BP 139/84 ± 17/13 versus 130/78 ± 13/10 mmHg (all Pwhite hypertensive patients for all spectra of age distribution. This might be the reason for the worse cardiovascular prognosis described in black hypertensive patients compared with white hypertensive patients.

  15. Computerized adaptive testing--ready for ambulatory monitoring?

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix

    2012-01-01

    Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.......Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted....

  16. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  17. Ambulatory Phlebectomy

    Science.gov (United States)

    ... for Every Season How to Choose the Best Skin Care Products In This Section Dermatologic Surgery What is dermatologic ... for Every Season How to Choose the Best Skin Care Products Ambulatory Phlebectomy What is ambulatory phlebectomy? Ambulatory phlebectomy ...

  18. Ambulatory (24 h) blood pressure and arterial stiffness measurement in Marfan syndrome patients: a case control feasibility and pilot study.

    Science.gov (United States)

    Hillebrand, Matthias; Nouri, Ghazaleh; Hametner, Bernhard; Parragh, Stephanie; Köster, Jelena; Mortensen, Kai; Schwarz, Achim; von Kodolitsch, Yskert; Wassertheurer, Siegfried

    2016-05-06

    The aim of this work is the investigation of measures of ambulatory brachial and aortic blood pressure and indices of arterial stiffness and aortic wave reflection in Marfan patients. A case-control study was conducted including patients with diagnosed Marfan syndrome following Ghent2 nosology and healthy controls matched for sex, age and daytime brachial systolic blood pressure. For each subject a 24 h ambulatory blood pressure and 24 h pulse wave analysis measurement was performed. All parameters showed a circadian pattern whereby pressure dipping was more pronounced in Marfan patients. During daytime only Marfan patients with aortic root surgery showed increased pulse wave velocity. In contrast, various nighttime measurements, wave reflection determinants and circadian patterns showed a significant difference. The findings of our study provide evidence that ambulatory measurement of arterial stiffness parameters is feasible and that these determinants are significantly different in Marfan syndrome patients compared to controls in particular at nighttime. Further investigation is therefore indicated.

  19. Perspectives on ambulatory anesthesia: the patient’s point of view

    Directory of Open Access Journals (Sweden)

    Sehmbi H

    2014-12-01

    Full Text Available Herman Sehmbi, Jean Wong, David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaAbstract: Recent advances in anesthetic and surgical techniques have led to tremendous growth of ambulatory surgery. With patients with many co-morbid conditions undergoing complex procedures in an ambulatory setting, the challenges in providing ambulatory surgery and anesthesia are immense. In recent years, the paradigm has shifted from a health-care provider focus involving process compliance and clinical outcomes, to a patient-centered strategy that includes patients’ perspectives of desired outcomes. Improving preoperative patient education while reducing unnecessary testing, improving postoperative pain management, and reducing postoperative nausea and vomiting may help enhance patient satisfaction. The functional status of most patients is reduced postoperatively, and thus the pattern of recovery is an area of ongoing research. Standardized and validated psychometric questionnaires such as Quality of Recovery-40 and Postoperative Quality of Recovery Scale are potential tools to assess this. Patient satisfaction has been identified as an important outcome measure and dedicated tools to assess this in various clinical settings are needed. Identification of key aspects of ambulatory surgery deemed important from patients’ perspectives, and implementation of validated outcome questionnaires, are important in improving patient centered care and patient satisfaction.Keywords: ambulatory, patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  20. Variation in Antibiotic Susceptibility of Uropathogens by Age among Ambulatory Pediatric Patients

    Science.gov (United States)

    Quach, Yennie; Bearden, David T.; Smith, David H.; Sharp, Susan E.; Guzman-Cottrill, Judith A.

    2013-01-01

    We compared uropathogen antibiotic susceptibility across age groups of ambulatory pediatric patients. For Escherichia coli (n=5,099) and other Gram-negative rods (n=626), significant differences (purinary anti-infectives may be lower in the youngest children. Further investigation into these differences is needed to facilitate appropriate and prudent treatment of urinary tract infections. PMID:24091131

  1. A Clinical Experience of Dental Treatment under Ambulatory General Anesthesia for A Disabled Patient Who Accepts Only One Favorite Dental Chair

    OpenAIRE

    佐藤, 潤; 川合, 宏仁; 山崎, 信也; 相澤, 徳久; 島村, 和宏; 鈴木, 康生; サトウ, ジュン; カワイ, ヒロヨシ; ヤマザキ, シンヤ; アイザワ, ノリヒサ; シマムラ, カズヒロ; スズキ, ヤスオ; Jun, SATO; Hiroyoshi, KAWAAI; Shinya, YAMAZAKI

    2007-01-01

    In our hospital, we have many cases of ambulatory general anesthesia in the dental treatment of disabled patients. However, if the disability patients have strong refusal to enter the general anesthesia room due to strong phobia, we can not apply the general anesthesia induction. We experienced a dental treatment under ambulatory general anesthesia of a disabled patient who could not sit on any dental chair except for his favorite one. The patient was a 16-year-old boy. He was diagnosed Down ...

  2. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    monitoring was significantly lower than heart rate at the onset of ST-segment change during exercise testing (100.2 +/- 14.6 vs. 115.8 +/- 19.6 beats/min, p less than 0.01), which may indicate different pathophysiological mechanisms. Transient impairment in coronary oxygen supply seems to be of importance......Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication...

  3. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  4. Indirect measurement of lymphatic absorption with inulin in continuous ambulatory peritoneal dialysis (CAPD) patients

    NARCIS (Netherlands)

    Struijk, D. G.; Krediet, R. T.; Koomen, G. C.; Boeschoten, E. W.; vd Reijden, H. J.; Arisz, L.

    1990-01-01

    To elucidate the importance of possible trapping of macromolecules in peritoneal tissue on the calculation of peritoneal lymphatic drainage, we compared the transport of inulin administered i.v. and i.p. in nine continuous ambulatory peritoneal dialysis (CAPD) patients on two separate days. In the

  5. Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

    Science.gov (United States)

    Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

    2010-01-01

    Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

  6. Perceived illness intrusions among continuous ambulatory peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Usha Bapat

    2012-01-01

    Full Text Available To study the perceived illness intrusion of continuous ambulatory peritoneal dialysis (CAPD patients, to examine their demographics, and to find out the association among demographics, duration of illness as well as illness intrusion, 40 chronic kidney disease stage V patients on CAPD during 2006-2007 were studied. Inclusion criteria were patients′ above 18 years, willing, stable, and completed at least two months of dialysis. Those with psychiatric co-morbidity were excluded. Sociodemographics were collected using a semi-structured interview schedule. A 14-item illness intrusion checklist covering various aspects of life was administered. The subjects had to rate the illness intrusion in their daily life and the extent of intrusion. The data was analyzed using descriptive statistics and chi square test of association. The mean age of the subjects was 56.05 ± 10.05 years. There was near equal distribution of gender. 82.5% were married, 70.0% belonged to Hindu religion, 45.0% were pre-degree, 25.0% were employed, 37.5% were housewives and 30.0% had retired. 77.5% belonged to the upper socioeconomic strata, 95.0% were from an urban background and 65.0% were from nuclear families. The mean duration of dialysis was 19.0 ± 16.49 months. Fifty-eight percent of the respondents were performing the dialysis exchanges by themselves. More than 95.0%were on three or four exchanges per day. All the 40 subjects reported illness intrusion in their daily life. Intrusion was perceived to some extent in the following areas: health 47.5%, work 25.0%, finance 37.5%, diet 40.0%, and psychological 50.0%. Illness had not intruded in the areas of relationship with spouse 52.5%, sexual life 30.0%, with friends 92.5%, with family 85.5%, social functions 52.5%, and religious functions 75.0%. Statistically significant association was not noted between illness intrusion and other variables. CAPD patients perceived illness intrusion to some extent in their daily life

  7. Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

    Science.gov (United States)

    Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth

    2000-01-01

    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis. PMID:10618142

  8. Disease Management Plus Recommended Care versus Recommended Care Alone for Ambulatory COPD Patients.

    Science.gov (United States)

    Kalter-Leibovici, Ofra; Benderly, Michal; Freedman, Laurence S; Kaufman, Galit; Molcho Falkenberg Luft, Tchiya; Murad, Havi; Olmer, Liraz; Gluch, Meri; Segev, David; Gilad, Avi; Elkrinawi, Said; Cukierman-Yaffe, Tali; Chen, Baruch; Jacobson, Orit; Key, Calanit; Shani, Mordechai; Fink, Gershon

    2018-03-01

    The efficacy of disease management programs in the treatment of patients with chronic obstructive pulmonary disease (COPD) remains uncertain. To study the effect of disease management (DM) added to recommended care (RC) in ambulatory COPD patients. In this trial, 1,202 COPD patients (age >40 years), with moderate to very severe airflow limitation were randomly assigned either to DM plus RC (study intervention) or to RC alone (control intervention). RC included follow-up by pulmonologists; inhaled long-acting bronchodilators and corticosteroids; smoking cessation intervention; nutritional advice and psychosocial support when indicated, and supervised physical activity sessions. DM, delivered by trained nurses during patients' visits to the designated COPD centers and remote contacts with the patients between these visits, included patient self-care education; monitoring patients' symptoms and adherence to treatment; provision of advice in case of acute disease exacerbation, and coordination of care vis-à-vis other healthcare providers. The primary composite endpoint was first hospital admission for respiratory symptoms or death from any cause. During 3,537 patient-years, 284 (47.2%) patients in the control group and 264 (44.0%) in the study intervention group had a primary endpoint event. The median (range) time elapsed until a primary endpoint event was 1.0 (0-4.0) years among patients assigned to the study intervention and 1.1 (0-4.1) years among patients assigned to the control intervention; adjusted hazard ratio, 0.92 (95%CI: 0.77 to 1.08). DM added to RC was not superior to RC alone in delaying first hospital admission or death among ambulatory COPD patients. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00982384.

  9. Ambulatory blood pressure monitoring: Is 24 hours necessary?

    Science.gov (United States)

    Vornovitsky, Michael; McClintic, Benjamin R; Beck, G Ronald; Bisognano, John D

    2013-01-01

    The variability of blood pressure (BP) makes any single measurement a poor indicator of a patient's true BP. Multiple studies have confirmed the superiority of ambulatory BP measurements over clinic BP measurements in predicting cardiovascular risk; however, this method presents the problem of patient acceptance as it causes frequent arm discomfort and sleep disturbance. We hypothesized that 6 h of daytime BP measurements would result in slightly higher BP readings, yet reveal similar clinical decision making when compared to 24 h of BP measurements. The source for writing this article was a retrospective analysis of 30 patients who underwent ambulatory BP monitoring. Data obtained included: age, sex, ethnicity, baseline medical problems, medications, laboratory values, reason given for ordering 24-h ambulatory BP measurements, ambulatory BP measurements, and a subsequent decision to change medication. The average BP of the 24-h measurements was 127/75 mm Hg and the average BP of the 6-h daytime measurements was 131/79 mm Hg (SD 15, p = 0.009). Twenty-six out of 30 patients were at goal or pre-hypertensive. Two out of 30 patients had stage 1 hypertension and 2 out of 30 patients had stage 2 hypertension. Thirteen out of 30 patients had nocturnal dipping. Twelve out of 30 patients had a change in medication, but those changes were not associated with the presence or absence of nocturnal dipping (p = 0.5) or other factors beyond mean BP. Although there was a statistically significant, 4 mm Hg systolic difference between 24-h and 6-h average BP readings, there was no evidence that this difference led to changes in clinical management. The presence or absence of nocturnal dipping was not associated with a change in medication. We conclude that 6-h daytime ambulatory BP measurements provide sufficient information to guide clinical decision making without the problems of patient acceptance, arm discomfort, and sleep disturbance associated with 24-h BP measurements.

  10. Patients' quality of life and role of the ambulatory in after-surgery stoma care. A single center experience.

    Science.gov (United States)

    Magistri, Paolo; Scordamaglia, Maria Rosa; Giulitti, Diego; Papaspyropoulos, Vassilios; Eleuteri, Edoardo; Coppola, Marcello

    2014-01-01

    The aim is to assess on which aspects of everyday-life the post surgery stoma-care ambulatory should physically and psychologically assist the patients. Seventy patients (33 male, 37 female, mean age 68 years) accepted to fill-in the Stoma-QoL questionnaire from January to December 2011. The questionnaire consists of 20 questions addressing different possible discomforts of everyday life. Our results demonstrate that patients with temporary ileostomy have a mean score of quality of life index of 63. Patients with ileostomy demonstrated a higher quality of life score compared to patients with colostomy. Our results confirmed that patients with ileostomy have a better perception of quality of life compared to patients with colostomy. Moreover, our data clearly show that patients are more concerned on stoma management compared to the hypothetical prejudice of society. The stoma care ambulatory have a crucial role, offering to the patient and his/her family an adequate psychological support, and teaching the management of the stoma and the pouch.

  11. Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

    DEFF Research Database (Denmark)

    Joffe, P; Olsen, F; Heaf, J G

    1989-01-01

    Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the d...

  12. Microbiological aspects of peritonitis in patients on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    S Vikrant

    2013-01-01

    Full Text Available The objective of the study was to identify the microbiological spectrum and drug-sensitivity pattern of peritonitis in patients on continuous ambulatory peritoneal dialysis. This was a prospective study done over a period of a year-and-a-half at a tertiary-care hospital in a hilly state of India. The effluent dialysate bags from 36 consecutive patients with peritonitis were studied. One hunderd ml dialysate fluid was processed under aseptic conditions by lysis centrifugation method. Microscopy and culture was done from the deposits for bacteriological, fungal, and mycobacterial isolates. They were identified by colony morphology and their biochemical reactions. Drug susceptibility testing was done by Kirby-Bauer disc diffusion method. In 36 dialysates, 33 (91.6% dialysates were culture-positive and in 3 (8.4%, the culture was negative. A total of 36 microorganisms were isolated in 33 cultures. Among the 36 microorganisms, 19 (52.8% isolates were gram-positive, 10 (27.8% were gram-negative, 5 (13.9% were fungi, and 2 (5.6% were mycobacterial isolates. All gram-positive organisms were sensitive to ampicillin, amoxi-clavulanic acid, cefazolin, clindamycin, and vancomycin. Neither a methicillin-resistant Staphylococci aureus nor a vancomycin-resistant Enterococcus was isolated in gram-positive isolates. Gram-negative organisms were sensitive to ciprofloxacin, ceftriaxone, ceftazidime, cefepime, gentamicin, piperacillin-tazobactam and imipenem. One of the gram-negative isolate was an extended spectrum beta-lactamase producer. Gram-positive peritonitis was more frequent than gram-negative peritonitis in our continuous ambulatory peritoneal dialysis patients. Mycobacterial causes were responsible for peritonitis in patients with culture-negative peritonitis which was not responding to the conventional antimicrobial therapy.

  13. Physical Activity Level of Ambulatory Stroke Patients: Is it Related to Neuropsychological Factors?

    Science.gov (United States)

    Ersöz Hüseyinsinoğlu, Burcu; Kuran Aslan, Gökşen; Tarakci, Devrim; Razak Özdinçler, Arzu; Küçükoğlu, Hayriye; Baybaş, Sevim

    2017-06-01

    Physical inactivity is an important risk factor for stroke and stroke recurrence. There is insufficient knowledge about the physical activity (PA) level in stroke patients who are ambulatory in the subacute phase. Our aim was to compare the PA level between ambulatory stroke patients and a population of the same age and to investigate neuropsychological factors that could affect the PA level in the same stroke group. Eighty-five subacute stroke patients and 58 healthy subjects were included. Patients' demographic features, disease-related features, and comorbidities were recorded. The PA level was assessed by the International Physical Activity Questionnaire-Short Version and a pedometer (OMRON Walking style II). The Apathy Rating Scale was applied to determine the apathy level. Depression level was investigated by the Geriatric Depression Scale. The standardized Mini-mental State Examination was performed to assess the cognitive status. The PA level was significantly higher in the healthy group than in the stroke group (plevel of men was significantly higher than that of women (p=0.03). Participants who were classified as level 4 had a lower PA level than those who were classified as level 5 according to the Functional Ambulation Category. There was no relationship between the PA level and the apathy, cognitive, and depression levels in the stroke patients (p>0.05). Subacute stroke patients have a lower PA level than healthy subjects. This is not related to neuropsychological factors. The reasons for minor deficits related to ambulation should be researched further while developing strategies for increasing the PA level of subacute stroke patients.

  14. [Residual renal function and nutritional status in patients on continuous ambulatory peritoneal dialysis].

    Science.gov (United States)

    Jovanović, Natasa; Lausević, Mirjana; Stojimirović, Biljana

    2005-01-01

    During the last years, an increasing number of patients with end-stage renal failure caused by various underlying diseases, all over the world, is treated by renal replacement therapy. NUTRITIONAL STATUS: Malnutrition is often found in patients affected by renal failure; it is caused by reduced intake of nutritional substances due to anorexia and dietary restrictions hormonal and metabolic disorders, comorbid conditions and loss of proteins, amino-acids, and vitamins during the dialysis procedure itself. Nutritional status significantly affects the outcome of patients on chronic dialysis treatment. Recent epiodemiological trials have proved that survival on chronic continuous ambulatory peritoneal dialysis program depends more on residual renal function (RRF) than on peritoneal clearances of urea and creatinine. The aim of the study was to analyze the influence of RRF on common biochemical and anthropometric markers of nutrition in 32 patients with end-stage renal failure with various underlying diseases during the first 6 months on continuous ambulatory peritoneal dialysis (CAPD). The mean residual creatinine clearance was 8,3 ml/min and the mean RRF was 16,24 l/week in our patients at the beginning of the chronic peritoneal dialysis treatment. During the follow-up, the RRF slightly decreased, while the nutritional status of patients significantly improved. Gender and age, as well as the leading disease and peritonitis didn't influence the RRF during the first 6 months of CAPD treatment. We found several positive correlations between RRF and laboratory and anthropometric markers of nutrition during the follow-up, proving the positive influence of RRF on nutritional status of patients on chronic peritoneal dialysis.

  15. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  16. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

    Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

  17. Nurse-led case management for ambulatory complex patients in general health care: A systematic review

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.

    2007-01-01

    Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized

  18. US National Practice Patterns in Ambulatory Operative Management of Lateral Epicondylitis.

    Science.gov (United States)

    Buller, Leonard T; Best, Matthew J; Nigen, David; Ialenti, Marc; Baraga, Michael G

    2015-12-01

    Lateral epicondylitis is a common cause of elbow pain, frequently responsive to nonoperative management. There are multiple operative techniques for persistently symptomatic patients who have exhausted conservative therapies. Little is known regarding US national trends in operative management of lateral epicondylitis. We conducted a study to investigate changes in use of ambulatory procedures for lateral epicondylitis. Cases of lateral epicondylitis were identified using the National Survey of Ambulatory Surgery and were analyzed for trends in demographics and use of ambulatory surgery. Between 1994 and 2006, the population-adjusted rate of ambulatory surgical procedures increased from 7.29 to 10.44 per 100,000 capita. The sex-adjusted rate of surgery for lateral epicondylitis increased by 85% among females and decreased by 31% among males. Most patients were between ages 40 and 49 years, and the largest percentage increase in age-adjusted rates was found among patients older than 50 years (275%) between 1994 and 2006. Use of regional anesthesia increased from 17% in 1994 to 30% in 2006. Private insurance remained the most common payer. Awareness of the increasing use of ambulatory surgery for lateral epicondylitis may lead to changes in health care policies and positively affect patient care.

  19. Preliminary study of percutaneous nephrolithotomy on an ambulatory basis.

    Science.gov (United States)

    El-Tabey, Magdy Ahmed; Abd-Allah, Osama Abdel-Wahab; Ahmed, Ahmed Sebaey; El-Barky, Ehab Mohammed; Noureldin, Yasser Abdel-Sattar

    2013-02-01

    Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.

  20. Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients

    NARCIS (Netherlands)

    Krediet, R. T.; Zuyderhoudt, F. M.; Boeschoten, E. W.; Arisz, L.

    1987-01-01

    The in situ intraperitoneal volume and the mass transfer area coefficients (MTC) of urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG were studied in eight continuous ambulatory peritoneal dialysis (CAPD) patients. All patients were studied during a 4-h

  1. Suttonella indologenes peritonitis in a patient receiving continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Nurhayat Ozkan Sevencan

    2018-01-01

    Full Text Available Suttonella indologenes is a Gram-negative, aerobic coccobacillus of Cardiobacteriaceae family and its natural habitat is the mucous membranes of the upper respiratory system. The literature includes limited number of case reports concerning fatal endocarditis due to infection in the prosthetic heart valves caused by the aforementioned microorganism. However, there is no information on extracardiac involvement due to this microorganism. Here, we present a peritonitis case caused by Suttonella indologenes in a patient receiving continuous ambulatory peritoneal dialysis.

  2. The Efficacy of Lavender Aromatherapy in Reducing Preoperative Anxiety in Ambulatory Surgery Patients Undergoing Procedures in General Otolaryngology

    Science.gov (United States)

    Wotman, Michael; Levinger, Joshua; Leung, Lillian; Kallush, Aron; Mauer, Elizabeth

    2017-01-01

    Background Preoperative anxiety is a common problem in hospitals and other health care centers. This emotional state has been shown to negatively impact patient satisfaction and outcomes. Aromatherapy, the therapeutic use of essential oils extracted from aromatic plants, may offer a simple, low‐risk and cost‐effective method of managing preoperative anxiety. The purpose of this study was to evaluate the efficacy of lavender aromatherapy in reducing preoperative anxiety in ambulatory surgery patients undergoing procedures in general otolaryngology. Methods A prospective and controlled pilot study was conducted with 100 patients who were admitted to New York‐Presbyterian/Weill Cornell Medical Center for ambulatory surgery from January of 2015 to August of 2015. The subjects were allocated to two groups; the experimental group received inhalation lavender aromatherapy in the preoperative waiting area while the control group received standard nursing care. Both groups reported their anxiety with a visual analog scale (VAS) upon arriving to the preoperative waiting area and upon departure to the operating room. Results According to a Welch's two sample t‐test, the mean reduction in anxiety was statistically greater in the experimental group than the control group (p = 0.001). Conclusion Lavender aromatherapy reduced preoperative anxiety in ambulatory surgery patients. This effect was modest and possibly statistically significant. Future research is needed to confirm the clinical efficacy of lavender aromatherapy. Level of Evidence 2b PMID:29299520

  3. Does clinical exposure matter? Pilot assessment of patient visits in an urban family medicine residency program.

    Science.gov (United States)

    Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul

    2018-01-01

    To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.

  4. Redesigning the regulatory framework for ambulatory care services in New York.

    Science.gov (United States)

    Chokshi, Dave A; Rugge, John; Shah, Nirav R

    2014-12-01

    Policy Points: The landscape of ambulatory care services in the United States is rapidly changing on account of payment reform, primary care transformation, and the rise of convenient care options such as retail clinics. New York State has undertaken a redesign of regulatory policy for ambulatory care rooted in the Triple Aim (better health, higher-quality care, lower costs)-with a particular emphasis on continuity of care for patients. Key tenets of the regulatory approach include defining and tracking the taxonomy of ambulatory care services as well as ensuring that convenient care options do not erode continuity of care for patients. While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory

  5. Risk of postoperative hypoxemia in ambulatory orthopedic surgery patients with diagnosis of obstructive sleep apnea: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    Ma Yan

    2010-06-01

    Full Text Available Abstract Background It is unclear when it is safe to discharge patients with a diagnosis of Obstructive Sleep Apnea (OSA after ambulatory surgical procedures due to concern for postoperative respiratory compromise and hypoxemia. Our OSA patients undergoing ambulatory-type orthopedic procedures are monitored overnight in the PACU, thus we reviewed patient records to determine incidence of complications. Methods Two hundred and six charts of patients with preoperative diagnosis of OSA based on ICD-9 codes were reviewed for outcomes including episodes of hypoxemia. Univariate analysis followed by logistic regression and propensity analysis was performed to determine independent risk factors for hypoxemia and association with adverse outcomes. Results The majority of patients had regional anesthesia (95%. Thirty four percent of patients had hypoxemia in the PACU. Initial risk factors for hypoxemia identified by univariate analysis were BMI ≥ 35, increased age, history of COPD, upper extremity procedure, and use of peripheral nerve block. Independent risk factors identified by logistic regression were history of COPD (OR 3.64 with 95% CI 1.03-12.88 and upper extremity procedure (2.53, 1.36-4.68. After adjustment with propensity scores, adverse events were rare, and unplanned hospital admission after PACU stay was not increased with hypoxemia (11% vs 16% Conclusions Episodes of postoperative hypoxemia in OSA patients undergoing ambulatory surgery with regional anesthesia are not associated with increased adverse outcomes or unplanned hospital admission.

  6. Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

    Directory of Open Access Journals (Sweden)

    Fernando Nobre

    2002-02-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

  7. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  8. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  9. Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial.

    Science.gov (United States)

    De Oliveira, Gildasio S; Rodes, Meghan E; Bialek, Jane; Kendall, Mark C; McCarthy, Robert J

    2017-11-15

    Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial. Healthy female subjects were randomized to receive 1 g single dose systemic acetaminophen at the end of the surgery or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman rho. P quality of recovery, P = .007. A single dose of systemic acetaminophen improves patient reported quality of recovery after ambulatory breast surgery. The use of systemic acetaminophen is an efficacious strategy to improve patient perceived quality of postsurgical recovery and analgesic outcomes after hospital discharge for ambulatory breast surgery. © 2017 Wiley Periodicals, Inc.

  10. The value of registered nurses in ambulatory care settings: a survey.

    Science.gov (United States)

    Mastal, Margaret; Levine, June

    2012-01-01

    Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.

  11. The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients

    Directory of Open Access Journals (Sweden)

    Nihal Ozkayar

    2016-11-01

    Full Text Available High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV. This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female with a mean age of 50.7 ± 11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r = 0.371 and p = 0.001, r = 0.329 and p = 0.028, respectively. Similarly, log(24-h urinary sodium was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r = 0.381 and p = 0.001, r = 0.320 and p = 0.020 respectively. Log(24-h urinary sodium was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV.

  12. The ten successful elements of an ambulatory care center.

    Science.gov (United States)

    Watkins, G

    1997-01-01

    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  13. Real efficiency of ambulatory laser treatment at the patients with different rheumatic diseases

    Science.gov (United States)

    Sidenco, Elena-Luminita; Ristache, Sanda; Belu, Luminita

    2001-06-01

    We consulted 189 patients, with different locomotory diseases: degenerative, posttraumatic and chronic inflammatory rheumatic diseases. We followed the main clinical parameters: pain, limitation of mobility, affected function, inflammation and disorders of sensitivity. We applied an infrared LASER source of 100 mW (BTL), daily, for 5 days. The tolerance of the patients at the LASER treatment was excellent (100%). The evolution of the clinical parameters was variated, but inflammation, limitation of mobility and the affected function significantly improved (30-50%). We found a significant diminution of pain (27- 39%). We believe the LASER treatment in ambulatory conditions is essential for the function of the patients with different locomotory diseases.

  14. Ambulatory blood pressure monitoring in daily clinical practice - the Spanish ABPM Registry experience.

    Science.gov (United States)

    Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M

    2016-01-01

    Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  15. Characteristics and significance of ischemia detected by ambulatory electrocardiographic monitoring

    International Nuclear Information System (INIS)

    Nabel, E.G.; Rocco, M.B.; Selwyn, A.B.

    1987-01-01

    Ambulatory electrocardiographic (ECG) monitoring of ischemia in patients with coronary artery disease (CAD) provides a new technique for the assessment of ischemic activity and the evaluation of therapies outside of the hospital. Numerous studies have demonstrated that the majority of patients with CAD have episodes of symptomatic and asymptomatic ST segment depression during routine daily activities. Rubidium-82 positron-emission tomographic studies have provided evidence for decreased myocardial perfusion during these episodes of ST segment depression. The prognostic importance of asymptomatic ischemia has been shown in patients with unstable angina to be a marker for early unfavorable cardiac events. Preliminary results suggest a poorer outcome for those patients with chronic stable angina who show episodes of ischemia as well. Ambulatory monitoring studies suggest that total ischemic activity may be underestimated by conventional testing. Whether all ischemic activity detected by ambulatory monitoring requires treatment awaits further study. 69 references

  16. Paecilomyces variotii peritonitis in a patient on continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Uzunoglu, E; Sahin, A M

    2017-06-01

    Paecilomyces variotii (P. variotii) is an extremely rare cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. When diagnosed, it usually portends poor prognosis. Patient's survival depends on early laboratory diagnosis and proper treatment. We herein report a P. variotii peritonitis in a patient on CAPD which is a quite rare clinical entity. Laboratory diagnosis was confirmed via both morphological analysis and DNA sequencing. Antifungal susceptibility tests were performed and interpreted according to the Clinical Laboratory Standards Institute M38-A2 guidelines. After laboratory diagnosis, the patient was treated succesfully with liposomal amphotericin B and itraconazole combination and the peritoneal catheter was removed. This case is worthy of reporting since P. variotii is an uncommon cause of peritonitis and leads to dilemmas in both laboratory diagnosis and treatment strategies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  18. Ambulatory care registered nurse performance measurement.

    Science.gov (United States)

    Swan, Beth Ann; Haas, Sheila A; Chow, Marilyn

    2010-01-01

    On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.

  19. Cisapride does not alter gastric volume or pH in patients undergoing ambulatory surgery.

    LENUS (Irish Health Repository)

    Lydon, A

    2012-02-03

    PURPOSE: To evaluate the efficacy of 20 mg cisapride p.o. in reducing residual gastric volume and pH in adult ambulatory surgical patients. METHODS: Using a prospective randomised double-blind controlled design, we administered either 20 mg cisapride p.o. or placebo preoperatively to 64 ASA 1-2 ambulatory surgical patients. Following induction of anesthesia we measured volume and pH of residual gastric contents, using blind aspiration through an orogastric tube. Parametric data were analysed using unpaired, one tail Students\\' t test. Non-parametric data were analysed using Fishers Exact test and Chi square analysis. Statistical significance was accepted at the probability level of < 0.05. RESULTS: Residual gastric volumes were similar in the two groups (19.5 +\\/- 23.8, 23.9 +\\/- 24.4 ml), in the cisapride and placebo groups respectively, P=0.24). Data shown are mean (+\\/- SD). The proportions of patients with a residual gastric volume exceeding 0.4 ml x kg(-1) were similar in the two groups (4 of 28, and 8 of 23 patients in the cisapride and placebo groups respectively, P=0.09). The pH of the residual gastric contents were similar in the cisapride and placebo groups (1.6 +\\/- 0.5, 1.4 +\\/- 0.5, respectively, P=0.26). The proportions of patients with pH < 2.5 was also similar in the cisapride and placebo groups (21 of 25, and 20 of 21 patients respectively, P=0.2). CONCLUSIONS: Preoperative administration of 20 mg cisapride p.o. to patients scheduled for outpatient surgery does not alter either the volume or the pH of gastric contents. Its use in this setting is of no apparent clinical benefit.

  20. Beyond the clinic: redefining hospital ambulatory care.

    Science.gov (United States)

    Rogut, L

    1997-07-01

    Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff

  1. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

    Directory of Open Access Journals (Sweden)

    Almog Levi

    Full Text Available Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI. Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI cure rate in patients with mixed urinary incontinence (MUI, intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10 and from the local anesthesia. Visual analog scale (VAS rating was low during and after the procedure (2.38 and 2.69 respectively. Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

  2. Relapsing peritonitis with Bacillus cereus in a patient on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Magnussen, Eyð Tausen; Vang, Amanda Gratton; á Steig, Torkil

    2016-01-01

    We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period....... Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin. As a result of the relapsing B....... cereus peritonitis diagnosis and a CT scan showing contraction of the peritoneum after longstanding inflammation, the peritoneal catheter was removed and the patient converted to haemodialysis. To date, the patient has not been readmitted due to peritonitis. A lack of proper hygiene when changing...

  3. The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients.

    Science.gov (United States)

    Ozkayar, Nihal; Dede, Fatih; Ates, Ihsan; Akyel, Fatma; Yildirim, Tolga; Altun, Bulent

    High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV). This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female) with a mean age of 50.7±11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium)] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r=0.371 and p=0.001, r=0.329 and p=0.028, respectively). Similarly, log(24-h urinary sodium) was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r=0.381 and p=0.001, r=0.320 and p=0.020 respectively). Log(24-h urinary sodium) was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Cuff inflation during ambulatory blood pressure monitoring and heart rate

    Directory of Open Access Journals (Sweden)

    Mia Skov-Madsen

    2008-11-01

    Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension

  5. Infection Prevention and Control in Pediatric Ambulatory Settings.

    Science.gov (United States)

    Rathore, Mobeen H; Jackson, Mary Anne

    2017-11-01

    Since the American Academy of Pediatrics published its statement titled "Infection Prevention and Control in Pediatric Ambulatory Settings" in 2007, there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent the transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated every 2 years, and enforced. Many of the recommendations for infection control and prevention from the Centers for Disease Control and Prevention for hospitalized patients are also applicable in the ambulatory setting. These recommendations include requirements for pediatricians to take precautions to identify and protect employees likely to be exposed to blood or other potentially infectious materials while on the job. In addition to emphasizing the key principles of infection prevention and control in this policy, we update those that are relevant to the ambulatory care patient. These guidelines emphasize the role of hand hygiene and the implementation of diagnosis- and syndrome-specific isolation precautions, with the exemption of the use of gloves for routine diaper changes and wiping a well child's nose or tears for most patient encounters. Additional topics include respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection, including those relevant for special populations like patients with cystic fibrosis or those in short-term residential facilities; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices; appropriate use of personal

  6. Ambulatory Melanoma Care Patterns in the United States

    International Nuclear Information System (INIS)

    Ji, A. L.; Davis, S. A.; Feldman, S. R.; Fleischer, A. B.; Baze, M. R.; Feldman, S. R.; Feldman, S. R.; Fleischer, A. B.

    2013-01-01

    To examine trends in melanoma visits in the ambulatory care setting. Methods. Data from the National Ambulatory Medical Care Survey (NAMCS) from 1979 to 2010 were used to analyze melanoma visit characteristics including number of visits, age and gender of patients, and physician specialty. These data were compared to US Census population estimates during the same time period. Results. The overall rate of melanoma visits increased (ρ< 0.0001) at an apparently higher rate than the increase in population over this time. The age of patients with melanoma visits increased at approximately double the rate (0.47 year per interval year, ρ< 0.0001) of the population increase in age (0.23 year per interval year). There was a nonsignificant(ρ=0.19) decline in the proportion of female patients seen over the study interval. Lastly, ambulatory care has shifted towards dermatologists and other specialties managing melanoma patients and away from family/internal medicine physicians and general/plastic surgeons. Conclusions. The number and age of melanoma visits has increased over time with respect to the overall population, mirroring the increase in melanoma incidence over the past three decades. These trends highlight the need for further studies regarding melanoma management efficiency

  7. Infection management following ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Chin AB

    2015-10-01

    Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

  8. Side effects of ambulatory blood pressure monitoring.

    NARCIS (Netherlands)

    Steen, M.S. van der; Lenders, J.W.M.; Thien, Th.

    2005-01-01

    OBJECTIVE: To study the experiences and complaints of patients who underwent 24 h blood pressure monitoring. METHODS: Two groups of hypertensive patients of a tertiary outpatient clinic were asked to fill in a nine-item questionnaire about the side effects of ambulatory blood pressure monitoring

  9. Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting.

    Science.gov (United States)

    Le-Abuyen, Sheila; Ng, Jessica; Kim, Susie; De La Franier, Anne; Khan, Bibi; Mosley, Jane; Gardam, Michael

    2014-04-01

    A survey pilot asked patients to observe the hand hygiene compliance of their health care providers. Patients returned 75.1% of the survey cards distributed, and the overall hand hygiene compliance was 96.8%. Survey results and patient commentary were used to motivate hand hygiene compliance. The patient-as-observer approach appeared to be a viable alternative for hand hygiene auditing in an ambulatory care setting because it educated, engaged, and empowered patients to play a more active role in their own health care. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Pathway to Best Practice in Spirometry in the Ambulatory Setting.

    Science.gov (United States)

    Peracchio, Carol

    2016-01-01

    Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

  11. Clinical value of ambulatory blood pressure: evidence and limits.

    Science.gov (United States)

    Mancia, Giuseppe; Verdecchia, Paolo

    2015-03-13

    This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ

  12. Ambulatory phlebectomy under tumescent local anesthesia in a kidney-transplant patient

    Directory of Open Access Journals (Sweden)

    Bjelanović Zoran

    2013-01-01

    Full Text Available Introduction. Tumescent local anesthesia (TLA is widely used for ambulatory surgery. Patients with transplanted organs are on immunosuppressive therapy and with risk for organ rejection or severe infection. Case report. Saphenectomy with phlebectomy on the left leg under TLA was performed in a patient with kidney transplantation performed four years ago. A combination of 35 mg of 1% prilocaine-hydrochloride, 5 mL of 8.4% sodium bicarbonate and 500 μg of epinephrine in 460 mL of normal saline was used for TLA. Overall 750 mL of the solution was used. The patient had satisfactory postoperative analgesia and was discharged home on the same day. Blood levels of urea, creatinine, estimated glomerular filtration rate (eGFR and tacrolimus concentration, measured preoperatively and on the second postoperative day, were in a regular range. Prilocaine blood concentrations determined on the 4th, 10th and 16th postoperative hours, were below toxic levels. Conclusion. TLA in a kidney-transplanted patient performed for saphenectomy with phlebectomy proved to be a safe and reliable anesthesia method.

  13. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  14. Relationship between systemic hemodynamics and ambulatory blood pressure level are sex dependent.

    Science.gov (United States)

    Alfie, J; Waisman, G D; Galarza, C R; Magi, M I; Vasvari, F; Mayorga, L M; Cámera, M I

    1995-12-01

    Sex-related differences in systemic hemodynamics were analyzed by means of cardiac index and systemic vascular resistance according to the level of daytime ambulatory blood pressure. In addition, we assessed the relations between ambulatory blood pressure measurements and systemic hemodynamics in male and female patients. We prospectively included 52 women and 53 men referred to our unit for evaluation of arterial hypertension. Women and men were grouped according to the level of daytime mean arterial pressure: or = 110 mm Hg. Patients underwent noninvasive evaluation of resting hemodynamics (impedance cardiography) and 24-hour ambulatory blood pressure monitoring. Compared with women men with lower daytime blood pressure had a 12% higher systemic vascular resistance index (P = NS) and a 14% lower cardiac index (P < .02), whereas men with higher daytime blood pressure had a 25% higher vascular resistance (P < .003) and a 21% lower cardiac index (P < .0004). Furthermore, in men systemic vascular resistance correlated positively with both daytime and nighttime systolic and diastolic blood pressures, whereas cardiac index correlated negatively only with daytime diastolic blood pressure. In contrast, women did not exhibit any significant correlation between hemodynamic parameters and ambulatory blood pressure measurements. In conclusion, sex-related differences in systemic hemodynamics were more pronounced in the group with higher daytime hypertension. The relations between systemic hemodynamics and ambulatory blood pressure level depended on the sex of the patient. In men a progressive circulatory impairment underlies the increasing level of ambulatory blood pressure, but this was not observed in women.

  15. Comparison of Central, Ambulatory, Home and Office Blood Pressure Measurement as Risk Markers for Mild Cognitive Impairment in Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Teodora Yaneva-Sirakova

    2017-08-01

    Full Text Available Aims: We compared the role of central blood pressure (BP, ambulatory BP monitoring (ABPM, home-measured BP (HMBP and office BP measurement as risk markers for the development of mild cognitive impairment (MCI. Methods: 70 hypertensive patients on combination medical therapy were studied. Their mean age was 64.97 ± 8.88 years. Eighteen (25.71% were males and 52 (74.28% females. All of the patients underwent full physical examination, laboratory screening, echocardiography, and office, ambulatory, home and central BP measurement. The neuropsychological tests used were: Mini Mental State Examination (MMSE and Montreal Cognitive Assessment (MoCA. SPSS 19 was used for the statistical analysis with a level of significance of 0.05. Results: The mean central pulse pressure values of patients with MCI were significantly (p = 0.016 higher than those of the patients without MCI. There was a weak negative correlation between central pulse pressure and the results from the MoCA and MMSE (r = –0.283, p = 0.017 and r = –0.241, p = 0.044, respectively. There was a correlation between ABPM and MCI as well as between HMBP and MCI. Conclusions: The correlation of central BP with target organ damage (MCI is as good as for the other types of measurements of BP (home and ambulatory. Office BP seems to be the poorest marker for the assessment of target organ damage.

  16. A prospective observational study comparing a physiological scoring system with time-based discharge criteria in pediatric ambulatory surgical patients.

    Science.gov (United States)

    Armstrong, James; Forrest, Helen; Crawford, Mark W

    2015-10-01

    Discharge criteria based on physiological scoring systems can be used in the postanesthesia care unit (PACU) to fast-track patients after ambulatory surgery; however, studies comparing physiological scoring systems with traditional time-based discharge criteria are lacking. The purpose of this study was to compare PACU discharge readiness times using physiological vs time-based discharge criteria in pediatric ambulatory surgical patients. We recorded physiological observations from consecutive American Society of Anesthesiologists physical status I-III patients aged 1-18 yr who were admitted to the PACU after undergoing ambulatory surgery in a tertiary academic pediatric hospital. The physiological score was a combination of the Aldrete and Chung systems. Scores were recorded every 15 min starting upon arrival in the PACU. Patients were considered fit for discharge once they attained a score ≥12 (maximum score, 14), provided no score was zero, with the time to achieve a score ≥12 defining the criteria-based discharge (CBD) time. Patients were discharged from the PACU when both the CBD and the existing time-based discharge (TBD) criteria were met. The CBD and TBD data were compared using Kaplan-Meier and log-rank analysis. Observations from 506 children are presented. Median (interquartile range [IQR]) age was 5.5 [2.8-9.9] yr. Median [IQR] CBD and TBD PACU discharge readiness times were 30 [15-45] min and 60 [45-60] min, respectively. Analysis of Kaplan-Meier curves indicated a significant difference in discharge times using the different criteria (hazard ratio, 5.43; 95% confidence interval, 4.51 to 6.53; P < 0.001). All patients were discharged home without incident. This prospective study suggests that discharge decisions based on physiological criteria have the potential for significantly speeding the transit of children through the PACU, thereby enhancing PACU efficiency and resource utilization.

  17. Ambulatory blood pressure monitoring - comparison with office ...

    African Journals Online (AJOL)

    ambulatory blood pressure recordings in private practice ... position according to established guidelines. ... white-coat effect was defined as a difference of at least 20 .... patients with hypertension: Importance of blood pressure response to ...

  18. Dynamic characteristic of gastro-oesophageal reflux in ambulatory patients with gastro-oesophageal reflux disease and normal control subjects

    NARCIS (Netherlands)

    Weusten, B. L.; Akkermans, L. M.; vanBerge-Henegouwen, G. P.; Smout, A. J.

    1995-01-01

    BACKGROUND: The aim of the study was to investigate the dynamic characteristics of pathologic gastro-oesophageal reflux. METHODS: Five-channel ambulatory 24-h oesophageal pH monitoring was performed in 19 gastro-oesophageal reflux disease patients (age, 21-74 years) and in 19 healthy volunteers

  19. The content of hope in ambulatory patients with colon cancer.

    Science.gov (United States)

    Beckman, Emily S; Helft, Paul R; Torke, Alexia M

    2013-01-01

    Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university-based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well-being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients' hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients' hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients' goals.

  20. Ambulatory blood pressure and adherence monitoring: diagnosing pseudoresistant hypertension.

    Science.gov (United States)

    Burnier, Michel; Wuerzner, Gregoire

    2014-01-01

    A small proportion of the treated hypertensive population consistently has a blood pressure greater than 140/90 mm Hg despite a triple therapy including a diuretic, a calcium channel blocker, and a blocker of the renin-angiotensin system. According to guidelines, these patients have so-called resistant hypertension. The prevalence of this clinical condition is higher in tertiary than primary care centers and often is associated with chronic kidney disease, diabetes, obesity, and sleep apnea syndrome. Exclusion of pseudoresistant hypertension using ambulatory or home blood pressure monitoring is a crucial step in the investigation of patients with resistant hypertension. Thus, among the multiple factors to consider when investigating patients with resistant hypertension, ambulatory blood pressure monitoring should be performed very early. Among other factors to consider, physicians should investigate patient adherence to therapy, assess the adequacy of treatment, exclude interfering factors, and, finally, look for secondary forms of hypertension. Poor adherence to therapy accounts for 30% to 50% of cases of resistance to therapy depending on the methodology used to diagnose adherence problems. This review discusses the clinical factors implicated in the pathogenesis of resistant hypertension with a particular emphasis on pseudoresistance, drug adherence, and the use of ambulatory blood pressure monitoring for the diagnosis and management of resistant hypertension.

  1. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  2. Comparison of 44-hour and fixed 24-hour ambulatory blood pressure monitoring in dialysis patients.

    Science.gov (United States)

    Liu, Wenjin; Ye, Hong; Tang, Bing; Sun, Zhiping; Wen, Ping; Wu, Wenhui; Bian, Xueqing; Shen, Xia; Yang, Junwei

    2014-01-01

    The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information. ©2013 Wiley Periodicals, Inc.

  3. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  4. Wait watchers: the application of a waiting list active management program in ambulatory care.

    Science.gov (United States)

    de Belvis, Antonio Giulio; Marino, Marta; Avolio, Maria; Pelone, Ferruccio; Basso, Danila; Dei Tos, Gian Antonio; Cinquetti, Sandro; Ricciardi, Walter

    2013-04-01

    This study describes and evaluates the application of a waiting list management program in ambulatory care. Waiting list active management survey (telephone call and further contact); before and after controlled trial. Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

  5. Effect of ambulatory medicine tutorial on clinical performance of 5th year medical students.

    Science.gov (United States)

    Phisalprapa, Pochamana; Pandejpong, Denla

    2013-02-01

    The present study provided a group learning activity called "Ambulatory Medicine Tutorial-AMT" for 5th year medical students in order to facilitate learning experience at ambulatory setting and to improve medical students' clinical performance. This research aimed specifically to study the effect of AMT. Two groups of twenty 5th-year medical students were enrolled during their ambulatory medicine blocks. Each medical student was assigned to have 8 ambulatory sessions. AMT was assigned to one group while the other group only used conventional learning activity. At the end of the present study, total internal medicine scores, patient satisfaction surveys, and data on average time spent on each clinical encounter were collected and compared. The AMT group received a higher total internal medicine score as compared to the conventional group (76.2 +/- 3.6 vs. 72.9 +/- 2.8, p = 0.003). The AMT group could reduce average time spent on each clinical encounter within their first-6 ambulatory sessions while the conventional group could acquire the same skill later in their last 2 ambulatory sessions. There was no significant difference found on comparing patient satisfaction scores between the 2 groups. AMT helped improving medical students' outcomes as shown from higher total internal medicine score as well as quicker improvement during real-life clinical encounters, AMT could be a good alternative learning activity for medical students at ambulatory setting.

  6. Polynomial analysis of ambulatory blood pressure measurements

    NARCIS (Netherlands)

    Zwinderman, A. H.; Cleophas, T. A.; Cleophas, T. J.; van der Wall, E. E.

    2001-01-01

    In normotensive subjects blood pressures follow a circadian rhythm. A circadian rhythm in hypertensive patients is less well established, and may be clinically important, particularly with rigorous treatments of daytime blood pressures. Polynomial analysis of ambulatory blood pressure monitoring

  7. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

    Science.gov (United States)

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

    2016-01-01

    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  8. Difficult airway management of children in ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Huang AS

    2016-11-01

    Full Text Available Andrea S Huang,1 Lindsey Rutland,2 John Hajduk,1 Narasimhan Jagannathan1,2 1Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, 2Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: As the field of pediatric ambulatory anesthesia expands, anesthesiologists can anticipate encountering an increasing number of patients with expected and unexpected difficult airways. This unique setting and patient population both present challenges in making a decision whether and how to safely proceed in the case of a child with a difficult airway. A host of patient, provider, procedure, and facility-specific factors should be considered. Providers should understand the differences between the pediatric and adult airway, recognize common features and syndromes associated with difficult airways, and be comfortable with different airway equipment and techniques available in the ambulatory setting. Early anticipation, a comprehensive patient assessment, and a clear decision-making algorithm with multiple airway management plans are all critical in safely and effectively managing these patients. These issues and recommendations will be discussed in this comprehensive narrative review. Keywords: difficult airway, pediatrics, ambulatory surgery, airway devices, children

  9. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... SAMBA Link Digital Newsletter Educational Bibliography Research IARS/Anesthesia & Analgesia SCOR About SCOR Sponsor SAMBA Meetings Affinity Sponsor Program We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, ...

  10. Comparison of ambulatory blood pressure monitoring and office blood pressure measurements in obese children and adolescents.

    Science.gov (United States)

    Renda, Rahime

    2018-04-01

    Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children. A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring. Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p lood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p lood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.

  11. Adverse Effects with Ambulatory Intravenous Immunoglobulin Administration in Adult Patients with Common Variable Immunodeficiency

    Directory of Open Access Journals (Sweden)

    Karen Alicia Rodríguez-Mireles

    2014-06-01

    Full Text Available Background: Common variable immunode ciency (CVID is the most frequent symptomatic primary immunodeficiency, affecting 1:25,000- 75,000 people. It is characterized by the absence or decrease antibody production. Treatment for CVID consists on human immunoglobulin administration, and the intravenous route is the most common route for administration, at 400-800 mg/kg of weight every 3-4 weeks. Adverse effects associated with intravenous immunoglobulin (IVIg use occur in 25% of all infusions, with severe adverse reactions presenting in less than 1% of all patients. Acute renal failure can occur as a severe adverse reaction, which presents 1-10 days after starting IVIg treatment. In our center we implemented an ambulatory scheme for IVIg administration, which allows its administration in an average of 3 hours, without severe adverse effects. Objectives: To describe adverse effects and to evaluate the frequency of renal failure secondary to ambulatory IVIg administration in patients with common variable immunode ciency. Material and method: A descriptive and prospective study was done including adult patients con de nitive diagnosis of common variable immunodeficiency, receiving IVIg at replacement dose every 3 weeks. All patients were evaluated with clinical exploration, somatometry, serum creatinine, albumin and urea determination, 24 hours creatinine clearance, glomerular ltration rate with CKD-EPI, and immediate renal function associated with accumulated IVIg. Results were analyzed with descriptive statistics. Results: We determined adverse effects in 25 patients with common variable immunode ciency (15 women and 10 men, average age 36.7 years, during a 10 months period (January-September 2013. During this period 284 IVIg infusions were administered using our scheme, frequency of adverse effects were 12.9%, with 5.2% of early adverse effects and 7.7% late adverse effects, all being mild to moderate, in some cases required analgesic and

  12. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adisa R

    2009-09-01

    Full Text Available Objective: The overall goal of the study was to evaluate the probable reasons for patients’ nonadherence to prescribed oral hypoglycemic medications in an ambulatory care setting in Nigeria with a view to identifying points for necessary intervention to improve adherence and treatment outcomes. Also, the recommended non-drug management options for diabetes patients with emphasis on self monitoring of blood glucose were assessed.Methods: A cross-sectional study was conducted at a 200-bed secondary health care facility in Southwestern Nigeria between 2nd April and 31st May 2008. Copies of pre-tested questionnaire were administered directly to 121 ambulatory patients with type 2 diabetes at the study site. Information on socio-demographic characteristic, probable barriers that affect adherence to prescribed oral hypoglycemic medications, non-drug treatment options for diabetes, and patients’ self management efforts were obtained. Descriptive and chi-square statistics were used to evaluate the distribution of respondents’ opinion.Results: The response rate was almost 100%. The commonly cited intentional nonadherence practice included dose omission (70.2%. Almost 50% respondents were fed up with daily ingestion of drugs and 19.8% were inconvenienced with taking medications outside home and gave these as reasons for the dose omission. Forgetfulness (49.6% and high cost of medication (35.5% were mentioned as major non-intentional reasons for nonadherence. Aside oral medications, 82.6% and 95.0% of respondents respectively, reported moderate exercise and dietary restrictions as part of the prescribed treatment modalities. More than two third of respondents (81.8% had never monitored blood glucose by themselves. Significant association exist between sex, occupation and patients’ tendencies to forget doses of prescribed oral medications (p<0.05. Conclusion: Nonadherence behaviors among ambulatory patients with type 2 diabetes occur mostly, as

  13. Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

    Science.gov (United States)

    Kabré, Yvette B; Traoré, Idriss S S; Kaboré, Flavien A R; Ki, Bertille; Traoré, Alain I; Ouédraogo, Isso; Bandré, Emile; Wandaogo, Albert; Ouédraogo, Nazinigouba

    2017-02-01

    Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

  14. DETERMINANTS OF SUBOPTIMAL BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS: 24-HOUR AMBULATORY BLOOD PRES-SURE MONITORING

    Directory of Open Access Journals (Sweden)

    Mansoor Moazenzadeh

    2010-12-01

    Full Text Available Abstract    INTRODUCTION: The study was conducted to define the determinants of suboptimal blood pressure (BP control among hypertensive patients under treatment and explore a predictive model for detecting the patients at risk for increased BP.    METHODS: We enrolled 97 patients (40 males, 57 females under treatment for hypertension between June 2006 and May 2007 in Shafa hospital, Kerman, Iran. BP was measured at clinic twice within 5-minute intervals. After setting up ambulatory blood pressure monitoring (ABPM, BP was measured at 30-minute intervals during the day and 60-minute intervals during the night. The frequency of increased BP (more than 140/90 mmHg was included in a regression model as dependent variable and all the others such as age, sex, body mass index (BMI, drugs and baseline clinical measurements as the predictors.    RESULTS: Increased BP was detected in 44% (95% CI: 38.79%-49.65% of all measurements during 24-hour monitoring. The frequency of increased BP had a significant relationship with BMI (b=0.35, P=0.001. Clinic's pulse pressure was a significant predicting factor for BP increase (P=0.02.    CONCLUSION: BMI and pulse pressure are the best predictors for being hypertensive during lifetime. Ineffective treatment of hypertension is frequent among the hypertensive patients.      Keywords: Blood pressure control, Pulse pressure, Ambulatory blood pressure monitoring (ABPM, BMI.

  15. New antithrombotic agents in the ambulatory setting.

    Science.gov (United States)

    Gibbs, Neville M; Weightman, William M; Watts, Stephen A

    2014-12-01

    Many patients presenting for surgical or other procedures in an ambulatory setting are taking new antiplatelet or anticoagulant agents. This review assesses how the novel features of these new agents affect the management of antithrombotic therapy in the ambulatory setting. There have been very few studies investigating the relative risks of continuing or ceasing new antithrombotic agents. Recent reviews indicate that the new antithrombotic agents offer greater efficacy or ease of administration but are more difficult to monitor or reverse. They emphasize the importance of assessing the bleeding risk of the procedure, the thrombotic risk if the agent is ceased, and patient factors that increase the likelihood of bleeding. The timing of cessation of the agent, if required, depends on its pharmacokinetics and patients' bleeding risks. Patients at high risk of thrombotic complications may require bridging therapy. Once agreed upon, the perioperative plan should be made clear to all involved. As there are few clinical studies to guide management, clinicians must make rational decisions in relation to continuing or ceasing new antithrombotic agents. This requires knowledge of their pharmacokinetics, and a careful multidisciplinary assessment of the relative thrombotic and bleeding risks in individual patients.

  16. Emergent risk factors associated with eyeball loss and ambulatory vision loss after globe injuries.

    Science.gov (United States)

    Hyun Lee, Seung; Ahn, Jae Kyoun

    2010-07-01

    The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma. We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis. The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss. An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.

  17. Elosulfase alfa enzyme replacement therapy attenuates disease progression in a non-ambulatory Japanese patient with Morquio A syndrome (case report

    Directory of Open Access Journals (Sweden)

    Misako Hiramatsu

    2017-12-01

    Full Text Available Enzyme replacement therapy (ERT with elosulfase alfa is the only approved therapy in Japan for patients with Morquio A syndrome, a lysosomal storage disorder inherited in an autosomal recessive fashion. The experience with ERT in severely affected, non-ambulatory patients has not been reported in previous studies. This case report describes clinical evidence for the 1-year efficacy and safety of ERT with elosulfase alfa in a severely affected, non-ambulatory, 47-year-old patient with Morquio A syndrome who needs intensive respiratory management. ERT with elosulfase alfa was well tolerated in this patient. Because of the possibility of potential hypersensitivity adverse events, special attention is needed when using ERT in patients with respiratory disorders. However, under the appropriate management of specialists, the patient in this case report showed significant respiratory improvement after starting ERT, and abdominal bloating was improved by gas evacuation. In addition, the patient was able to lift up her arms, reach behind her back, and move her legs slightly, and she recovered her grip strength. Her hearing loss improved and she could hear without a hearing aid. This report shows that ERT with elosulfase alfa can be used with appropriate respiratory care in patients with severe respiratory dysfunction.

  18. Transitioning the RN to Ambulatory Care: An Investment in Orientation.

    Science.gov (United States)

    Allen, Juliet Walshe

    2016-01-01

    Registered nurses (RNs) struggle when transitioning from the inpatient setting to the outpatient clinical environment because it results in a diverse skill-set shift. The RN, considered an outpatient revenue source, experiences a decrease in peer-to-peer relationships, changes in leadership responsibilities, and changes in workgroup dynamics (supervision of unlicensed clinical personnel who function under the direction of the physician, not the RN). Ambulatory organizations find themselves implementing clinical orientation programs that may not delineate the attributes of the RN. This diminishes their value while emphasizing the unlicensed technical skill set. Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting. The literature reveals several areas where improving the value of the RN will ultimately enhance recruitment and retention, patient care outcomes, and leverage the RN role within any organization. Eleven 30-minute in-depth telephone interviews were conducted in addition to 4 nurse observations to explore the lived experience of the RN in ambulatory care. The findings disclosed an overarching theme of nurse isolation and offered insightful underpinnings for the nurse leader as ambulatory growth continues and nurse leaders further endorse the RN presence in the ambulatory setting.

  19. Improving adherence to the Epic Beacon ambulatory workflow.

    Science.gov (United States)

    Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

    2017-06-01

    Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

  20. Análisis y clasificación de las urgencias hospitalarias mediante los Ambulatory Patient Groups Analysis and classification of hospital emergencies through Ambulatory Patient Groups

    Directory of Open Access Journals (Sweden)

    A. Conesa

    2003-12-01

    Full Text Available Objetivo: Describir la factibilidad y el resultado de la aplicación del sistema Ambulatory Patient Groups (APG a la casuística atendida en los servicios de urgencias de seis hospitales del área de Barcelona. Métodos: Confección de un conjunto mínimo básico de datos específico para urgencias (CMBDAU. Obtención de las variables necesarias en una muestra aleatoria de visitas atendidas, a partir de los informes de asistencia correspondientes. Aplicación del sistema APG a los episodios seleccionados. Resultados: Se ha codificado y agrupado en APG un total de 11.188 visitas de urgencias. Quince diagnósticos identifican el 25% de los episodios. El 50% de los procedimientos de urgencias son exploraciones complementarias sencillas. Quince APG agrupan el 50% de la casuística atendida en urgencias. Conclusiones: El CMBDAU es válido para describir la casuística de urgencias y su agrupación en APG proporciona resultados consistentes e interpretables. La aplicación generalizada de sistemas como los APG en urgencias requiere una validación previa en nuestro entorno de los valores de peso norteamericanos. También debe valorarse la disponibilidad de recursos técnicos y humanos suficientes para garantizar la calidad y la continuidad de un registro de estas características.Aim: To assess the feasibility and results of application of Ambulatory Patient Groups (APG patient's classification system to the case-mix of patients seen at the Emergency Departments (ED of 6 Barcelona metropolitan area hospitals. Methods: Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU. Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes. Results: A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the

  1. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  2. Progressive rise in red cell distribution width is associated with disease progression in ambulatory patients with chronic heart failure.

    Science.gov (United States)

    Cauthen, Clay A; Tong, Wilson; Jain, Anil; Tang, W H Wilson

    2012-02-01

    Single red cell distribution width (RDW) assessment is a consistent prognostic marker of poor outcomes in heart failure as well as in other patient cohorts. The objective of this study was to determine the prognostic value of sequential RDW assessment in ambulatory patients with chronic heart failure. We reviewed 6,159 consecutive ambulatory patients with chronic heart failure between 2001-2006 and examined changes in RDW values from baseline to 1-year follow-up. Clinical, demographic, laboratory, and ICD-9 coding data were extracted from electronic health records, and all-cause mortality was followed over a mean follow-up of 4.4 ± 2.4 years. In this study cohort, median baseline RDW was 14.9%. RDW >16% at baseline (18.5% of cohort) was associated with a higher mortality rates than RDW ≤16%. For each +1% increment of baseline RDW, the risk ratio for all-cause mortality was 1.17 (95% confidence interval [CI] 1.15-1.19; P < .0001). At 12-month follow-up (n = 1,601), a large majority of subjects (68% in first tertile, 56% in second tertile of baseline RDW) showed rising RDW and correspondingly higher risk for all-cause mortality (risk ratio for +1% increase in changes in RDW was 1.08 (95% CI 1.03-1.13; P = .001). This effect was independent of anemia status or other baseline cardiac or renal indices, and particularly strong in those with lower baseline RDW. In our ambulatory cohort of patients with chronic heart failure, baseline and serial increases in RDW were associated with poor long-term outcomes independently from standard cardiac, hematologic, and renal indices. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes.

    Science.gov (United States)

    Gorostidi, Manuel; de la Sierra, Alejandro; González-Albarrán, Olga; Segura, Julián; de la Cruz, Juan J; Vinyoles, Ernest; Llisterri, José L; Aranda, Pedro; Ruilope, Luis M; Banegas, José R

    2011-11-01

    Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68,045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of >1200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12,600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, P<0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, P<0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, P<0.001). Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, P<0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered.

  4. Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism.

    Science.gov (United States)

    Concistrè, A; Grillo, A; La Torre, G; Carretta, R; Fabris, B; Petramala, L; Marinelli, C; Rebellato, A; Fallo, F; Letizia, C

    2018-04-01

    Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.

  5. Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis.

    Science.gov (United States)

    Ramanathan, Kumaresan; Padmanabhan, Giri; Vijayaraghavan, Bhooma

    2016-05-01

    Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis.

  6. Anaesthesia for Ambulatory Paediatric Surgery: Common ...

    African Journals Online (AJOL)

    BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as ...

  7. Ambulatory heart rate is underestimated when measured by an Ambulatory Blood Pressure device

    NARCIS (Netherlands)

    Vrijkotte, T.G.M.; de Geus, E.J.C.

    1999-01-01

    Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

  8. Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

    NARCIS (Netherlands)

    Vrijkotte, T. G.; de Geus, E. J.

    2001-01-01

    To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings

  9. Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

    NARCIS (Netherlands)

    Vrijkotte, T.G.M.; de Geus, E.J.C.

    2001-01-01

    Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

  10. Reproducibility of the ambulatory arterial stiffness index in hypertensive patients

    DEFF Research Database (Denmark)

    Dechering, D.G.; Steen, M.S. van der; Adiyaman, A.

    2008-01-01

    BACKGROUND: We studied the repeatability of the ambulatory arterial stiffness index (AASI), which can be computed from 24-h blood pressure (BP) recordings as unity minus the regression slope of diastolic on systolic BP. METHODS: One hundred and fifty-two hypertensive outpatients recruited...... in Nijmegen (mean age = 46.2 years; 76.3% with systolic and diastolic hypertension) and 145 patients enrolled in the Systolic Hypertension in Europe (Syst-Eur) trial (71.0 years) underwent 24-h BP monitoring at a median interval of 8 and 31 days, respectively. We used the repeatability coefficient, which...... were approximately 30%. Differences in AASI between paired recordings were correlated with differences in the goodness of fit (r2) of the AASI regression line as well as with differences in the night-to-day BP ratio. However, in sensitivity analyses stratified for type of hypertension, r2, or dipping...

  11. Differences in Treatment of Chlamydia trachomatis by Ambulatory Care Setting.

    Science.gov (United States)

    Pearson, William S; Gift, Thomas L; Leichliter, Jami S; Jenkins, Wiley D

    2015-12-01

    Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection (STI) in the US and timely, correct treatment can reduce CT transmission and sequelae. Emergency departments (ED) are an important location for diagnosing STIs. This study compared recommended treatment of CT in EDs to treatment in physician offices. Five years of data (2006-2010) were analyzed from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Surveys (NHAMCS), including the Outpatient survey (NHAMCS-OPD) and Emergency Department survey (NHAMCS-ED). All visits with a CT diagnosis and those with a diagnosis of unspecified venereal disease were selected for analysis. Differences in receipt of recommended treatments were compared between visits to physician offices and emergency departments using Chi square tests and logistic regression models. During the 5 year period, approximately 3.2 million ambulatory care visits had diagnosed CT or an unspecified venereal disease. A greater proportion of visits to EDs received the recommended treatment for CT compared to visits to physician offices (66.1 vs. 44.9 %, p < .01). When controlling for patients' age, sex and race/ethnicity, those presenting to the ED with CT were more likely to receive the recommended antibiotic treatment than patients presenting to a physician's office (OR 2.16; 95 % CI 1.04-4.48). This effect was attenuated when further controlling for patients' expected source of payment. These analyses demonstrate differences in the treatment of CT by ambulatory care setting as well as opportunities for increasing use of recommended treatments for diagnosed cases of this important STI.

  12. Ambulatory intravenous ceftriaxone in paediatric A&E: a useful alternative to hospital admission?

    Science.gov (United States)

    Smith, Jennifer K; Alexander, Saji; Abrahamson, Ed

    2011-10-01

    Treatment of children with intravenous ceftriaxone on an ambulatory basis is described. This allows a child to remain at home, but also be reviewed regularly when attending the Emergency Department for antibiotics. Indications for, and length of, treatment and laboratory parameters were recorded. Also, a survey of children's parents was undertaken to ascertain opinions regarding ambulatory treatment. 36 patients were treated with ambulatory ceftriaxone over 4 months. Indications included fever without focus, tonsillitis, periorbital cellulitis, urinary tract infection, petechial rash and lymphadenitis. Median duration of treatment was 2.3 days. There was no occult bacteraemia but five positive urine cultures. There was one failure of treatment with subsequent admission for alternative intravenous antibiotics. Parental opinion favours ambulatory treatment, with 94% of parents acknowledging they would choose it again in similar circumstances. Cost analysis favours ambulatory treatment based on predicted costs of a similar length of inpatient stay.

  13. Health promotion behaviors and related factors in end stage renal disease patients treated with continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Wechpradit, Apinya; Thaiyuenwong, Jutiporn; Kanjanabuch, Talerngsak

    2011-09-01

    To present study health promotion behaviors and related factors in end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Questionnaires of Pender to evaluate health promotion behaviors which measure 5 aspects of health-affected behaviors were examined in 90 CAPD patients at dialysis unit of Udornthani Hospital. Results were categorized into 3 groups according to Bloom's scale as follows: high, moderate, and low levels. The data were displayed as ranges or means +/- standard deviation, according to the characteristics of each variable, with a 5% (p cherish health behaviors of the patients.

  14. Patients' quality assessment of ambulatory obstetric and gynaecological services.

    Science.gov (United States)

    Bojar, I; Wdowiak, L; Ostrowski, T

    2005-01-01

    The quality could be assessed from two perspectives: internal and external. From the internal perspective the quality means being consistent with particular conditions and standards. The external perspective is based on relative assessment of the product made by a client who is also aware of other competitors' offer. Despite the professional assessment which is focused on providing health services according to medical and managerial correctness, patient's assessment is also relevant. Measuring patient's satisfaction is additional method of health services quality assessment. The aim of the study was to estimate patients' opinion on quality of ambulatory obstetric and gynaecological services. The study was conducted in 11 obstetric and gynaecological out-patient clinics of Lublin in September and October 2003. The study tool was an author's questionnaire. Patients were asked to assess such areas as registration before visit, their relationship with nurses and gynaecologists and other aspects of services provision like intimacy assurance and respecting Patient's Rights. The collected data was statistically analysed. 635 patients took part in the study. The biggest groups in the studied population were women at the age of 20-30 years, married, living in cities and secondary educated. It was found that around half of the population is satisfied and 2.2% of them are unsatisfied with the fact that they have chosen particular out-patient clinic. More than 70% of women had positive opinion of following aspects influencing general opinion about service quality: politness of reception desk staff, opening hours, the length of time before a patient is seen by the specialist, intimacy assurance and respect for Patient's Rights in the practice. 80% of patients were satisfied with the relationship with nurses and 3.3% were unsatisfied with it. Eight patients out of ten were satisfied with gynaecological care, less than 2% were unsatisfied. The studied women had also high opinion

  15. [Ambulatory blood pressure monitoring is a useful tool for all patients].

    Science.gov (United States)

    de la Sierra, A

    Clinical blood pressure measurement (BP) is an occasional and imperfect way of estimating this biological variable. Ambulatory blood pressure monitoring (ABPM) is by far the best clinical tool for measuring an individual's blood pressure. Mean values over 24h, through the daytime and at night all make it more possible to predict organic damage and the future development of the disorder. ABPM enables the detection of white-coat hypertension and masked hypertension in both the diagnosis and follow-up of treated patients. Although some of the advantages of ABPM can be reproduced by more automated measurement without the presence of an observer in the clinic or self-measurement at home, there are some other elements of great interest that are unique to ABPM, such as seeing what happens to a patient's BP at night, the night time dipping pattern and short-term variability, all of which relate equally to the patient's prognosis. There is no scientific or clinical justification for denying these advantages, and ABPM should form part of the evaluation and follow-up of practically all hypertensive patients. Rather than continuing unhelpful discussions as to its availability and acceptability, we should concentrate our efforts on ensuring its universal availability and clearly explaining its advantages to both doctors and patients. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

    International Nuclear Information System (INIS)

    Nguyen, Thanh Vân France; Bosset, Jean-François; Monnier, Alain; Fournier, Jacqueline; Perrin, Valérie; Baumann, Cédric; Brédart, Anne; Mercier, Mariette

    2011-01-01

    The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p < 0.0001). Patients treated by radiotherapy (vs patients treated by chemotherapy) reported lower levels of satisfaction with doctors' technical and interpersonal skills, information provided by caregivers, and waiting times. Patients with primary head and neck cancer (vs other localisations), and those living alone were less satisfied with information provided by doctors, and younger patients (< 55 years) were less satisfied with doctors' availability. A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time

  17. Icodextrine and insulin resistance in continuous ambulatory peritoneal dialysis patients.

    Science.gov (United States)

    Canbakan, Mustafa; Sahin, Gülizar Manga

    2007-01-01

    Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 +/- 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 +/- 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 +/- 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 +/- 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 +/- 17.86 in the glucose group and 10.15 +/- 6.87 in the icodextrin group (p = 0.0001). Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8+/-4.1 vs 2.3+/- 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.

  18. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2016-06-01

    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

  19. Ambulatory surgery centers best practices for the 90s.

    Science.gov (United States)

    Hoover, J A

    1994-05-01

    Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

  20. Acceptance of Ambulatory Laparoscopic Cholecystectomy in Central Switzerland.

    Science.gov (United States)

    Widjaja, Sandra P; Fischer, Henning; Brunner, Alexander R; Honigmann, Philipp; Metzger, Jürg

    2017-11-01

    Currently, most patients undergoing laparoscopic cholecystectomy (LC) in Switzerland are inpatients for 2-3 days. Due to a lack of available hospital beds, we asked whether day-case surgery would be an option for patients in central Switzerland. The questions of acceptability of outpatient LC and factors contributing to the acceptability thus arose. Hundred patients suffering from symptomatic cholecystolithiasis, capable of communicating in German, and between 18 and 65 years old, were included. Patients received a pre-operative questionnaire on medical history and social situation when informed consent on surgery and participation in the study was obtained. Exclusion criteria were patients suffering from acute cholecystitis or any type of cancer; having a BMI >40 kg/m 2 ; needing conversion to open cholecystectomy or an intraoperative drainage; and non-German speakers. Surgery was performed laparoscopically. Both surgeon and patient filled in a postoperative questionnaire. The surgeon's questionnaire listed medical and technical information, and the patients' questionnaire listed medical information, satisfaction with the treatment and willingness to be released on the same day. These data from both questionnaires were grouped into social and medical factors and analysed on their influence upon willingness to accept an ambulatory procedure. No outpatient follow-up apart from checking for readmission to our hospital within 1 month after discharge was performed. Of the 100 participants, one-third was male. More than two-thirds were Swiss citizens. Only one participant was ineligible for rapid release evaluation due to need of a drainage. Among the social factors contributing to the acceptability of ambulatory care, we found nationality to be relevant; Swiss citizens preferred an inpatient procedure, whereas non-Swiss citizens were significantly more willing to return home on the same day. Household size, sex and age did not correlate with a preference for

  1. Electronic health record "super-users" and "under-users" in ambulatory care practices.

    Science.gov (United States)

    Rumball-Smith, Juliet; Shekelle, Paul; Damberg, Cheryl L

    2018-01-01

    This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. Use of health IT functionalities in ambulatory care is important for delivering high-quality care, including that provided in coordination with multiple practitioners. We used data from the 2014 Healthcare Information and Management Systems Society Analytics survey. The responses of 30,123 ambulatory practices with an operational EHR were analyzed to examine the extent of use of EHR-based health IT functionalities for each practice. We created a novel framework for classifying ambulatory care practices employing 7 domains of health IT functionality. Drawing from the survey responses, we created a composite "use" variable indicating the extent of health IT functionality use across these domains. "Super-user" practices were defined as having near-full employment of the 7 domains of health IT functionalities and "under-users" as those with minimal or no use of health IT functionalities. We used multivariable logistic regression to investigate how the odds of super-use and under-use varied by practice size, type, urban or rural location, and geographic region. Seventy-three percent of practices were not using EHR technologies to their full capability, and nearly 40% were classified as under-users. Under-user practices were more likely to be of smaller size, situated in the West, and located outside a metropolitan area. To achieve the broader benefits of the EHR and health IT, health systems and policy makers need to identify and address barriers to full use of health IT functionalities.

  2. Walking during body-weight-supported treadmill training and acute responses to varying walking speed and body-weight support in ambulatory patients post-stroke.

    Science.gov (United States)

    Aaslund, Mona Kristin; Helbostad, Jorunn Lægdheim; Moe-Nilssen, Rolf

    2013-05-01

    Rehabilitating walking in ambulatory patients post-stroke, with training that is safe, task-specific, intensive, and of sufficient duration, can be challenging. Some challenges can be met by using body-weight-supported treadmill training (BWSTT). However, it is not known to what degree walking characteristics are similar during BWSTT and overground walking. In addition, important questions regarding the training protocol of BWSTT remain unanswered, such as how proportion of body-weight support (BWS) and walking speed affect walking characteristics during training. The objective was therefore to investigate if and how kinematic walking characteristics are different between overground walking and treadmill walking with BWS in ambulatory patients post-stroke, and the acute response of altering walking speed and percent BWS during treadmill walking with BWS. A cross-sectional repeated-measures design was used. Ambulating patients post-stroke walked in slow, preferred, and fast walking speed overground and at comparable speeds on the treadmill with 20% and 40% BWS. Kinematic walking characteristics were obtained using a kinematic sensor attached over the lower back. Forty-four patients completed the protocol. Kinematic walking characteristics were similar during treadmill walking with BWS, compared to walking overground. During treadmill walking, choice of walking speed had greater impact on kinematic walking characteristics than proportion of BWS. Faster walking speeds tended to affect the kinematic walking characteristics positively. This implies that in order to train safely and with sufficient intensity and duration, therapists may choose to include BWSTT in walking rehabilitation also for ambulatory patients post-stroke without aggravating gait pattern during training.

  3. Admission characteristics, diagnoses and outcomes of HIV-infected patients registered in an ambulatory HIV-care programme in western Kenya.

    Science.gov (United States)

    Siika, A M; Ayuo, P O; Sidle, Mwangi J E; Wools-Kaloustian, K; Kimaiyo, S N; Tierney, W M

    2008-11-01

    To determine admissions diagnosis and outcomes of HIV-infected patients attending AMPATH ambulatory HIV-care clinics. Prospective cohort study. Academic Model for Prevention and Treatment of HIV/ AIDS (AMPATH) ambulatory HIV-care clinic in western Kenya. Between January 2005 and December 2006, 495 HIV-infected patients enrolled in AMPATH were admitted. Median age at admission was 38 years (range: 19-74), 62% females, 375 (76%) initiated cART a median 56 days (range: 1-1288) before admission. Majority (53%) had pre-admission CD4 counts 200 cells/ml. Common admissions diagnoses were: tuberculosis (27%); pneumonia (15%); meningitis (11%); diarrhoea (11%); malaria (6%); severe anaemia (4%); and toxoplasmosis (3%). Deaths occurred in 147 (30%) patients who enrolled at AMPATH a median 44 days (range: 1-711) before admission and died a median 41 days (range: 1-713) after initiating cART. Tuberculosis (27%) and meningitis (14%) were the most common diagnoses in the deceased. Median admission duration was six days (range: 1-30) for deceased patients and eight days (range: 1-44) for survivors (P=0.0024). Deceased patients enrolled in AMPATH or initiated cART more recently, had lower CD4 counts and were more frequently lost to follow-up than survivors (P<0.05 for each comparison). Initiation of cART before admission and clinic appointment adherence were independent predictors of survival. Although high mortality rate is seen in HIV-infected in-patients, those initiating cART before admission were more likely to survive.

  4. Speak Up: Help Prevent Errors in Your Care: Ambulatory Care

    Science.gov (United States)

    ... Your Care Ambulatory Care To prevent health care errors, patients are urged to... SpeakUP TM Everyone has a ... he or she has confused you with another patient. P ay attention to the ... for their identification (ID) badges. • Notice whether your caregivers have washed ...

  5. Concerns of stem cell transplant patients during routine ambulatory assessment

    Directory of Open Access Journals (Sweden)

    Klein C

    2013-01-01

    Full Text Available Lisa Kennedy Sheldon,1 Maryum Kazmi,1 Cynthia Klein,2 Donna L Berry31University of Massachusetts Boston, Boston, MA, 2Seattle Cancer Care Alliance, Seattle, WA, 3Phyllis Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USABackground: Stem cell transplant (SCT is a treatment choice for many hematological malignancies. There is currently a lack of evidence regarding the self-reported concerns of SCT patients before and after SCT.Aim and design: This exploratory study performed a secondary analysis of self-reported, written concerns of SCT patients before and after transplant to determine patients' concerns.Methods: Content analysis of text box entries of SCT patients collected between 2005 and 2007 at the Seattle Cancer Care Alliance. Text box entries were collected as part of symptom assessment using the Electronic Self-Report Assessment – Cancer instrument. The assessment was presented to 137 patients undergoing SCT at two time points: prior to ambulatory visits before any therapy had begun (T1 and at the first visit after hospital discharge following SCT (T2.Results: Text box entries were made before (n = 52 and after (n = 87 the transplant, resulting in 139 text box entries made by 137 patients representing 133 concerns. Using content analysis, the entries were categorized and ranked according to frequency. After symptom concerns, patients ranked work and financial issues the most frequent concerns prior to SCT. After SCT, symptoms remained the most frequently entered area of concern, followed by survival.Conclusion: Oncology providers need to assess SCT patients for work and financial concerns before and after transplant. Appropriate and timely referrals may ease the burden of these concerns for patients. Thus, assessment of financial and work concerns by the oncology team should be an integral part of quality health care for patients undergoing SCT.Keywords: self-report, electronic

  6. A Randomized Trial to Evaluate the Sustained Efficacy of a Mucus Clearance Device in Ambulatory Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Norman Wolkove

    2004-01-01

    Full Text Available OBJECTIVE: To determine whether a mucus clearance device (MCD (Flutter; Axcan Scandipharm, USA could consistently improve the bronchodilator response and exercise performance in patients with chronic obstructive pulmonary disease (COPD when used in an ambulatory setting over a one-week period.

  7. Interior design for ambulatory care facilities: how to reduce stress and anxiety in patients and families.

    Science.gov (United States)

    Frasca-Beaulieu, K

    1999-01-01

    The following article illustrates some important factors to consider when designing ambulatory care facilities (ACFs), and focuses on how wayfinding, noise control, privacy, security, color and lighting, general ambience, textures, and nature can have a profound influence on patient and family stress, consumer satisfaction, health and well-being. Other important design issues: convenience and accessibility, accommodation to various populations, consumer and family focus, patient education, image, as well as current equipment needs and future growth are examined in light of the prevailing trends in health care delivery. In sum, this feature explores the important stress-reducing and health-promoting elements involved in successful ACF design.

  8. Asian patients with Hinchey Ia acute diverticulitis: a condition for the ambulatory setting?

    Science.gov (United States)

    Chan, Dedrick Kok Hong; Tan, Ker-Kan

    2018-01-01

    Diverticulitis in Asians is a different disease entity from Western counterparts. Few Asian studies have evaluated the management of acute Hinchey Ia diverticulitis with consideration for outpatient management. The purpose of this study was to evaluate the outcomes of Asian patients with Hinchey Ia acute diverticulitis. A retrospective review of all patients who were treated for Hinchey Ia acute colonic diverticulitis between 2012 and 2014 was performed. All patients were diagnosed on computed tomography (CT). There were 129 patients with Hinchey Ia acute diverticulitis. Fifty-five (42.6%) patients were male, and the median age was 54 years (range, 30-86). Eighty-seven (67.4%) patients had right-sided diverticulitis. Most patients were treated empirically with intravenous ceftriaxone and metronidazole (89.1%). They were then discharged with oral antibiotics. Only 6.1% of patients had a positive blood culture. The median length of stay in the hospital was 4 (range, 3-4) days. Only three (2.3%) patients were readmitted for acute diverticulitis within 30 days. They were managed with antibiotics and discharged well. The repeated CT scans reconfirmed Hinchey Ia diverticulitis. No patients required emergency surgery, and there were no 30-day mortalities. Asian patients with Hinchey Ia diverticulitis recovered well with conservative management and could be amenable to outpatient therapy. Future prospective studies should be performed amongst Asians to evaluate managing this condition in an ambulatory setting.

  9. Ambulatory blood pressure monitoring and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Cohen Cesar Nissan

    2000-01-01

    Full Text Available OBJECTIVE: To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. METHODS: Thirty-seven patients underwent determination of the rate of urinary excretion of albumin through radioimmunoassay and ambulatory blood pressure monitoring. Their mean age was 26.5±6.7 years, and the mean duration of their disease was 8 (1-34 years. Microalbuminuria was defined as urinary excretion of albumin > or = 20 and 50% and diastolic pressure load > 30% during sleep was associated with microalbuminuria (p=0.008. The pressure drop during sleep did not differ between the groups. CONCLUSION: Microalbuminuric normotensive insulin-dependent diabetic patients show greater mean pressure value and pressure load during ambulatory blood pressure monitoring, and these variables correlate with urinary excretion of albumin.

  10. Pediatric ambulatory anesthesia.

    Science.gov (United States)

    August, David A; Everett, Lucinda L

    2014-06-01

    Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Postoperative pain management following ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Schug SA

    2015-01-01

    Full Text Available Stephan A Schug,1,2 Chandani Chandrasena2 1School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; 2Department of Anesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia Abstract: Worldwide, there is an increasing trend toward performing more and more complex surgery in an ambulatory setting, partially driven by economic considerations. Provision of appropriate pain relief is still often inadequate in this setting; poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. Therefore, improved analgesia after ambulatory surgery is an important goal; appropriate strategies include identification of at-risk patients, provision of multimodal analgesia, and early use of rescue strategies. Multimodal analgesia is based on the combined use of multiple medications or techniques for pain control, which have different mechanisms of action or act on different sites at the pain pathways. Thereby, such an approach improves analgesia, reduces opioid requirements, and reduces adverse effects of opioids. Important components of multimodal analgesia are nonopioids (acetaminophen and anti-inflammatory drugs, corticosteroids, and alpha-2-delta modulators (gabapentin, pregabalin, but most importantly the use of local and regional anesthesia techniques. Here, the use of adjuvants is one way to increase the duration of pain relief, but, increasingly, continuous peripheral nerve blocks via catheters are used in ambulatory patients, too. Finally, the planning of discharge medications needs a balancing act between the requirements for provision of good analgesia and the risk of opioids going out into the community. Keywords: ambulatory surgery, short-stay surgery, multimodal analgesia, nonopioids, local anesthetics, regional anesthesia

  12. Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Ansari Zahid

    2012-12-01

    Full Text Available Abstract Background Ambulatory Care Sensitive Conditions (ACSCs are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in a primary care setting. ACSCs are used extensively as indicators of accessibility and effectiveness of primary health care. We examined the association between patient characteristics and hospitalisation for ACSCs in the adult and paediatric population in Victoria, Australia, 2003/04. Methods Hospital admissions data were merged with two area-level socioeconomic indexes: Index of Socio-Economic Disadvantage (IRSED and Accessibility/Remoteness Index of Australia (ARIA. Univariate and multiple logistic regressions were performed for both adult (age 18+ years and paediatric (age Results Predictors were much more strongly associated with ACSCs admissions compared to non-ACSCs admissions in the adult group than for the paediatric group with the exception of rurality. Significant adjusted ORs in the adult group were 1.06, 1.15, 1.13, 1.06 and 1.11 for sex, rurality, age, IRSED and ARIA variables, and 1.34, 1.04 and 1.09 in the paediatric group for rurality, IRSED and ARIA, respectively. Conclusions Disadvantaged paediatric and adult population experience more need of hospital care for ACSCs. Access barriers to primary care are plausible causes for the observed disparities. Understanding the characteristics of individuals experiencing access barriers to primary care will be useful for developing targeted interventions meeting the unique ambulatory needs of the population.

  13. Parents' satisfaction with pediatric ambulatory anesthesia in northeast of Thailand.

    Science.gov (United States)

    Boonmak, Suhattaya; Boonmak, Polpun; Pothiruk, Kittawan; Hoontanee, Nattakhan

    2009-12-01

    Study the satisfaction of parents with ambulatory anesthesia and associated factors, including characteristics of the patients and their parents. This was a prospective, descriptive, observation study. The authors included children who were scheduled for ambulatory anesthetic service between birth and 14 years of age and attended at Srinagarind Hospital, Khon Kaen, Thailand. The authors excluded patients whose parents could not be reached by telephone. Before anesthesia, the authors recorded the patients and parents' characteristics, level of information perception (pre-, peri- and post-anesthesia and complications). After anesthesia, the anesthesia technique and any complications were recorded. The day after anesthesia, the authors made phone calls to the patients to record the parents' satisfaction score (viz, of overall, pre-, peri- and post-anesthesia care, and information about the level of patient care at home), and any anesthesia related complications. Ninety-two patients and their parents were included in the present study. Overall parents 'satisfaction with the anesthesia service was 96.7% (i.e., 89/92) (95% CI 90.8-99.3). Parents' satisfaction with pre- and peri-anesthesia care was 100% (95% CI 96.1-100) and 97.9% (95% CI 92.4-99.7), respectively. Parents' satisfaction with the PACU care and information of patient care at home was 96.7% (95% CI 90.8-99.3) and 91.3% (95% CI 83.6-96.2), respectively. Associated factors where parents were dissatisfied included PACU care satisfaction (i.e., relative risk 22.5 (95% CI 3.2-158)) and patient care information at home (i.e., relative risk 13.3 (95% CI 1.3-136.0)). The present study showed a high level of parents' satisfaction. Parents' dissatisfaction associated with PACU care and information about post anesthesia care at home. Additionally information on parents' characteristics provides invaluable data for improving pediatric ambulatory anesthesia in Srinagarind Hospital.

  14. Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Raichlen, J.S.; Brest, A.N.

    1988-01-01

    Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease. 41 references.

  15. Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease

    International Nuclear Information System (INIS)

    Raichlen, J.S.; Brest, A.N.

    1988-01-01

    Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease. 41 references

  16. Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases.

    Science.gov (United States)

    Kim, Kyoung Bog; Oh, Mi Kyeong; Kim, Haa Gyoung; Ki, Ji Hoon; Lee, Soo Hee; Kim, Su Min

    2013-03-01

    It has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences. We examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|). The mean absolute IAD in SBP and DBP were 3.19 ± 2.38 and 2.41 ± 1.59 mm Hg, respectively, in men and 2.61 ± 2.18 and 2.25 ± 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of ≤ 6 mm Hg, 98.1% with the IAD in SBP of ≤ 10 mm Hg, 96.5% with the IAD in DBP of ≤ 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of ≤ 6 mm Hg, 92.1% with IAD in DBP of ≤ 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function. Our results showed that there

  17. Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension.

    Science.gov (United States)

    Kang, Yuan-Yuan; Li, Yan; Huang, Qi-Fang; Song, Jie; Shan, Xiao-Li; Dou, Yu; Xu, Xin-Juan; Chen, Shou-Hong; Wang, Ji-Guang

    2015-08-01

    We investigated accuracy of home blood pressure (BP) monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring. Our study participants were enrolled in the China Ambulatory and Home BP Registry, and underwent clinic, home, and 24-h ambulatory BP measurements. We defined white-coat hypertension as an elevated clinic SBP/DBP (≥140/90 mmHg) and a normal 24-h ambulatory (coat hypertension (13.1 vs. 19.9%), masked hypertension (17.8 vs. 13.1%), and sustained hypertension (46.4 vs. 39.6%) significantly (P ≤ 0.02) differed between 24-h ambulatory and home BP monitoring. In treated patients (n = 1201), only the prevalence of masked hypertension differed significantly (18.7 vs. 14.5%; P = 0.005). Regardless of the treatment status, home compared with 24-h ambulatory BP had low sensitivity (range 47-74%), but high specificity (86-94%), and accordingly low positive (41-87%), but high negative predictive values (80-94%), and had moderate diagnostic agreement (82-85%) and Kappa statistic (0.41-0.66). In untreated and treated patients, age advancing was associated with a higher prevalence of white-coat hypertension and a lower prevalence of masked hypertension defined by 24-h ambulatory (P ≤ 0.03) but not home BP (P ≥ 0.10). Home BP monitoring has high specificity, but low sensitivity in the diagnosis of white-coat and masked hypertension, and may therefore behave as a complementary to, but not a replacement of, ambulatory BP monitoring.

  18. Ambulatory thyroidectomy: A multistate study of revisits and complications

    OpenAIRE

    Orosco, RK; Lin, HW; Bhattacharyya, N

    2015-01-01

    © 2015 American Academy of Otolaryngology - Head and Neck Surgery Foundation. Objective. Determine rates and reasons for revisits after ambulatory adult thyroidectomy. Study Design. Cross-sectional analysis of multistate ambulatory surgery and hospital databases. Setting. Ambulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011. Subjects and Methods. Ambulatory thyroidectomy cases were linked to state ambul...

  19. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  20. Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes.

    Science.gov (United States)

    Chiu, Yi-Wen; Chang, Jer-Ming; Lin, Li-Ing; Chang, Pi-Yu; Lo, Wan-Ching; Wu, Ling-Chu; Chen, Tun-Chieh; Hwang, Shang-Jyh

    2009-04-01

    Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: -2.5 +/- 1.8% vs. -1.1 +/- 1.7%, p decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.

  1. Adherence to A Diabetic Care Plan Provides Better Glycemic Control in Ambulatory Patients With Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Yi-Wen Chiu

    2009-04-01

    Full Text Available Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3–4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: −2.5 ± 1.8% vs. −1.1 ± 1.7%, p < 0.01. The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05. Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.

  2. Sustainable business models: systematic approach toward successful ambulatory care pharmacy practice.

    Science.gov (United States)

    Sachdev, Gloria

    2014-08-15

    This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  3. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  4. Neighborhood blight, stress, and health: a walking trial of urban greening and ambulatory heart rate

    Science.gov (United States)

    Eugenia C. South; Michelle C. Kondo; Rose A. Cheney; Charles C. Branas

    2015-01-01

    We measured dynamic stress responses using ambulatory heart rate monitoring as participants in Philadelphia, Pennsylvania walked past vacant lots before and after a greening remediation treatment of randomly selected lots. Being in view of a greened vacant lot decreased heart rate significantly more than did being in view of a nongreened vacant lot or not in view of...

  5. A phase II clinical trial evaluating the use of two sequential, four-drug combination chemotherapy regimens in ambulatory bronchogenic adenocarcinoma patients.

    Science.gov (United States)

    Broder, L E; Sridhar, K S; Selawry, O S; Charyulu, K N; Rao, R K; Saldana, M J; Lenz, C

    1992-12-01

    Forty-three ambulatory patients with locally advanced or metastatic bronchogenic adenocarcinoma were sequentially treated with two potentially mutually non-cross-resistant chemotherapy regimens. A new regimen, MVPF (mitomycin-c, vinblastine, procarbazine, and 5-fluorouracil), was given until progressive disease occurred. Then, a second regimen--MOCC (methotrexate, vincristine [Oncovin], cyclophosphamide, and CCNU)--was initiated. At further progression, regional disease patients received radiotherapy, whereas extensive disease patients received Phase II agents. Of the 43 patients entered on the study, 40 were evaluable. Three patients withdrew early due to poor tolerance of the regimen. The response rate for MVPF was 33% (12 of 40 PR, 1 of 40 CR) compared to a 4% (1 of 23 PR) response for MOCC (difference: p < or = .03), for a total response rate of 35%. Although there was an initial improvement in survival for responders (31.7 weeks) versus nonresponders (15.7 weeks) at the 75th percentile (p < or = .05), there was no significant difference in median survival. The hematologic toxicity was equivalent for both groups, whereas nonhematologic toxicity revealed a high incidence of nausea and vomiting in the MVPF group. It is concluded that this approach lent itself well to ambulatory care, and MVPF could be considered an alternative to cyclophosphamide-based regimens. However, the absence of a meaningful CR rate and lack of influence of response on median survival were factors limiting its effectiveness.

  6. Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi.

    Science.gov (United States)

    Otieno, C F; Kariuki, M; Ng'ang'a, L

    2003-08-01

    Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. To determine the glycaemic control of ambulatory diabetic patients. Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. Kenyatta National Hospital. Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and

  7. 45. Ezetimibe and statins yields on silent holter ambulatory myocardial ischemia

    Directory of Open Access Journals (Sweden)

    W. Kadro

    2016-07-01

    Full Text Available Further cholestrol lowering may affect silent ischemia detected on holter monitoring. Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. Statins are the main drugs for cholesterol lowering. Ezetimibe when added to statins gives further reduction in cholesterol but its long-term effect on cardiovascular morbidity and mortality and ischemic events is not known. This study sought to determine whether further cholesterol lowering with ezitimibe will also results in a reduction of myocardial ischemia during daily life. We enrolled 50 patients with proven stable coronary artery disease (CAD and at least one episode of ST-segment depression on ambulatory ECG monitoring. All of them were receiving optimal therapy for CAD including statin therapy for cholesterol reduction. 25 patients were randomized to continue their statin therapy (Statin only group and 25 to recieve statin plus ezitimibe 10 mg/day (ezitimibe group. Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4–6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. The ezitimibe group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the statin only group. ST-segment depression was completely resolved in 13 of 25 patients (52% in the ezitimibe group versus 3 of 25 (12% in the statin only group. The ezitimibe group exhibited a highly significant reduction in ambulatory ischemia (P < .001. By logistic regression, treatment with ezitimibe was an independent predictor of ischemia resolution. Further cholesterol lowering with ezitimibe can result in reduction or resolution of myocardial ischemia recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG.

  8. Ambulatory blood pressure monitoring for hypertension in general practice.

    OpenAIRE

    Taylor, R S; Stockman, J; Kernick, D; Reinhold, D; Shore, A C; Tooke, J E

    1998-01-01

    Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-ho...

  9. Ambulatory intercostal drainage for the management of malignant pleural effusion: a single center experience.

    Science.gov (United States)

    Bazerbashi, Samer; Villaquiran, Jaime; Awan, Mohammad Yousaf; Unsworth-White, Michael Jonathan; Rahamim, Joe; Marchbank, Adrian

    2009-12-01

    Malignant pleural effusions are common and can be difficult to manage. We have reviewed our use of ambulatory drains (Pleurex drains) in this regard with particular reference to hospital stay, duration of drainage, and incidence of complications. Of 125 patients with malignant pleural effusion with trapped lung or failed previous pleurodesis who underwent insertion of ambulatory pleural drain, 41 patients were under local anesthesia and 84 patients were under general anesthesia. Mean age was 66.5 years with male:female = 80:45. Data were collected retrospectively from the clinical notes, and the family doctors' clinics were contacted to enquire about the patients' survival. When data collection concluded, 48 patients (38.4%) had died, giving mean survival following drain insertion of 84.1 days. There were no in-hospital deaths related to the procedure. One procedure was converted to a mini-thoracotomy to control bleeding from a lung tear. Mean duration of catheter placement was 87.01 days (5-434). Video-assisted thoracoscopic surgery was used in 77 patients (61.6%), and Seldinger's technique was used in 48 patients (38.4%). Mesothelioma was the most common malignant cause. Minor complications were encountered in 15 patients (12%), and they were managed as outpatients. The use of ambulatory pleural catheters for managing malignant pleural effusion is a safe and effective strategy. It has only minor complications that are related to prolonged drainage. We feel that this strategy should be considered the first choice option for these patients.

  10. [Risk scores for the development of venous thromboembolism in ambulatory patients and in patients hospitalized for acute medical disease].

    Science.gov (United States)

    Junod, A

    2015-10-28

    The recognition of an increased risk of VTE following surgery has initiated a similar investigation in: 1) Ambulatory subjects. In this group, the Qthrombosis score has identified 8 to 11 risk factors. The incidence of VTE is of the order of 0,15%/year. 2) The patients admitted to hospital for an acute medical disease. Nine scores are available for analysis. Results are difficult to interpret because of confusing factors: the inclusion of symptomatic VTE only or both symptomatic and asymptomatic VTE; the uncontrolled prescription of thromboprophylaxis. VTE incidence over 3 months varies between 15 and 0,5%, but is around 1% in the most recent studies. New studies, with a more rigorous methodological approach, are needed.

  11. Improving visit cycle time using patient flow analysis in a high-volume inner-city hospital-based ambulatory clinic serving minority New Yorkers.

    Science.gov (United States)

    Dhar, Sanjay; Michel, Raquel; Kanna, Balavenkatesh

    2011-01-01

    Patient waiting time and waiting room congestion are quality indicators that are related to efficiency of ambulatory care systems and patient satisfaction. Our main purpose was to test a program to decrease patient visit cycle time, while maintaining high-quality healthcare in a high-volume inner-city hospital-based clinic in New York City. Use of patient flow analysis and the creation of patient care teams proved useful in identifying areas for improvement, target, and measure effectiveness of interventions. The end result is reduced visit cycle time, improved provider team performance, and sustained patient care outcomes. © 2010 National Association for Healthcare Quality.

  12. Ventricular fibrillation in an ambulatory patient supported by a left ventricular assist device: highlighting the ICD controversy.

    Science.gov (United States)

    Boilson, Barry A; Durham, Lucian A; Park, Soon J

    2012-01-01

    Left ventricular assist devices (LVADs) provide an effective means of managing advanced pump failure as a means of bridging to cardiac transplantation or as permanent therapy. Although ventricular arrhythmias remain common post-LVAD implantation, such therapy may allow malignant arrhythmias to be tolerated hemodynamically. This report describes the clinical findings in a patient who had likely been in a ventricular tachyarrhythmia for several days and presented in ventricular fibrillation, ambulatory, and mentating normally. This report, with previous similar reports, is additive to the body of evidence that LVADs alter the physiologic impact of ventricular arrhythmias in advanced heart failure and highlights the need for thoughtful programming of implantable cardioverter defibrillator therapies in these patients.

  13. Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.

    Science.gov (United States)

    Meyerhoefer, Chad D; Sherer, Susan A; Deily, Mary E; Chou, Shin-Yi; Guo, Xiaohui; Chen, Jie; Sheinberg, Michael; Levick, Donald

    2018-05-16

    The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital. Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration. Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

  14. Anesthesia for ambulatory anorectal surgery.

    Science.gov (United States)

    Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

    2004-01-01

    The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

  15. Ambulatory movements, team dynamics and interactions during robot-assisted surgery.

    Science.gov (United States)

    Ahmad, Nabeeha; Hussein, Ahmed A; Cavuoto, Lora; Sharif, Mohamed; Allers, Jenna C; Hinata, Nobuyuki; Ahmad, Basel; Kozlowski, Justen D; Hashmi, Zishan; Bisantz, Ann; Guru, Khurshid A

    2016-07-01

    To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events. With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply-1 zone. A total of 50% of ambulatory movements were found to be avoidable. More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  16. Impact of renal denervation on 24-hour ambulatory blood pressure: results from SYMPLICITY HTN-3.

    Science.gov (United States)

    Bakris, George L; Townsend, Raymond R; Liu, Minglei; Cohen, Sidney A; D'Agostino, Ralph; Flack, John M; Kandzari, David E; Katzen, Barry T; Leon, Martin B; Mauri, Laura; Negoita, Manuela; O'Neill, William W; Oparil, Suzanne; Rocha-Singh, Krishna; Bhatt, Deepak L

    2014-09-16

    Prior studies of catheter-based renal artery denervation have not systematically performed ambulatory blood pressure monitoring (ABPM) to assess the efficacy of the procedure. SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) was a prospective, blinded, randomized, sham-controlled trial. The current analysis details the effect of renal denervation or a sham procedure on ABPM measurements 6 months post-randomization. Patients with resistant hypertension were randomized 2:1 to renal denervation or sham control. Patients were on a stable antihypertensive regimen including maximally tolerated doses of at least 3 drugs including a diuretic before randomization. The powered secondary efficacy endpoint was a change in mean 24-h ambulatory systolic blood pressure (SBP). Nondipper to dipper (nighttime blood pressure [BP] 10% to 20% lower than daytime BP) conversion was calculated at 6 months. The 24-h ambulatory SBP changed -6.8 ± 15.1 mm Hg in the denervation group and -4.8 ± 17.3 mm Hg in the sham group: difference of -2.0 mm Hg (95% confidence interval [CI]: -5.0 to 1.1; p = 0.98 with a 2 mm Hg superiority margin). The daytime ambulatory SBP change difference between groups was -1.1 (95% CI: -4.3 to 2.2; p = 0.52). The nocturnal ambulatory SBP change difference between groups was -3.3 (95 CI: -6.7 to 0.1; p = 0.06). The percent of nondippers converted to dippers was 21.2% in the denervation group and 15.0% in the sham group (95% CI: -3.8% to 16.2%; p = 0.30). Change in 24-h heart rate was -1.4 ± 7.4 in the denervation group and -1.3 ± 7.3 in the sham group; (95% CI: -1.5 to 1.4; p = 0.94). This trial did not demonstrate a benefit of renal artery denervation on reduction in ambulatory BP in either the 24-h or day and night periods compared with sham (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]; NCT01418261). Copyright © 2014 American College of Cardiology Foundation. Published by

  17. Devices for Ambulatory Monitoring of Sleep-Associated Disorders in Children with Neurological Diseases.

    Science.gov (United States)

    Ulate-Campos, Adriana; Tsuboyama, Melissa; Loddenkemper, Tobias

    2017-12-25

    Good sleep quality is essential for a child's wellbeing. Early sleep problems have been linked to the later development of emotional and behavioral disorders and can negatively impact the quality of life of the child and his or her family. Sleep-associated conditions are frequent in the pediatric population, and even more so in children with neurological problems. Monitoring devices can help to better characterize sleep efficiency and sleep quality. They can also be helpful to better characterize paroxysmal nocturnal events and differentiate between nocturnal seizures, parasomnias, and obstructive sleep apnea, each of which has a different management. Overnight ambulatory detection devices allow for a tolerable, low cost, objective assessment of sleep quality in the patient's natural environment. They can also be used as a notification system to allow for rapid recognition and prompt intervention of events like seizures. Optimal monitoring devices will be patient- and diagnosis-specific, but may include a combination of modalities such as ambulatory electroencephalograms, actigraphy, and pulse oximetry. We will summarize the current literature on ambulatory sleep devices for detecting sleep disorders in children with neurological diseases.

  18. Data Accuracy of the Bubble Sheet Ambulatory Data System and the KG-Ambulatory Data System in the Internal Medicine Clinic, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana

    National Research Council Canada - National Science Library

    MacLaren, Lisa

    2000-01-01

    ...) and Ambulatory Patient Group (APG) outpatient prospective payment system (OPPS). Three data sets were examined at different points in time based on type of ADS used and implementation of data quality management efforts...

  19. Special article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.

    Science.gov (United States)

    Larach, Marilyn Green; Dirksen, Sharon J Hirshey; Belani, Kumar G; Brandom, Barbara W; Metz, Keith M; Policastro, Michael A; Rosenberg, Henry; Valedon, Arnaldo; Watson, Charles B

    2012-01-01

    Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.

  20. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....

  1. Information perception, wishes, and satisfaction in ambulatory cancer patients under active treatment: patient-reported outcomes with QLQ-INFO25

    Science.gov (United States)

    Pinto, Ana Catarina; Ferreira-Santos, Fernando; Lago, Lissandra Dal; de Azambuja, Evandro; Pimentel, Francisco Luís; Piccart-Gebhart, Martine; Razavi, Darius

    2014-01-01

    Background Information is vital to cancer patients. Physician–patient communication in oncology presents specific challenges. The aim of this study was to evaluate self-reported information of cancer patients in ambulatory care at a comprehensive cancer centre and examine its possible association with patients’ demographic and clinical characteristics. Patients and methods This study included adult patients with solid tumours undergoing chemotherapy at the Institute Jules Bordet’s Day Hospital over a ten-day period. EORTC QLQ-C30 and QLQ-INFO25 questionnaires were administered. Demographic and clinical data were collected. Descriptive and inferential statistics were used. Results 101 (99%) fully completed the questionnaires. They were mostly Belgian (74.3%), female (78.2%), with a mean age of 56.9 ± 12.8 years. The most frequent tumour was breast cancer (58.4%). Patients were well-informed about the disease and treatments, but presented unmet information domains. The Jules Bordet patients desired more information on treatment side effects, long-term outcome, nutrition, and recurrence symptoms. Patients on clinical trials reported having received less information about their disease and less written information than patients outside clinical trials. Higher information levels were associated with higher quality of life (QoL) scores and higher patient satisfaction. Conclusion Patients were satisfied with the information they received and this correlated with higher QoL, but they still expressed unmet information wishes. Additional studies are required to investigate the quality of the information received by patients enrolled in clinical trials. PMID:24834120

  2. Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience.

    Science.gov (United States)

    Sive, Jonathan; Ardeshna, Kirit M; Cheesman, Simon; le Grange, Franel; Morris, Stephen; Nicholas, Claire; Peggs, Karl; Statham, Paula; Goldstone, Anthony H

    2012-12-01

    Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them.

  3. Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting.

    Science.gov (United States)

    Di Bella, Alexandra; Blake, Claire; Young, Adrienne; Pelecanos, Anita; Brown, Teresa

    2018-02-01

    The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening. This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher-led screening and intra-rater reliability between an initial and a repeat patient screening. This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample). Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test-retest screening, and patient acceptability. Percent and chance-corrected agreement (Cohen's kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with "almost perfect" chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with "almost perfect" chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided

  4. Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up.

    Science.gov (United States)

    Comoretto, Rosanna Irene; Facchin, Domenico; Ghidina, Marco; Proclemer, Alessandro; Gregori, Dario

    2017-08-01

    Health-related quality of life (HRQoL) improves shortly after pacemaker (PM) implantation. No studies have investigated the HRQoL trend for elderly patients with a remote device monitoring follow-up system. Using EuroQol-5D Questionnaire and the PM-specific Assessment of Quality of Life and Related Events Questionnaire, HRQoL was measured at baseline and then repeatedly during the 6 months following PM implantation in a cohort of 42 consecutive patients. Twenty-five patients were followed-up with standard outpatient visits, while 17 used a remote monitoring system. Aquarel scores were significantly higher in patients with remote device monitoring system regarding chest discomfort and arrhythmia subscales the first month after PM implant and remained stable until 6 months. Remote monitoring affected the rate of HRQoL improvement in the first 3 months after pacemaker implantation more than ambulatory follow-up. Remote device monitoring has a significant impact on HRQoL in pacemaker patients, increasing its levels up to 6 months after implant. © 2017 John Wiley & Sons, Ltd.

  5. Ambulatory anesthesia and postoperative nausea and vomiting: predicting the probability

    Directory of Open Access Journals (Sweden)

    Hegarty AT

    2016-08-01

    Full Text Available Aoife T Hegarty,1 Muiris A Buckley,1 Conan L McCaul1–3 1Department of Anaesthesia, The Rotunda Hospital, 2Mater Misericordiae University Hospital, 3School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Abstract: Nausea and vomiting are distinctly unpleasant symptoms that may occur after surgery and anesthesia, and high priority is given to their prevention by patients. Research in this area is plentiful and has focused on event prediction and pharmacological prophylaxis but despite this, postoperative nausea and vomiting (PONV typically occurs in 20%–30% of patients in contemporary practice. Prediction of postoperative and postdischarge nausea and vomiting is particularly important in the ambulatory surgical population as these symptoms may occur following discharge from hospital and continue for up to one week when access to antiemetic therapies is limited. Many of the existing predictive scoring systems are based on data from inpatient populations and limited to the first 24 hours after surgery. Scoring systems based on data from ambulatory surgical populations to predict PONV are only moderately good. The best-performing systems in ambulatory patients are those of Sinclair and Sarin with an area under the receiver operating characteristic curve of 0.78 and 0.74, respectively, but are limited by the short duration of follow-up and a greater emphasis on nausea than vomiting. Given that the ability to predict both PONV and postdischarge nausea and vomiting is clearly limited, emphasis has been placed on prophylactic strategies that incorporate antiemetic medication, intravenous hydration, and nonnarcotic analgesia. PONV has been reduced to <10% in institutions using multimodal approaches. Scoring systems may facilitate “risk tailoring” in which patient risk profile is used as a stratification method for pharmacointervention. Keywords: postoperative nausea and vomiting, prediction, antiemetics, anesthesia

  6. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings.

    Science.gov (United States)

    Napoles, Tessa M; Burke, Nancy J; Shim, Janet K; Davis, Elizabeth; Moskowitz, David; Yen, Irene H

    2017-12-01

    We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing

  7. Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older.

    Science.gov (United States)

    Divisón-Garrote, Juan A; Ruilope, Luis M; de la Sierra, Alejandro; de la Cruz, Juan J; Vinyoles, Ernest; Gorostidi, Manuel; Escobar-Cervantes, Carlos; Velilla-Zancada, Sonsoles M; Segura, Julián; Banegas, José R

    2017-05-01

    Elderly patients can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study examined the prevalence of hypotension and associated demographic and clinical factors among very old treated hypertensive patients undergoing ABPM. Cross-sectional study in which 5066 patients aged 80 years and older with treated hypertension drawn from the Spanish ABPM Registry were included. Office BP and 24-hour ambulatory BP were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as systolic/diastolic BP ABPM, ABPM, and ABPM. Participants' mean age was 83.2 ± 3.1 years (64.4% women). Overall, 22.8% of patients had office hypotension, 33.7% daytime hypotension, 9.2% nighttime hypotension, and 20.5% 24-hour ABPM hypotension. Low diastolic BP values were responsible for 90% of cases of hypotension. In addition, 59.1% of the cases of hypotension detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently associated with office and ABPM hypotension were diabetes, coronary heart disease, and a higher number of antihypertensive medications. One in 3 very elderly treated hypertensive patients attended in usual clinical practice were potentially at risk of having hypotension according to daytime ABPM. More than half of them had masked hypotension; that is, they were not identified if relying on office BP alone. Thus, ABPM could be especially helpful for identifying ambulatory hypotension and avoiding overtreatment, in particular, in patients with diabetes, heart disease, or on antihypertensive polytherapy. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  8. The dynamic process of adherence to a renal therapeutic regimen: perspectives of patients undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Lam, Lai Wah; Lee, Diana T F; Shiu, Ann T Y

    2014-06-01

    The nature of end-stage renal disease and the need for continuous ambulatory peritoneal dialysis require patients to manage various aspects of the disease, its symptoms and treatment. After attending a training programme, patients are expected to adhere to the renal therapeutic regimen and manage their disease with the knowledge and skills learned. While patients are the stakeholders of their health and related behaviour, their perceptions of adherence and how they adhere to their renal therapeutic regimen remains unexplored. To understand adherence from patients' perspectives and to describe changes in adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis. This study used a mixed methods design with two phases - a survey in phase I and semi-structured interviews in phase II. This paper presents phase II of the study. The study was conducted at a renal unit of an acute hospital in Hong Kong. Based on the phase I survey results, maximum variation sampling was employed to purposively recruit 36 participants of different genders (18 males, 18 females), ages (35-76 years), and lengths of dialysis experience (11-103 months) for the phase II interviews. Data were collected by tape-recorded semi-structured interviews. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously. Adherence was a dynamic process with three stages. At the stage of initial adherence, participants attempted to follow instructions but found that strict persistent adherence was impossible. After the first 2-6 months of dialysis, participants entered the stage of subsequent adherence, when they adopted selective adherence through experimenting, monitoring and making continuous adjustments. The stage of long-term adherence commenced after 3-5 years of dialysis, when participants were able to assimilate the modified therapeutic regimen into everyday life. The process of adherence was

  9. Ambulatory Arterial Stiffness Indexes in Cushing's Syndrome.

    Science.gov (United States)

    Battocchio, Marialberta; Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Maffei, Pietro; Bernardi, Stella; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco

    2017-03-01

    Long-standing exposure to endogenous cortisol excess is associated with high cardiovascular risk. The aim of our study was to investigate arterial stiffness, which has been recognized as an independent predictor of adverse cardiovascular outcome, in a group of patients with Cushing's syndrome. Twenty-four patients with Cushing's syndrome (3 males, mean age 49±13 years; 20 pituitary-dependent Cushing's disease and 4 adrenal adenoma) underwent 24-h ambulatory blood pressure monitoring (ABPM) and evaluation of cardiovascular risk factors. The Ambulatory Arterial Stiffness Index (AASI) and symmetric AASI (sAASI) were derived from ABPM tracings. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 16 hypertensive (HYP-CUSH) patients, and were compared with 8 normotensive (NOR-CTR) and 16 hypertensive (HYP-CTR) control subjects, matched for demographic characteristics, 24-h ABPM and cardiometabolic risk factors. The AASI and sAASI indexes were significantly higher in Cushing patients than in controls, either in the normotensive (p=0.048 for AASI and p=0.013 for sAASI) or in the hypertensive (p=0.004 for AASI and p=0.046 for sAASI) group. No difference in metabolic parameters was observed between NOR-CUSH and NOR-CTR or between HYP-CUSH and HYP-CTR groups. AASI and sAASI were both correlated with urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho=0.40, p=0.05, and 0.61, p=0.003, respectively), while no correlation was found in controls. Both AASI and sAASI are increased in Cushing syndrome, independent of BP elevation, and may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in arterial stiffness has to be further clarified. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Quality of life in automated and continuous ambulatory peritoneal dialysis

    NARCIS (Netherlands)

    Michels, Wieneke M.; van Dijk, Sandra; Verduijn, Marion; le Cessie, Saskia; Boeschoten, Elisabeth W.; Dekker, Friedo W.; Krediet, Raymond T.; Apperloo, A. J.; Bijlsma, J. A.; Boekhout, M.; Boer, W. H.; van der Boog, P. J. M.; Büller, H. R.; van Buren, M.; de Charro, F. Th; Doorenbos, C. J.; van den Dorpel, M. A.; van Es, A.; Fagel, W. J.; Feith, G. W.; de Fijter, C. W. H.; Frenken, L. A. M.; Grave, W.; van Geelen, J. A. C. A.; Gerlag, P. G. G.; Gorgels, J. P. M. C.; Huisman, R. M.; Jager, K. J.; Jie, K.; Koning-Mulder, W. A. H.; Koolen, M. I.; Kremer Hovinga, T. K.; Lavrijssen, A. T. J.; Luik, A. J.; van der Meulen, J.; Parlevliet, K. J.; Raasveld, M. H. M.; van der Sande, F. M.; Schonck, M. J. M.; Schuurmans, M. M. J.; Siegert, C. E. H.; Stegeman, C. A.; Stevens, P.; Thijssen, J. G. P.; Valentijn, R. M.; Vastenburg, G. H.; Verburgh, C. A.; Vincent, H. H.; Vos, P. F.

    2011-01-01

    Despite a lack of strong evidence, automated peritoneal dialysis (APD) is often prescribed on account of an expected better quality of life (QoL) than that expected with continuous ambulatory peritoneal dialysis (CAPD). Our aim was to analyze differences in QoL in patients starting dialysis on APD

  11. A Comparison of Aromatherapy to Standard Care for Relief of PONV and PDNV in Ambulatory Surgical Patients.

    Science.gov (United States)

    Stallings-Welden, Lois M; Doerner, Mary; Ketchem, Elizabeth Libby; Benkert, Laura; Alka, Susan; Stallings, Jonathan D

    2018-04-01

    To determine effectiveness of aromatherapy (AT) compared with standard care (SC) for postoperative and postdischarge nausea and vomiting (PONV/PDNV) in ambulatory surgical patients. Prospective randomized study. Patients (n = 254) received either SC or AT for PONV and interviewed for effectiveness of PDNV. Machine learning methods (eight algorithms) were used to evaluate. Of patients (64 of 221) that experienced PONV, 52% were in the AT group and 48% in the SC group. The majority were satisfied with treatment (timely, P = .60; effectiveness, P = .86). Of patients that experienced PDNV, treatment was 100% effective in the AT group and 67% in the SC group. The cforest algorithm was used to develop a model for predicting PONV with literature-based risk factors (0.69 area under the curve). AT is an effective way to manage PONV/PDNV. Gender and age were the most important predictors of PONV. Copyright © 2016 American Society of PeriAnesthesia Nurses. All rights reserved.

  12. Ambulatory blood pressure and tubulointerstitial injury in patients with IgA nephropathy.

    Science.gov (United States)

    Haruhara, Kotaro; Tsuboi, Nobuo; Koike, Kentaro; Kanzaki, Go; Okabayashi, Yusuke; Miyazaki, Yoichi; Kawamura, Tetsuya; Ogura, Makoto; Yokoo, Takashi

    2015-12-01

    Few studies have been conducted to assess the ambulatory blood pressure (ABP) in IgA nephropathy (IgAN) patients. This study aimed to determine the relationships between ABP and renal histopathological findings assessed using the Oxford classification (OC) and the Japanese classification (JC), which have recently established histopathological criteria for IgAN. This cross-sectional study included biopsy-diagnosed IgAN patients, in whom both a renal biopsy and ABP measurement were performed. The histopathological findings were assessed using the OC and the JC and were analyzed in relation to the ABP. A total of 111 IgAN patients were included. The score of interstitial fibrosis and tubular atrophy (T score) using the OC was a significantly associated factor with both the daytime and nighttime ABP values. In contrast, the other histopathological scores, including mesangial hypercellularity, endocapillary hypercellularity and segmental glomerulosclerosis, did not show significant associations with the ABP. The histological grade (H-grade) using the JC, which was based on the sum of injured glomeruli, was associated with the daytime ABP, but not with the nighttime ABP. The associations between the T score using the OC (%) and the daytime and nighttime ABP values were independent of age, gender, renal function, proteinuria and the use of antihypertensive medications, whereas the H-grade using the JC (%) did not show significant associations after adjusting for these clinical parameters. These results suggest that the T score using the OC is the most relevant renal histopathological parameter associated with abnormalities of circadian blood pressure in IgAN patients.

  13. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adisa R

    2011-06-01

    Full Text Available Objective: To assess adherence to medication among ambulatory patients with type 2 diabetes, ascertain the level of glycemic control, and evaluate patients’ opinions on probable reasons for non-adherence with a view to identify areas of intervention to improve adherence.Methods: A prospective cross-sectional study was carried out at a 900-bed tertiary teaching hospital in Ibadan, Southwestern Nigeria between June and August, 2009. Out of 140 consented patients, 114 (81.4% properly responded to the validated and pre-tested data collection tool and these were subsequently considered for analysis. Descriptive statistics were used to summarize the data. Means and proportions were compared using student t-test and chi-square or Kruskal-Wallis test as appropriate, with p<0.05 considered statistical significant.Results: Approximately sixty percent of the patients were adjudged adherent with prescribed medication. Out of 58.8% of the cohort who gave their recent fasting plasma glucose (FPG values, 59.7% had FPG above 110mg/dL. The mean FPG for patients was 139.05 (SD=70.5mg/dL, males and females significantly differed in their mean FPG, 146.55 (SD=85.0mg/dL versus 133.33 (SD=57.6mg/dL respectively (p=0.032. Also, the mean FPG values for adherent patients, 137.09 (SD=59.3mg/dL was lower than their non-adherent counterparts, 143.92 (SD=87.6 mg/dL, but the difference was not statistically significant (p=0.095. Financial constraint (34.4% was the major barrier to optimal adherence with medication. A significant association exist between genders and opinions on physician’s mode of approach during patient-physician interaction as a contributory factor for non-adherence (p=0.038.Conclusion: Medication adherence of ambulatory type 2 diabetes patients is considerable. However, the relatively high level of adherence did not appear to have significantly impacted on patients’ glycemic status due to a substantial number who had plasma glucose above the

  14. Use of ambulatory blood pressure measurement in the definition of resistant hypertension: a review of the evidence.

    Science.gov (United States)

    Persu, Alexandre; O'Brien, Eoin; Verdecchia, Paolo

    2014-11-01

    Resistant hypertension as defined by the European Society of Hypertension and American Heart Association is a blood pressure that remains uncontrolled despite concomitant intake of at least three antihypertensive drugs (one of them preferably being a diuretic) at full doses. This definition is still based on office rather than out-of-office blood pressure measurement. In this review we propose a new, stricter definition of resistant hypertension based on ambulatory blood pressure measurement. The main arguments in favor of this are: (1) in patients with resistant hypertension, ambulatory blood pressure is an independent predictor of cardiovascular morbidity whereas, after adjustment for conventional risk factors, conventional blood pressure has little added value; (2) white-coat resistant hypertension (uncontrolled office with normal ambulatory blood pressure) is frequent (30-40% of patients with apparently resistant hypertension) carrying a prognosis similar to that of controlled hypertension, and intensification of blood pressure lowering treatment, or the use of nondrug treatment strategies such as renal denervation or carotid baroreceptor stimulation, is not justified; (3) masked resistant hypertension (controlled office with elevated ambulatory blood pressure) is frequent (approximately one-third of patients with controlled office blood pressure on triple antihypertensive therapy) and associated with an increased risk of cardiovascular events; in such patients, treatment intensification should be considered; (4) the current definition of resistant hypertension (office blood pressure ⩾ 140/90 mm Hg on triple antihypertensive therapy) allows a substantial proportion of patients with spurious or white-coat resistant hypertension to undergo renal denervation in the absence of proven long-term benefits.

  15. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    Directory of Open Access Journals (Sweden)

    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  16. Ambulatory anaesthesia and cognitive dysfunction

    DEFF Research Database (Denmark)

    Rasmussen, Lars S; Steinmetz, Jacob

    2015-01-01

    serious adverse outcomes, hence difficult to obtain sound scientific evidence for avoiding complications. RECENT FINDINGS: Few studies have assessed recovery of cognitive function after ambulatory surgery, but it seems that both propofol and modern volatile anaesthetics are rational choices for general...... anaesthesia in the outpatient setting. Cognitive complications such as delirium and postoperative cognitive dysfunction are less frequent in ambulatory surgery than with hospitalization. SUMMARY: The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation...

  17. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    as important reasons for the inconsistent findings. The precise role of ambulatory ST segment monitoring in clinical practice has yet to be established. Direct comparisons with exercise stress testing may not be appropriate for two reasons. Firstly, the main advantage of ambulatory monitoring may...

  18. Ambulatory care of children treated with anticonvulsants - pitfalls after discharge from hospital.

    Science.gov (United States)

    Bertsche, A; Dahse, A-J; Neininger, M P; Bernhard, M K; Syrbe, S; Frontini, R; Kiess, W; Merkenschlager, A; Bertsche, T

    2013-09-01

    Anticonvulsants require special consideration particularly at the interface from hospital to ambulatory care. Observational study for 6 months with prospectively enrolled consecutive patients in a neuropediatric ward of a university hospital (age 0-anticonvulsant. Assessment of outpatient prescriptions after discharge. Parent interviews for emergency treatment for acute seizures and safety precautions. We identified changes of the brand in 19/82 (23%) patients caused by hospital's discharge letters (4/82; 5%) or in ambulatory care (15/82; 18%). In 37/76 (49%) of patients who were deemed to require rescue medication, no recommendation for such a medication was included in the discharge letters. 17/76 (22%) of the respective parents stated that they had no immediate access to rescue medication. Safety precautions were applicable in 44 epilepsy patients. We identified knowledge deficits in 27/44 (61%) of parents. Switching of brands after discharge was frequent. In the discharge letters, rescue medications were insufficiently recommended. Additionally, parents frequently displayed knowledge deficits in risk management. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Effects of health information exchange adoption on ambulatory testing rates.

    Science.gov (United States)

    Ross, Stephen E; Radcliff, Tiffany A; Leblanc, William G; Dickinson, L Miriam; Libby, Anne M; Nease, Donald E

    2013-01-01

    To determine the effects of the adoption of ambulatory electronic health information exchange (HIE) on rates of laboratory and radiology testing and allowable charges. Claims data from the dominant health plan in Mesa County, Colorado, from 1 April 2005 to 31 December 2010 were matched to HIE adoption data on the provider level. Using mixed effects regression models with the quarter as the unit of analysis, the effect of HIE adoption on testing rates and associated charges was assessed. Claims submitted by 306 providers in 69 practices for 34 818 patients were analyzed. The rate of testing per provider was expressed as tests per 1000 patients per quarter. For primary care providers, the rate of laboratory testing increased over the time span (baseline 1041 tests/1000 patients/quarter, increasing by 13.9 each quarter) and shifted downward with HIE adoption (downward shift of 83, prates or imputed charges in either provider group. Ambulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, higher quality care.

  20. Biomedical Wireless Ambulatory Crew Monitor

    Science.gov (United States)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  1. Feasibility of cardiopulmonary exercise testing and training using a robotics-assisted tilt table in dependent-ambulatory stroke patients.

    Science.gov (United States)

    Saengsuwan, Jittima; Huber, Celine; Schreiber, Jonathan; Schuster-Amft, Corina; Nef, Tobias; Hunt, Kenneth J

    2015-09-26

    We evaluated the feasibility of an augmented robotics-assisted tilt table (RATT) for incremental cardiopulmonary exercise testing (CPET) and exercise training in dependent-ambulatory stroke patients. Stroke patients (Functional Ambulation Category ≤ 3) underwent familiarization, an incremental exercise test (IET) and a constant load test (CLT) on separate days. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and real-time visual feedback to guide the exercise work rate was used. Feasibility assessment considered technical feasibility, patient tolerability, and cardiopulmonary responsiveness. Eight patients (4 female) aged 58.3 ± 9.2 years (mean ± SD) were recruited and all completed the study. For IETs, peak oxygen uptake (V'O2peak), peak heart rate (HRpeak) and peak work rate (WRpeak) were 11.9 ± 4.0 ml/kg/min (45 % of predicted V'O2max), 117 ± 32 beats/min (72 % of predicted HRmax) and 22.5 ± 13.0 W, respectively. Peak ratings of perceived exertion (RPE) were on the range "hard" to "very hard". All 8 patients reached their limit of functional capacity in terms of either their cardiopulmonary or neuromuscular performance. A ventilatory threshold (VT) was identified in 7 patients and a respiratory compensation point (RCP) in 6 patients: mean V'O2 at VT and RCP was 8.9 and 10.7 ml/kg/min, respectively, which represent 75 % (VT) and 85 % (RCP) of mean V'O2peak. Incremental CPET provided sufficient information to satisfy the responsiveness criteria and identification of key outcomes in all 8 patients. For CLTs, mean steady-state V'O2 was 6.9 ml/kg/min (49 % of V'O2 reserve), mean HR was 90 beats/min (56 % of HRmax), RPEs were > 2, and all patients maintained the active work rate for 10 min: these values meet recommended intensity levels for bouts of training. The augmented RATT is deemed feasible for incremental cardiopulmonary exercise testing and exercise training in dependent-ambulatory

  2. Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.

    Science.gov (United States)

    Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A

    2018-01-01

    In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.

  3. Pain Management in Ambulatory Surgery—A Review

    Directory of Open Access Journals (Sweden)

    Jan G. Jakobsson

    2014-07-01

    Full Text Available Day surgery, coming to and leaving the hospital on the same day as surgery as well as ambulatory surgery, leaving hospital within twenty-three hours is increasingly being adopted. There are several potential benefits associated with the avoidance of in-hospital care. Early discharge demands a rapid recovery and low incidence and intensity of surgery and anaesthesia related side-effects; such as pain, nausea and fatigue. Patients must be fit enough and symptom intensity so low that self-care is feasible in order to secure quality of care. Preventive multi-modal analgesia has become the gold standard. Administering paracetamol, NSIADs prior to start of surgery and decreasing the noxious influx by the use of local anaesthetics by peripheral block or infiltration in surgical field prior to incision and at wound closure in combination with intra-operative fast acting opioid analgesics, e.g., remifentanil, have become standard of care. Single preoperative 0.1 mg/kg dose dexamethasone has a combined action, anti-emetic and provides enhanced analgesia. Additional α-2-agonists and/or gabapentin or pregabalin may be used in addition to facilitate the pain management if patients are at risk for more pronounced pain. Paracetamol, NSAIDs and rescue oral opioid is the basic concept for self-care during the first 3–5 days after common day/ambulatory surgical procedures.

  4. Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes.

    Science.gov (United States)

    Kipp, Ryan; Young, Natasha; Barnett, Anne; Kopp, Douglas; Leal, Miguel A; Eckhardt, Lee L; Teelin, Thomas; Hoffmayer, Kurt S; Wright, Jennifer; Field, Michael

    2017-09-01

    Implantable loop recorder (ILR) insertion has historically been performed in a surgical environment such as the electrophysiology (EP) lab. The newest generation loop recorder (Medtronic Reveal LINQ™, Minneapolis, MN, USA) is injectable with potential for implantation in a non-EP lab setting by advanced practice providers (APPs) facilitating improved workflow and resource utilization. We report the safety and efficacy of injectable ILR placement in the ambulatory care setting by APPs. A retrospective review was performed including all patients referred for injectable ILR placement from March 2014 to November 2015. All device placement procedures were performed in an ambulatory care setting using the standard manufacturer deployment kit with sterile technique and local anesthetic following a single dose of intravenous antibiotics. Acute procedural success and complication rates following injectable ILR placement in the ambulatory setting were reviewed. During the study period, 125 injectable ILRs were implanted. Acute procedural success with adequate sensing (R-waves ≥ 0.2 mV) occurred in 100% of patients. There were no acute procedural complications. Subacute complications occurred in two patients (1.6% of implantations), including one possible infection treated with oral antibiotics and one device removal due to pain at the implant site. In this retrospective single-center study, implantation of injectable ILR in an ambulatory care setting by APPs following a single dose of intravenous antibiotics and standard manufacturer technique yielded a low complication rate with high acute procedural success. Use of this implantation strategy may improve EP lab workflow while providing a safe and effective technique for device placement. © 2017 Wiley Periodicals, Inc.

  5. The Negative Impact of Early Peritonitis on Continuous Ambulatory Peritoneal Dialysis Patients

    Science.gov (United States)

    Hsieh, Yao-Peng; Wang, Shu-Chuan; Chang, Chia-Chu; Wen, Yao-Ko; Chiu, Ping-Fang; Yang, Yu

    2014-01-01

    ♦ Background: Peritonitis rate has been reported to be associated with technique failure and overall mortality in previous literatures. However, information on the impact of the timing of the first peritonitis episode on continuous ambulatory peritoneal dialysis (CAPD) patients is sparse. The aim of this research is to study the influence of time to first peritonitis on clinical outcomes, including technique failure, patient mortality and dropout from peritoneal dialysis (PD). ♦ Methods: A retrospective observational cohort study was conducted over 10 years at a single PD unit in Taiwan. A total of 124 patients on CAPD with at least one peritonitis episode comprised the study subjects, which were dichotomized by the median of time to first peritonitis into either early peritonitis patients or late peritonitis patients. Cox proportional hazard model was used to analyze the correlation of the timing of first peritonitis with clinical outcomes. ♦ Results: Early peritonitis patients were older, more diabetic and had lower serum levels of creatinine than the late peritonitis patients. Early peritonitis patients were associated with worse technique survival, patient survival and stay on PD than late peritonitis patients, as indicated by Kaplan-Meier analysis (log-rank test, p = 0.04, p peritonitis was still a significant predictor for technique failure (hazard ratio (HR), 0.54; 95% confidence interval (CI), 0.30 - 0.98), patient mortality (HR, 0.34; 95% CI, 0.13 - 0.92) and dropout from PD (HR, 0.50; 95% CI, 0.30 - 0.82). In continuous analyses, a 1-month increase in the time to the first peritonitis episode was associated with a 2% decreased risk of technique failure (HR, 0.98; 95% CI, 0.97 - 0.99), a 3% decreased risk of patient mortality (HR, 0.97; 95% CI, 0.95 - 0.99), and a 2% decreased risk of dropout from PD (HR, 98%; 95% CI, 0.97 - 0.99). Peritonitis rate was inversely correlated with time to first peritonitis according to the Spearman analysis (r = -0

  6. Surgery of the hallux valgus in an ambulatory setting: a liability risk?

    Science.gov (United States)

    Galois, L; Serwier, J-M; Arashvand, A D

    2017-05-01

    The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization. The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire. We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084). No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures

  7. Patient satisfaction with community pharmacy: comparing urban and suburban chain-pharmacy populations.

    Science.gov (United States)

    Malewski, David F; Ream, Aimrie; Gaither, Caroline A

    2015-01-01

    Patient satisfaction with pharmaceutical care can be a strong predictor of medication and other health-related outcomes. Less understood is the role that location of pharmacies in urban or suburban environments plays in patient satisfaction with pharmacy and pharmacist services. The purpose of this study was to serve as a pilot examining urban and suburban community pharmacy populations for similarities and differences in patient satisfaction. Community pharmacy patients were asked to self-administer a 30-question patient satisfaction survey. Fifteen questions addressed their relationship with the pharmacist, 10 questions addressed satisfaction and accessibility of the pharmacy, and five questions addressed financial concerns. Five urban and five suburban pharmacies agreed to participate. Data analysis included descriptive statistics and chi-square analysis. Most patients reported high levels of satisfaction. Satisfaction with pharmacist relationship and service was 70% or higher with no significant differences between locations. There were significant differences between the urban and suburban patients regarding accessibility of pharmacy services, customer service and some patient/pharmacist trust issues. The significant differences between patient satisfaction in the suburban and urban populations warrant a larger study with more community pharmacies in other urban, suburban and rural locations to better understand and validate study findings. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. [Management of alcohol use disorders in ambulatory care: Which follow-up and for how long?].

    Science.gov (United States)

    Benyamina, A; Reynaud, M

    2016-02-01

    Alcohol consumption with its addictive potential may lead to physical and psychological dependence as well as systemic toxicity all of which have serious detrimental health outcomes in terms of morbimortality. Despite the harmful potential of alcohol use disorders, the disease is often not properly managed, especially in ambulatory care. Psychiatric and general practitioners in ambulatory care are first in line to detect and manage patients with excessive alcohol consumption. However, this is still often regarded as an acute medical condition and its management is generally considered only over the short-term. On the contrary, alcohol dependence has been defined as a primary chronic disease of the brain reward, motivation, memory and related circuitry, involving the signalling pathway of neurotransmitters such as dopamine, opioid peptides, and gamma-aminobutyric acid. Thus, it should be regarded in terms of long-term management as are other chronic diseases. To propose a standard pathway for the management of alcohol dependence in ambulatory care in terms of duration of treatment and follow-up. Given the lack of official recommendations from health authorities which may help ambulatory care physicians in long-term management of patients with alcohol dependence, we performed a review and analysis of the most recent literature regarding the long-term management of other chronic diseases (diabetes, bipolar disorders, and depression) drawing a parallel with alcohol dependence. Alcohol dependence shares many characteristics with other chronic diseases, including a prolonged duration, intermittent acute and chronic exacerbations, and need for prolonged and often-lifelong care. In all cases, this requires sustained psychosocial changes from the patient. Patient motivation is also a major issue and should always be taken into consideration by psychiatric and general practitioners in ambulatory care. In chronic diseases, such as diabetes, bipolar disorders, or depression

  9. Ambulatory Feedback System

    Science.gov (United States)

    Finger, Herbert; Weeks, Bill

    1985-01-01

    This presentation discusses instrumentation that will be used for a specific event, which we hope will carry on to future events within the Space Shuttle program. The experiment is the Autogenic Feedback Training Experiment (AFTE) scheduled for Spacelab 3, currently scheduled to be launched in November, 1984. The objectives of the AFTE are to determine the effectiveness of autogenic feedback in preventing or reducing space adaptation syndrome (SAS), to monitor and record in-flight data from the crew, to determine if prediction criteria for SAS can be established, and, finally, to develop an ambulatory instrument package to mount the crew throughout the mission. The purpose of the Ambulatory Feedback System (AFS) is to record the responses of the subject during a provocative event in space and provide a real-time feedback display to reinforce the training.

  10. Self-reported adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Lam, Lai Wah; Twinn, Sheila F; Chan, Sally W C

    2010-04-01

    This paper is a report of a study conducted to examine self-reported adherence to a therapeutic regimen for continuous ambulatory peritoneal dialysis. Studies of patients' adherence during dialysis have primarily focused on haemodialysis and have frequently yielded inconsistent results, which are attributed to the inconsistent tools used to measure adherence. Levels of adherence to all four components of the therapeutic regimen (i.e. dietary and fluid restrictions, medication, and the dialysis regimen) among patients receiving peritoneal dialysis have not been examined, especially from a patient perspective. A total population sample was used. A cross-sectional survey was carried out by face-to-face interviews in 2005 in one renal clinic in Hong Kong. A total of 173 patients undergoing peritoneal dialysis (56% of the total population) participated in the study. Patients perceived themselves as more adherent to medication (83%; 95% confidence interval 77-88%) and dialysis (93%; 95% confidence interval 88-96%) prescriptions than to fluid (64%; 95% confidence interval 56-71%) and dietary (38%; 95% confidence interval 30-45%) restrictions. Those who were male, younger or had received dialysis for 1-3 years saw themselves as more non-adherent compared with other patients. Healthcare professionals should take cultural issues into consideration when setting dietary and fluid restriction guidelines. Additional attention and support are required for patients who identify themselves as more non-adherent. To help patients live with end-stage renal disease and its treatment, qualitative research is required to understand how they go through the dynamic process of adherence.

  11. Successful Semi-Ambulatory Veno-Arterial Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation in a Very Small Child.

    Science.gov (United States)

    Wong, J Y W; Buchholz, H; Ryerson, L; Conradi, A; Adatia, I; Dyck, J; Rebeyka, I; Lien, D; Mullen, J

    2015-08-01

    Lung transplantation (LTx) may be denied for children on extracorporeal membrane oxygenation (ECMO) due to high risk of cerebral hemorrhage. Rarely has successful LTx been reported in children over 10 years of age receiving awake or ambulatory veno-venous ECMO. LTx following support with ambulatory veno-arterial ECMO (VA ECMO) in children has never been reported to our knowledge. We present the case of a 4-year-old, 12-kg child with heritable pulmonary artery hypertension and refractory right ventricular failure. She was successfully bridged to heart-lung transplantation (HLTx) using ambulatory VA ECMO. Initial resuscitation with standard VA ECMO was converted to an ambulatory circuit using Berlin heart cannulae. She was extubated and ambulating around her bed while on VA ECMO for 40 days. She received an HLTx from an oversized marginal lung donor. Despite a cardiac arrest and Grade 3 primary graft dysfunction, she made a full recovery without neurological deficits. She achieved 104% force expiratory volume in 1 s 33 months post-HLTx. Ambulatory VA ECMO may be a useful strategy to bridge very young children to LTx or HLTx. Patient tailored ECMO cannulation, minimization of hemorrhage, and thrombosis risks while on ECMO contributed to a successful HLTx in our patient. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  12. Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency.

    Science.gov (United States)

    Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham R; Edelman, Elazer R; Cremers, Bodo; Kulenthiran, Saarraaken; Ukena, Christian; Linz, Dominik; Kindermann, Ingrid; Tsioufis, Costas; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    2018-03-02

    Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Accessory renal arteries and renal artery disease were present in 56 (37%) and 14 patients (9%), respectively. At 6-months, 24 h-ambulatory BP was reduced by 11/6 mm Hg (p renal arteries (p = 0.543) or renal artery disease (p = 0.598). Patients with at least one main renal artery diameter ≤ 4 mm had a more pronounced reduction of 24 h-ambulatory SBP compared to patients where both arteries were >4 mm (-19 vs. -10 mmHg; p = 0.038). Neither the length of the renal artery nor the number of RF ablations influenced 24 h-ambulatory BP reduction at 6 months. 24 h-ambulatory BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, accessory arteries or renal artery disease. Further, there was no dose-response relationship observed with increasing number of ablations. Because little is known of the impact of renal anatomy and procedural parameters on blood pressure (BP) response to renal denervation (RDN), anatomical and procedural data were analyzed in 150 patients undergoing bilateral RDN. BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, the presence of renal artery disease or accessory renal

  13. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable. © 2011 National Association for Healthcare Quality.

  14. The comprehensive care project: measuring physician performance in ambulatory practice.

    Science.gov (United States)

    Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S

    2010-12-01

    To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; pmeasures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.

  15. An efficient and effective teaching model for ambulatory education.

    Science.gov (United States)

    Regan-Smith, Martha; Young, William W; Keller, Adam M

    2002-07-01

    Teaching and learning in the ambulatory setting have been described as inefficient, variable, and unpredictable. A model of ambulatory teaching that was piloted in three settings (1973-1981 in a university-affiliated outpatient clinic in Portland, Oregon, 1996-2000 in a community outpatient clinic, and 2000-2001 in an outpatient clinic serving Dartmouth Medical School's teaching hospital) that combines a system of education and a system of patient care is presented. Fully integrating learners into the office practice using creative scheduling, pre-rotation learning, and learner competence certification enabled the learners to provide care in roles traditionally fulfilled by physicians and nurses. Practice redesign made learners active members of the patient care team by involving them in such tasks as patient intake, histories and physicals, patient education, and monitoring of patient progress between visits. So that learners can be active members of the patient care team on the first day of clinic, pre-training is provided by the clerkship or residency so that they are able to competently provide care in the time available. To assure effective education, teaching and learning times are explicitly scheduled by parallel booking of patients for the learner and the preceptor at the same time. In the pilot settings this teaching model maintained or improved preceptor productivity and on-time efficiency compared with these outcomes of traditional scheduling. The time spent alone with patients, in direct observation by preceptors, and for scheduled case discussion was appreciated by learners. Increased satisfaction was enjoyed by learners, teachers, clinic staff, and patients. Barriers to implementation include too few examining rooms, inability to manipulate patient appointment schedules, and learners' not being present in a teaching clinic all the time.

  16. Clinical productivity of primary care nurse practitioners in ambulatory settings.

    Science.gov (United States)

    Xue, Ying; Tuttle, Jane

    Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review.

    Science.gov (United States)

    Mus-Peters, Cindy T R; Huisstede, Bionka M A; Noten, Suzie; Hitters, Minou W M G C; van der Slot, Wilma M A; van den Berg-Emons, Rita J G

    2018-05-22

    Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied. Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ -2.0. In addition, we focused on Z-score ≤ -1.0 because this may indicate a tendency towards low bone mineral density. We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ -2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ -1.0) for several body parts. Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy. Implications for Rehabilitation Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.

  18. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Sirio Hassem Sobrinho

    2010-04-01

    Full Text Available A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.La endocarditis bacteriana es una severa enfermedad infecciosa cuyo tratamiento se hace tradicionalmente con el paciente internado, recibiendo medicación intravenosa. La posibilidad de tratamiento domiciliar o clínico, en casos estrictamente seleccionados, es atractivo desde el punto de vista social como del económico. Presentamos el caso clínico de 6 pacientes con diagnóstico de endocarditis bacteriana por streptococcus, tratados parcial o integralmente en régimen ambulatorio. Todos evolucionaron sin complicaciones y con resolución completa del cuadro infeccioso.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

  19. Performance of internal medicine residents in the primary interpretation of musculoskeletal radiographs in an ambulatory care setting

    International Nuclear Information System (INIS)

    Mann, F.A.; Stewart, N.R.; Terrell, C.B.

    1990-01-01

    This paper determines the characteristics of misinterpretations of musculoskeletal radiographs by internal medicine residents (IMRs) in an ambulatory care setting. Discordances between IMRs and staff radiologists were prospectively identified and retrospectively reviewed to assess type of error and patient outcome. The setting was an acute ambulatory care clinic at a large university hospital staffed by board-certified emergency medicine faculty and IMRs. Of 541 patients radiographed, 321 (59%) had adequate follow-up to establish outcome. Error characteristics examined included nature and site, type (false negative ([F-] or false positive [F+]), clinical significance, interpreter responsible, and level of interpreter training

  20. Adesão de pacientes HIV positivos à dietoterapia ambulatorial Adherence of positive HIV patients to ambulatory diet therapy

    Directory of Open Access Journals (Sweden)

    Késia Diego Quintaes

    1999-08-01

    Full Text Available É conhecida a importância do estado nutricional para a evolução clínica de pacientes HIV positivos. Entretanto, é desconhecida a expectativa do paciente com relação à dietoterapia. Por um período de 30 semanas foram acompanhados 50,0% dos pacientes HIV positivo (grupos II e IV atendidos pelo ambulatório de Doenças Sexualmente Transmissíveis do Hospital e Maternidade Celso Pierro. Neste período foram realizadas duas entrevistas, sendo o intervalo entre elas de 10 semanas. Na primeira foram colhidos dados socioeconômicos, antropométricos, verificadas as modificações voluntárias feitas na alimentação e também a expectativa do paciente quanto a este tipo de tratamento. Na segunda foram colhidos indicadores diretos e indiretos de adesão ao tratamento. A adesão foi maior entre os pacientes do grupo IV (64,7% do que entre os do grupo II (35,3%. No entanto, 81,3% dos pacientes do grupo II, após tomarem conhecimento da sorologia positiva para HIV, modificaram voluntariamente sua alimentação, demostrando ser este um importante período para sensibilização do paciente para o tratamento.It's well known the importance of nutritional status to the clinical evolution of positive HIV patients. However, the patient expectation in relation to diet therapy is unknown. During 30 weeks, 50.0% of the patients HIV positive (groups II and IV attended by the ambulatory of Sexually Transmitted Diseases of Hospital and Maternity Celso Pierro, were interviewed. In this period two interviews with an interval of ten weeks were carried out. At the first one socioeconomic and anthropometric data were collected voluntary feeding modifications and also the patient expectation about such treatment were verified. At the second one, direct and indirect indicators of the adherence to treatment were colleded. The adherence was greater in pacients of group IV (64.7% than in group II (35.3%. However, 81.3% of the patients from group II, after being aware

  1. Ambulatory Care after Acute Kidney Injury: An Opportunity to Improve Patient Outcomes

    Directory of Open Access Journals (Sweden)

    Samuel A. Silver

    2015-10-01

    Full Text Available Purpose of review: Acute kidney injury (AKI is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. However, most patients who survive an AKI episode do not receive any follow-up nephrology care. This narrative review describes the experience of two new clinical programs to care for AKI patients after hospital discharge: the Acute Kidney Injury Follow-up Clinic for adults (St. Michael's Hospital and University Health Network, Toronto, Canada and the AKI Survivor Clinic for children (Cincinnati Children's Hospital, USA. Sources of information: MEDLINE, PubMed, ISI Web of Science Findings: These two ambulatory clinics have been in existence for close to two (adult and four (pediatric years, and were developed separately and independently in different populations and health systems. The components of both clinics are described, including the target population, referral process, medical interventions, patient education activities, and follow-up schedule. Common elements include targeting patients with KDIGO stage 2 or 3 AKI, regular audits of the inpatient nephrology census to track eligible patients, medication reconciliation, and education on the long-term consequences of AKI. Limitations: Despite the theoretical benefits of post-AKI follow-up and the clinic components described, there is no high quality evidence to prove that the interventions implemented in these clinics will reduce morbidity or mortality. Therefore, we also present a plan to evaluate the adult AKI Follow-up Clinic in order to determine if it can improve clinical outcomes compared to patients with AKI who do not

  2. Attitude of clinical faculty members in Shiraz Medical University towards private practice physicians' participation in ambulatory care education

    Directory of Open Access Journals (Sweden)

    Khatereh Mahori

    2002-04-01

    Full Text Available Background: Improvement of medical education is necessary for meeting health care demands. Participation of private practice physicians in ambulatory care training is an effective method for enhancing medical students' skills. Purpose This study was undertaken to determine clinical professors' views about participation of physicians with private office in ambulatory care training. Methods: Participants composed of 162 Shiraz Medical University faculty members from 12 disciplines. A questionnaire requesting faculty members' views on different aspects of ambulat01y care teaching and interaction of community-based organizations was distributed. Results: Of 120 (74.1% respondents, 64 (54.2% believed that clinical settings of medical university are appropriate for ambulatory care training. Private practice physicians believed more than academic physicians without private office that private offices have wider range of patients, more common cases, and better follow up chance; and is also a better setting for learning ambulatory care compared with medical university clinical centers. Overall, 32 (29.1% respondent’s found the participation of physicians with private practice on medical education positive. Key words medical education, ambulatory medicine, private practice

  3. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel

    2013-09-01

    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  4. MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL INTENSIVE PROGRAM OF VIDEOLAPAROSCOPY CHOLECYSTECTOMY ON AN AMBULATORY SURGERY BASIS

    Directory of Open Access Journals (Sweden)

    J.S. Santos

    2001-01-01

    Full Text Available Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A e 79 dos 80 operados nos Mutirões III e IV (Grupo B. Análise estatística: teste de Wilcoxon e exato de Fisher (pIntroduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I

  5. Prevalence of Hypothyroidism and Its Association with Diabetes Mellitus in Patients of an Ambulatory Clinic.

    Science.gov (United States)

    Bernal, Mariela; Escobar, Eddy; Rodríguez González, Carmen E

    2016-01-01

    Hypothyroidism is the most common thyroid disorder in the adult population. Studies have found a higher prevalence of overt hypothyroidism in type 2 diabetic population than in the general population, but the relationship between subclinical hypothyroidism and diabetes mellitus 2 is still controversial. The aim of this study is to estimate the prevalence rate of hypothyroidism in the adult population receiving services in an ambulatory clinic and to determine if there is an association between hypothyroidism and diabetes mellitus. From the database of all adult patients who attended the outpatient clinic at Family Medicine Center Policlínica Bella Vista in Mayagüez, P.R. during 2014, a random sample of 200 subjects was obtained and the medical records were reviewed. The prevalence rate of diabetes mellitus in this group was 22% and the prevalence rate of hypothyroidism was 17%. The prevalence rate of hypothyroidism in diabetic patients was 10/44 (22.7%). The prevalence rate of hypothyroidism in non-diabetic patients was 24/156 (15.4%). The prevalence ratio was 1.48 (95% CI: 0.77, 2.85; X2 = 1.31, p = 0.25). The results of this cross-sectional study showed a non-statistically significant tendency for a higher prevalence of hypothyroidism in diabetic patients, which suggest that screening for hypothyroidism among patients with diabetes should be considered. More studies with more patients are necessary to investigate the association between thyroid dysfunction and diabetic patients.

  6. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  7. Hospitalization for uncomplicated hypertension: an ambulatory care sensitive condition.

    Science.gov (United States)

    Walker, Robin L; Chen, Guanmin; McAlister, Finlay A; Campbell, Norm R C; Hemmelgarn, Brenda R; Dixon, Elijah; Ghali, William; Rabi, Doreen; Tu, Karen; Jette, Nathalie; Quan, Hude

    2013-11-01

    Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization. A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension. The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004. We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  8. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  9. Quality and Variability of Patient Directions in Electronic Prescriptions in the Ambulatory Care Setting.

    Science.gov (United States)

    Yang, Yuze; Ward-Charlerie, Stacy; Dhavle, Ajit A; Rupp, Michael T; Green, James

    2018-01-18

    The prescriber's directions to the patient (Sig) are one of the most quality-sensitive components of a prescription order. Owing to their free-text format, the Sig data that are transmitted in electronic prescriptions (e-prescriptions) have the potential to produce interpretation challenges at receiving pharmacies that may threaten patient safety and also negatively affect medication labeling and patient counseling. Ensuring that all data transmitted in the e-prescription are complete and unambiguous is essential for minimizing disruptions in workflow at prescribers' offices and receiving pharmacies and optimizing the safety and effectiveness of patient care. To (a) assess the quality and variability of free-text Sig strings in ambulatory e-prescriptions and (b) propose best-practice recommendations to improve the use of this quality-sensitive field. A retrospective qualitative analysis was performed on a nationally representative sample of 25,000 e-prescriptions issued by 22,152 community-based prescribers across the United States using 501 electronic health records (EHRs) or e-prescribing software applications. The content of Sig text strings in e-prescriptions was classified according to a Sig classification scheme developed with guidance from an expert advisory panel. The Sig text strings were also analyzed for quality-related events (QREs). For purposes of this analysis, QREs were defined as Sig text content that could impair accurate and unambiguous interpretation by staff at receiving pharmacies. A total of 3,797 unique Sig concepts were identified in the 25,000 Sig text strings analyzed; more than 50% of all Sigs could be categorized into 25 unique Sig concepts. Even Sig strings that expressed apparently simple and straightforward concepts displayed substantial variability; for example, the sample contained 832 permutations of words and phrases used to convey the Sig concept of "Take 1 tablet by mouth once daily." Approximately 10% of Sigs contained QREs

  10. Influences on patient satisfaction in healthcare centers: a semi-quantitative study over 5 years.

    Science.gov (United States)

    Thornton, Ruth D; Nurse, Nicole; Snavely, Laura; Hackett-Zahler, Stacey; Frank, Kenice; DiTomasso, Robert A

    2017-05-19

    Knowledge of ambulatory patients' satisfaction with clinic visits help improve communication and delivery of healthcare. The goal was to examine patient satisfaction in a primary care setting, identify how selected patient and physician setting and characteristics affected satisfaction, and determine if feedback provided to medical directors over time impacted patient satisfaction. A three-phase, semi-quantitative analysis was performed using anonymous, validated patient satisfaction surveys collected from 889 ambulatory outpatients in 6 healthcare centers over 5-years. Patients' responses to 21 questions were analyzed by principal components varimax rotated factor analysis. Three classifiable components emerged: Satisfaction with Physician, Availability/Convenience, and Orderly/Time. To study the effects of several independent variables (location of clinics, patients' and physicians' age, education level and duration at the clinic), data were subjected to multivariate analysis of variance (MANOVA).. Changes in the healthcare centers over time were not significantly related to patient satisfaction. However, location of the center did affect satisfaction. Urban patients were more satisfied with their physicians than rural, and inner city patients were less satisfied than urban or rural on Availability/Convenience and less satisfied than urban patients on Orderly/Time. How long a patient attended a center most affected satisfaction, with patients attending >10 years more satisfied in all three components than those attending 60 years old. Patients were significantly more satisfied with their 30-40 year-old physicians compared with those over 60. On Orderly/Time, patients were more satisfied with physicians who were in their 50's than physicians >60. Improvement in patient satisfaction includes a need for immediate, specific feedback. Although Medical Directors received feedback yearly, we found no significant changes in patient satisfaction over time. Our results

  11. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

    Science.gov (United States)

    Plotzke, Michael Robert; Courtemanche, Charles

    2011-07-01

    Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

  12. Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

    Science.gov (United States)

    Drawz, Paul E.; Abdalla, Mohamed; Rahman, Mahboob

    2014-01-01

    Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk for target organ damage and hypertension related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables the measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are two of the newer methods for assessing blood pressure and hypertension related target organ damage. PMID:22521624

  13. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    NARCIS (Netherlands)

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.

    2014-01-01

    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of

  14. Abordagem ambulatorial do nutricionista em anemia hemolítica Nutritional ambulatory approach in hemolytic anemia

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Vieira

    1999-04-01

    Full Text Available Descreve a atuação do nutricionista em ambulatório de Hematologia Pediátrica em um hospital escola e relata as condutas dietéticas necessárias na abordagem de crianças com anemia hemolítica com e sem sobrecarga de ferro, e também as atitudes mais freqüentes dos familiares em relação à alimentação desses pacientes.The Authors describe the performance of the Dietitian in a Pediatric Hematology Ambulatory. They emphasize the necessary dietetic procedures for adequate management of children with hemolytic anemia, with and without iron overload. Furthermore, they approach the family's attitude towards the patient's nutrition.

  15. A single-center audit of the indications and clinical impact of prolonged ambulatory small intestinal manometry.

    Science.gov (United States)

    Ang, D; Pannemans, J; Vanuytsel, T; Tack, J

    2018-05-01

    Small bowel manometry is a diagnostic test available only in a few specialized referral centers. Its exact place in the management of refractory symptoms is controversial. The records of all patients who underwent 24-hour ambulatory duodenojejunal manometry over a 6-year period were retrospectively reviewed. We studied the clinical indications for small bowel manometry, and reviewed the impact of manometric findings on the clinical outcome. One hundred and forty-six studies were performed in 137 patients (46M, 91F) with a mean age of 44.9 ± 15.7 years. Mean follow-up duration was 15.1 ± 22.6 months. Appropriate endoscopic, radiological and gastric scintigraphy studies were performed in all patients prior to small bowel manometry. Criteria for abnormal motor activity were based on Bharucha's classification. The indications for small bowel manometry were chronic abdominal pain (n = 43), slow-transit constipation (n = 17), refractory gastroparesis (n = 16), chronic diarrhea (n = 7), recurrent episodes of subocclusion (n = 16), postsurgical evaluation (n = 36), suspicion of gut involvement in systemic disease (n = 9), and unexplained nausea (n = 2). The most common finding was a normal 24-hour ambulatory small bowel manometry (n = 113). Thirty-three studies yielded abnormal findings which included extrinsic neuropathy (n = 6), intrinsic neuropathy (n = 18), intestinal myopathy (n = 2), and subocclusion (n = 7). Ambulatory small bowel manometry excluded a generalized motility disorder in 77% and had a significant impact on the subsequent clinical course in 23%. Ambulatory small bowel manometry is a useful and safe diagnostic tool to complement traditional investigative modalities in patients with severe unexplained abdominal symptoms. © 2018 John Wiley & Sons Ltd.

  16. [Clinical analysis for patients with continuous ambulatory peritoneal dialysis associated peritonitis].

    Science.gov (United States)

    Liu, Jian; Huang, Xun; Liu, Yao; Xu, Hui; Gong, Rui'e; Li, Chunhui

    2016-12-28

    To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis

  17. Development of Quality Metrics in Ambulatory Pediatric Cardiology.

    Science.gov (United States)

    Chowdhury, Devyani; Gurvitz, Michelle; Marelli, Ariane; Anderson, Jeffrey; Baker-Smith, Carissa; Diab, Karim A; Edwards, Thomas C; Hougen, Tom; Jedeikin, Roy; Johnson, Jonathan N; Karpawich, Peter; Lai, Wyman; Lu, Jimmy C; Mitchell, Stephanie; Newburger, Jane W; Penny, Daniel J; Portman, Michael A; Satou, Gary; Teitel, David; Villafane, Juan; Williams, Roberta; Jenkins, Kathy

    2017-02-07

    The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Characteristics of physicians and patients who join team-based primary care practices: evidence from Quebec's Family Medicine Groups.

    Science.gov (United States)

    Coyle, Natalie; Strumpf, Erin; Fiset-Laniel, Julie; Tousignant, Pierre; Roy, Yves

    2014-06-01

    New models of delivering primary care are being implemented in various countries. In Quebec, Family Medicine Groups (FMGs) are a team-based approach to enhance access to, and coordination of, care. We examined whether physicians' and patients' characteristics predicted their participation in this new model of primary care. Using provincial administrative data, we created a population cohort of Quebec's vulnerable patients. We collected data before the advent of FMGs on patients' demographic characteristics, chronic illnesses and health service use, and their physicians' demographics, and practice characteristics. Multivariate regression was used to identify key predictors of joining a FMG among both patients and physicians. Patients who eventually enrolled in a FMG were more likely to be female, reside outside of an urban region, have a lower SES status, have diabetes and congestive heart failure, visit the emergency department for ambulatory sensitive conditions and be hospitalized for any cause. They were also less likely to have hypertension, visit an ambulatory clinic and have a usual provider of care. Physicians who joined a FMG were less likely to be located in urban locations, had fewer years in medical practice, saw more patients in hospital, and had patients with lower morbidity. Physicians' practice characteristics and patients' health status and health care service use were important predictors of joining a FMG. To avoid basing policy decisions on tenuous evidence, policymakers and researchers should account for differential selection into team-based primary health care models. Copyright © 2014. Published by Elsevier Ireland Ltd.

  19. Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

    Science.gov (United States)

    Granger, Elder; Prada, Stefan; Bereczki, Zoltan; Weiss, Michael; Wade, Chip; Davis, Reginald

    2018-05-21

    Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

  20. [Day hospital in internal medicine: A chance for ambulatory care].

    Science.gov (United States)

    Grasland, A; Mortier, E

    2018-04-16

    Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  1. Weight loss in nonalcoholic Fatty liver disease patients in an ambulatory care setting is largely unsuccessful but correlates with frequency of clinic visits.

    Directory of Open Access Journals (Sweden)

    Anwar Dudekula

    Full Text Available Nonalcoholic fatty liver disease (NALFD is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.We retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1st 2007 to April 30th 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change  =  (weightinitial - weightfinal/(weightinitial. Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.The mean baseline BMI was 33.3±6.6 kg/m2, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1% or class I obesity (30.5% categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively. Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8% lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.Weight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.

  2. Reproducibility of blood pressure variation in older ambulatory and bedridden subjects.

    Science.gov (United States)

    Tsuchihashi, Takuya; Kawakami, Yasunobu; Imamura, Tsuyoshi; Abe, Isao

    2002-06-01

    We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. Nursing home in Japan. Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.

  3. Ambulatory Multi-Drug Resistant Tuberculosis Treatment Outcomes in a Cohort of HIV-Infected Patients in a Slum Setting in Mumbai, India

    Science.gov (United States)

    Isaakidis, Petros; Cox, Helen S.; Varghese, Bhanumati; Montaldo, Chiara; Da Silva, Esdras; Mansoor, Homa; Ladomirska, Joanna; Sotgiu, Giovanni; Migliori, Giovanni B.; Pontali, Emanuele; Saranchuk, Peter; Rodrigues, Camilla; Reid, Tony

    2011-01-01

    Background India carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India. Methods HIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment. Results Between May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment. Conclusions Despite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a

  4. Effects of exercise rehabilitation on cardiac electrical instability assessed by T-wave alternans during ambulatory electrocardiogram monitoring in coronary artery disease patients without and with diabetes mellitus.

    Science.gov (United States)

    Kenttä, Tuomas; Tulppo, Mikko P; Nearing, Bruce D; Karjalainen, Jaana J; Hautala, Arto J; Kiviniemi, Antti M; Huikuri, Heikki V; Verrier, Richard L

    2014-09-15

    Effects of exercise rehabilitation on electrocardiographic markers of risk for sudden cardiac death have not been adequately studied. We examined effects of controlled exercise training on T-wave alternans (TWA) in 24-hour ambulatory electrocardiogram recordings in patients with stable coronary artery disease (CAD) without and with type 2 diabetes mellitus (DM). Consecutive patients with angiographically confirmed CAD were recruited to join the ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) study. Exercise (n = 65) and control groups (n = 65) were matched on age, sex, DM, and previous myocardial infarction. Ambulatory electrocardiograms were recorded before and after a 2-year training period. TWA was assessed using time domain-modified moving average method by an investigator blinded to patients' clinical status. Average TWA values decreased in the rehabilitation group but not in control patients (rehabilitation [mean ± SEM]: 52.8 ± 1.7 μV vs 48.7 ± 1.5 μV, p exercise versus 10% (n = 2 of 20) of controls (p = 0.020). In CAD patients, 30% (n = 8 of 27) of positive TWA cases were converted with exercise versus 4% (n = 1 of 28) of controls (p = 0.012). In conclusion, this is the first report of the effectiveness of exercise rehabilitation to reduce TWA, a marker of sudden cardiac death risk, in patients with stable CAD. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Technical and clinical view on ambulatory assessment in Parkinson's disease.

    Science.gov (United States)

    Hobert, M A; Maetzler, W; Aminian, K; Chiari, L

    2014-09-01

    With the progress of technologies of recent years, methods have become available that use wearable sensors and ambulatory systems to measure aspects of--particular axial--motor function. As Parkinson's disease (PD) can be considered a model disorder for motor impairment, a significant number of studies have already been performed with these patients using such techniques. In general, motion sensors such as accelerometers and gyroscopes are used, in combination with lightweight electronics that do not interfere with normal human motion. A fundamental advantage in comparison with usual clinical assessment is that these sensors allow a more quantitative, objective, and reliable evaluation of symptoms; they have also significant advantages compared to in-lab technologies (e.g., optoelectronic motion capture) as they allow long-term monitoring under real-life conditions. In addition, based on recent findings particularly from studies using functional imaging, we learned that non-motor symptoms, specifically cognitive aspects, may be at least indirectly assessable. It is hypothesized that ambulatory quantitative assessment strategies will allow users, clinicians, and scientists in the future to gain more quantitative, unobtrusive, and everyday relevant data out of their clinical evaluation and can also be designed as pervasive (everywhere) and intensive (anytime) tools for ambulatory assessment and even rehabilitation of motor and (partly) non-motor symptoms in PD. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Prospective Register Of patients undergoing repeated OFfice and Ambulatory Blood Pressure Monitoring (PROOF-ABPM): protocol for an observational cohort study.

    Science.gov (United States)

    Sheppard, James P; Martin, Una; Gill, Paramjit; Stevens, Richard; McManus, Richard J

    2016-10-31

    The diagnosis and management of hypertension depends on accurate measurement of blood pressure (BP) in order to target antihypertensive treatment appropriately. Most BP measurements take place in a clinic setting, but it has long been recognised that readings taken out-of-office (via home or ambulatory monitoring) estimate true underlying BP more accurately. Recent studies have shown that the change in clinic BP over multiple readings is a significant predictor of the difference between clinic and out-of-office BP. Used in combination with patient characteristics, this change has been shown to accurately predict a patient's out-of-office BP level. The present study proposes to collect real-life BP data to prospectively validate this new prediction tool in routine clinical practice. A prospective, multicentre observational cohort design will be used, recruiting patients from primary and secondary care. All patients attending participating centres for ambulatory BP monitoring will be eligible to participate. Anonymised clinical data will be collected from all eligible patients, who will be invited to give informed consent to permit identifiable data to be collected for data linkage to external outcome registries. Descriptive statistics will be used to calculate the sensitivity, specificity, positive and negative predictive values of the out-of-office BP prediction tool. Area under the receiver operator characteristic curve statistics will be used to examine model performance. Ethical approval for this study has been obtained from the National Research. Ethics Service Committee South Central-Oxford A (reference; 15/SC/0184), and site-specific R&D approval has been acquired from the relevant NHS trusts. All findings will be presented at relevant conferences and published in peer-reviewed journals, on the study website and disseminated in lay and social media where appropriate. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  7. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  8. [Comparative analysis of efficiency indicators in ambulatory surgery].

    Science.gov (United States)

    Rodríguez Ortega, María; Porrero Carro, José Luis; Aranaz Andrés, Jesús María; Castillo Fe, María José; Alonso García, María Teresa; Sánchez-Cabezudo Díaz-Guerra, Carlos

    2017-05-25

    To find comparative elements for quality control in major ambulatory surgery (MAS) units. Descriptive and comparative study of the Ambulatory Care Index (AI) and Substitution Index (SI) in the Santa Cristina Hospital Surgery Service (Madrid, Spain) compared to Key Indicators (KI) of the National Health Service (NHS). 7,817 MAS procedures (between 2006 and 2014) were analysed. The average annual AI was 54%, higher (p <0.0001) than «ambulatory surgery» KI. The hernia outpatient procedures (average 72%) were also superior to the national KI (p <0.0001), but ambulatory haemorrhoidectomy (average 33.6%) was clearly lower (p <0.0001). KI of the NHS are useful and allow to establish a proper development in the global AI and hernia outpatient surgery with opportunities for improvement in haemorrhoidectomy. Their collection should be careful, not including minor surgeries. Also, their usefulness could be increased if data was broken down by speciality and by complexity. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Signs, symptoms, and treatment patterns across serial ambulatory cardiology visits in patients with heart failure: insights from the NCDR PINNACLE® registry.

    Science.gov (United States)

    Allen, Larry A; Tang, Fengming; Jones, Philip; Breeding, Tracie; Ponirakis, Angelo; Turner, Stuart J

    2018-05-03

    Due to a relative lack of outpatient heart failure (HF) clinical registries, we aimed to describe symptoms, signs, and medication treatment among ambulatory patients with heart failure (HF) over time. Using health records from 234 PINNACLE (Practice Innovation and Clinical Excellence) U.S. cardiology practices (2008-2014), serial visits for patients with HF were characterized. Symptoms, signs, and HF medications (angiotensin-converting enzyme inhibitors [ACEI], angiotensin receptor blockers [ARB], beta blockers [BB], and diuretics) were compared between visits. Among 763,331 patients with HF, 550,581 had ≥2 clinic visits < 1 year apart, with 2,998,444 visit pairs. In the 12 months following an index visit, patients had a mean of 2.5 ± 2.3 additional visits. Recorded index visit symptoms ranged from dyspnea (53.6%) to orthopnea (23.1%); signs ranged from peripheral edema (52.2%) to hepatomegaly (0.6%). Of those with ejection fraction < 40%, ACEI was prescribed in 58.6%, ARB in 18.5%, BB in 85.2%, and diuretics in 70.0%. Between-visit recorded changes were infrequent: dyspnea appeared in 3.8%, resolved in 2.7%; NYHA class increased in 2.9%, decreased in 2.9%; number of signs increased in 6.0%, decreased in 5.1%; ACEI/ARB or BB added in 6.4%, removed in 6.2%; diuretic added in 3.7%, removed in 3.8%. Changes in recorded symptoms were rarely associated with initiation or discontinuation in HF medication classes. Ambulatory HF care in U.S. cardiology practices seldom recorded changes in symptoms, signs, and medication class. Although templated medical records and absence of medication dosing likely underestimated the degree to which clinical changes occur over serial visits for HF, these PINNACLE data suggest opportunities for greater symptom-based and therapy-focused visits.

  10. 44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients.

    Science.gov (United States)

    Haskin, Orly; Wong, Cynthia J; McCabe, Lonisa; Begin, Brandy; Sutherland, Scott M; Chaudhuri, Abanti

    2015-04-01

    The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥ 25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.

  11. Service quality and patient experiences of ambulatory care in a specialized clinic vs. a general hospital.

    Science.gov (United States)

    De Regge, Melissa; De Groote, Hélène; Trybou, Jeroen; Gemmel, Paul; Brugada, Pedro

    2017-04-01

    Health care organizations are constantly looking for ways to establish a differential advantage to attract customers. To this end, service quality has become an important differentiator in the strategy of health care organizations. In this study, we compared the service quality and patient experience in an ambulatory care setting of a physician-owned specialized facility with that of a general hospital. A comparative case study with a mixed method design was employed. Data were gathered through a survey on health service quality and patient experience, completed with observations, walkthroughs, and photographic material. Service quality and patient experiences are high in both the investigated health care facilities. A significant distinction can be made between the two facilities in terms of interpersonal quality (p = 0.001) and environmental quality (P ≤ 0.001), in favor of the medical center. The difference in environmental quality is also indicated by the scores given by participants who had been in both facilities. Qualitative analysis showed higher administrative quality in the medical center. Environmental quality and patient experience can predict the interpersonal quality; for environmental quality, interpersonal quality and age are significant predictors. Service quality and patient experiences are high in both facilities. The medical center has higher service quality for interpersonal and environmental service quality and is more process-centered.

  12. Differential effectiveness of depression disease management for rural and urban primary care patients.

    Science.gov (United States)

    Adams, Scott J; Xu, Stanley; Dong, Fran; Fortney, John; Rost, Kathryn

    2006-01-01

    Federally qualified health centers across the country are adopting depression disease management programs following federally mandated training; however, little is known about the relative effectiveness of depression disease management in rural versus urban patient populations. To explore whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). A preplanned secondary analysis was conducted in a consecutively sampled cohort of 479 depressed primary care patients recruited from 12 practices in 10 states across the country participating in the Quality Enhancement for Strategic Teaming study. Depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients. Depression disease management appears to improve clinical outcomes in urban but not rural patients. Because these programs compete for scarce resources, health care organizations interested in delivering depression disease management to rural populations need to advocate for programs whose clinical effectiveness has been demonstrated for rural residents.

  13. Twenty-four-hour ambulatory blood pressure monitoring in very elderly patients

    Science.gov (United States)

    Cappelleri, Claudia; Janoschka, Alin; Berli, Reto; Kohler, Sibylle; Braun-Dullaeus, Ruediger C.; Heuss, Ludwig T.; Wolfrum, Mathias

    2017-01-01

    Abstract Elevated blood pressure (BP) is frequently diagnosed in very elderly hospitalized patients. Accurate diagnosis of hypertension is challenging in the hospital environment, due to the “white coat effect,” and both overtreatment and undertreatment can adversely affect clinical outcome. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has the potential to avoid the “white coat effect” and accurately guide the management of hypertension. However, effects of the hospital environment on ABPM are unknown in the very elderly. We set out to enroll 45 patients, age ≥70 years, with elevated conventional BP during hospitalization in this observational study. It was prespecified by protocol to assess initially the difference between 24-hour BP during hospital-admission and home follow-up. Subsequent analysis should investigate the change in anxiety (Hospital Anxiety and Depression Scale-A [HADS-A]) after discharge, the correlation with change in 24-hour BP after discharge, and the prevalence of orthostatic hypertension. Thirty-one patients were included in the final analysis (age 83.5 ± 4.4 years; 71% female). Twenty-four-hour BP decreased significantly after hospital discharge (systolic from 133.5 ± 15.6 to 126.2 ± 14.4 mm Hg [millimeter of mercury], P = .008; diastolic from 71.0 ± 9.0 to 68.3 ± 8.6 mm Hg, P = .046). Anxiety level (HADS-A) decreased significantly after discharge, from 7.5 (interquartile range [IQR]: 4.0–13.8) to 5.0 (IQR: 4.0–8.0, P = .012). The change in anxiety was a predictor of change in systolic BP after discharge (F[1,20] = 5.9, P = .025). Sixty-one percent of the patients had significant orthostatic hypotension during hospital stay. In conclusion, 24-hour BP in very elderly patients is lower in the home environment than during hospitalization. This phenomenon seems to be directly linked to a lower anxiety-level at home. Reassessing hypertension at home may decrease the

  14. Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto Raquianestesia posterior para cirugías anorrectales en régimen ambulatorial: estudio piloto Restricted dorsal spinal anesthesia for ambulatory anorectal surgery: a pilot study

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2004-12-01

    sometidos a la raquianestesia con solución hipobárica de bupivacaína a 0,15% a través de aguja 27G Quincke para cirugías anorrectales. La punción subaracnóidea fue realizada con el paciente en decúbito ventral con auxilio de un cojin en su abdomen para corregir la lordosis lumbar y el espacio intervertebral. RESULTADOS: El bloqueo sensitivo fue logrado en todos los pacientes. Su dispersión varió de T10 a L2 con moda en T12. Apenas tres pacientes presentaron algún grado de bloqueo motor. La duración del bloqueo fue de 122,17 ± 15,35 minutos. Estabilidad hemodinámica fue observada en todos los pacientes. Ningún paciente desarrolló cefalea después de punción de la dura-máter. CONCLUSIONES: Seis miligramos de bupivacaína a 0,15% en solución hipobárica proporcionaron un bloqueo predominantemente sensitivo, cuando inyectados en decúbito ventral. Las principales ventajas son la rápida recuperación, estabilidad hemodinámica y satisfacción del paciente, siendo una buena indicación para anestesia ambulatorial.BACKGROUND AND OBJECTIVES: The increasing number of ambulatory procedures requires anesthetic methods allowing patients to be discharged soon after surgery completion. Currently, anorectal procedures are performed in inpatient settings. This study aimed at evaluating the feasibility of performing these procedures in outpatient settings with low hypobaric bupivacaine doses. METHODS: Participated in this study 30 patients physical status ASA I and II, submitted to spinal anesthesia with 0.15% hypobaric bupivacaine with 27G Quincke needle for anorectal procedures. Spinal puncture was performed with patients in the prone position with the help of a pad under the abdomen to correct lumbar lordosis and the vertebral interspace. RESULTS: Sensory block was obtained in all patients. Sensory block spread varied T10 to L2 (mode = T12. Only three patients presented motor block. Blockade length was 122.17 ± 15.35 minutes. No hemodynamic changes were observed in

  15. A radiolucent chair for sitting-posture radiographs in non-ambulatory children: use in biplanar digital slot-scanning

    International Nuclear Information System (INIS)

    Bouloussa, Houssam; Dubory, Arnaud; Bachy, Manon; Seiler, Catherine; Morel, Baptiste; Vialle, Raphael

    2015-01-01

    EOS imaging (EOS System; EOS imaging, Paris, France) enables fast 2-D/3-D imaging of children in standing load-bearing position. Non-ambulatory children with neuromuscular scoliosis need evaluation of their spinal balance while in a normal daily position. We designed a customized chair fitting the EOS patient-area dimensions to obtain images in natural sitting postures. The chair is a 360 rotating orthopaedic chair made of fully radiolucent polyethylene and equipped with an adjustable headrest and three-point belts. Out of 41 consecutive patients, 36 (88%, 95% confidence interval 74-96%) had successful imaging. In most patients with severe neuromuscular trunk deformities, the EOS system combined with our chair was useful for assessing preoperative trunk collapse, pelvic obliquity and postoperative corrections in all planes. This specific device changed our daily practice for the assessment of spinal deformities in non-ambulatory patients. (orig.)

  16. A radiolucent chair for sitting-posture radiographs in non-ambulatory children: use in biplanar digital slot-scanning

    Energy Technology Data Exchange (ETDEWEB)

    Bouloussa, Houssam; Dubory, Arnaud; Bachy, Manon [Universite Pierre et Marie Curie-Paris 6, Armand Trousseau Hospital, Department of Pediatric Orthopaedics, Paris Cedex 12 (France); Seiler, Catherine [Groupe Lagarrigue, Clichy (France); Morel, Baptiste [Universite Pierre et Marie Curie-Paris 6, Armand Trousseau Hospital, Department of Pediatric Imaging, Paris (France); Vialle, Raphael [Universite Pierre et Marie Curie-Paris 6, Armand Trousseau Hospital, Department of Pediatric Orthopaedics, Paris Cedex 12 (France); Armand Trousseau Hospital, The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases, Paris (France)

    2015-11-15

    EOS imaging (EOS System; EOS imaging, Paris, France) enables fast 2-D/3-D imaging of children in standing load-bearing position. Non-ambulatory children with neuromuscular scoliosis need evaluation of their spinal balance while in a normal daily position. We designed a customized chair fitting the EOS patient-area dimensions to obtain images in natural sitting postures. The chair is a 360 rotating orthopaedic chair made of fully radiolucent polyethylene and equipped with an adjustable headrest and three-point belts. Out of 41 consecutive patients, 36 (88%, 95% confidence interval 74-96%) had successful imaging. In most patients with severe neuromuscular trunk deformities, the EOS system combined with our chair was useful for assessing preoperative trunk collapse, pelvic obliquity and postoperative corrections in all planes. This specific device changed our daily practice for the assessment of spinal deformities in non-ambulatory patients. (orig.)

  17. Performance measurement for ambulatory care: moving towards a new agenda.

    Science.gov (United States)

    Roski, J; Gregory, R

    2001-12-01

    Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.

  18. Controlled-Release Oxycodone Versus Naproxen at Home After Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Björn Stessel, MD

    2014-12-01

    Conclusions: Paracetamol/CR oxycodone and paracetamol/naproxen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction level. We suggest paracetamol/CR oxycodone to be a valuable alternative for the current paracetamol/naproxen gold standard, particularly in patients with a contraindication for nonsteroidal anti-inflammatory drugs. ClinicalTrials.gov identifier: NCT02152592.

  19. Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology.

    Science.gov (United States)

    Laws, M Barton; Lee, Yoojin; Taubin, Tatiana; Rogers, William H; Wilson, Ira B

    2018-01-01

    While some studies have assessed patient recall of important information from ambulatory care visits, none has done so recently. Furthermore, little is known about features of clinical interactions which are associated with patient understanding and recall, without which shared decision making, a widely shared ideal for patient care, cannot occur. Our objective was to evaluate characteristics of patients and outpatient encounters associated with patient recall of information after one week, along with observation of elements of shared decision making. This was an observational study based on coded transcripts of 189 outpatient encounters, and post-visit interviews with patients 1 week later. Coding used three previously validated systems, adopted for this study. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36% recalled with a prompt; 15% recalled erroneously or not at all. Provider behaviors hypothesized to be associated with patient recall, such as open-questioning and "teach back," were rare. Patients with less than high school education recalled 38% of items freely and accurately, while patients with a college degree recalled 65% (p total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider ("verbal dominance"), were significant predictors of poorer recall. The item count was associated with poorer recall for lower, but not higher, educated patients.

  20. Risk Factors for the First Episode of Peritonitis in Southern Chinese Continuous Ambulatory Peritoneal Dialysis Patients

    Science.gov (United States)

    Fan, Xiaoguang; Huang, Rong; Wang, Juan; Ye, Hongjian; Guo, Qunying; Yi, Chunyan; Lin, Jianxiong; Zhou, Qian; Shao, Fengmin; Yu, Xueqing; Yang, Xiao

    2014-01-01

    Background The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis. Results In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) [hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin peritonitis in Southern Chinese CAPD patients. PMID:25222609

  1. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Sonia Gaucher

    Full Text Available To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial.Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults, was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6% vs. 113 (5.8%, adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57. Checklist administration revealed that 355 patients (28.0% had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0% still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.

  2. Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

    Science.gov (United States)

    Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

    2017-08-01

    Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all Pcoaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

  3. Incremental Yield of Including Determine-TB LAM Assay in Diagnostic Algorithms for Hospitalized and Ambulatory HIV-Positive Patients in Kenya.

    Science.gov (United States)

    Huerga, Helena; Ferlazzo, Gabriella; Bevilacqua, Paolo; Kirubi, Beatrice; Ardizzoni, Elisa; Wanjala, Stephen; Sitienei, Joseph; Bonnet, Maryline

    2017-01-01

    Determine-TB LAM assay is a urine point-of-care test useful for TB diagnosis in HIV-positive patients. We assessed the incremental diagnostic yield of adding LAM to algorithms based on clinical signs, sputum smear-microscopy, chest X-ray and Xpert MTB/RIF in HIV-positive patients with symptoms of pulmonary TB (PTB). Prospective observational cohort of ambulatory (either severely ill or CD4<200cells/μl or with Body Mass Index<17Kg/m2) and hospitalized symptomatic HIV-positive adults in Kenya. Incremental diagnostic yield of adding LAM was the difference in the proportion of confirmed TB patients (positive Xpert or MTB culture) diagnosed by the algorithm with LAM compared to the algorithm without LAM. The multivariable mortality model was adjusted for age, sex, clinical severity, BMI, CD4, ART initiation, LAM result and TB confirmation. Among 474 patients included, 44.1% were severely ill, 69.6% had CD4<200cells/μl, 59.9% had initiated ART, 23.2% could not produce sputum. LAM, smear-microscopy, Xpert and culture in sputum were positive in 39.0% (185/474), 21.6% (76/352), 29.1% (102/350) and 39.7% (92/232) of the patients tested, respectively. Of 156 patients with confirmed TB, 65.4% were LAM positive. Of those classified as non-TB, 84.0% were LAM negative. Adding LAM increased the diagnostic yield of the algorithms by 36.6%, from 47.4% (95%CI:39.4-55.6) to 84.0% (95%CI:77.3-89.4%), when using clinical signs and X-ray; by 19.9%, from 62.2% (95%CI:54.1-69.8) to 82.1% (95%CI:75.1-87.7), when using clinical signs and microscopy; and by 13.4%, from 74.4% (95%CI:66.8-81.0) to 87.8% (95%CI:81.6-92.5), when using clinical signs and Xpert. LAM positive patients had an increased risk of 2-months mortality (aOR:2.7; 95%CI:1.5-4.9). LAM should be included in TB diagnostic algorithms in parallel to microscopy or Xpert request for HIV-positive patients either ambulatory (severely ill or CD4<200cells/μl) or hospitalized. LAM allows same day treatment initiation in patients at

  4. Sensitivity and specificity of obesity diagnosis in pediatric ambulatory care in the United States.

    Science.gov (United States)

    Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M

    2013-09-01

    We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits. We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis. Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%. The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.

  5. Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

    Science.gov (United States)

    Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

    2000-07-01

    The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

  6. Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics.

    Science.gov (United States)

    Desjarlais-deKlerk, Kristen; Wallace, Jean E

    2013-07-08

    Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to "cure-oriented interactions" and tends to be more task-oriented focusing on the patient's health concerns and reason for the appointment. In contrast, socioemotional communication refers to more "care-oriented interactions" that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional

  7. Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

    Science.gov (United States)

    2017-01-01

    Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin. PMID:28378550

  8. Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

    Science.gov (United States)

    2013-01-01

    Background Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. Methods We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to “cure-oriented interactions” and tends to be more task-oriented focusing on the patient’s health concerns and reason for the appointment. In contrast, socioemotional communication refers to more “care-oriented interactions” that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. Results The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Conclusions Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient

  9. Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

    Science.gov (United States)

    O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia

    2015-01-01

    Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the

  10. A novel ambulatory closed circuit breathing system for use during exercise.

    LENUS (Irish Health Repository)

    McMorrow, R C N

    2011-05-01

    We describe a unique ambulatory closed circuit for delivering high fractions of inspired oxygen to an exercising user who does not require isolation from their environment. We describe the major components and their function and suggest potential applications for such a circuit. This circuit may benefit patients who are chronically dependant on oxygen, are unable to exercise due to hypoxia, or require oxygen supplementation at high altitude.

  11. Development of quality metrics for ambulatory pediatric cardiology: Chest pain.

    Science.gov (United States)

    Lu, Jimmy C; Bansal, Manish; Behera, Sarina K; Boris, Jeffrey R; Cardis, Brian; Hokanson, John S; Kakavand, Bahram; Jedeikin, Roy

    2017-12-01

    As part of the American College of Cardiology Adult Congenital and Pediatric Cardiology Section effort to develop quality metrics (QMs) for ambulatory pediatric practice, the chest pain subcommittee aimed to develop QMs for evaluation of chest pain. A group of 8 pediatric cardiologists formulated candidate QMs in the areas of history, physical examination, and testing. Consensus candidate QMs were submitted to an expert panel for scoring by the RAND-UCLA modified Delphi process. Recommended QMs were then available for open comments from all members. These QMs are intended for use in patients 5-18 years old, referred for initial evaluation of chest pain in an ambulatory pediatric cardiology clinic, with no known history of pediatric or congenital heart disease. A total of 10 candidate QMs were submitted; 2 were rejected by the expert panel, and 5 were removed after the open comment period. The 3 approved QMs included: (1) documentation of family history of cardiomyopathy, early coronary artery disease or sudden death, (2) performance of electrocardiogram in all patients, and (3) performance of an echocardiogram to evaluate coronary arteries in patients with exertional chest pain. Despite practice variation and limited prospective data, 3 QMs were approved, with measurable data points which may be extracted from the medical record. However, further prospective studies are necessary to define practice guidelines and to develop appropriate use criteria in this population. © 2017 Wiley Periodicals, Inc.

  12. Developments in ambulatory surgery in orthopedics in France in 2016.

    Science.gov (United States)

    Hulet, C; Rochcongar, G; Court, C

    2017-02-01

    Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  13. Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients.

    Science.gov (United States)

    Tonelli, Marcello; Lloyd, Anita; Pannu, Neesh; Klarenbach, Scott; Ravani, Pietro; Jindal, Kailash; MacRae, Jennifer; Unsworth, Larry; Manns, Braden; Hemmelgarn, Brenda

    2018-02-01

    Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

  14. Emergency service: a strategy for hospital-sponsored ambulatory care satellites.

    Science.gov (United States)

    Gregory, D; Klegon, D; Steinhauer, B

    1984-01-01

    This analysis of the overall market position of free-standing emergency care was based on a telephone survey of 300 randomly chosen households in a southeastern metropolitan area. Results show that consumer preferences for cost and convenience create a strong market for free-standing emergency facilities. Emergicare centers are in an ideal situation to capture the market for acute and minor emergency care. To be worthwhile, the emergency room in a more comprehensive ambulatory care facility should serve as a feeder of new patients and be profitable in its own right. However, free-standing emergency facilities must not only attract patients through convenience and price, but they must also maintain patients through assuring quality care and satisfaction.

  15. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    Science.gov (United States)

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  16. Ambulatory Medical Follow-Up in the Year After Surgery and Subsequent Survival in a National Cohort of Veterans Health Administration Surgical Patients.

    Science.gov (United States)

    Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

    2016-06-01

    Among a national cohort of surgical patients, the authors analyzed the association between medical follow-up during the first postsurgical year and survival during the second postsurgical year. Retrospective cohort study. US Veterans Hospitals. The study included adults who received surgical care in any Veterans Health Administration facility from 2006 to 2011 who were discharged within 10 days of surgery and who survived for at least 1 year postoperatively. None. The association between the receipt of nonsurgical ambulatory medical care during the first postoperative year and the hazard of death during postsurgical year 2 was measured. Among 236,200 veterans, 93.2% received a nonsurgical medical follow-up visit in postsurgical year 1; of those, 5.1% died during postsurgical year 2. This compares with 9.4% year-2 mortality among patients lacking year-1 medical follow-up (p<0.0001). After adjustment for confounders, medical follow-up in postoperative year 1 again was associated with a significantly lower hazard of death in postoperative year 2 (hazard ratio 0.71; 95% confidence interval 0.66-0.78). Sensitivity analyses examining patient subgroups stratified by procedural specialty demonstrated comparable findings. The results were robust under a variety of simulated scenarios of unmeasured confounding. Within a national cohort of US veterans who presented for surgery, those who received nonsurgical ambulatory follow-up during the first postoperative year demonstrated lower all-cause mortality in the subsequent postoperative year than those who did not receive the same type of follow-up care. Interventions focused on postoperative care coordination of outpatient medical follow-up may have the potential to improve long-term postoperative survival. Copyright © 2016. Published by Elsevier Inc.

  17. Needs of cancer patients treated in rural and urban cancer departments

    International Nuclear Information System (INIS)

    Mercurit, Angelina; Kallady, Susannah

    2005-01-01

    Literature indicates that cancer patients experience high levels of unmet needs, particularly in relation to health information, psychological requirements and physical and daily living needs. It suggests that the needs of patients living in rural areas are likely to be higher than those of urban patients due to geographical factors and health service accessibility issues. This paper will explore the needs of cancer patients with particular focus on the impact of location (rural vs. urban), present the basis of these needs and identify strategies that address the needs expressed, by reviewing current literature. Copyright (2005) Australian Institute of Radiography

  18. Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study.

    Science.gov (United States)

    Conway, Kyle S; Forbang, Nketi; Beben, Tomasz; Criqui, Michael H; Ix, Joachim H; Rifkin, Dena E

    2015-12-01

    Twenty-four-hour ambulatory blood pressure (BP) patterns have been associated with diminished cognitive function in hypertensive and very elderly populations. The relationship between ambulatory BP patterns and cognitive function in community-living older adults is unknown. We conducted a cross-sectional study in which 24-hour ambulatory BP, in-clinic BP, and cognitive function measures were obtained from 319 community-living older adults. The mean age was 72 years, 66% were female, and 13% were African-American. We performed linear regression with performance on the Montreal Cognitive Assessment (MoCA) as the primary outcome and 24-hour BP patterns as the independent variable, adjusting for age, sex, race/ethnicity, education, and comorbidities. Greater nighttime systolic dipping (P = 0.046) and higher 24-hour diastolic BP (DBP; P = 0.015) were both significantly associated with better cognitive function, whereas 24-hour systolic BP (SBP), average real variability, and ambulatory arterial stiffness were not. Higher 24-hour DBP and greater nighttime systolic dipping were significantly associated with improved cognitive function. Future studies should examine whether low 24-hour DBP and lack of nighttime systolic dipping predict future cognitive impairment. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. [Analysis of several containment measures of pharmaceutical expenditure in an Ambulatory Surgery Centre].

    Science.gov (United States)

    Esteban, J L; León, A; Porras, I

    2013-11-01

    In the context of the current crisis, sustainability of National Health Service must be considered a priority issue. To compare several cost saving measures in drug expenditure due to outpatient drug treatment after surgery in an Ambulatory Surgical Centre. Pharmaco-economic analysis of cost minimization of ambulatory pharmaceutical services during the year 2011. A total of 3,346 patients were operated on and discharged on the same day, were included. Treatments were collected from the discharge report of each patient. We compared changes in real outpatient drug spending after separately applying each of the following measures: 1) increasing the co-payment; 2) improving the quality of prescribing; 3) dispensing by units of drugs through pharmacies, and 4) dispensing through the hospital pharmacy service. The real outpatient pharmaceutical expenditure was 29,454.21€. Increasing the co-payment mean a transfer of 2,091.82€ from the funding institutions to users. Improving the quality of prescriptions, dispensing through units of drugs in the pharmacy, and dispensing through the hospital pharmacy service led to a pharmaceutical expenditure of 24,215.14€, 21,766.24€ and 7,827.71€, respectively. Only considering co-payment to contain pharmaceutical expenditure arising from prescribing in an Ambulatory Surgical Centre is the least effective measure. The most effective measure, for this purpose, is the supply of drugs through the hospital pharmacy service. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  20. [The determination of arterial pressure by the physician or the nurse: its relation to ambulatory pressure and left ventricular mass. The MAPA-Madrid Group. Monitorización Ambulatoria de la Presión Arterial (Ambulatory Monitoring of Arterial Pressure)].

    Science.gov (United States)

    Martínez, M A; Aguirre, A; Sánchez, M; Nevado, A; Laguna, I; Torre, A; Manuel, E; Villar, C; García-Puig, J

    1999-12-11

    In the present study we evaluated the influence of the observer's status--physician or nurse--on blood pressure levels and the relationship among clinic blood pressure measurement with ambulatory blood pressure and left ventricle mass. Cross sectional study performed in seven primary care centers. Participating physicians and nurses were trained for blood pressure measurement prior to the study and subsequently retrained at 3 month intervals during the study. Patients included in the study were 122 subjects with mild to moderate hypertension who underwent the following study protocol: a) measurement of clinic blood pressure by physician and nurse, in an independent fashion, on 3 visits; b) clinic-epidemiologic questionnaire; c) conventional hematological and biochemical study; d) electrocardiogram; e) 24-hour ambulatory blood pressure monitoring, f) M-mode and Doppler echocardiography (only in 58 subjects). Nurse-measured blood pressure levels were higher than those determined by physicians (mean differences: 3.9 [6.7] mmHg in systolic blood pressure and 2.6 [5.4] mmHg in diastolic blood pressure). The blood pressure level differences between the two observers were higher in female patients and subjects with low educational level, independently of the observer's gender. Nurse-measured blood pressure was more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. Nurse-measured blood pressure levels are lower than those determined by physicians and more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. These data support that nurses, instead of doctors, should routinely measure blood pressure in primary care centers.

  1. Should mean arterial pressure be included in the definition of ambulatory hypertension in children?

    Science.gov (United States)

    Suláková, Terezie; Feber, Janusz

    2013-07-01

    The diagnosis of hypertension (HTN)/normotension (NT) on ambulatory blood pressure monitoring (ABPM) is usually based on systolic (SBP) or diastolic blood pressure (DBP). The goal of this study was to analyze whether inclusion of mean arterial pressure (MAP) improves the detection of HTN on ABPM. We retrospectively studied ABPM records in 229 children (116 boys, median age = 15.3 years) who were referred for evaluation of HTN. A diagnosis of HTN was made if: (A) MAP or SBP or DBP was ≥ 1.65 SDS (95th percentile); (B) SBP or DBP was ≥ 1.65 SDS (95th percentile), during 24-h or daytime or night-time in both definitions. Using definition A, 46/229 patients had HTN compared to definition B by which only 37/229 patients had HTN (p = 0.001). The level of agreement between the two definitions was very good (kappa = 0.86 ± 0.04), however nine patients (19.5 %) were missed by not using MAP in the definition of HTN. These nine patients had only mild HTN with a median Z score of 1.69. The inclusion of MAP in the definition of ambulatory HTN significantly increased the number of hypertensive patients. MAP may be very helpful in detecting mild HTN in patients with normal/borderline SBP and DBP.

  2. AMBULATORY BLOOD PRESSURE PATTERNS IN CHILDREN WITH CHRONIC KIDNEY DISEASE

    Science.gov (United States)

    Samuels, Joshua; Ng, Derek; Flynn, Joseph T.; Mitsnefes, Mark; Poffenbarger, Tim; Warady, Bradley A.; Furth, Susan

    2012-01-01

    Ambulatory blood pressure monitoring (ABPM) is the best method of detecting abnormal blood pressure (BP) in patients with chronic kidney disease (CKD), whose hypertension may be missed with office BP measurements. We report ABPM findings in 332 children 1 year after entry in the Chronic Kidney Disease in Children (CKiD) cohort study. All subjects underwent casual and ambulatory BP measurement. BP was categorized based on casual and ABPM results into normal, white coat, masked, and ambulatory hypertension. Only half of the subjects had a normal ABPM. BP load was elevated (>25%) in 52% (n= 172) while mean BP was elevated in 32% (n= 105). In multivariate analysis, those using an ACE inhibitor (ACEi) were 89% more likely to have a normal ABPM than those who did not report using an ACEi (OR: 1.89, 95%CI: 1.17, 3.04). For every 20% faster decline in annualized GFR change, the odds of an abnormal ABPM increased 26% (OR: 1.26, 95%CI: 0.97, 1.64; p= 0.081). A 2.25 fold increase in urine protein:creatinine ratio annualized change was associated with a 39% higher odds of an abnormal ABPM (OR: 1.39, 95%CI: 1.06, 1.82; p= 0.019). Abnormalities on ABPM are common in children with CKD, and are strongly associated with known risk factors for end stage renal disease. Individuals on ACEi were less likely to have abnormal ABPM, suggesting a possible therapeutic intervention. ABPM should be used to monitor risk and guide therapy in children with CKD. PMID:22585950

  3. Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting.

    Science.gov (United States)

    Goh, Ivy; Lai, Olive; Chew, Lita

    2018-03-26

    This was a single center, retrospective cross-sectional study looking into the incidence and types of drug-related problems (DRPs) detected among elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, and the types of intervention taken to address these DRPs. This paper serves to elucidate the prevalence and risk of polypharmacy in our geriatric oncology population in an ambulatory care setting, to raise awareness on this growing issue and to encourage more resource allocation to address this healthcare phenomenon. DRP was detected in 77.6% of elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, with an average incidence of three DRPs per patient. Approximately half of DRPs were related to long-term medications. Forty percent of DRPs required interventions at the prescriber level. The use of five or more medications was shown to almost double the risk of DRP occurrence (OR 1.862, P = 0.039). Out of the eight predefined categories of DRPs, underprescribing was the most common (26.7%), followed by adverse drug reaction (25.0%) and drug non-adherence (16.2%). Polypharmacy leading to DRPs is a common occurrence in elderly cancer patients receiving outpatient IV chemotherapy. There should be systematic measures in place to identify patients who are at greater risk of inappropriate polypharmacy and DRPs, and hence more frequent drug therapy optimization and monitoring. The identification of DRPs is an important step to circumvent serious drug-related harm. Future healthcare interventions directed at reducing DRPs should aim to assess the clinical and economic impact of such interventions.

  4. Center of mass movement estimation using an ambulatory measurement sytem

    NARCIS (Netherlands)

    Schepers, H. Martin; Veltink, Petrus H.

    2007-01-01

    Center of Mass (CoM) displacement, an important variable to characterize human walking, was estimated in this study using an ambulatory measurement system. The ambulatory system was compared to an optical reference system. Root-mean-square differences between the magnitudes of the CoM appeared to be

  5. Comparison of Postoperative Pain between Infiltrative Local Anesthesia plus Paracetamol and Total Intravenous Anesthesia plus Paracetamol in Ambulatory Breast Surgery

    Directory of Open Access Journals (Sweden)

    Kasra Karvandian

    2015-08-01

    Full Text Available Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia.Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA, the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU stay was recorded for each patient.Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001. The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001. Patients in the LA group had longer PACU admission (P = 0.001.Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient.

  6. Comparison of analgesic efficacy of flupirtine maleate and ibuprofen in gynaecological ambulatory surgeries: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vanita Ahuja

    2015-01-01

    Full Text Available Background and Aims: Flupirtine maleate is a centrally acting, non-opioid analgesic with unique muscle relaxant properties as compared to common analgesics. The aim of this study was to compare post-operative analgesic efficacy of flupirtine maleate and ibuprofen in patients undergoing gynaecological ambulatory surgeries. Methods: This prospective, randomised controlled study was conducted in 60 women of American Society of Anesthesiologists physical status I/II, 18-70 years of age and scheduled to undergo gynaecological ambulatory surgeries. The participants were randomised to receive either 100 mg oral flupirtine maleate (group flupirtine, n = 30 or 800 mg oral ibuprofen (group ibuprofen, n = 30, 1 h prior to surgery and then every 8 h for 48 h. Verbal Numerical Rating Scale (VNRS on movement was assessed at 0, 2, 4, 6 and 8 h following surgery. Following discharge from hospital, the patients were interviewed telephonically at 12, 24 and 48 h post-operatively. VNRS was statistically analysed using Mann-Whitney test. Results: VNRS on movement was statistically reduced at 2 h after surgery (P = 0.04 in group flupirtine as compared to group ibuprofen. The analgesic efficacy was similar in both the groups at 4, 6, 8, 12, 24 and 48 h after surgery. The satisfaction scores at 24 and 48 h post-operatively were superior in group flupirtine as compared to group ibuprofen (P < 0.001. Conclusion: Analgesic efficacy of flupirtine maleate was comparable with ibuprofen in patients in ambulatory gynaecological patients up to 48 h postoperatively with superior satisfaction scores.

  7. Ambulatory oesophageal pH monitoring: a comparison between antimony, ISFET, and glass pH electrodes

    NARCIS (Netherlands)

    Hemmink, Gerrit J. M.; Weusten, Bas L. A. M.; Oors, Jac; Bredenoord, Albert J.; Timmer, Robin; Smout, André J. P. M.

    2010-01-01

    BACKGROUND AND AIM: Ambulatory oesophageal pH-impedance monitoring is a widely used test to evaluate patients with reflux symptoms. Several types of pH electrodes are available: antimony, ion sensitive field effect transistor (ISFET), and glass electrodes. These pH electrodes have not been compared

  8. Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis.

    Science.gov (United States)

    Olson, Jacob K; Deming, Lisa A; King, Denis R; Rager, Terrence M; Gartner, Sarah; Huibregtse, Natalie; Moss, R Lawrence; Besner, Gail E

    2017-10-10

    Single visit surgery (SVS) consists of same-day pre-operative assessment and operation with telephone post-operative follow-up. This reduces family time commitment to 1 hospital trip rather than 2-3. We began SVS for ambulatory patients with clear surgical indications in 2013. We sought to determine family satisfaction, cost savings to families, and institutional financial feasibility of SVS. SVS patients were compared to age/case matched conventional surgery (CS) patients. Satisfaction was assessed by post-operative telephone survey. Family costs were calculated as the sum of lost revenue (based on median income) and transportation costs ($0.50/mile). Satisfaction was high in both groups (98% for SVS vs. 93% for CS; p=0.27). 40% of CS families indicated that they would have preferred SVS, whereas no SVS families indicated preference for the CS option (p<0.001). Distance from the hospital did not correlate with satisfaction. Estimated cost savings for an SVS family was $188. Reimbursement, hospital and physician charges, and day-of-surgery cancellation rates were similar. SVS provides substantial cost savings to families while maintaining patient satisfaction and equivalent institutional reimbursement. SVS is an effective approach to low-risk ambulatory surgical procedures that is less disruptive to families, facilitates access to pediatric surgical care, and reduces resource utilization. Cost Effectiveness Study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Ambulatory blood pressure response to a bout of HIIT in metabolic syndrome patients.

    Science.gov (United States)

    Ramirez-Jimenez, M; Morales-Palomo, F; Pallares, J G; Mora-Rodriguez, Ricardo; Ortega, J F

    2017-07-01

    The effectiveness of exercise to lower blood pressure may depend on the type and intensity of exercise. We study the short-term (i.e., 14-h) effects of a bout of high-intensity aerobic interval training (HIIT) on blood pressure in metabolic syndrome (MetS) patients. Nineteen MetS patients (55.2 ± 7.3 years, 6 women) entered the study. Eight of them were normotensive and eleven hypertensive according to MetS threshold (≥130 mmHg for SBP and/or ≥85 mmHg for DBP). In the morning of 3 separated days, they underwent a cycling exercise bout of HIIT (>90% of maximal heart rate, ~85% VO 2max ), or a bout of isocaloric moderate-intensity continuous training (MICT; ~70% of maximal heart rate, ~60% VO 2max ), or a control no-exercise trial (REST). After exercise, ambulatory blood pressure (ABP; 14 h) was monitored, while subjects continued their habitual daily activities wearing a wrist-band activity monitor. No ABP differences were found for normotensive subjects. In hypertensive subjects, systolic ABP was reduced by 6.1 ± 2.2 mmHg after HIIT compared to MICT and REST (130.8 ± 3.9 vs. 137.4 ± 5.1 and 136.4 ± 3.8 mmHg, respectively; p HIIT exercise bout is superior to an equivalent bout of continuous exercise when used as a non-pharmacological aid in the treatment of hypertension in MetS.

  10. A syphilis co-infection study in human papilloma virus patients attended in the sexually transmitted infection ambulatory clinic, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Lúcia Maria de Sena Souza

    Full Text Available Despite the prevalence of syphilis worldwide, little is known about its manifestations when associated with other Sexually Transmitted Infections (STI, specifically the Human Papilloma Virus (HPV. Current epidemiological studies show that there is a high incidence of both diseases in ambulatory clinics all over Brazil. This study aims to estimate the incidence of syphilis - HPV co-infections, among patients from the STI ambulatory clinic at the Santa Casa da Misericórdia Hospital, Rio de Janeiro, Brazil. Two-hundred and seven patients were seen in the clinic between March and December 2005, of which 113 (54.6% sought care for an HPV infection. Blood samples were taken from all patients to check syphilis serology using the flocculation and the non-treponemic test or VDRL (Venereal Disease Research Laboratory and the TPHA (Treponema Pallidum Hemagglutination Assay treponemic and confirmatory method. Of the 207 patients, 113 (54.6% consulted referring to HPV as their primary complaint, and of these, 18 (15.9% also presented with positive syphilis serology, demonstrating a high incidence of coinfection. The average age of the patients varied between 20 and 25 years, 203 (98.1% were male and 4 (1.9% were female. The predominance of the male sex in this sample confirms the profile usually treated in STI clinics across the country, and the age range is that of typically high sexually activity. Conclusion: The results demonstrated the need for a differentiated examination of all STD patients.

  11. Developing a business-practice model for pharmacy services in ambulatory settings.

    Science.gov (United States)

    Harris, Ila M; Baker, Ed; Berry, Tricia M; Halloran, Mary Ann; Lindauer, Kathleen; Ragucci, Kelly R; McGivney, Melissa Somma; Taylor, A Thomas; Haines, Stuart T

    2008-02-01

    A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.

  12. Awake insertion of a Laryngeal Mask Airway-Proseal™ as alternative to awake fiberoptic intubation in management of anticipated difficult airway in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Matilde Zaballos

    Full Text Available Abstract Background and objectives The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. Case report A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. Conclusion We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.

  13. Office blood pressure or ambulatory blood pressure for the prediction of cardiovascular events

    DEFF Research Database (Denmark)

    Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke

    2017-01-01

    Aims: To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Methods...... and results: A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events....... Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0...

  14. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience.

    Science.gov (United States)

    El-Reshaid, Wael; Al-Disawy, Hanan; Nassef, Hossameldeen; Alhelaly, Usama

    2016-09-01

    Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.

  15. Length of Stay in Ambulatory Surgical Oncology Patients at High Risk for Sleep Apnea as Predicted by STOP-BANG Questionnaire

    Directory of Open Access Journals (Sweden)

    Diwakar D. Balachandran

    2016-01-01

    Full Text Available Background. The STOP-BANG questionnaire has been used to identify surgical patients at risk for undiagnosed obstructive sleep apnea (OSA by classifying patients as low risk (LR if STOP-BANG score < 3 or high risk (HR if STOP-BANG score ≥ 3. Few studies have examined whether postoperative complications are increased in HR patients and none have been described in oncologic patients. Objective. This retrospective study examined if HR patients experience increased complications evidenced by an increased length of stay (LOS in the postanesthesia care unit (PACU. Methods. We retrospectively measured LOS and the frequency of oxygen desaturation (<93% in cancer patients who were given the STOP-BANG questionnaire prior to cystoscopy for urologic disease in an ambulatory surgery center. Results. The majority of patients in our study were men (77.7%, over the age of 50 (90.1%, and had BMI < 30 kg/m2 (88.4%. STOP-BANG results were obtained on 404 patients. Cumulative incidence of the time to discharge between HR and the LR groups was plotted. By 8 hours, LR patients showed a higher cumulative probability of being discharged early (80% versus 74%, P=0.008. Conclusions. Urologic oncology patients at HR for OSA based on the STOP-BANG questionnaire were less likely to be discharged early from the PACU compared to LR patients.

  16. Improving Timely Resident Follow-Up and Communication of Results in Ambulatory Clinics Utilizing a Web-Based Audit and Feedback Module.

    Science.gov (United States)

    Boggan, Joel C; Swaminathan, Aparna; Thomas, Samantha; Simel, David L; Zaas, Aimee K; Bae, Jonathan G

    2017-04-01

    Failure to follow up and communicate test results to patients in outpatient settings may lead to diagnostic and therapeutic delays. Residents are less likely than attending physicians to report results to patients, and may face additional barriers to reporting, given competing clinical responsibilities. This study aimed to improve the rates of communicating test results to patients in resident ambulatory clinics. We performed an internal medicine, residency-wide, pre- and postintervention, quality improvement project using audit and feedback. Residents performed audits of ambulatory patients requiring laboratory or radiologic testing by means of a shared online interface. The intervention consisted of an educational module viewed with initial audits, development of a personalized improvement plan after Phase 1, and repeated real-time feedback of individual relative performance compared at clinic and program levels. Outcomes included results communicated within 14 days and prespecified "significant" results communicated within 72 hours. A total of 76 of 86 eligible residents (88%) reviewed 1713 individual ambulatory patients' charts in Phase 1, and 73 residents (85%) reviewed 1509 charts in Phase 2. Follow-up rates were higher in Phase 2 than Phase 1 for communicating results within 14 days and significant results within 72 hours (85% versus 78%, P  Communication of "significant" results was more likely to occur via telephone, compared with communication of nonsignificant results. Participation in a shared audit and feedback quality improvement project can improve rates of resident follow-up and communication of results, although communication gaps remained.

  17. Correlates of late-life major depression: a comparison of urban and rural primary care patients.

    Science.gov (United States)

    Friedman, Bruce; Conwell, Yeates; Delavan, Rachel L

    2007-01-01

    The objective of this study was to determine whether factors associated with depression differ between elderly residents of rural and urban areas. The research design was cross-sectional and observational. The study subjects consisted of 926 Medicare primary care patients (650 urban and 276 rural) who were age 65+ and cognitively intact and had enrolled in a randomized, controlled Medicare demonstration. Major depression was identified by the Mini International Neuropsychiatric Interview. A logistic regression model was estimated that included a rural-urban indicator variable, additional independent variables, and interaction terms between the rural-urban indicator and independent variables that were significant at p Reporting 0-1 close friends (odds ratio [OR]: 6.86; 95% confidence interval [CI]: 2.18-21.58), 2+ emergency room visits during the past 6 months (OR: 4.00; 95% CI: 1.19-13.43), and more financial strain (OR: 1.50; 95% CI: 1.01-2.23) were associated with significantly higher likelihood of major depression among rural as compared with urban patients. The SF-36 Physical Component Summary score had a curvilinear relationship with major depression and was higher for urban patients. The predicted probability for major depression is lower for the rural patients when financial strain is low, about the same for rural and urban patients when strain is intermediate, and higher for rural patients when strain is high. Clinicians in rural areas should be vigilant for major depression among patients with very few close friends, several recent emergency department visits, and financial strain.

  18. White Coat Hypertension and Masked Hypertension Among Omani Patients Attending a Tertiary Hospital for Ambulatory Blood Pressure Monitoring

    Directory of Open Access Journals (Sweden)

    Khamis Al-Hashmi

    2015-03-01

    Full Text Available Objectives: Our study aimed to estimate the rate of white coat hypertension (WCH and effect, and masked hypertension in patients attending a tertiary care hospital for 24 hour ambulatory blood pressure monitoring (24-h ABPM. Methods: A total of 231 adult patients were referred to the Department of Clinical Physiology at Sultan Qaboos University Hospital, Muscat, for ABPM, between January 2010 and June 2012. The following data were gathered and analyzed: demographic data, clinic blood pressure (BP measurements, and 24-h BP profile from ABPM. Thirty-two patients were excluded and the final analysis included 199 patients. Results: There were 105 (52.8% women and 94 (47.2% men studied. The mean age of patients was 46±15 years and most patients were overweight with a mean BMI of 29.6±5kg/m2. Around half of patients (53.8% were on one or more antihypertensive medications. WCH was found in 10.6% and white coat effect was found in 16% of patients. The majority of patients (57% with WCH were aged 40 years or above. Masked hypertension was present in 6% of patients and masked uncontrolled hypertension in 8.5% of patients. Conclusions: Our study showed that WCH and effect, and masked hypertension are common in hypertensive patients. Identifying these patients will have an impact on their management. However, the results of the study should be interpreted within the context of its limitations. Prospective randomized community and hospital-based studies should be conducted to estimate the true prevalence in the general population as well as in hypertensive patients.

  19. Tracking Reflective Practice-Based Learning by Medical Students during an Ambulatory Clerkship

    Science.gov (United States)

    Goldberg, Harry

    2007-01-01

    Objective To explore the use of web and palm digital assistant (PDA)-based patient logs to facilitate reflective learning in an ambulatory medicine clerkship. Design Thematic analysis of convenience sample of three successive rotations of medical students’ patient log entries. Setting Johns Hopkins University School of Medicine. Participants MS3 and MS4 students rotating through a required block ambulatory medicine clerkship. Interventions Students are required to enter patient encounters into a web-based log system during the clerkship. Patient-linked entries included an open text field entitled, “Learning Need.” Students were encouraged to use this field to enter goals for future study or teaching points related to the encounter. Measurement and Main Results The logs of 59 students were examined. These students entered 3,051 patient encounters, and 51 students entered 1,347 learning need entries (44.1% of encounters). The use of the “Learning Need” field was not correlated with MS year, gender or end-of-clerkship knowledge test performance. There were strong correlations between the use of diagnostic thinking comments and observations of therapeutic relationships (Pearson’s r=.42, p<0.001), and between diagnostic thinking and primary interpretation skills (Pearson’s r=.60, p<0.001), but not between diagnostic thinking and factual knowledge (Pearson’s r =.10, p=.46). CONCLUSIONS We found that when clerkship students were cued to reflect on each patient encounter with the electronic log system, student entries grouped into categories that suggested different levels of reflective thinking. Future efforts should explore the use of such entries to encourage and track habits of reflective practice in the clinical curriculum. PMID:17786523

  20. The effect of race on postsurgical ambulatory medical follow-up among United States Veterans.

    Science.gov (United States)

    Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

    2017-08-01

    To investigate the association between self-identified black or African American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, black or African American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Retrospective observational. All US Veterans Affairs hospitals. A total of 236,200 Veterans undergoing surgery between 2006 and 2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. None. Attendance at an internal medicine follow-up appointment within 1 year after surgery. After controlling for year of surgery, age, age ≥65 years, sex, Hispanic ethnicity, and number of inpatient days, black or African American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio, 1.11; 95% confidence interval, 1.06-1.16). When accounting for geographic region, this difference remained significant at the Bonferoni-corrected P < .007 level only in the Midwest United States where black or African American patients were 28% more likely to lack medical follow-up in the year after surgery (odds ratio, 1.28; 95% confidence interval, 1.16-1.42; P < .0001). The disparity in ambulatory medical follow-up following surgery among black or African American vs nonblack or non-African American Veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health. © 2013.

  2. Nurse-Driven Training Courses: Impact on Implementation of Ambulatory Blood Pressure Monitoring

    OpenAIRE

    F?lez-Carrob?, Estel; Sagarra-Ti?, Maria; Romero, Araceli; Rubio, Montserrat; Planas, Lourdes; P?rez-Lucena, Mar?a Jos?; Baiget, Montserrat; Cabista?, Cristina; F?lez, Jordi

    2013-01-01

    Background: Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients. Objective: To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program. Materials and Methodology: Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhab...

  3. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  4. Prevalence of Polyherbacy in Ambulatory Visits to Traditional Chinese Medicine Clinics in Taiwan

    Science.gov (United States)

    Lin, Ming-Hwai; Chang, Hsiao-Ting; Tu, Chun-Yi; Chen, Tzeng-Ji; Hwang, Shinn-Jang

    2015-01-01

    Patients with a polyherbal prescription are more likely to receive duplicate medications and thus suffer from adverse drug reactions. We conducted a population-based retrospective study to examine the items of Chinese herbal medicine (CHM) per prescription in the ambulatory care of traditional Chinese medicine (TCM) in Taiwan. We retrieved complete TCM ambulatory visit datasets for 2010 from the National Health Insurance database in Taiwan. A total of 59,790 patients who received 313,482 CHM prescriptions were analyzed. Drug prescriptions containing more than five drugs were classified as polyherbal prescriptions; 41.6% of patients were given a polyherbal prescription. There were on average 5.2 ± 2.5 CHMs: 2.3 ± 1.1 compound herbal formula items, and 3.0 ± 2.5 single Chinese herb items in a single prescription. Approximately 4.6% of patients were prescribed 10 CHMs or more. Men had a lower odds ratio (OR) among polyherbal prescriptions (OR = 0.96, 95% confidence interval [CI] 0.92–0.99), and middle-aged patients (35–49 years) had the highest frequency of polyherbal prescription (OR = 1.19, 95% CI = 1.13–1.26). Patients with neoplasm, skin and subcutaneous tissue disease, or genitourinary system disease were more likely to have a polyherbal prescription; OR = 2.20 (1.81–2.67), 1.65 (1.50–1.80), and 1.52 (1.40–1.64), respectively. Polyherbal prescription is widespread in TCM in Taiwan. Potential herb interactions and iatrogenic risks associated with polyherbal prescriptions should be monitored. PMID:26287228

  5. Fungal peritonitis in continuous ambulatory peritoneal dialysis: The impact of antifungal prophylaxis on patient and technique outcomes

    Directory of Open Access Journals (Sweden)

    K V Kumar

    2014-01-01

    Full Text Available Fungal peritonitis (FP is a rare, but serious complication of peritoneal dialysis. We analyzed the incidence of FP, associated risk factors and outcome of patients with FP and evaluated the role of prophylactic antifungal agent in reducing its incidence. We studied all patients with FP from January 2005 to January 2012. Study period was divided into two parts, period I (January 2005 to January 2010, when prophylactic antifungal was not used and period II (January 2010 to January 2012, when prophylactic antifungal (fluconazole was used. A total of 142 episodes of peritonitis were documented during this period of which 20 (14% were FP. During the study period I, 18 of 102 episodes of peritonitis (17.6% and in the study period II (with antifungal prophylaxis, only 2 of 40 episodes of peritonitis (5% were due to fungal infection (P = 0.04. Nine out of 20 patients (45% had prior exposure to antibiotics. Fungal isolates were Candida albicans in 65%, non-albicans Candida in 25%, Rhizopus species in 5% and Alternaria in 5% of the patients. While 12 out of 20 patients (60% recovered completely and were re-initiated on continuous ambulatory peritoneal dialysis (CAPD, 4 of them expired (20% and 4 others (20% were shifted to hemodialysis. Use of prophylactic antifungal agent significantly reduced the incidence of FP (P = 0.04. We conclude that - fluconazole when used as a prophylactic agent in the setting of bacterial peritonitis significantly reduces the incidence of subsequent FP in CAPD patients.

  6. Patient Safety Outcomes in Small Urban and Small Rural Hospitals

    Science.gov (United States)

    Vartak, Smruti; Ward, Marcia M.; Vaughn, Thomas E.

    2010-01-01

    Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was…

  7. National Ambulatory Medical Care Survey (NAMCS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Ambulatory Medical Care Survey (NAMCS) is a national survey designed to meet the need for objective, reliable information about the provision and use of...

  8. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients

    Science.gov (United States)

    Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

    2016-01-01

    Abstract Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients’ technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients. This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes. During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality. We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality. These results may help to identify and target patients who are at higher risk of HPR at the start

  9. Development of quality metrics for ambulatory pediatric cardiology: Transposition of the great arteries after arterial switch operation.

    Science.gov (United States)

    Baker-Smith, Carissa M; Carlson, Karina; Ettedgui, Jose; Tsuda, Takeshi; Jayakumar, K Anitha; Park, Matthew; Tede, Nikola; Uzark, Karen; Fleishman, Craig; Connuck, David; Likes, Maggie; Penny, Daniel J

    2018-01-01

    To develop quality metrics (QMs) for the ambulatory care of patients with transposition of the great arteries following arterial switch operation (TGA/ASO). Under the auspices of the American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Steering committee, the TGA/ASO team generated candidate QMs related to TGA/ASO ambulatory care. Candidate QMs were submitted to the ACPC Steering Committee and were reviewed for validity and feasibility using individual expert panel member scoring according to the RAND-UCLA methodology. QMs were then made available for review by the entire ACC ACPC during an "open comment period." Final approval of each QM was provided by a vote of the ACC ACPC Council. Patients with TGA who had undergone an ASO were included. Patients with complex transposition were excluded. Twelve candidate QMs were generated. Seven metrics passed the RAND-UCLA process. Four passed the "open comment period" and were ultimately approved by the Council. These included: (1) at least 1 echocardiogram performed during the first year of life reporting on the function, aortic dimension, degree of neoaortic valve insufficiency, the patency of the systemic and pulmonary outflows, the patency of the branch pulmonary arteries and coronary arteries, (2) neurodevelopmental (ND) assessment after ASO; (3) lipid profile by age 11 years; and (4) documentation of a transition of care plan to an adult congenital heart disease (CHD) provider by 18 years of age. Application of the RAND-UCLA methodology and linkage of this methodology to the ACPC approval process led to successful generation of 4 QMs relevant to the care of TGA/ASO pediatric patients in the ambulatory setting. These metrics have now been incorporated into the ACPC Quality Network providing guidance for the care of TGA/ASO patients across 30 CHD centers. © 2017 Wiley Periodicals, Inc.

  10. [Medical Service Information Seeking Behaviors in Rural and Urban Patients in Sichuan Province].

    Science.gov (United States)

    Zhang, Wen-Jie; Xue, Li; Chen, Rao; Duan, Zhan-Qi; Liu, Dan-Ping

    2018-03-01

    To understand how rural and urban patients seek medical service information in Sichuan province. A self-designed questionnaire was distributed randomly to patients who visited primary,secondary and tertiary health facilities in Chengdu,Yibin and Suining,collecting data in relation to their sources of medical service information,as well as the contents and credibility of the information. The major sources of medical service information came from friends,past experiences and television programs,which were consistent with the most desirable access channels. The urban patients were more likely to trust (5.3%) and use (10.6%) the Internet to obtain medical service information compared with their rural counterparts (3.4% and 5.5%,respectively, P marketing strategies for urban and rural patients should be developed to channel patients to appropriate health facilities. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  11. Prescribing Safety in Ambulatory Care: Physician Perspectives

    National Research Council Canada - National Science Library

    Rundall, Thomas G; Hsu, John; Lafata, Jennifer E; Fung, Vicki; Paez, Kathryn A; Simpkins, Jan; Simon, Steven R; Robinson, Scott B; Uratsu, Connie; Gunter, Margaret J; Soumerai, Stephen B; Selby, Joseph V

    2005-01-01

    .... We asked about current safety practices, perceptions of ambulatory prescribing safety. Using a content analysis approach, three investigators independently coded responses into thematic categories...

  12. 76 FR 66929 - Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2011-10-28

    ...] Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery Facilities... receipt of a deeming application from the American Association for Accreditation of Ambulatory Surgery... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice also...

  13. Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

    Science.gov (United States)

    Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

    2015-12-01

    Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

  14. Testing the reliability of the Fall Risk Screening Tool in an elderly ambulatory population.

    Science.gov (United States)

    Fielding, Susan J; McKay, Michael; Hyrkas, Kristiina

    2013-11-01

    To identify and test the reliability of a fall risk screening tool in an ambulatory outpatient clinic. The Fall Risk Screening Tool (Albert Lea Medical Center, MN, USA) was scripted for an interview format. Two interviewers separately screened a convenience sample of 111 patients (age ≥ 65 years) in an ambulatory outpatient clinic in a northeastern US city. The interviewers' scoring of fall risk categories was similar. There was good internal consistency (Cronbach's α = 0.834-0.889) and inter-rater reliability [intra-class correlation coefficients (ICC) = 0.824-0.881] for total, Risk Factor and Client's Health Status subscales. The Physical Environment scores indicated acceptable internal consistency (Cronbach's α = 0.742) and adequate reliability (ICC = 0.688). Two Physical Environment items (furniture and medical equipment condition) had low reliabilities [Kappa (K) = 0.323, P = 0.08; K = -0.078, P = 0.648), respectively. The scripted Fall Risk Screening Tool demonstrated good reliability in this sample. Rewording two Physical Environment items will be considered. A reliable instrument such as the scripted Fall Risk Screening Tool provides a standardised assessment for identifying high fall risk patients. This tool is especially useful because it assesses personal, behavioural and environmental factors specific to community-dwelling patients; the interview format also facilitates patient-provider interaction. © 2013 John Wiley & Sons Ltd.

  15. Treatment of early-stage prostate cancer among rural and urban patients.

    Science.gov (United States)

    Baldwin, Laura-Mae; Andrilla, C Holly A; Porter, Michael P; Rosenblatt, Roger A; Patel, Shilpen; Doescher, Mark P

    2013-08-15

    Geographic barriers and limited availability of cancer specialists may influence early prostate cancer treatment options for rural men. This study compares receipt of different early prostate cancer treatments between rural and urban patients. Using 2004-2006 SEER Limited-Use Data, 51,982 early prostate cancer patients were identified (T1c, T2a, T2b, T2c, T2NOS; no metastases) who were most likely to benefit from definitive treatment (rural-urban residence overall, and for different sociodemographic and cancer characteristics, and different states based on logistic regression analyses, using general estimating equation methods to account for clustering by county. Adjusted definitive treatment rates were lower for rural (83.7%) than urban (87.1%) patients with early-stage prostate cancer (P ≤ .01). Rural men were more likely than urban men to receive non-definitive surgical treatment and no initial treatment. The lowest definitive treatment rates were among rural subgroups: 70 to 74 years (73.9%), African Americans (75.6%), American Indians/Alaska Natives (77.8%), single/separated/divorced (76.8%), living in New Mexico (69.3%), and living in counties with persistent poverty (79.6%). Between 2004 and 2006, this adjusted analysis found that men who were living in rural areas were less likely to receive definitive treatment for their early-stage prostate cancer than those living in urban areas. Certain rural patient groups with prostate cancer need particular attention to ensure their access to appropriate treatment. Rural providers, rural health care systems, and cancer advocacy and support organizations should ensure resources are in place so that the most vulnerable rural groups (men between 60 and 74 years of age; African American men; men who are single, separated, or divorced; and men living in rural New Mexico) can make informed prostate cancer treatment choices based on their preferences. Copyright © 2013 American Cancer Society.

  16. Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Mun Jang

    2017-09-01

    Full Text Available Background: Volume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD. The ratio of bioimpedance (RBI might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI. Methods: RBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI by bioimpedance spectroscopy (BCM®, Fresenius Medical Care before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI to control for the electro-physiological effects of peritoneal dialysate. Results: The mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001 of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001. Conclusion: The volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.

  17. Casual and ambulatory blood pressure monitoring in children with renal scarring

    Directory of Open Access Journals (Sweden)

    Miloševski Gordana

    2005-01-01

    Full Text Available INTRODUCTION Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM in comparison to the casual method (CBP, and to determine the correlation between ambulatory blood pressure (ABP and/or casual blood pressure (CBP values and proteinuria in children with renal scarring. METHOD This forward-looking study comprised thirty-five children (26 girls and 9 boys, aged between 3-13 years, 10.4±3.9, X+SD. Blood pressure was measured using the casual method (CBP with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the Space Labs device, model 90207. RESULTS 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p<0.01. "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION Nocturnal systolic hypertension (systolic non-dipping alteration is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.

  18. The Influence of Ambulatory Aid on Lower-Extremity Muscle Activation During Gait.

    Science.gov (United States)

    Sanders, Michael; Bowden, Anton E; Baker, Spencer; Jensen, Ryan; Nichols, McKenzie; Seeley, Matthew K

    2018-05-10

    Foot and ankle injuries are common and often require a nonweight-bearing period of immobilization for the involved leg. This nonweight-bearing period usually results in muscle atrophy for the involved leg. There is a dearth of objective data describing muscle activation for different ambulatory aids that are used during the aforementioned nonweight-bearing period. To compare activation amplitudes for 4 leg muscles during (1) able-bodied gait and (2) ambulation involving 3 different ambulatory aids that can be used during the acute phase of foot and ankle injury care. Within-subject, repeated measures. University biomechanics laboratory. Sixteen able-bodied individuals (7 females and 9 males). Each participant performed able-bodied gait and ambulation using 3 different ambulatory aids (traditional axillary crutches, knee scooter, and a novel lower-leg prosthesis). Muscle activation amplitude quantified via mean surface electromyography amplitude throughout the stance phase of ambulation. Numerous statistical differences (P < .05) existed for muscle activation amplitude between the 4 observed muscles, 3 ambulatory aids, and able-bodied gait. For the involved leg, comparing the 3 ambulatory aids: (1) knee scooter ambulation resulted in the greatest vastus lateralis activation, (2) ambulation using the novel prosthesis and traditional crutches resulted in greater biceps femoris activation than knee scooter ambulation, and (3) ambulation using the novel prosthesis resulted in the greatest gastrocnemius activation (P < .05). Generally speaking, muscle activation amplitudes were most similar to able-bodied gait when subjects were ambulating using the knee scooter or novel prosthesis. Type of ambulatory aid influences muscle activation amplitude. Traditional axillary crutches appear to be less likely to mitigate muscle atrophy during the nonweighting, immobilization period that often follows foot or ankle injuries. Researchers and clinicians should consider

  19. Prospective Validation of the Decalogue, a Set of Doctor-Patient Communication Recommendations to Improve Patient Illness Experience and Mood States within a Hospital Cardiologic Ambulatory Setting

    Directory of Open Access Journals (Sweden)

    Piercarlo Ballo

    2017-01-01

    Full Text Available Strategies to improve doctor-patient communication may have a beneficial impact on patient’s illness experience and mood, with potential favorable clinical effects. We prospectively tested the psychometric and clinical validity of the Decalogue, a tool utilizing 10 communication recommendations for patients and physicians. The Decalogue was administered to 100 consecutive patients referred for a cardiologic consultation, whereas 49 patients served as controls. The POMS-2 questionnaire was used to measure the total mood disturbance at the end of the consultation. Structural equation modeling showed high internal consistency (Cronbach alpha 0.93, good test-retest reproducibility, and high validity of the psychometric construct (all > 0.80, suggesting a positive effect on patients’ illness experience. The total mood disturbance was lower in the patients exposed to the Decalogue as compared to the controls (1.4±12.1 versus 14.8±27.6, p=0.0010. In an additional questionnaire, patients in the Decalogue group showed a trend towards a better understanding of their state of health (p=0.07. In a cardiologic ambulatory setting, the Decalogue shows good validity and reliability as a tool to improve patients’ illness experience and could have a favorable impact on mood states. These effects might potentially improve patient engagement in care and adherence to therapy, as well as clinical outcome.

  20. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study.

    Science.gov (United States)

    Head, Geoffrey A; Mihailidou, Anastasia S; Duggan, Karen A; Beilin, Lawrence J; Berry, Narelle; Brown, Mark A; Bune, Alex J; Cowley, Diane; Chalmers, John P; Howe, Peter R C; Hodgson, Jonathan; Ludbrook, John; Mangoni, Arduino A; McGrath, Barry P; Nelson, Mark R; Sharman, James E; Stowasser, Michael

    2010-04-14

    Twenty-four hour ambulatory blood pressure thresholds have been defined for the diagnosis of mild hypertension but not for its treatment or for other blood pressure thresholds used in the diagnosis of moderate to severe hypertension. We aimed to derive age and sex related ambulatory blood pressure equivalents to clinic blood pressure thresholds for diagnosis and treatment of hypertension. We collated 24 hour ambulatory blood pressure data, recorded with validated devices, from 11 centres across six Australian states (n=8575). We used least product regression to assess the relation between these measurements and clinic blood pressure measured by trained staff and in a smaller cohort by doctors (n=1693). Mean age of participants was 56 years (SD 15) with mean body mass index 28.9 (5.5) and mean clinic systolic/diastolic blood pressure 142/82 mm Hg (19/12); 4626 (54%) were women. Average clinic measurements by trained staff were 6/3 mm Hg higher than daytime ambulatory blood pressure and 10/5 mm Hg higher than 24 hour blood pressure, but 9/7 mm Hg lower than clinic values measured by doctors. Daytime ambulatory equivalents derived from trained staff clinic measurements were 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg threshold (target upper limit for patients with associated conditions), and 1/1 mm Hg less than the 125/75 mm Hg threshold. Equivalents were 1/2 mm Hg lower for women and 3/1 mm Hg lower in older people compared with the combined group. Our study provides daytime ambulatory blood pressure thresholds that are slightly lower than equivalent clinic values. Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds. These results provide a framework for the diagnosis and management of hypertension using ambulatory blood pressure values.

  1. Ambulatory care visits by Taiwanese dentists

    Directory of Open Access Journals (Sweden)

    Ying-Hwa Su

    2013-06-01

    Conclusion: There were inequalities in risks of ambulatory care use among Taiwan's dentists. Further studies should be conducted to investigate the causes responsible for the observed geographic and institutional variations in the risk of morbidity among dentists in Taiwan.

  2. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

    Directory of Open Access Journals (Sweden)

    Künzi Beat

    2010-11-01

    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  3. Clinical Assessment Applications of Ambulatory Biosensors

    Science.gov (United States)

    Haynes, Stephen N.; Yoshioka, Dawn T.

    2007-01-01

    Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals…

  4. Optimizing the design of preprinted orders for ambulatory chemotherapy: combining oncology, human factors, and graphic design.

    Science.gov (United States)

    Jeon, Jennifer; White, Rachel E; Hunt, Richard G; Cassano-Piché, Andrea L; Easty, Anthony C

    2012-03-01

    To establish a set of guidelines for developing ambulatory chemotherapy preprinted orders. Multiple methods were used to develop the preprinted order guidelines. These included (A) a comprehensive literature review and an environmental scan; (B) analyses of field study observations and incident reports; (C) critical review of evidence from the literature and the field study observation analyses; (D) review of the draft guidelines by a clinical advisory group; and (E) collaboration with graphic designers to develop sample preprinted orders, refine the design guidelines, and format the resulting content. The Guidelines for Developing Ambulatory Chemotherapy Preprinted Orders, which consist of guidance on the design process, content, and graphic design elements of ambulatory chemotherapy preprinted orders, have been established. Health care is a safety critical, dynamic, and complex sociotechnical system. Identifying safety risks in such a system and effectively addressing them often require the expertise of multiple disciplines. This study illustrates how human factors professionals, clinicians, and designers can leverage each other's expertise to uncover commonly overlooked patient safety hazards and to provide health care professionals with innovative, practical, and user-centered tools to minimize those hazards.

  5. The financial and health burden of diabetic ambulatory care sensitive hospitalisations in Mexico

    OpenAIRE

    Lugo-Palacios, David G; Cairns, John

    2016-01-01

    Objective. To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH) in Mexico during 2001-2011. Materials and methods. We identified ACSH due to diabetic complications in general hospitals run by local health ministries and estimated their financial cost using diagnostic related groups. The health burden estimation assumes that patients would not have experienced complications if they had received appropriate primary care and computes the assoc...

  6. Ambulatory blood pressure monitoring in essential hypertensive patients with acute ischaemic stroke

    Directory of Open Access Journals (Sweden)

    S. P. Zhemanyuk

    2016-12-01

    Full Text Available Blood pressure (BP has been identified as a risk factor for various health disorders, including stroke onsets. Hypertension is one of the crucial health problem among adult Ukrainian. Due to the importance of elevated BP in stroke causality, BP measurement remains critical. However, it is limited information about value in clinical practice of ambulatory blood pressure monitoring (ABPM data in hypertensive patients with inadequately controlled BP with acute stroke compared with those individuals who has no vascular onset. The aim of the study was to determine ABPM parameters in essential hypertensive patients with ischaemic hemisphere stroke. Materials and methods. A total of 114 study participants were analyzed (mean age 62 (56;72 years, 40 % women. We divided them into two groups according to the level of 24-h systolic BP (SBP and diastolic BP (DBP, and the results of clinical examination. The first group (n=83 were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABMP results, and the second one (n=31 were EH patients with an acute hemispheric ischaemic stroke (IS. Diagnosis of stroke was confirmed with clinical examination and computed tomography scan or magnetic resonance imaging results, and ABPM was conducted in 4.2±2.3 days after the stroke onset. Results. We had statistician difference (p<0.001 between groups of such parameters, as average SBP (diurnal, daytime, nighttime; diurnal pulse BP; SBP load (p<0.05; the diurnal AASI (p<0.05; circadian rhythm of DBP (p<0.05. No differences were found between the groups in morning surge calculated as speed and amplitude of the BP climbed in morning hours both for SBP (P=0.422 and P=0.395, respectively and DBP (P=0.860 and P=0.337, respectively. Conclusion. In the present study, we evaluated the ABPM parameters in inadequately controlled essential hypertensive individuals with and without acute ischaemic hemispheric stroke

  7. The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation.

    Science.gov (United States)

    Rowe, Jeannine M; Rizzo, Victoria M; Shier Kricke, Gayle; Krajci, Kate; Rodriguez-Morales, Grisel; Newman, Michelle; Golden, Robyn

    2016-01-01

    An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.

  8. Effects of telmisartan on office and 24-hour ambulatory blood pressure: an observational study in hypertensive patients managed in primary care

    Directory of Open Access Journals (Sweden)

    Frederic Kontny

    2010-01-01

    Full Text Available Frederic Kontny1, Terje Risanger2, Arne Bye3, Øyvind Arnesen4, Odd Erik Johansen4 for the TELMIMORE Study Investigators51Dept of Cardiology, Volvat Medical Centre, Oslo, Norway; 2Prinsdal Health Centre, Oslo, Norway; 3Frosta Health Centre, Frosta, Norway; 4Medical Department, Boehringer-Ingelheim Norway KS, Asker, Norway; 5The TELMIMORE Study Investigators are listed at the end of the paperPurpose: Although elevated blood pressure (BP predicts future cardiovascular events, recommended BP targets often is not reached in the general community. In a clinical real-life setting we evaluated BP impact and tolerability of the angiotensin-II receptor blocker telmisartan in patients with essential hypertension.Patients and methods: Patients in this observational study not at target BP started or switched to telmisartan monotherapy (40 or 80 mg or a fixed-dose combination of telmisartan and hydrochlorothiazide (HCT 80 mg/12.5 mg. Office and 24-hour ambulatory BP (AMBP were measured before and after 8 weeks of treatment and physicians reported perceived drug efficacy and tolerability as “Very good”, “Good”, “Moderate” or “Bad”.Results: 100 patients (34% female, 60 years, BMI 29.4 kg/m2, mean office BP 159/92 mmHg of whom 38% were treatment naïve and 30%, 17%, 9% and 6% respectively were on 1, 2, 3 or 4 BP-lowering drugs, completed 8 weeks of treatment. The proportion of patients with office BP < 140/90 mmHg increased from 3% to 54% for systolic (P < 0.001, 38% to 75% for diastolic (P < 0.001, and 2% to 45% for systolic and diastolic BP (P < 0.001. A significant effect on BP levels was seen in patients being either treatment naïve or on 1 to 3 BP-lowering drugs at study entry, whereas no BP improvement occurred in those who switched from 4 drugs. Overall, mean 24-hour AMBP was reduced from 141/85 to 131/79 mmHg (P < 0.001. Drug efficacy and tolerability were perceived as “Very good” or “Good” by 44%/34% and 66%/27%, respectively

  9. Quality of life in patients with sickle cell disease in Jamaica: rural-urban differences.

    Science.gov (United States)

    Asnani, Monika R; Reid, Marvin E; Ali, Susanna B; Lipps, Garth; Williams-Green, Pauline

    2008-01-01

    Quality of life (QOL) refers to people's ability to function in the ordinary tasks of living. It moves beyond direct manifestations of illness to the patient's personal morbidity. These assessments are an important aspect of chronic disease management. Sickle cell disease (SCD) is a chronic and potentially, quite a debilitating disease. The disease is severe and may result in significant morbidity, as well as a shortened life span. It is the most common genetic disorder seen in Jamaica and impacts on physical, psychological, social and occupational wellbeing. Jamaica is a developing country where support systems that exist for patients with SCD are sparse. Health related QOL has been shown to be poorer in people living in the rural areas as compared with urban populations. Utilization of comprehensive sickle cells disease services has also been shown to be lower for individuals with the disease living in rural areas than for those living in urban areas. As there are rural-urban differences in Jamaica's health services, it is hypothesized that there may be rural-urban differences in the experiences of the disease and the QOL of these patients in these subgroups. The SF 36 v2 (Short Form 36) questionnaire has been validated for use in the Jamaican SCD population. This validated questionnaire was interviewer-administered to 166 patients presenting to an urban clinic for routine health maintenance visits and to 90 patients presenting to the rural clinics for routine visits. Socio-demographic information was also collected on these two groups. Multiple linear regression analyses were performed to study predictors of QOL in these two sub-populations. The study received ethical approval from the University of the West Indies/University Hospital of the West Indies Ethics Committee. There were no significant differences in the measured socio-demographic characteristics of the rural and urban patients. Living in rural areas compared with urban areas (p <0.001), being

  10. Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics

    OpenAIRE

    Desjarlais-deKlerk, Kristen; Wallace, Jean E

    2013-01-01

    Background Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. Methods We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either ins...

  11. Development of quality metrics for ambulatory pediatric cardiology: Infection prevention.

    Science.gov (United States)

    Johnson, Jonathan N; Barrett, Cindy S; Franklin, Wayne H; Graham, Eric M; Halnon, Nancy J; Hattendorf, Brandy A; Krawczeski, Catherine D; McGovern, James J; O'Connor, Matthew J; Schultz, Amy H; Vinocur, Jeffrey M; Chowdhury, Devyani; Anderson, Jeffrey B

    2017-12-01

    In 2012, the American College of Cardiology's (ACC) Adult Congenital and Pediatric Cardiology Council established a program to develop quality metrics to guide ambulatory practices for pediatric cardiology. The council chose five areas on which to focus their efforts; chest pain, Kawasaki Disease, tetralogy of Fallot, transposition of the great arteries after arterial switch, and infection prevention. Here, we sought to describe the process, evaluation, and results of the Infection Prevention Committee's metric design process. The infection prevention metrics team consisted of 12 members from 11 institutions in North America. The group agreed to work on specific infection prevention topics including antibiotic prophylaxis for endocarditis, rheumatic fever, and asplenia/hyposplenism; influenza vaccination and respiratory syncytial virus prophylaxis (palivizumab); preoperative methods to reduce intraoperative infections; vaccinations after cardiopulmonary bypass; hand hygiene; and testing to identify splenic function in patients with heterotaxy. An extensive literature review was performed. When available, previously published guidelines were used fully in determining metrics. The committee chose eight metrics to submit to the ACC Quality Metric Expert Panel for review. Ultimately, metrics regarding hand hygiene and influenza vaccination recommendation for patients did not pass the RAND analysis. Both endocarditis prophylaxis metrics and the RSV/palivizumab metric passed the RAND analysis but fell out during the open comment period. Three metrics passed all analyses, including those for antibiotic prophylaxis in patients with heterotaxy/asplenia, for influenza vaccination compliance in healthcare personnel, and for adherence to recommended regimens of secondary prevention of rheumatic fever. The lack of convincing data to guide quality improvement initiatives in pediatric cardiology is widespread, particularly in infection prevention. Despite this, three metrics were

  12. Patients' need for more counseling on diet, exercise, and smoking cessation: results from the National Ambulatory Medical Care Survey.

    Science.gov (United States)

    Heaton, Pamela C; Frede, Stacey M

    2006-01-01

    To determine the percentage of physicians who reported counseling patients on diet/nutrition, exercise, weight reduction, or smoking cessation during their office visits when responding to the 2002 National Ambulatory Medical Care Survey (NAMCS). We sought to establish whether patients are receiving adequate counseling from physicians on the basis of this nationwide survey. Retrospective database analysis. United States. Data included 184,668,007 physician visits for patients diagnosed with type 2 diabetes, hyperlipidemia, hypertension, or obesity; 140,362,102 physician visits for patients in which insulin/oral antidiabetics, antihyperlipidemia drugs, angiotensin-converting enzyme inhibitors, thiazide diuretics, or weight loss drugs were prescribed; and 82,317,640 physician visits for patients who smoked or used tobacco. Not applicable. Frequency of responses for counseling/education/therapy about diet/nutrition, exercise, weight reduction, and tobacco use/exposure. For patients with type 2 diabetes, hyperlipidemia, or hypertension, or patients receiving a drug in one of the drug classes that may indicate the presence of these diseases, patients did not receive any type of diet or exercise counseling during more than one half of all visits. Visits by patients who were diagnosed as obese were most likely to receive any type of counseling (80.2%). Of visits for patients who used tobacco, 78.6% did not include any counseling about smoking cessation. Patients are insufficiently counseled and educated about the need for lifestyle changes that can affect their risks for common chronic diseases. As accessible and ideally positioned health care providers, pharmacists could potentially affect the rising epidemic of obesity and other lifestyle-related diseases by filling this void.

  13. Factors associated with health-related quality of life in stable ambulatory congestive heart failure patients: Systematic review.

    Science.gov (United States)

    Baert, Anneleen; De Smedt, Delphine; De Sutter, Johan; De Bacquer, Dirk; Puddu, Paolo Emilio; Clays, Els; Pardaens, Sofie

    2018-03-01

    Background Since improved treatment of congestive heart failure has resulted in decreased mortality and hospitalisation rates, increasing self-perceived health-related quality of life (HRQoL) has become a major goal of congestive heart failure treatment. However, an overview on predictieve factors of HRQoL is currently lacking in literature. Purpose The aim of this study was to identify key factors associated with HRQoL in stable ambulatory patients with congestive heart failure. Methods A systematic review was performed. MEDLINE, Web of Science and Embase were searched for the following combination of terms: heart failure, quality of life, health perception or functional status between the period 2000 and February 2017. Literature screening was done by two independent reviewers. Results Thirty-five studies out of 8374 titles were included for quality appraisal, of which 29 were selected for further data extraction. Four distinct categories grouping different types of variables were identified: socio-demographic characteristics, clinical characteristics, health and health behaviour, and care provider characteristics. Within the above-mentioned categories the presence of depressive symptoms was most consistently related to a worse HRQoL, followed by a higher New York Heart Association functional class, younger age and female gender. Conclusion Through a systematic literature search, factors associated with HRQoL among congestive heart failure patients were investigated. Age, gender, New York Heart Association functional class and depressive symptoms are the most consistent variables explaining the variance in HRQoL in patients with congestive heart failure. These findings are partly in line with previous research on predictors for hard endpoints in patients with congestive heart failure.

  14. Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study.

    Science.gov (United States)

    Weber, Thomas; Wassertheurer, Siegfried; Schmidt-Trucksäss, Arno; Rodilla, Enrique; Ablasser, Cornelia; Jankowski, Piotr; Lorenza Muiesan, Maria; Giannattasio, Cristina; Mang, Claudia; Wilkinson, Ian; Kellermair, Jörg; Hametner, Bernhard; Pascual, Jose Maria; Zweiker, Robert; Czarnecka, Danuta; Paini, Anna; Salvetti, Massimo; Maloberti, Alessandro; McEniery, Carmel

    2017-12-01

    We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm Hg, respectively. Mean left ventricular mass was 93.3 kg/m 2 , and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively ( P =0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively ( P =0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732. © 2017 American Heart Association, Inc.

  15. Leading Causes of Anesthesia-Related Liability Claims in Ambulatory Surgery Centers.

    Science.gov (United States)

    Ranum, Darrell; Beverly, Anair; Shapiro, Fred E; Urman, Richard D

    2017-11-16

    We present a contemporary analysis of patient injury, allegations, and contributing factors of anesthesia-related closed claims, which involved cases that specifically occurred in free-standing ambulatory surgery centers (ASCs). We examined ASC-closed claims data between 2007 and 2014 from The Doctors Company, a medical malpractice insurer. Findings were coded using the Comprehensive Risk Intelligence Tool developed by CRICO Strategies. We compared coded data from ASC claims with hospital operating room (HOR) claims, in terms of injury severity category, nature of injury, nature of allegation, contributing factors identified, and contributing comorbidities and claim value. Ambulatory surgery center claims were more likely to be classified as medium severity than HOR claims, more likely to involve dental damage or pain than HOR claims, but less likely to involve death or respiratory or cardiac arrest. Technical performance was the most common contributing factor: 47% of ASCs and 48% of HORs. Only 7% of allegations relating to technical performance were judged to be a direct result of poor technical performance. The most common anesthesia procedures resulting in ASC claims were injection of anesthesia into a peripheral nerve (34%) and intubation (29%). Obesity was the most common contributing comorbidity in both settings. Mean closed claim value was significantly lower for ASC than HOR claims, averaging US $87,888 versus $107,325. Analysis of ASC and HOR claims demonstrates significant differences and several common sources of liability. These include improving strategies for thorough screening, preoperative assessment and risk stratifying of patients, incorporating routine dental and airway assessment and documentation, diagnosing and treating perioperative pain adequately, and improving the efficacy of communication between patients and care providers.

  16. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    International Nuclear Information System (INIS)

    Scheidler, J.; Weoeres, I.; Scharf, M.; Siebels, M.; Brinkschmidt, C.; Zeitler, H.; Heuck, A.; Panzer, S.

    2012-01-01

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  17. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    Energy Technology Data Exchange (ETDEWEB)

    Scheidler, J. [Radiologisches Zentrum Muenchen-Pasing, Muenchen (Germany); Weoeres, I.; Scharf, M.; Siebels, M. [Urologische Gemeinschaftspraxis Pasing (Germany); Brinkschmidt, C. [Gemeinschaftspraxis Pathologie, Starnberg (Germany); Zeitler, H.; Heuck, A. [Radiologisches Zentrum Muenchen (Germany); Panzer, S. [Unfallklinik Murnau (Germany). Radiologie

    2012-02-15

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  18. Measuring the educational environment in ambulatory settings

    Directory of Open Access Journals (Sweden)

    Arnoldo Riquelme

    2015-04-01

    Conclusions: The 50-item ACLEEM inventory is a multidimensional and valid instrument requiring only 15 respondents for reliable results. We recommend using it to measure the EE in the ambulatory postgraduate Spanish-speaking programs.

  19. Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review.

    Science.gov (United States)

    Griffiths, Peter; Richardson, Alison; Blackwell, Rebecca

    2012-07-01

    There is long standing interest in identifying patient outcomes that are sensitive to nursing care and an increasing number of systems that include outcomes in order to demonstrate or monitor the quality of nursing care. We undertook scoping reviews of the literature in order to identify patient outcomes sensitive to the quality of nursing services in ambulatory cancer chemotherapy settings to guide the development of an outcomes-based quality measurement system. A 2-stage scoping review to identify potential outcome areas which were subsequently assessed for their sensitivity to nursing was carried out. Data sources included the Cochrane Library, Medline, Embase, the British Nursing Index, Google and Google scholar. We identified a broad range of outcomes potentially sensitive to nursing. Individual trials support many nursing interventions but we found relatively little clear evidence of effect on outcomes derived from systematic reviews and no evidence associating characteristics of nursing services with outcomes. The purpose of identifying a set of outcomes as specifically nurse-sensitive for quality measurement is to give clear responsibility and create an expectation of strong clinical leadership by nurses in terms of monitoring and acting on results. It is important to select those outcomes that nurses have most impact upon. Patient experience, nausea, vomiting, mucositis and safe medication administration were outcome areas most likely to yield sensitive measures of nursing service quality in ambulatory cancer chemotherapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

    Science.gov (United States)

    Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.

    2015-01-01

    Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (pinterns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962

  1. 42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Ambulatory payment classification (APC) system and... Outpatient Services § 419.31 Ambulatory payment classification (APC) system and payment weights. (a) APC... of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and...

  2. Meta-synthesis on nurse practitioner autonomy and roles in ambulatory care.

    Science.gov (United States)

    Wang-Romjue, Pauline

    2018-04-01

    Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments. © 2017 Wiley Periodicals, Inc.

  3. Evaluation of percutaneous kidney biopsy complications in ambulatory patients- a two year review from a tertiary care centre

    International Nuclear Information System (INIS)

    Mansoor, K.; Azam, N.; Hashim, R.

    2016-01-01

    Objective: To evaluate the complications of percutaneous kidney biopsy in ambulatory patients in a tertiary care centre over a two year period. Study Design: Cross sectional, descriptive. Place and Duration of Study: The study was carried out at the Department of Nephrology Military Hospital, Rawalpindi from Jan 2008 to Jan 2010. Material and Methods: Patients referred to the Nephrology Department for kidney biopsy were considered for inclusion in the study provided they did not have any contraindications to the procedure and had a normotensive state with BP <130/90 mm Hg and a normal coagulation profile including partial thromboplastin time, prothrombin time, bleeding time and platelet count. Patients with an evidence of malignancy, congenital anomalies of kidneys on ultrasound examination or a skin disorder affecting the likely site of biopsy were excluded. Results: A total of 100 patients who merited standard indications for kidney biopsy were included in the study. Average age was 45.53 years (+1 SD = 10.96) with age range of 25 years to 75 years. There were 83 males (83 percent) and 17 females (17 percent) with male to female ratio of 4.9:1. Microscopic hematuria occurred in 82 (82 percent) patients. Gross hematuria occurred in 12 (12 percent) patients. Decrease in hemoglobin level by 1 g/dL or more occurred in 35 (35 percent). There was no episode of hypotension secondary to severe bleeding. No patient required transfusion. Surgery was not required in any patient for controlling bleeding. Death was not recorded among the reported complications. Conclusion: Percutaneous kidney biopsy can be safely conducted as an outpatient procedure with an observation time of 12 hours post-biopsy to watch for any complications. (author)

  4. Ambulatory versus home versus clinic blood pressure: the association with subclinical cerebrovascular diseases: the Ohasama Study.

    Science.gov (United States)

    Hara, Azusa; Tanaka, Kazushi; Ohkubo, Takayoshi; Kondo, Takeo; Kikuya, Masahiro; Metoki, Hirohito; Hashimoto, Takanao; Satoh, Michihiro; Inoue, Ryusuke; Asayama, Kei; Obara, Taku; Hirose, Takuo; Izumi, Shin-Ichi; Satoh, Hiroshi; Imai, Yutaka

    2012-01-01

    The usefulness of ambulatory, home, and casual/clinic blood pressure measurements to predict subclinical cerebrovascular diseases (silent cerebrovascular lesions and carotid atherosclerosis) was compared in a general population. Data on ambulatory, home, and casual/clinic blood pressures and brain MRI to detect silent cerebrovascular lesions were obtained in 1007 subjects aged ≥55 years in a general population of Ohasama, Japan. Of the 1007 subjects, 583 underwent evaluation of the extent of carotid atherosclerosis. Twenty-four-hour, daytime, and nighttime ambulatory and home blood pressure levels were closely associated with the risk of silent cerebrovascular lesions and carotid atherosclerosis (all Ppressure values were simultaneously included in the same regression model, each of the ambulatory blood pressure values remained a significant predictor of silent cerebrovascular lesions, whereas home blood pressure lost its predictive value. Of the ambulatory blood pressure values, nighttime blood pressure was the strongest predictor of silent cerebrovascular lesions. The home blood pressure value was more closely associated with the risk of carotid atherosclerosis than any of the ambulatory blood pressure values when home and one of the ambulatory blood pressure values were simultaneously included in the same regression model. The casual/clinic blood pressure value had no significant association with the risk of subclinical cerebrovascular diseases. Although the clinical indications for ambulatory blood pressure monitoring and home blood pressure measurements may overlap, the clinical significance of each method for predicting target organ damage may differ for different target organs.

  5. Ambulatory Measurement of Ground Reaction Forces

    NARCIS (Netherlands)

    Veltink, Peter H.; Liedtke, Christian; Droog, Ed

    2004-01-01

    The measurement of ground reaction forces is important in the biomechanical analysis of gait and other motor activities. It is the purpose of this study to show the feasibility of ambulatory measurement of ground reaction forces using two six degrees of freedom sensors mounted under the shoe. One

  6. Baseline Knowledge and Education on Patient Safety in the Ambulatory Care Setting for 4th Year Pharmacy Students

    Directory of Open Access Journals (Sweden)

    Jessica W. Skelley

    2015-01-01

    Full Text Available Objectives: To assess the baseline knowledge of fourth year student pharmacists on their ability to properly identify and categorize medication related problems (MRP during their Advanced Pharmacy Practice Experience (APPE in the ambulatory care setting, and to assess the efficacy of a written resource designed to educate and train users on identification and documentation of MRP's and used for this purpose with participating students on their ambulatory care APPE. Methods: A pretest consisting of ten multiple-choice questions was administered electronically to fourth year student pharmacists (N=18 at the start of their ambulatory care APPE. The test was designed to assess both the students' baseline knowledge regarding MRP's, and their ability to identify a wide variety of medication-related problems. Students then received a written copy of The Medication Therapy Intervention & Safety Documentation Program training manual and were asked to read it in its entirety in the first week of their APPE. Finally, students were given a posttest survey (identical to the pretest to complete to assess if their knowledge had increased from baseline. Results: The average score for the 18 students taking the baseline knowledge pre-test was 63.33%, indicating limited baseline knowledge regarding the identification and classification of MRP's. In assessing the effectiveness of the written training document, the overall posttest results compared to pretest results did not indicate improvement in students' knowledge or ability to properly identify and classify medication related problems (MRP after reviewing the training manual. The average scores declined from 63.33% on the pretest to 62.78% on the posttest, although this was not found to be statistically significant (p = 0.884. However, a statistically significant decline in students' knowledge occurred on one specific question, which tested their ability to classify MRP's (p = 0.029. Conclusions: Based on the

  7. Relationships of muscle strength and bone mineral density in ambulatory children with cerebral palsy.

    Science.gov (United States)

    Chen, C-L; Lin, K-C; Wu, C-Y; Ke, J-Y; Wang, C-J; Chen, C-Y

    2012-02-01

    This work explores the relationships of muscle strength and areal bone mineral density (aBMD) in ambulatory children with cerebral palsy (CP). The knee extensor strength, but not motor function, was related to aBMD. Thus, muscle strength, especially antigravity muscle strength, was more associated with aBMD in these children than motor function. Muscle strength is related to bone density in normal children. However, no studies have examined these relationships in ambulatory children with CP. This work explores the relationships of muscle strength and aBMD in ambulatory children with CP. Forty-eight ambulatory children with spastic CP, aged 5-15 years, were classified into two groups based on Gross Motor Function Classification System levels: I (n = 28) and II (n = 20). Another 31 normal development (ND) children were recruited as the comparison group for the aBMD. Children with CP underwent assessments of growth, lumbar and distal femur aBMD, Gross Motor Function Measure-66 (GMFM-66), and muscle strength of knee extensor and flexor by isokinetic dynamometer. The distal femur aBMD, but not lumbar aBMD, was lower in children with CP than in ND children (p antigravity muscle strength, were more associated with the bone density of ambulatory children with CP than motor function. The data may allow clinicians for early identifying the ambulatory CP children of potential low bone density.

  8. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    Directory of Open Access Journals (Sweden)

    Radha S Vanmali

    2013-01-01

    Full Text Available Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring. Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%, patient education (23.3%, and adherence monitoring (9.8%. Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS (P = 0.01, have current or history of opportunistic infection (OI (P=0.01, and have current or history of OI prophylaxis (P = 0.03. Adherence monitoring was less common amongst the non-Hispanics (7.1% compared to the Hispanic sub-population (16.5%, (P = 0.04. Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.   Type: Original Research

  9. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    Directory of Open Access Journals (Sweden)

    Ann M. Fugit, Pharm.D., BCPS

    2013-01-01

    Full Text Available Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring. Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%, patient education (23.3%, and adherence monitoring (9.8%. Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS (P = 0.01, have current or history of opportunistic infection (OI (P=0.01, and have current or history of OI prophylaxis (P = 0.03. Adherence monitoring was less common amongst the non-Hispanics (7.1% compared to the Hispanic sub-population (16.5%, (P = 0.04. Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.

  10. [Epidemiology of the medico-legal risk associated with the practice of ambulatory surgery in France: a study based on insurance data].

    Science.gov (United States)

    Theissen, A; Fuz, F; Catineau, J; Sultan, W; Beaussier, M; Carles, M; Raucoules-Aimé, M; Niccolai, P

    2014-03-01

    The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery. The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We searched the files in the SHAM database, and then analyzed them. On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n=16) and nosocomial infections (n=13). The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  11. Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients

    Directory of Open Access Journals (Sweden)

    Regina Grazuleviciene

    2016-05-01

    Full Text Available The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031 and 60 min after the walk (−6.00 mm Hg, p = 0.002. The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05. Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

  12. A Study to Develop a Model for the Allocation of Medical Supply Funds to the Various Clinical Services at Keller Army Community Hospital Based Upon Inpatient Weighted Units and Ambulatory Weighted Units

    Science.gov (United States)

    1989-05-11

    zDiagnosis Related Groups (DRGs), as developed by ther Mz researchers at Yale University in the late 1960s, were a m mmeans of classifying patients by...the group’s recalibration of the Rickard 19 ambulatory portion of the HCU was most important. This was because it resulted in, "an ambulatory

  13. Age-specific differences between conventional and ambulatory daytime blood pressure values

    DEFF Research Database (Denmark)

    Conen, David; Aeschbacher, Stefanie; Thijs, Lutgarde

    2014-01-01

    Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals ... population-based cohorts. We compared individual differences between daytime ambulatory and conventional BP according to 10-year age categories. Age-specific prevalences of white coat and masked hypertension were calculated. Among individuals aged 18 to 30, 30 to 40, and 40 to 50 years, mean daytime BP...

  14. Pattern of Ambulatory Care Visits to Obstetrician-Gynecologists in Taiwan: A Nationwide Analysis

    Directory of Open Access Journals (Sweden)

    An-Min Lynn

    2015-06-01

    Full Text Available Although obstetrician-gynecologists (OB-GYNs are the main actors in the provision of health care to women, their practice patterns have rarely been analyzed. The current study investigated the nationwide ambulatory visits to OB-GYNs in Taiwan using the National Health Insurance Research Database. From the 1/500 sampling datasets indicating 619,760 ambulatory visits in 2012, it was found that 5.8% (n = 35,697 of the visits were made to OB-GYNs. Two-fifths of the services provided were performed by male OB-GYNs aged 50–59 years. Women of childbearing age accounted for more than half of the visits to OB-GYNs (57.2%, and elderly patients above 60 years accounted for only 7.7%. The most frequent diagnoses were menstrual disorders and other forms of abnormal bleeding from the female genital tract (13.1%. Anti-infective agents were prescribed in 15.1% of the visits to OB-GYNs. The study revealed the proportion of aging practicing OB-GYNs, and our detailed results could contribute to evidence-based discussions on health policymaking.

  15. Effects of the glucagon-like peptide-1receptor agonist liraglutide on 24-h ambulatory blood pressure in patients with type 2 diabetes and stable coronary artery disease

    DEFF Research Database (Denmark)

    Kumarathurai, Preman; Anholm, Christian; Fabricius-Bjerre, Andreas

    2017-01-01

    -one patients with type 2 diabetes and stable coronary artery disease were randomized to receive liraglutide or placebo to a backbone therapy of metformin in this double-blind, placebo-controlled 12 along with 12 weeks crossover study. Ambulatory blood pressure monitoring (ABPM) was performed at the start...... or the nocturnal BP dipping. Conclusions: We could not demonstrate any BP-lowering effect of liraglutide when using 24-h ABPM. Liraglutide exhibited diurnal variation in the effect on BP without affecting the BP variability or nocturnal BP dipping....

  16. The internal medicine clerkship and ambulatory learning experiences: results of the 2010 clerkship directors in internal medicine survey.

    Science.gov (United States)

    Shaheen, Amy; Papp, Klara K; Torre, Dario

    2013-01-01

    Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear. The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship. An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques. The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources. There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination

  17. Effect of continuous ambulatory peritoneal dialysis on a British renal unit.

    Science.gov (United States)

    Morgan, A G; Burden, R P

    1986-10-11

    Experience in the use of continuous ambulatory peritoneal dialysis (CAPD) for the treatment of end stage renal failure in Nottingham was reviewed. During six years 150 patients aged from 11 to 73 received this type of treatment. At three years patient actuarial survival was 69% and CAPD technique survival was 41%. Although CAPD was satisfactory as a first treatment for many patients, its long term use was possible in only a few. Actuarial survival of patients who changed to haemodialysis was 64% at one year after the change, suggesting that unsuccessful CAPD increased the risk of death. Hospital haemodialysis was the only suitable form of treatment for most patients in whom CAPD had been abandoned. British renal units have adopted CAPD to a much greater extent than those in Europe, but care in the selection of patients is necessary to reduce mortality, and many patients may eventually need hospital haemodialysis. Greater numbers of hospital haemodialysis places will probably have to be made available to meet this extra demand.

  18. The effect of ventilatory muscle training on respiratory function and capacity in ambulatory and bed-ridden patients with neuromuscular disease.

    Science.gov (United States)

    Gross, D; Meiner, Z

    1993-08-01

    Most patients with neuromuscular disease develop muscle weakness, including the ventilatory muscles leading to respiratory difficulty and, at times, respiratory insufficiency. We studied the effect of ventilatory muscle training on the ventilatory function and capacity of patients with various types of neuromuscular disease. The ambulatory patients were divided into three major groups. Group I (n = 6) patients with motor neuron disease (MND), such as amyotrophic latera sclerosis; Group II (n = 11) patients with myoneural junction disease (MNJ), such as myasthenia gravis and: Group III (n = 7) patients with muscle diseases such as progressive muscular disease. Patients were evaluated for their neuromuscular diagnosis and status of the disease. A complete physical examination and the various neuromuscular tests were performed. A complete respiratory evaluation was applied: pulmonary function tests (PFT), maximum inspiratory pressure (MIP). Patients then started ventilatory muscle training by resistive breathing, as a prophylactic treatment, for 10 min, three times daily, with a resistance which would induce fatigue. All tests were repeated every six weeks, and the results were as follow: forced vital capacity (FVC) changed from 38.8 +/- 12.3 to 53.2 +/- 9.6% (NS) of predicted value in group I, from 49.8 +/- 8.7 to 66.1 +/- 7.5% (p < 0.002) in group II, and from 47.0 +/- 7.5 to 53.3 +/- 7.6% (p < 0.04) in group III. Forced expiratory volume in one second (FEV1) was 34.8 +/- 11.0, 46.3 +/- 5, and 45.1 +/- 9% for the three groups, respectively, and did not change with training.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. EFFECT OF MORNING AND EVENING RAMIPRIL TAKING ON AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    V. M. Gorbunov

    2016-01-01

    Full Text Available Aim. To compare antihypertensive effect of ramipril monotherapy at morning and evening taking.Material and methods. 22 patients (10 men, 12 women; aged 62,1±1,9 y.o. with arterial hypertension of 1-2 stage were involved into the open randomized crossover study. Patients were randomized into 2 groups depending on ramipril taking time (morning or evening. Ambulatory blood pressure (BP monitoring (ABPM was performed. Patients of both groups were comparable in basic clinical characteristics and initial ABPM indices. Analysis of peak and phase characteristics of 24 hour BP profile was used as well as standard evaluation. Treatment duration was 3 weeks. Ramipril dose titration was made in 1,5 weeks. The average daily dose of ramipril was 6,1 mg in the morning taking, and 5,0 mg in the evening taking.Results. 20 patients finished study completely. 24 hour initial level of systolic (SBP and diastolic BP (DBP was 141,5±1,6/85,3±1,1 mm Hg. After ramipril monotherapy with evening taking BP reduced to 132,6±1,6/79,8±1,1 mm Hg (p<0,001 and with morning taking – to 131,8±1,6/79,2±1,1 mm Hg (p<0,001. Evening ramipril taking led to significant improvement of 24 hour BP profile. Night SBP/DBP reduction became deeper from 7,7±1,2/11,5±1,3% to 12,5±1,2/19,1±1,3 % (p<0,01. Morning taking did not have significant influence on these indices. Ramipril did not result in clinically significant hypotension including night one.Conclusion. Evening ramipril taking is effective and safe. It can be recommended to patients with insufficient night BP dipping (non dippers. 

  20. EFFECT OF MORNING AND EVENING RAMIPRIL TAKING ON AMBULATORY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    V. M. Gorbunov

    2009-01-01

    Full Text Available Aim. To compare antihypertensive effect of ramipril monotherapy at morning and evening taking.Material and methods. 22 patients (10 men, 12 women; aged 62,1±1,9 y.o. with arterial hypertension of 1-2 stage were involved into the open randomized crossover study. Patients were randomized into 2 groups depending on ramipril taking time (morning or evening. Ambulatory blood pressure (BP monitoring (ABPM was performed. Patients of both groups were comparable in basic clinical characteristics and initial ABPM indices. Analysis of peak and phase characteristics of 24 hour BP profile was used as well as standard evaluation. Treatment duration was 3 weeks. Ramipril dose titration was made in 1,5 weeks. The average daily dose of ramipril was 6,1 mg in the morning taking, and 5,0 mg in the evening taking.Results. 20 patients finished study completely. 24 hour initial level of systolic (SBP and diastolic BP (DBP was 141,5±1,6/85,3±1,1 mm Hg. After ramipril monotherapy with evening taking BP reduced to 132,6±1,6/79,8±1,1 mm Hg (p<0,001 and with morning taking – to 131,8±1,6/79,2±1,1 mm Hg (p<0,001. Evening ramipril taking led to significant improvement of 24 hour BP profile. Night SBP/DBP reduction became deeper from 7,7±1,2/11,5±1,3% to 12,5±1,2/19,1±1,3 % (p<0,01. Morning taking did not have significant influence on these indices. Ramipril did not result in clinically significant hypotension including night one.Conclusion. Evening ramipril taking is effective and safe. It can be recommended to patients with insufficient night BP dipping (non dippers. 

  1. [Hospitalizations for ambulatory care-sensitive conditions: validation study at a Hospital Information System (SIH) in the Federal District, Brazil, in 2012].

    Science.gov (United States)

    Cavalcante, Danyelle Monteiro; de Oliveira, Maria Regina Fernandes; Rehem, Tânia Cristina Morais Santa Bárbara

    2016-03-01

    This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive.

  2. Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients

    Directory of Open Access Journals (Sweden)

    Shahram Taheri

    2017-01-01

    Full Text Available Bachground: Peritonitis and exit site (ES infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing. Materials and Methods: This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection. Results: A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02. Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months. In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months, and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months (P = 0.03. Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025 and in dressing group (52% vs. 15%, P = 0.003. In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01. Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 − 84.4; P = 0.045, and 4.4 in men (95% CI = 1.26 − 15.19; P = 0.02. Conclusion: In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.

  3. Supportive care needs and psychological distress and/or quality of life in ambulatory advanced colorectal cancer patients receiving chemotherapy: a cross-sectional study.

    Science.gov (United States)

    Sakamoto, Nobuhiro; Takiguchi, Shuji; Komatsu, Hirokazu; Okuyama, Toru; Nakaguchi, Tomohiro; Kubota, Yosuke; Ito, Yoshinori; Sugano, Koji; Wada, Makoto; Akechi, Tatsuo

    2017-12-01

    Although currently many advanced colorectal cancer patients continuously receive chemotherapy, there are very few findings with regard to the supportive care needs of such patients. The purposes of this study were to investigate the patients' perceived needs and the association with psychological distress and/or quality of life, and to clarify the characteristics of patients with a high degree of unmet needs. Ambulatory colorectal cancer patients who were receiving chemotherapy were asked to complete the Short-Form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs), the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Complete data were available for 100 patients. Almost all of the top 10 most common unmet needs belonged to the psychological domain. The patients' total needs were significantly associated with both psychological distress (r = 0.65, P quality of life (r = -0.38, P patients' needs and psychological distress and/or quality of life suggest that interventions that respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing quality of life. Female patients' needs should be evaluated more carefully. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. [The subjective quality of life of patients with schizophrenia: influence of psychopathology and patients' expectations. A comparative study].

    Science.gov (United States)

    Salomé, F; Petitjean, F; Germain, C; Demant, J-C

    2004-01-01

    Most studies on the quality of life (Qol) of patients with schizophrenia deal with objective living conditions and how they are perceived by hospitalized patients. The few studies that compare Qol for patients treated in part time services with the Qol of ambulatory patients do not show any significant difference in terms of subjective Qol. Some stu-dies evaluate the influence of psychopathology and needs (or expectations) on the subjective Qol in these groups of patients. Available data indicate that the general well-being is influenced by psychopathology (positive, negative or depressive symptoms) and unmet needs in ambulatory patients. They also show that subjective Qol in certain life domains (social relations, family relations, leisure, health, law and security) is influenced by negative symptoms, anxiety and depression in patients treated in part-time services. The aim of this study is to compare the objective and subjective Qol of patients with schizophrenia treated in part time services (day hospital and day care center) to the Qol of out-patients treated on a purely ambulatory basis (out patient clinic). We studied the Qol of 2 groups of 30 patients with schizophrenia (ICD 10 criteria) treated in various centers. The first group was made of ambulatory patients, the second one was constituted of patients treated in a day hospital or a day care center. Patients were matched for age, duration of illness, number of hospitalizations. The instruments used for rating were the following: Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Positive And Negative Symptoms Scale (PANSS), Drug Attitude Inventory (DAI-10). The Qol was measured with a french version of the Lancashire Quality Of Life Profile (LQOLP) (Salomé, Germain, Petitjean, Demant and Boyer, 2000). This instrument measures the objective Qol as well as the subjective Qol. It does possess satisfying psychometric properties and offers the possibility to establish Qol profiles. All

  5. Efectividad de la cirugía ambulatoria en la dacriocistitis crónica Effectiveness of ambulatory surgery in chronic dacryocystitis

    Directory of Open Access Journals (Sweden)

    Ileana Agramonte Centelles

    2004-06-01

    Full Text Available La dacriocistitis es la inflamación del saco lagrimal, cuyo tratamiento es quirúrgico. El presente trabajo tiene como objetivo comparar la evolución posoperatoria en pacientes ambulatorios y hospitalizados, teniendo en cuenta las complicaciones que se presentaron, el grado de satisfacción del paciente y los costos institucionales en cada grupo. El estudio descriptivo, prospectivo de 202 pacientes operados de dacriocistorrinostomía, se conformaron en dos grupos ambulatorios y hospitalizados, en el período comprendido de enero del 2000 a abril de 2002. En ambos grupos se evaluaron y compararon los resultados quirúrgicos y los costos institucionales y para el paciente incluidos. El 56 % de los pacientes hospitalizados y el 48,03 % de los ambulatorios fueron mayores de 61 años, el sexo femenino predominó en un 57 % de los hospitalizados y en el 66,6 % de los ambulatorios. El 97 % de los pacientes hospitalizados y el 97,5 % de los ambulatorios no tuvieron complicaciones. La media del costo institucional fue de $ 284 por paciente operado. El 93,7 % de los pacientes ingresados prefirieron la cirugía ambulatoria y el 100 % de los ambulatorios se sintió satisfecho. Los dos grupos de pacientes presentaron una distribución de edad y sexo similar, prevaleció la ausencia de complicaciones en ambos grupos, así como el éxito quirúrgico, con la cirugía ambulatoria se ahorró un total de $ 32 400 en moneda nacionalDacryocystitis is the inflammation of the lacrimal sac that requires surgical treatment. The present paper is aimed at comparing the postoperative evolution in outpatients and inpatients, taking into consideration the complications, the satisfaction degree of the patient and the institutional costs in each group. Descriptive prospective study of 202 patients operated on of dacryocystorhinostomy divided into 2 ambulatory and hospitalized groups from January 2000 to April 2002. The surgical results and the institutional and patient

  6. Renal Nerve Stimulation-Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation.

    Science.gov (United States)

    de Jong, Mark R; Adiyaman, Ahmet; Gal, Pim; Smit, Jaap Jan J; Delnoy, Peter Paul H M; Heeg, Jan-Evert; van Hasselt, Boudewijn A A M; Lau, Elizabeth O Y; Persu, Alexandre; Staessen, Jan A; Ramdat Misier, Anand R; Steinberg, Jonathan S; Elvan, Arif

    2016-09-01

    Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)-induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (Pefficacy of RDN and predict BP response to RDN. © 2016 American Heart Association, Inc.

  7. Mechanical complications of continuous ambulatory peritoneal dialysis: Experience at the Ibn Sina University Hospital.

    Science.gov (United States)

    Flayou, Kaoutar; Ouzeddoun, Naima; Bayahia, Rabia; Rhou, Hakima; Benamar, Loubna

    2016-01-01

    Peritoneal dialysis is a new renal replacement therapy recently introduced in Morocco since 2006. Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study was to evaluate the outcome of complications in patients treated with peritoneal dialysis at our center. The nature of non-infectious complications was noted during follow-up in these patients. Fiftyseven complications were noted among 34 patients between June 2006 and June 2014. Catheter migration was the most common complication (36.8%), followed by obstruction (14%), dialysate leaks (14%), hemorrhagic complications (10.5%) and, finally, hernia (12.2%), catheter perforation (5.2%) and externalization (3.5%).

  8. Inappropriate Usage of Dietary Supplements in Patients by Miscommunication with Physicians in Japan

    Science.gov (United States)

    Chiba, Tsuyoshi; Sato, Yoko; Nakanishi, Tomoko; Yokotani, Kaori; Suzuki, Sachina; Umegaki, Keizo

    2014-01-01

    Recently, people have used dietary supplements not only for nutritional supplementation, but also for treatment of their diseases. However, use of dietary supplements to treat diseases, especially with medications, may cause health problems in patients. In this study, we investigated use of dietary supplements in patients in Japan. This survey was conducted from January to December 2012, and was completed by 2732 people, including 599 admitted patients, 1154 ambulatory patients, and 979 healthy subjects who attended a seminar about dietary supplements. At the time of the questionnaire, 20.4% of admitted patients, 39.1% of ambulatory patients, and 30.7% of healthy subjects were using dietary supplements, which including vitamin/mineral supplements, herbal extracts, its ingredients, or food for specified health uses. The primary purpose for use in all groups was health maintenance, whereas 3.7% of healthy subjects, 10.0% of ambulatory patients, and 13.2% of admitted patients used dietary supplements to treat diseases. In addition, 17.7% of admitted patients and 36.8% of ambulatory patients were using dietary supplements concomitantly with their medications. However, among both admitted patients and ambulatory patients, almost 70% did not mention dietary supplement use to their physicians. Overall, 3.3% of all subjects realized adverse effects associated with dietary supplements. Communication between patients and physicians is important to avoid health problems associated with the use of dietary supplements. PMID:25431879

  9. The clinical utility of ambulatory blood pressure monitoring (ABPM): a review.

    Science.gov (United States)

    Harianto, Harry; Valente, Michael; Hoetomo, Soenarno; Anpalahan, Mahesan

    2014-01-01

    The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities. It further discusses the clinical significance of abnormal ambulatory blood pressure patterns and hypertensive syndromes such as white coat, masked and resistant hypertension.

  10. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

    Directory of Open Access Journals (Sweden)

    Robinson H

    2017-04-01

    Full Text Available Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED and emergence agitation (EA. New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.Summary: Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up. Keywords: myringotomy, ventilation tubes, anesthesia, pediatrics, ambulatory, day case

  11. Ambulatory assessment of ankle and foot dynamics

    NARCIS (Netherlands)

    Schepers, H. Martin; Koopman, Hubertus F.J.M.; Veltink, Petrus H.

    Ground reaction force (GRF) measurement is important in the analysis of human body movements. The main drawback of the existing measurement systems is the restriction to a laboratory environment. This paper proposes an ambulatory system for assessing the dynamics of ankle and foot, which integrates

  12. Office blood pressure or ambulatory blood pressure for the prediction of cardiovascular events.

    Science.gov (United States)

    Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke; Torp-Pedersen, Christian

    2017-11-21

    To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0.01% (-0.3%; 0.1%) for cardiovascular mortality and -0.1% (-1.1%; 0.5%) for cardiovascular events. The difference in AUC (95% confidence interval) was 0.65% (0.22-1.08%) for cardiovascular mortality and 1.33% (0.83-1.84%) for cardiovascular events. Comparing daytime and night-time blood pressure, the median difference in 10-year risks was 0.002% (-0.1%; 0.1%) for cardiovascular mortality and -0.01% (-0.5%; 0.2%) for cardiovascular events. The difference in AUC was 0.10% (-0.08 to 0.29%) for cardiovascular mortality and 0.15% (-0.06 to 0.35%) for cardiovascular events. Ten-year predictions obtained from ambulatory blood pressure are similar to predictions from office blood pressure. Night-time blood pressure does not improve 10-year predictions obtained from daytime measurements. For an otherwise healthy population sufficient prognostic accuracy of cardiovascular risks can be achieved with office blood pressure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  13. Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study.

    Science.gov (United States)

    Tian, Yuanshi; Xie, Xishao; Xiang, Shilong; Yang, Xin; Zhang, Xiaohui; Shou, Zhangfei; Chen, Jianghua

    2016-12-01

    Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to

  14. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.

    Science.gov (United States)

    Hersh, Adam L; Chambers, Henry F; Maselli, Judith H; Gonzales, Ralph

    2008-07-28

    Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a common cause of skin and soft-tissue infections (SSTIs) in the United States. It is unknown whether this development has affected the national rate of visits to primary care practices and emergency departments (EDs) and whether changes in antibiotic prescribing have occurred. We examined visits by patients with SSTIs to physician offices, hospital outpatient departments, and EDs using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1997 to 2005. We estimated annual visit rates for all SSTIs and a subset classified as abscess/cellulitis. For abscess/cellulitis visits, we examined trends in characteristics of patients and clinical settings and in antibiotic prescribing. Overall rate of visits for SSTIs increased from 32.1 to 48.1 visits per 1000 population (50%; P = .003 for trend), reaching 14.2 million by 2005. More than 95% of this change was attributable to visits for abscess/cellulitis, which increased from 17.3 to 32.5 visits per 1000 population (88% increase; P trend). The largest relative increases occurred in EDs (especially in high safety-net-status EDs and in the South), among black patients, and among patients younger than 18 years. Use of antibiotics recommended for CA-MRSA increased from 7% to 28% of visits (P < .001) during the study period. Independent predictors of treatment with these antibiotics included being younger than 45 years, living in the South, and an ED setting. The incidence of SSTIs has rapidly increased nationwide in the CA-MRSA era and appears to disproportionately affect certain populations. Although physicians are beginning to modify antibiotic prescribing practices, opportunities for improvement exist, targeting physicians caring for patients who are at high risk.

  15. Ambulatory blood pressure monitoring after 1 year on valsartan or amlodipine-based treatment: a VALUE substudy

    DEFF Research Database (Denmark)

    Pedersen, Ole Lederballe; Mancia, Giuseppe; Pickering, Thomas

    2007-01-01

    OBJECTIVE: The ambulatory blood pressure (ABP) monitoring substudy of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial was carried out in a subset of patients from USA, Italy and Denmark. ABP was measured after 1 year in the trial, with the aim of evaluating comparability...... of ABP levels on valsartan (VAL) and amlodipine (AML)-based regimens. METHODS: ABP was measured every 20 min during a 25-h period after morning administration of medicine; 659 patients were available for intention-to-treat analysis. RESULTS: Office blood pressure (BP) differences were smaller than...

  16. Ambulatory blood pressure monitoring (ABPM) in nonagenarians.

    Science.gov (United States)

    Formiga, Francesc; Ferrer, Assumpta; Sobrino, Javier; Coca, Antonio; Riera, Antoni; Pujol, Ramón

    2009-01-01

    The objective of the study is to investigate ambulatory blood pressure monitoring (ABPM) in a sample of Spanish nonagenarians. We also analyzed the misdiagnosis of hypertension and investigated blood pressure (BP) control in treated hypertensive nonagenarians. Twenty-four-hour ABPM was undertaken in a group of 42 nonagenarians. The 24-h mean, daytime BP, nighttime BP and heart rate (HR) were extracted from the ABPM. Sociodemographic data, the ability to perform basic daily activities, measured by the Barthel index (BI) or instrumental activities revealed by the Lawton and Brody index (LI), cognition, and comorbidity were evaluated. Thirty-one subjects were receiving antihypertensive drug treatment. Twenty-four hour, daytime and sleeping pressures averaged 130/65, 131/68 and 128/63mmHg, respectively. Seventeen (40.5%) of the 42 patients had a daytime BP of 135/85 or higher. In terms of the BP pattern, 8 (19%) subjects were dippers, 19 (45%) non-dippers, and 15 (36%) were risers. Five (45.46%) out of 11 patients with no evidence of hypertension (normotensive patients) had a daytime BP of 135/85 or higher. The mean daytime BP was 135/85 or higher in 12 (38.7%) out of 31 nonagenarians who had previously received therapy for hypertension. In, conclusion a high prevalence of hypertension, misdiagnosis and inadequate BP control was found in nonagenarians treated for hypertension.

  17. Ambulatory major surgery of benign tumors of the thyroid gland

    International Nuclear Information System (INIS)

    Luzardo Silveira, Ernesto Manuel; Eirin Aranno, Juana Elisa

    2011-01-01

    A descriptive and prospective study on the practice of ambulatory major surgery to eliminate benign tumours of the thyroid gland, was carried out in the General Surgery Service of 'Dr. Joaquin Castillo Duany' Teaching Clinical Surgical Hospital in Santiago de Cuba during the years 1996-2008, both included, through a previous clinical evaluation of 74 patients in the Endocrinology Outpatient Department, where it was decided that they could definitely have a surgical treatment. The female sex, the age groups from 31 to 45 years, the hemithyroidectomy as surgical technique, acupuncture as analgesic procedure and the follicular adenoma as cytohistological result prevailed in the case material. Mild complications occurred in 5 members of the sample, but recovery was absolute in all, so that even 72 of them were discharged before the 24 hours. Due to its good acceptance, this surgical method is beneficial for patient and hospital institutions.(author)

  18. Can information technology improve my ambulatory practice ...

    African Journals Online (AJOL)

    eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the ...

  19. Very poor agreement between routine outpatient clinic office and ambulatory blood pressure: time to improve an old hospital outpatient clinic routine?

    Science.gov (United States)

    Reinhard, Mark; Poulsen, Per L; Christensen, Kent L

    2016-12-01

    We investigated the agreement between elevated outpatient clinic office blood pressure (OC-OBP) as measured in the daily routine in our University Hospital Cardiology Outpatient Clinic and subsequent awake ambulatory blood pressure (AABP). In all patients referred for ambulatory blood pressure monitoring from our Cardiology Outpatient Clinic, we identified OC-OBP and changes in medication in the period from 1 January 2014 to 15 September 2015. The AABP was used as a reference measurement for the OC-OBP. A total of 183 patients were included in the study. Their mean age was 62.1±14.0 years and 49% were women. The mean systolic OC-OBP was 166.8±17.9 mmHg and the difference between the mean systolic OC-OBP and AABP was 28.0±19.5 mmHg (Pclinic agrees poorly with AABP and may lead to unnecessary treatment and pharmacologically induced symptomatic hypotension, particularly in elderly patients. The results of this study urgently call for alternative solutions to routine OC-OBP in hospital outpatient clinics.

  20. Pharmacokinetics of Gefitinib in a Patient with Non-Small Cell Lung Cancer Undergoing Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Teppei Yamaguchi

    2015-02-01

    Full Text Available A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750 in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level. On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD.

  1. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives.

    Science.gov (United States)

    Robinson, Hal; Engelhardt, Thomas

    2017-01-01

    Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction. This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed. Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6-4-0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

  2. Association between ambulatory blood pressure values and central aortic pressure in a large population of normotensive and hypertensive patients.

    Science.gov (United States)

    Rouxinol-Dias, Ana; Araújo, Sara; Silva, José A; Barbosa, Loide; Polónia, Jorge

    2018-02-01

    Our aim was to examine the association of ambulatory blood pressure monitoring (ABPM) and central blood pressure (CBP) data in a large set of normotensive and hypertensive patients and its relation with pulse wave velocity (PWV). This cross-sectional study was carried out in a single centre and included 2864 individuals who carried out an ABPM, measurement of CBP from the aortic waveform (SphygmoCor) and carotid-femoral PWV (Complior). In our study, 26.6% of the normotensive individuals and 32.5% of controlled hypertensive patients had abnormal values of at least one or of both ABPM and CBP values, compared with 96.6% of uncontrolled hypertensive patients. In the overall population, normal ABPM and CBP occurred in 25.3% (group 1), abnormal ABPM and CBP occurred in 44.4% (group 4), abnormal ABPM and normal CBP occurred in 10.5% (group 3) and normal ABPM and abnormal CBP occurred in 19.8% (group 2). PWV was significantly superior in group 4 versus group 3; group 4 versus group 1 and group 3 versus group 2 and group 2 versus group 1 (Mann-Whitney U-test; PABPM or CBP associated with target organ damages. When abnormal values of ABPM and CBP coexist, target organ damage (aortic stiffness) is greater than that occurring when only one abnormal ABPM or CBP is present in the absence of the other. Isolated central hypertension entails greater organ damage than both normal ABPM and CBP. These patients may be at higher risk of further target organ damage because of unawareness of their central hypertension.

  3. Risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts by 24-hour ambulatory blood pressure monitoring

    International Nuclear Information System (INIS)

    Shiraishi, Makoto; Watanabe, Hirofumi; Sakurai, Kenzo; Kato, Bunta; Hasegawa, Yasuhiro

    2012-01-01

    Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (≥133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

  4. Ambulatory care pavilion takes its place out front by solving multiple needs.

    Science.gov (United States)

    Saukaitis, C A

    1994-09-01

    In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century.

  5. Implementation of a Computerized Order Entry Tool to Reduce the Inappropriate and Unnecessary Use of Cardiac Stress Tests With Imaging in Hospitalized Patients.

    Science.gov (United States)

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R

    2016-10-15

    The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. 75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2010-11-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN] Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery... Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national...

  7. Increased masked hypertension prevalence in patients with obesity.

    Science.gov (United States)

    Özkan, Selçuk; Ata, Naim; Yavuz, Bunyamin

    2018-02-08

    Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.

  8. Increased systolic ambulatory blood pressure and microalbuminuria in treated and non-treated hypertensive smokers

    DEFF Research Database (Denmark)

    Sørensen, Kaspar; Kristensen, Kjeld S; Bang, Lia E

    2004-01-01

    The primary aim of the present study was to evaluate the impact of smoking status on both clinic and ambulatory blood pressure (BP) and heart rate (HR) by using 24-h ambulatory BP monitoring in treated and non-treated hypertensive smokers and non-smokers. A secondary aim was to evaluate...

  9. Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010).

    Science.gov (United States)

    Gawron, Andrew J; Feinglass, Joseph; Pandolfino, John E; Tan, Bruce K; Bove, Michiel J; Shintani-Smith, Stephanie

    2015-01-01

    Introduction. Proton pump inhibitors (PPI) are one of the most commonly prescribed medication classes with similar efficacy between brand name and generic PPI formulations. Aims. We determined demographic, clinical, and practice characteristics associated with brand name PPI prescriptions at ambulatory care visits in the United States. Methods. Observational cross sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) of all adult (≥18 yrs of age) ambulatory care visits from 2006 to 2010. PPI prescriptions were identified by using the drug entry code as brand name only or generic available formulations. Descriptive statistics were reported in terms of unweighted patient visits and proportions of encounters with brand name PPI prescriptions. Global chi-square tests were used to compare visits with brand name PPI prescriptions versus generic PPI prescriptions for each measure. Poisson regression was used to determine the incidence rate ratio (IRR) for generic versus brand PPI prescribing. Results. A PPI was prescribed at 269.7 million adult ambulatory visits, based on 9,677 unweighted visits, of which 53% were brand name only prescriptions. In 2006, 76.0% of all PPI prescriptions had a brand name only formulation compared to 31.6% of PPI prescriptions in 2010. Visits by patients aged 25-44 years had the greatest proportion of brand name PPI formulations (57.9%). Academic medical centers and physician-owned practices had the greatest proportion of visits with brand name PPI prescriptions (58.9% and 55.6% of visits with a PPI prescription, resp.). There were no significant differences in terms of median income, patient insurance type, or metropolitan status when comparing the proportion of visits with brand name versus generic PPI prescriptions. Poisson regression results showed that practice ownership type was most strongly associated with the likelihood of receiving a brand name PPI over the entire study period. Compared to HMO visits

  10. Marginal ambulatory teaching cost under varying levels of service utilization.

    Science.gov (United States)

    Panton, D M; Mushlin, A I; Gavett, J W

    1980-06-01

    The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

  11. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.

    Science.gov (United States)

    Salles, Gil F; Reboldi, Gianpaolo; Fagard, Robert H; Cardoso, Claudia R L; Pierdomenico, Sante D; Verdecchia, Paolo; Eguchi, Kazuo; Kario, Kazuomi; Hoshide, Satoshi; Polonia, Jorge; de la Sierra, Alejandro; Hermida, Ramon C; Dolan, Eamon; O'Brien, Eoin; Roush, George C

    2016-04-01

    The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-to-day ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end points: HRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (Panalysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels. © 2016 American Heart Association, Inc.

  12. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

    Directory of Open Access Journals (Sweden)

    Wearne N

    2017-01-01

    Full Text Available Nicola Wearne,1 Kajiru Kilonzo,2 Emmanuel Effa,3 Bianca Davidson,1 Peter Nourse,4 Udeme Ekrikpo,1,5 Ikechi G Okpechi1 1Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa; 2Department of Medicine, Kilimanjaro Christian Medical College, Moshi, Tanzania; 3Department of Medicine, University of Calabar, Calabar, Nigeria; 4Division of Paediatric Nephrology, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa; 5Department of Internal Medicine, University of Uyo, Uyo, Nigeria Abstract: Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs. There is evidence that people living in LMICs have the highest need for renal replacement therapy (RRT despite the lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD does not require advanced technologies, much infrastructure, or need for dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. However, CAPD is scarcely available in many LMICs, and even where available, there are several hurdles to be confronted regarding patient selection for this modality. High cost of CAPD due to unavailability of fluids, low patient education and motivation, low remuneration for nephrologists, lack of expertise/experience for catheter insertion and management of complications, presence of associated comorbid diseases, and various socio-demographic factors contribute significantly toward reduced patient selection for CAPD. Cost of CAPD fluids seems to be a major constraint given that many countries do not have the capacity to manufacture fluids but instead rely heavily on fluids imported from developed countries. There is need to invest in fluid manufacturing (either nationally or

  13. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

    Directory of Open Access Journals (Sweden)

    Kolhe S

    2018-03-01

    Full Text Available Shilpa Kolhe Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK Abstract: The rapid evolution in ambulatory hysteroscopy (AH has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB. The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting. Keywords: abnormal uterine bleeding, ambulatory hysteroscopy, endometrial polyps, one-stop clinic, vaginoscopic approach

  14. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: design and rationale of the ROADMAP clinical trial.

    Science.gov (United States)

    Rogers, Joseph G; Boyle, Andrew J; O'Connell, John B; Horstmanshof, Douglas A; Haas, Donald C; Slaughter, Mark S; Park, Soon J; Farrar, David J; Starling, Randall C

    2015-02-01

    Mechanical circulatory support is now a proven therapy for the treatment of patients with advanced heart failure and cardiogenic shock. The role for this therapy in patients with less severe heart failure is unknown. The objective of this study is to examine the impact of mechanically assisted circulation using the HeartMate II left ventricular assist device in patients who meet current US Food and Drug Administration-defined criteria for treatment but are not yet receiving intravenous inotropic therapy. This is a prospective, nonrandomized clinical trial of 200 patients treated with either optimal medical management or a mechanical circulatory support device. This trial will be the first prospective clinical evaluation comparing outcomes of patients with advanced ambulatory heart failure treated with either ongoing medical therapy or a left ventricular assist device. It is anticipated to provide novel insights regarding relative outcomes with each treatment and an understanding of patient and provider acceptance of the ventricular assist device therapy. This trial will also provide information regarding the risk of events in "stable" patients with advanced heart failure and guidance for the optimal timing of left ventricular assist device therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Ambulatory blood pressure and urinary albumin excretion in clinically healthy subjects

    DEFF Research Database (Denmark)

    Clausen, Peter Vilhelm; Jensen, J S; Borch-Johnsen, K

    1998-01-01

    UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects with elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects...... loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour systolic and diastolic blood pressure levels in addition to increased blood pressure loads but normal circadian variation...

  16. Type D personality, illness perception, social support and quality of life in continuous ambulatory peritoneal dialysis patients.

    Science.gov (United States)

    Li, Jianying; Wu, Xiaofeng; Lin, Jianxiong; Zou, Dongmei; Yang, Xiao; Cheng, Shouzhen; Guo, Qunying

    2017-02-01

    The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients' QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p mental component score (MCS) (r = -0.31, p social support (r = -0.24, p illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.

  17. Profiling outcomes of ambulatory care: casemix affects perceived performance.

    Science.gov (United States)

    Berlowitz, D R; Ash, A S; Hickey, E C; Kader, B; Friedman, R; Moskowitz, M A

    1998-06-01

    The authors explored the role of casemix adjustment when profiling outcomes of ambulatory care. The authors reviewed the medical records of 656 patients with hypertension, diabetes, or chronic obstructive pulmonary disease (COPD) receiving care at one of three Department of Veterans Affairs medical centers. Outcomes included measures of physiological control for hypertension and diabetes, and of exacerbations for COPD. Predictors of poor outcomes, including physical examination findings, symptoms, and comorbidities, were identified and entered into regression models. Observed minus expected performance was described for each site, both before and after casemix adjustment. Risk-adjustment models were developed that were clinically plausible and had good performance properties. Differences existed among the three sites in the severity of the patients being cared for. For example, the percentage of patients expected to have poor blood pressure control were 35% at site 1, 37% at site 2, and 44% at site 3 (P Casemix-adjusted measures of performance were different from unadjusted measures. Sites that were outliers (P Casemix adjustment models can be developed for outpatient medical conditions. Sites differ in the severity of patients they treat, and adjusting for these differences can alter judgments of site performance. Casemix adjustment is necessary when profiling outpatient medical conditions.

  18. Diagnostic value and cost-benefit analysis of 24?hours ambulatory blood pressure monitoring in primary care in Portugal

    OpenAIRE

    Pessanha, Paulo; Viana, Manuel; Ferreira, Paula; Bertoquini, Susana; Pol?nia, Jorge

    2013-01-01

    Background Hypertensive patients (HTs) are usually attended in primary care (PC). We aimed to assess the diagnostic accuracy and cost-benefit ratio of 24-hour ambulatory blood pressure monitoring (ABPM) in all newly diagnosed hypertensive patients (HTs) attended in PC. Methods In a cross-sectional study ABPM was recorded in all 336 never treated HTs (Office BP ?140 and/or???90?mm Hg) that were admitted during 16?months. Since benefits from drug treatment in white-coat hypertension (WCH) remai...

  19. A hospitalização por asma e a carência de acompanhamento ambulatorial Asthma-related hospitalizations and lack of outpatient follow-up treatment

    Directory of Open Access Journals (Sweden)

    Emanuel Sarinho

    2007-08-01

    Full Text Available OBJETIVO: Verificar se as crianças e os adolescentes internados por crise aguda de asma em duas unidades de saúde da cidade do Recife faziam acompanhamento ambulatorial preventivo para controle da asma. MÉTODOS: Estudo prospectivo de uma série de casos de pacientes internados por asma aos quais foi aplicado um questionário no momento da internação para verificar a freqüência de acompanhamento ambulatorial para tratamento profilático. Foi considerado asmático aquele paciente que apresentou duas ou mais crises de broncoespasmo com boa resposta aos broncodilatadores. RESULTADOS: Do total de 169 pacientes internados por asma, 67% (112/167 - dados referentes a 2 pacientes não foram fornecidos foram atendidos exclusivamente em serviços de urgência no período intercrise. Apesar de haver encaminhamento médico para atendimento ambulatorial em 53,3% (89/167 - dados referentes a 2 pacientes não foram fornecidos dos casos, apenas 16% (27/169 dos pacientes efetivamente freqüentavam um ambulatório específico de asma para tratamento preventivo e somente 13% (22/169 usavam medicação profilática. CONCLUSÃO: A maioria das crianças e dos adolescentes internados por asma não fazia acompanhamento ambulatorial preventivo. Uma série de problemas, tais como a não referência para acompanhamento ambulatorial após a alta hospitalar, a dificuldade de acesso ao ambulatório e a impossibilidade de se obter a medicação profilática gratuitamente, entre outros fatores relacionados ao sistema de saúde, podem ter contribuído para esta baixa taxa de procura por atendimento ambulatorial. Recomenda-se a implementação de uma política de saúde que possibilite o efetivo funcionamento do programa de controle da asma.OBJECTIVE: To determine whether the children and adolescents with acute asthma attacks admitted to two public hospitals in the city of Recife, Brazil underwent outpatient follow-up treatment for the prevention and control of asthma

  20. Utilization of lean management principles in the ambulatory clinic setting.

    Science.gov (United States)

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

    2009-03-01

    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  1. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-02-01

    The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

  2. [Comparison of Patients and their Care in Urban and Rural Specialised Palliative Home Care - A Single Service Analysis].

    Science.gov (United States)

    Heckel, M; Stiel, S; Frauendorf, T; Hanke, R M; Ostgathe, C

    2016-07-01

    Specialised outpatient palliative care teams (in Germany called SAPV) aim to ensure best possible end-of-life care for outpatients with complex needs. Information on the influence of living areas (rural vs. urban) on patient and care related aspects is rare. This study aims to explore differences between palliative care patients in urban and rural dwellings concerning their nursing and service characteristics. A retrospective data analysis of documentary data for 502 patients supplied by SAPV team from December 2009 to June 2012 was conducted. Patients and care characteristics were investigated by frequency analysis and were compared for both groups of urban and rural dwelling patients (T test, Chi², Fisher's exact test p care, disease and service related aspects of palliative home care could be detected. An exception is that the rate of re-admittance to hospital is higher for rural dwelling patients (Fisher's exact test p=0.022). Although predominantly presumed, the single service analysis shows - except for the re-admittance rate to hospital - no considerable differences between palliative care patients regarding their living area. Our findings indicate that patients cared for in rural and urban settings have similar needs and impose similar requirements on palliative care teams. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Cognitive assessment on elderly people under ambulatory care

    Directory of Open Access Journals (Sweden)

    Bruna Zortea

    2015-04-01

    Full Text Available Objective: to evaluate the cognitive state of elderly people under ambulatory care and investigating the connection between such cognitive state and sociodemographic variables, health conditions, number of and adhesion to medicine. Methods: transversal, exploratory, and descriptive study, with a quantitative approach, realized with 107 elderly people under ambulatory care in a university hospital in southern Brazil, in november, 2013. The following variables were used: gender, age, civil status, income, schooling, occupation, preexisting noncommunicable diseases, number and type of prescribed medications, adhesion, mini-mental state examination score, and cognitive status. Data was analyzed through inferential and descriptive statistics. Results: the prevalence of cognitive deficit was of 42.1% and had a statistically significant connection to schooling, income, civil status, hypertension, and cardiopathy. Conclusion: nurses can intervene to avoid the increase of cognitive deficit through an assessment of the elderly person, directed to facilitative strategies to soften this deficit.

  4. Ambulatory Assessment.

    Science.gov (United States)

    Carpenter, Ryan W; Wycoff, Andrea M; Trull, Timothy J

    2016-08-01

    In recent years, significant technological advances have changed our understanding of dynamic processes in clinical psychology. A particularly important agent of change has been ambulatory assessment (AA). AA is the assessment of individuals in their daily lives, combining the twin benefits of increased ecological validity and minimized retrospective biases. These benefits make AA particularly well-suited to the assessment of dynamic processes, and recent advancements in technology are providing exciting new opportunities to understand these processes in new ways. In the current article, we briefly detail the capabilities currently offered by smartphones and mobile physiological devices, as well as some of the practical and ethical challenges of incorporating these new technologies into AA research. We then provide several examples of recent innovative applications of AA methodology in clinical research, assessment, and intervention and provide a case example of AA data generated from a study utilizing multiple mobile devices. In this way, we aim to provide a sense of direction for researchers planning AA studies of their own.

  5. Nutritional status of adults participating in ambulatory rehabilitation.

    Science.gov (United States)

    Kaur, Supreet; Miller, Michelle D; Halbert, Julie; Giles, Lynne C; Crotty, Maria

    2008-01-01

    To assess the overall nutritional status of older adults participating in ambulatory rehabilitation and determine its association with relevant outcomes including physical function and quality of life. Cross-sectional. Ambulatory rehabilitation service in the Southern region of Adelaide, Australia. A total of 229 participants recruited as part of a RCT between June 2005 and June 2006, stroke (n=83), elective orthopedic procedure (n=44) and other medical condition (n=102). Nutritional status was measured using Mini Nutritional Assessment (MNA), Simplified Nutrition Appetite Questionnaire (SNAQ) and Body Mass Index. Functional performance was assessed using the Modified Barthel Index (MBI) and quality of life was measured using the Short Form-36 (SF-36). Sixty-three percent of participants were malnourished or at risk of malnutrition according to the MNA and a third had a risk of >or= 5% weight loss in the subsequent six months, according to the SNAQ. Participants with a diagnosis other than stroke or elective orthopedic procedure were the most vulnerable, with 53% (n=74/140) classified as at risk of malnutrition or malnourished and a longer length of stay in hospital. Functional performance was no different for participants assessed as at risk of malnutrition or malnourished compared to the well nourished, but the SF-36 mental component score was significantly higher for those who were well nourished (p=0.003). Findings emphasise the magnitude of the malnutrition problem in ambulatory rehabilitation settings. Further research is required to evaluate the resource implications against expected benefits of providing nutrition interventions at this point.

  6. Mistakes and complications in the surgical treatment of ambulatory equino planovalgus foot deformities in patients with cerebral palsy using extra-articular subtalar arthrodesis

    Directory of Open Access Journals (Sweden)

    Valery V Umnov

    2016-06-01

    Full Text Available Aim. To evaluate the results of a modified technique for extra-articular arthrodesis of the subtalar joint for patients with cerebral palsy with an ambulatory form of equine-planovalgus deformity of the foot. The mistakes and complications that occurred during treatment with this technique are discussed. Materials and methods. Between 2005 and 2015, this surgical method for performing arthrodesis of the subtalar joint, was performed on 544 patients (989 feet between 4 and 15 years old. Correction of equinus contracture was performed using Achilles tendon plasty or dissection of the tendon of the gastrocnemius muscle. Abnormal muscle tone was reduced either by administering Dysport® in the calf muscle or by selective neurotomy of the tibial nerve. Results. Good results were achieved for 72% of cases, satisfactory for 23% of cases, and unsatisfactory for 5% of cases. Unsatisfactory results of treatment were associated with overvaluation of the degree of mobility of the deformity and with a number of technical and tactical mistakes. Conclusion. This analysis of mistakes and complications of extra-articular arthrodesis of the subtalar joint will allow surgeons to avoid these issues in the future and improve the quality of treatment for similar patients.

  7. Patient Satisfaction with Collection of Patient-Reported Outcome Measures in Routine Care.

    Science.gov (United States)

    Recinos, Pablo F; Dunphy, Cheryl J; Thompson, Nicolas; Schuschu, Jesse; Urchek, John L; Katzan, Irene L

    2017-02-01

    Systematic collection of patient-reported outcome measures (PROMs) during ambulatory clinic visits can enhance communication between patient and provider, and provide the ability to evaluate outcomes of care. Little is known about patient satisfaction of PROM data collection in routine clinical care. To evaluate patient reaction to the routine collection of PROMs in the ambulatory setting. Before all ambulatory clinic visits at our neurological institute, patients electronically complete health status questionnaires. We administered an 8-question patient satisfaction survey to a sample of patients seen across the institute after their clinical visit. Of 343 patients approached, 323 agreed to participate. The majority responded that the questionnaire system was easy to use, was an appropriate length, and benefited their care overall (strongly agree or agree = 92.3%, 87.6%, and 77.3%, respectively). Provider review of the PROMs with the patient during the clinic visit was associated with significantly higher positive responses to all questions, even those regarding logistical aspects of the collection process. There were significant age and race differences in response to perceived benefit: those in the Black/other race category had a markedly lower probability of viewing the process favorably with increasing age. Systematic collection of PROMs via an electronic questionnaire appears to be well accepted by patients. A minority of patients did not feel the questionnaire content applied to their appointment or that the system was a beneficial feature of the clinical practice. The provider can significantly improve the patient's perception of PROM collection and the patient-physician encounter by reviewing the questionnaire results with the patient.

  8. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization

    International Nuclear Information System (INIS)

    Kaul, S.; Lilly, D.R.; Gascho, J.A.; Watson, D.D.; Gibson, R.S.; Oliner, C.A.; Ryan, J.M.; Beller, G.A.

    1988-01-01

    The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3)

  9. Ambulatory Estimation of Relative Foot Positions using Ultrasound

    NARCIS (Netherlands)

    Weenk, D.; van der Coelen, Michiel; Geessink, Arno A.G.; van der Hoek, Frank J.; Verstoep, Bart; Kortier, H.G.; van Meulen, Fokke; van Beijnum, Bernhard J.F.; Veltink, Petrus H.

    2013-01-01

    The recording of human movement is used for biomedical applications like physical therapy and sports training. Over the last few years inertial sensors have been proven to be a useful ambulatory alternative to traditional optical systems. An example of a successful application is the instrumented

  10. Specific opsonic activity for staphylococci in peritoneal dialysis effluent during continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Nielsen, H; Espersen, F; Kharazmi, A

    1992-01-01

    In a prospective study of intraperitoneal opsonins in 30 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), the IgG concentration, the fibronectin concentration, the specific antistaphylococcal antibody level, and the opsonic activity against Staphylococcus epidermidis were...... measured in peritoneal dialysis effluent from the initiation of CAPD and monthly for 6 months. Significant correlation was found between the four assays, but the interindividual and intraindividual variations were considerable. No statistically significant correlation was observed between susceptibility...... of the patients to CAPD-related infectious peritonitis and any of the above-mentioned parameters of humoral defense. We conclude that at the present time it is not feasible to use these assays for the establishment of prognosis with regard to peritonitis in CAPD....

  11. [Ambulatory pediatrics: a challenge].

    Science.gov (United States)

    Ransy, V; Gevers, B; Landsberg, M

    2006-01-01

    Ambulatory paediatrics in University hospitals has remarkably evolved during the past decade, along with technological progress and the current need for undelayed information and attention; demand for hospital medical advice increases consequently, either directly in outpatients wards or indirectly by phone or e-mails. Specific medico-social aspects linked essentially to populations' migration, poverty, chronic stress and family splitting are regularly encountered. Hospital architecture and adequacy of medical and nursing staff must both be adjusted to these changing medical demands including medical teaching. We now face the ever-growing challenge of providing an adequate management of actual medico-psycho-social aspects and integrating up-to-date paediatrics in our daily practices.

  12. Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Joyce Martini

    2014-01-01

    Full Text Available Objective: During the transitional phase (ambulatory to non-ambulatory, synergies characterize the evolution of Duchenne muscular dystrophy (DMD. This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. Method: Eighty videos (5 children × 4 assessments × 4 tasks were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. Results: The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. Conclusion: Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.

  13. Residual myocardial ischaemia in first non-Q versus Q wave infarction: maximal exercise testing and ambulatory ST-segment monitoring

    DEFF Research Database (Denmark)

    Mickley, H; Pless, P; Nielsen, J R

    1993-01-01

    the infarction. The prevalence of exercise-induced ischaemic manifestations in the infarct types was similar: chest pain 14% vs 16% and ST-segment depression 54% vs 54%. The ischaemic threshold did not differ either (heart rate at 1 mm of ST-segment depression 120 +/- 27 vs 119 +/- 25 beats.min-1). During early...... in non-Q wave infarction (51%) as compared to Q wave infarction (31%) (P depression on ambulatory recording and exercise testing significantly predicted the development of future angina pectoris, whereas patients at increased risk for subsequent......In a prospective study of 123 consecutive survivors of a first myocardial infarction (43 non-Q wave, 80 Q wave), we determined the total residual ischaemic burden by use of pre-discharge maximal exercise testing and post-discharge 36 h ambulatory ST-segment monitoring initiated 11 +/- 5 days after...

  14. Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial.

    Science.gov (United States)

    Burke, Valerie; Beilin, Lawrie J; Cutt, Hayley E; Mansour, Jacqueline; Wilson, Amy; Mori, Trevor A

    2005-06-01

    To assess effects of multifactorial lifestyle modification on antihypertensive drug needs in treated hypertensive individuals. Randomized controlled trial. Research studies unit. Overweight hypertensive patients, receiving one or two antihypertensive drugs, were recruited by advertising, and allocated randomly to a usual care group (controls; n = 118) or a lifestyle modification group (programme group; n = 123). A 4-month programme of weight loss, a low-sodium 'Dietary Approaches to Stop Hypertension'-type diet with added fish, physical activity and moderation of alcohol intake. After 4 months, if mean 24-h ambulatory blood pressure (ABP) was less than 135/85 mmHg, antihypertensive drugs were withdrawn over 4 weeks and long-term home blood pressure monitoring was begun. Antihypertensive drug requirements, ABP, weight, waist girth at 4 months and 1-year follow-up. Ninety control group and 102 programme group participants completed the study. Mean 24-h ABP changed after 4 months by -1.0/-0.3 +/- 0.5/0.4 mmHg in controls and -4.1/-2.1 +/- 0.7/0.5 mmHg with the lifestyle programme (P lifestyle modification in patients with treated hypertension reduced blood pressure in the short-term. Decreased central obesity persisted 1 year later and could reduce overall cardiovascular risk.

  15. 75 FR 78246 - Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC...

    Science.gov (United States)

    2010-12-15

    ...] Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups... announces the re-chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the... (APC) groups and their associated weights established under the Medicare hospital Outpatient...

  16. Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients.

    Science.gov (United States)

    Mehnert, A; Lehmann, C; Graefen, M; Huland, H; Koch, U

    2010-11-01

    The aim of this study is to identify anxiety, depression and post-traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health-related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow-up care for an average of 27 months after surgery using standardised self-report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, Illness-Specific Social Support Scale, Short-Form Health Survey). Seventy-six per cent of patients evaluated their disease as 'not' or a 'little threatening'. The cancer diagnosis and uncertainty were most frequently reported as 'distressing', while medical treatment and doctor-patient interaction were most frequently evaluated as 'most helpful'. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age-adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co-morbidity (P interactions, threat of cancer, disease stage and age significantly predicted mental health (P social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening. © 2009 The Authors. European Journal of Cancer Care © 2009 Blackwell Publishing Ltd.

  17. Defining your role in ambulatory care: clinical nurse specialist or nurse practitioner?

    Science.gov (United States)

    Sawyers, J E

    1993-01-01

    A collaborative practice was established at the University of Southern California/Kenneth Norris Jr. Cancer Hospital utilizing combined roles of the CNS and nurse practitioner. The role was created out of a specific need of the physicians of the gastrointestinal malignancy service. Increased administrative and clinical responsibilities necessitated another clinical expert to be readily available for the management of the acute care private practice patients. As a CNS for both the departments of medicine and nursing, my primary responsibilities are focused within the ambulatory care area. This paper presents the concept for this position, the professional and personal benefits, advantages and disadvantages, and recommendations for nursing practice.

  18. Análisis y clasificación de las urgencias hospitalarias mediante los Ambulatory Patient Groups

    Directory of Open Access Journals (Sweden)

    Conesa A.

    2003-01-01

    Full Text Available Objetivo: Describir la factibilidad y el resultado de la aplicación del sistema Ambulatory Patient Groups (APG a la casuística atendida en los servicios de urgencias de seis hospitales del área de Barcelona. Métodos: Confección de un conjunto mínimo básico de datos específico para urgencias (CMBDAU. Obtención de las variables necesarias en una muestra aleatoria de visitas atendidas, a partir de los informes de asistencia correspondientes. Aplicación del sistema APG a los episodios seleccionados. Resultados: Se ha codificado y agrupado en APG un total de 11.188 visitas de urgencias. Quince diagnósticos identifican el 25% de los episodios. El 50% de los procedimientos de urgencias son exploraciones complementarias sencillas. Quince APG agrupan el 50% de la casuística atendida en urgencias. Conclusiones: El CMBDAU es válido para describir la casuística de urgencias y su agrupación en APG proporciona resultados consistentes e interpretables. La aplicación generalizada de sistemas como los APG en urgencias requiere una validación previa en nuestro entorno de los valores de peso norteamericanos. También debe valorarse la disponibilidad de recursos técnicos y humanos suficientes para garantizar la calidad y la continuidad de un registro de estas características.

  19. Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial

    Directory of Open Access Journals (Sweden)

    Rawal N

    2011-04-01

    Full Text Available Narinder Rawal1, Valery Macquaire2, Elena Catalá3, Marco Berti4, Rui Costa5, Markus Wietlisbach61Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; 2Clinique du Parc Leopold, Brussels, Belgium; 3Pain Clinic, Department Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 4Department of Anesthesiology and Reanimation, Parma Hospital, Parma, Italy; 5Garcia de Orta Hospital, Almada, Portugal; 6Department of Anesthesiology, Sursee Hospital, Sursee, SwitzerlandAbstract: This randomized, double-blind, double-dummy, multicenter trial compared efficacy and safety of tramadol HCL 37.5 mg/paracetamol 325 mg combination tablet with tramadol HCL 50 mg capsule in the treatment of postoperative pain following ambulatory hand surgery with iv regional anesthesia. Patients received trial medication at admission, immediately after surgery, and every 6 hours after discharge until midnight of the first postoperative day. Analgesic efficacy was assessed by patients (n = 128 in each group, full analysis set and recorded in a diary on the evening of surgery day and of the first postoperative day. They also documented the occurrence of adverse events. By the end of the first postoperative day, the proportion of treatment responders based on treatment satisfaction (primary efficacy variable was comparable between the groups (78.1% combination, 71.9% tramadol; P = 0.24 and mean pain intensity (rated on a numerical scale from 0 = no pain to 10 = worst imaginable pain had been reduced to 1.7 ± 2.0 for both groups. Under both treatments, twice as many patients experienced no pain (score = 0 on the first postoperative day compared to the day of surgery (35.9% vs 16.4% for tramadol/paracetamol and 36.7% vs 18% for tramadol treatment. Rescue medication leading to withdrawal (diclofenac 50 mg was required by 17.2% patients with tramadol/paracetamol and 13.3% with tramadol. Adverse events (mainly nausea, dizziness

  20. Distinct clinical characteristics and helminth co-infections in adult tuberculosis patients from urban compared to rural Tanzania.

    Science.gov (United States)

    Sikalengo, George; Hella, Jerry; Mhimbira, Francis; Rutaihwa, Liliana K; Bani, Farida; Ndege, Robert; Sasamalo, Mohamed; Kamwela, Lujeko; Said, Khadija; Mhalu, Grace; Mlacha, Yeromin; Hatz, Christoph; Knopp, Stefanie; Gagneux, Sébastien; Reither, Klaus; Utzinger, Jürg; Tanner, Marcel; Letang, Emilio; Weisser, Maja; Fenner, Lukas

    2018-03-24

    Differences in rural and urban settings could account for distinct characteristics in the epidemiology of tuberculosis (TB). We comparatively studied epidemiological features of TB and helminth co-infections in adult patients from rural and urban settings of Tanzania. Adult patients (≥ 18 years) with microbiologically confirmed pulmonary TB were consecutively enrolled into two cohorts in Dar es Salaam, with ~ 4.4 million inhabitants (urban), and Ifakara in the sparsely populated Kilombero District with ~ 400 000 inhabitants (rural). Clinical data were obtained at recruitment. Stool and urine samples were subjected to diagnose helminthiases using Kato-Katz, Baermann, urine filtration, and circulating cathodic antigen tests. Differences between groups were assessed by χ 2 , Fisher's exact, and Wilcoxon rank sum tests. Logistic regression models were used to determine associations. Between August 2015 and February 2017, 668 patients were enrolled, 460 (68.9%) at the urban and 208 (31.1%) at the rural site. Median patient age was 35 years (interquartile range [IQR]: 27-41.5 years), and 454 (68%) were males. Patients from the rural setting were older (median age 37 years vs. 34 years, P = 0.003), had a lower median body mass index (17.5 kg/m 2 vs. 18.5 kg/m 2 , P urban Tanzania. There was no significant difference in frequencies of HIV infection, diabetes mellitus, and haemoglobin concentration levels between the two settings. The overall prevalence of helminth co-infections was 22.9% (95% confidence interval [CI]: 20.4-27.0%). The significantly higher prevalence of helminth infections at the urban site (25.7% vs. 17.3%, P = 0.018) was predominantly driven by Strongyloides stercoralis (17.0% vs. 4.8%, P rural setting (adjusted odds ratio [aOR]: 3.97, 95% CI: 1.16-13.67) and increasing age (aOR: 1.06, 95% CI: 1.02-1.10). Clinical characteristics and helminth co-infections pattern differ in TB patients in urban and rural Tanzania. The

  1. Cost and resource use of patients on antiretroviral therapy in the urban and semiurban public sectors of South Africa.

    Science.gov (United States)

    Meyer-Rath, Gesine; Miners, Alec; Santos, Andreia C; Variava, Ebrahim; Venter, Willem Daniel Francois

    2012-11-01

    South Africa has the world's largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important. Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics. Patients in both clinics had comparable CD4 cell counts at initiation and under treatment. In the urban clinic, mean cost per patient-year on ART in 2011 USD was $1040 [95% confidence interval (CI): $800 to $1280], of which outpatient cost was $692 (67%) and inpatient cost was $348 (33%). Fourteen percent of urban patients required inpatient care at a mean length of stay of 9 days and mean cost per hospitalized patient of $1663 (95% CI: $1103 to $2041). In the semiurban clinic, mean cost per patient-year on ART was $1115 (95% CI: $776 to $1453), of which outpatient cost was $697 (63%) and inpatient cost $418 (37%). Seven percent of semiurban patients required inpatient care at a mean length of stay of 28 days and mean cost per hospitalized patient of $3824 (95% CI: $1143 to $6505). Outpatient ART provision in the semiurban setting cost the same as in the urban setting, but inpatient costs are higher in the semiurban clinic because of longer hospitalizations. Cost in both clinics was highest in the first 3 months on ART and at CD4 cell counts <50 cells/μL.

  2. Ambulatory diffuse optical tomography and multimodality physiological monitoring system for muscle and exercise applications

    Science.gov (United States)

    Hu, Gang; Zhang, Quan; Ivkovic, Vladimir; Strangman, Gary E.

    2016-09-01

    Ambulatory diffuse optical tomography (aDOT) is based on near-infrared spectroscopy (NIRS) and enables three-dimensional imaging of regional hemodynamics and oxygen consumption during a person's normal activities. Although NIRS has been previously used for muscle assessment, it has been notably limited in terms of the number of channels measured, the extent to which subjects can be ambulatory, and/or the ability to simultaneously acquire synchronized auxiliary data such as electromyography (EMG) or electrocardiography (ECG). We describe the development of a prototype aDOT system, called NINscan-M, capable of ambulatory tomographic imaging as well as simultaneous auxiliary multimodal physiological monitoring. Powered by four AA size batteries and weighing 577 g, the NINscan-M prototype can synchronously record 64-channel NIRS imaging data, eight channels of EMG, ECG, or other analog signals, plus force, acceleration, rotation, and temperature for 24+ h at up to 250 Hz. We describe the system's design, characterization, and performance characteristics. We also describe examples of isometric, cycle ergometer, and free-running ambulatory exercise to demonstrate tomographic imaging at 25 Hz. NINscan-M represents a multiuse tool for muscle physiology studies as well as clinical muscle assessment.

  3. Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

    Science.gov (United States)

    Norsidah, A M; Yahya, N; Adeeb, N; Lim, A L

    2001-03-01

    Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

  4. Nutritional status and food habits of drug addicts in an ambulatory treatment

    OpenAIRE

    Ferreira, Isadora Borne; Paiva, Camila Bosse; Narvaez, Joana Corrêa de Magalhães; Bosa, Vera Lucia

    2015-01-01

    Objetivo: Identificar o estado nutricional e hábitos alimentares de pacientes masculinos em recuperação de dependência química em acompanhamento ambulatorial de uma unidade de adição. Métodos: Estudo transversal com 25 pacientes adultos em tratamento ambulatorial para dependência química. Foram aferidos parâmetros antropométricos (peso, estatura, circunferência da cintura e índice de massa corporal) e de composição corporal (bioimpedância elétrica), e foram investigados hábitos alimentares (Q...

  5. Ambulatory EHR functionality: a comparison of functionality lists.

    Science.gov (United States)

    Drury, Barbara M

    2006-01-01

    There is a proliferation of lists intended to define and clarify the functionality of an ambulatory electronic health record system. These lists come from both private and public entities and vary in terminology, granularity, usability, and comprehensiveness. For example, functionality regarding a problem list includes the following possible definitions: * "Create and maintain patient-specific problem lists," from the HL7 Electronic Health Record Draft Standard for Trial Use. * "Provide a flexible mechanism for retrieval of encounter information that can be organized by diagnosis, problem, problem type," from the Bureau of Primary Health Care. * "The system shall associate encounters, orders, medications and notes with one or more problems," from the Certification Commission on Health Information Technology. * "Displays dates of problems on problem list," from COPIC Insurance Co. * "Shall automatically close acute problems using an automated algorithm," from the Physicians Foundations HIT Subcommittee. This article will compare the attributes of these five electronic health record functionality lists and their usefulness to different audiences-clinicians, application developers and payers.

  6. Preoperative Expectations and Postoperative Outcomes of Visual Functioning among Cataract Patients in Urban Southern China.

    Directory of Open Access Journals (Sweden)

    Ziyan Chen

    Full Text Available To investigate the relationship between preoperative expectations and actual postoperative outcomes of visual function (VF among patients undergoing first eye cataract surgery.A longitudinal study of 182 patients from hospitals in urban Southern China were surveyed prior to surgery and 3 month after cataract surgery regarding their preoperative, expected postoperative and actual postoperative VF for each of the items on the Catquest-9SF and their satisfaction with cataract surgery. In addition, detailed clinical data were collected preoperatively and postoperatively.The majority of cataract patients in urban Southern China had high expectations for VF outcomes after cataract surgery and in most cases postoperative outcomes achieved the expected level of improvement. The mean (standard deviation, SD preoperative Catquest-9SF score was 15.7 (5.86 and the mean (SD expected postoperative score was 26.3 (2.93. The discrepancy between actual and expected improvement was significantly correlated with patients' health literacy, presence of systemic and ocular comorbidity, preoperative visual acuity of the surgery eye, LOCS III nuclear opalescence and cortical cataract grading.Cataract patients in urban Southern China had high expectations for surgery outcomes. Patients with low level of health literacy and the presence of systemic and ocular comorbidity may need a comprehensive counseling to decrease the discrepancy regarding expected and actual outcomes.

  7. Usability Testing of Two Ambulatory EHR Navigators.

    Science.gov (United States)

    Hultman, Gretchen; Marquard, Jenna; Arsoniadis, Elliot; Mink, Pamela; Rizvi, Rubina; Ramer, Tim; Khairat, Saif; Fickau, Keri; Melton, Genevieve B

    2016-01-01

    Despite widespread electronic health record (EHR) adoption, poor EHR system usability continues to be a significant barrier to effective system use for end users. One key to addressing usability problems is to employ user testing and user-centered design. To understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. Participants completed tasks for five patient cases using the navigators, while employing a think-aloud protocol. The tasks were based on Meaningful Use (MU) requirements. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. A relatively small portion of navigator content was used to complete the MU-related tasks, though navigation patterns were highly variable across participants for both navigators. Preferences for EHR navigation structures appeared to be individualized. This study demonstrates the importance of EHR usability assessments to evaluate group and individual performance of different interfaces and preferences for each design.

  8. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  9. Epidemiologic profile of patients seen in primary care clinics in an urban and a rural setting in Haiti, 2010-11.

    Science.gov (United States)

    Dickstein, Yaakov; Neuberger, Ami; Golus, Miri; Schwartz, Eli

    2014-09-01

    This study examined the demographic and epidemiological differences between patient populations presenting to a rural and an urban clinic in Haiti. A primary health clinic was established in urban Leogane, and a once-weekly clinic was established in Magandou, a rural village. Patient data were recorded for all individuals presenting to each clinic. Over 7 months, 6632 patients (median age 25) were seen in the urban clinic, and 567 (median age 47) in the rural clinic. There was a female majority at both sites. Hypertension was diagnosed in 41.9% (238/567) of the rural population over 40 years of age, while 29.5% (1956/6632) of patients in the urban setting had the same diagnosis (pHaiti must address the wide rural prevalence. STDs are a major urban health issue requiring treatment for both patients and their partners. Vector-borne disease was unseen in the rural clinic, despite an altitude insufficient to prevent mosquito-borne illness. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Addition of Aliskiren to Angiotensin Receptor Blocker Improves Ambulatory Blood Pressure Profile and Cardiorenal Function Better than Addition of Benazepril in Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Satoshi Umemura

    2013-07-01

    Full Text Available An altered ambulatory blood pressure (BP and heart rate (HR profile is related to chronic kidney disease (CKD and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18 or the benazepril add-on group (n = 18. Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.

  11. Addition of aliskiren to Angiotensin receptor blocker improves ambulatory blood pressure profile and cardiorenal function better than addition of benazepril in chronic kidney disease.

    Science.gov (United States)

    Ohsawa, Masato; Tamura, Kouichi; Kanaoka, Tomohiko; Wakui, Hiromichi; Maeda, Akinobu; Dejima, Toru; Azushima, Kengo; Uneda, Kazushi; Kobayashi, Ryu; Tsurumi-Ikeya, Yuko; Toya, Yoshiyuki; Fujikawa, Tetsuya; Umemura, Satoshi

    2013-07-24

    An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI) was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.

  12. Do the Preferences of Healthcare Provider Selection Vary among Rural and Urban Patients with Different Income and Cause Different Outcome?

    Directory of Open Access Journals (Sweden)

    Tsung-Hsien Yu

    Full Text Available Equal access to healthcare facilities and high-level quality of care are important strategies to eliminate the disparity in outcome of care. However, the existing literature regarding how urban or rural dwelling patients with different income level select healthcare providers is insufficient. The purposes of this study were to examine whether differences of healthcare provider selection exist among urban and rural coronary artery bypass surgery (CABG patients with different income level. If so, we further investigated the associated impact on mortality.A retrospective, multilevel study design was conducted using claims data from 2007-2011 Taiwan's Universal Health Insurance Scheme. Healthcare providers' performance and patients' travelling distance to hospitals were used to define the patterns of healthcare provider selection. Baron and Kenny's procedures for mediation effect were conducted.There were 10,108 CABG surgeries included in this study. The results showed that urban dwelling and higher income patients were prone to receive care from better-performance providers. The travelling distances of urban dwelling patients was 15 KM shorter, especially when they received better-performance provider's care. The results also showed that the difference of healthcare provider selection and mortality rate existed between rural and urban dwelling patients with different income levels. After the procedure of mediation effect testing, the results showed that the healthcare provider selection partially mediated the relationships between patients' residential areas with different income levels and 30-day mortality.Preferences of healthcare provider selection vary among rural and urban patients with different income, and such differences partially mediated the outcome of care. Health authorities should pay attention to this issue, and propose appropriate solutions to eliminate the disparity in outcome of CABG care.

  13. Do the Preferences of Healthcare Provider Selection Vary among Rural and Urban Patients with Different Income and Cause Different Outcome?

    Science.gov (United States)

    Yu, Tsung-Hsien; Chung, Kuo-Piao; Wei, Chung-Jen; Chien, Kuo-Liong; Hou, Yu-Chang

    2016-01-01

    Equal access to healthcare facilities and high-level quality of care are important strategies to eliminate the disparity in outcome of care. However, the existing literature regarding how urban or rural dwelling patients with different income level select healthcare providers is insufficient. The purposes of this study were to examine whether differences of healthcare provider selection exist among urban and rural coronary artery bypass surgery (CABG) patients with different income level. If so, we further investigated the associated impact on mortality. A retrospective, multilevel study design was conducted using claims data from 2007-2011 Taiwan's Universal Health Insurance Scheme. Healthcare providers' performance and patients' travelling distance to hospitals were used to define the patterns of healthcare provider selection. Baron and Kenny's procedures for mediation effect were conducted. There were 10,108 CABG surgeries included in this study. The results showed that urban dwelling and higher income patients were prone to receive care from better-performance providers. The travelling distances of urban dwelling patients was 15 KM shorter, especially when they received better-performance provider's care. The results also showed that the difference of healthcare provider selection and mortality rate existed between rural and urban dwelling patients with different income levels. After the procedure of mediation effect testing, the results showed that the healthcare provider selection partially mediated the relationships between patients' residential areas with different income levels and 30-day mortality. Preferences of healthcare provider selection vary among rural and urban patients with different income, and such differences partially mediated the outcome of care. Health authorities should pay attention to this issue, and propose appropriate solutions to eliminate the disparity in outcome of CABG care.

  14. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

    Science.gov (United States)

    Lorenzi, Nancy M; Kouroubali, Angelina; Detmer, Don E; Bloomrosen, Meryl

    2009-02-23

    Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. The EHR

  15. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2009-02-01

    Full Text Available Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff

  16. Elastase, α1-Proteinase Inhibitor, and Interleukin-8 in Children and Young Adults with End-Stage Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis

    OpenAIRE

    Polańska, Bożena; Augustyniak, Daria; Makulska, Irena; Niemczuk, Maria; Jankowski, Adam; Zwolińska, Danuta

    2013-01-01

    Peritoneal dialysis is one of the main modality of treatment in end-stage kidney diseases (ESKD) in children. In our previous work in chronic kidney disease patients, in pre-dialyzed period and on hemodialysis, the neutrophils were highly activated. The aim of this study was to assess an inflammatory condition and neutrophil activation in ESKD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Thirteen CAPD patients without infection, both sexes, aged 2.5–24 years, and grou...

  17. Anestesia ambulatorial para radioterapia em paciente portador de miastenia gravis: relato de caso Anestesia ambulatorial para radioterapia en paciente portador de miastenia gravis: relato de caso Outpatient anesthesia for radiotherapy in a patient with myasthenia gravis: case report

    Directory of Open Access Journals (Sweden)

    Raquel Marcondes Bussolotti

    2006-08-01

    , 87 años, 87 kg, estado físico ASA III, con historial de miastenia gravis; accidente vascular encefálico previo (AVE; marcapaso por bloqueo atrio-ventricular total; hipertensión arterial sistémica (HAS. Fueron programadas siete sesiones de radioterapia de 20 minutos para tratamiento del tumor de parótida bajo anestesia general. En la sala de radioterapia fue monitorizado con cardioscopio, monitor de presión arterial no invasiva, oxímetro de pulso y sometido a anestesia general con propofol y sevoflurano. Después de la inducción, se mantuvo en ventilación espontánea con cánula de Guedel y catéter nasofaríngeo con O2 /sevoflurano, para acomodación de la máscara de inmovilización. En la sala de recuperación postanestésica, no presentó complicaciones. CONCLUSIONES: La elección de los anestésicos y el acompañamiento clínico de criterio permitieron la buena evolución del paciente, con AVE previo, cardiopata y anciano, sometido a la anestesia general balanceada para procedimiento de aplicación de radioterapia, en régimen ambulatorial.BACKGROUND AND OBJECTIVES: Myasthenia Gravis (MG is a rare autoimmune disease, characterized by the reduction in the number of nicotinic receptors in the neuromuscular junction, with an incidence of 14/100,000. The objective of this report is to describe the case of a patient with myasthenia gravis who underwent balanced general anesthesia for radiotherapy of a spinocellular carcinoma of the parotid gland as an outpatient. CASE REPORT: Male patient, 87 years old, 87 kg, physical status ASA III, with a prior history of myasthenia gravis; stroke; pacemaker for a third-degree AV block; and hypertension. He was scheduled for seven 20-minutes radiotherapy sessions under general anesthesia. In the radiotherapy room he was monitored with a cardioscope, noninvasive blood pressure, pulse oxymeter, and underwent general anesthesia with propofol and sevoflurane. After the induction, he maintained spontaneous ventilation with a

  18. Differentiating between light and deep sleep stages using an ambulatory device based on peripheral arterial tonometry

    International Nuclear Information System (INIS)

    Bresler, Ma'ayan; Sheffy, Koby; Preiszler, Meir; Herscovici, Sarah; Pillar, Giora

    2008-01-01

    The objective of this study is to develop and assess an automatic algorithm based on the peripheral arterial tone (PAT) signal to differentiate between light and deep sleep stages. The PAT signal is a measure of the pulsatile arterial volume changes at the finger tip reflecting sympathetic tone variations and is recorded by an ambulatory unattended device, the Watch-PAT100, which has been shown to be capable of detecting wake, NREM and REM sleep. An algorithm to differentiate light from deep sleep was developed using a training set of 49 patients and was validated using a separate set of 44 patients. In both patient sets, Watch-PAT100 data were recorded simultaneously with polysomnography during a full night sleep study. The algorithm is based on 14 features extracted from two time series of PAT amplitudes and inter-pulse periods (IPP). Those features were then further processed to yield a prediction function that determines the likelihood of detecting a deep sleep stage epoch during NREM sleep periods. Overall sensitivity, specificity and agreement of the automatic algorithm to identify standard 30 s epochs of light and deep sleep stages were 66%, 89%, 82% and 65%, 87%, 80% for the training and validation sets, respectively. Together with the already existing algorithms for REM and wake detection we propose a close to full stage detection method based solely on the PAT and actigraphy signals. The automatic sleep stages detection algorithm could be very useful for unattended ambulatory sleep monitoring assessing sleep stages when EEG recordings are not available

  19. Hunger and Food Insecurity among Patients in an Urban Emergency Department.

    Science.gov (United States)

    Miner, James R; Westgard, Bjorn; Olives, Travis D; Patel, Roma; Biros, Michelle

    2013-05-01

    To determine the prevalence of hunger and food insecurity among patients presenting to the emergency department (ED) over 3 consecutive years. This was a cross-sectional study of patients presenting to the ED at Hennepin County Medical Center, and urban, Level I trauma center. We prospectively screened adult (age >18) patients presenting to the ED during randomized daily 8-hour periods between June 1 and August 31, 2007 and 2008, and randomized every-other-day periods between June 1 and August 31, 2009. We excluded patients with high acuity complaints, altered mental status, prisoners, those who did not speak Spanish or English, or those considered to be vulnerable. Consenting participants completed a brief demographic survey. The main outcome measures included age, gender, ethnicity, employment, housing status, insurance, access to food, and having to make choices between buying food and buying medicine. All responses were self reported. 26,211 patients presented during the study; 15,732 (60%) were eligible, 8,044 (51%) were enrolled, and 7,852 (98%) were included in the analysis. The rate of patients reporting hunger significantly increased over the 3-year period [20.3% in 2007, 27.8% in 2008, and 38.3% in 2009 (pfood and medicine also increased [20.0% in 2007, 18.5% in 2008, and 22.6% in 2009 (p=0.006)]. A significant proportion of our ED patients experience food insecurity and hunger. Hunger and food insecurity have become more prevalent among patients seen in this urban county ED over the past 3 years. Emergency physicians should be aware of the increasing number of patients who must choose between obtaining food and their prescribed medications, and should consider the contribution of hunger and food insecurity to the development of health conditions for which ED treatment is sought.

  20. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-01-01

    

 The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1) errors inevitably occur and usually derive from faulty system design, not from negligence; (2) accident prevention should be an ongoing process based on open and full reporting; (3) major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff. PMID:12571343

  1. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  2. Ambulatory blood pressure monitoring and development of cardiovascular events in high-risk patients included in the Spanish ABPM registry: the CARDIORISC Event study.

    Science.gov (United States)

    de la Sierra, Alejandro; Banegas, José R; Segura, Julián; Gorostidi, Manuel; Ruilope, Luis M

    2012-04-01

    Ambulatory blood pressure monitoring (ABPM) is superior to conventional BP measurement in predicting outcome, with baseline 24-h, daytime and night-time absolute values, as well as relative nocturnal decline, as powerful determinants of prognosis. We aimed to evaluate ABPM estimates on the appearance of cardiovascular events and mortality in a cohort of high-risk treated hypertensive patients. A total of 2115 treated hypertensive patients with high or very high added risk were evaluated by means of office and 24-h ABPM. Cardiovascular events and mortality were assessed after a median follow-up of 4 years. Two hundred and sixty-eight patients (12.7%) experienced a primary event (nonfatal coronary or cerebrovascular event, heart failure hospitalization or cardiovascular death) and 114 died (45 from cardiovascular causes). In a multiple Cox regression model, and after adjusting for baseline cardiovascular risk and office BP, night-time SBP predicted cardiovascular events [hazard ratio for each SD increase: 1.45; 95% confidence interval (CI) 1.29-1.59]. Values above 130 mmHg increased the risk by 52% in comparison to values less than 115 mmHg. In addition to clinical determinants of cardiovascular risk and conventional BP, ABPM performed during treatment adds prognostic significance on the development of cardiovascular events in high-risk hypertensive patients. Among different ABPM-derived values, night-time SBP is the most potent predictor of outcome.

  3. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R.; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E.; Fluent, Thomas

    2017-01-01

    Objectives To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Experimental Design Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Principal Observations Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). Conclusions This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery. PMID:28936009

  4. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist.

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E; Fluent, Thomas

    2017-09-15

    To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.

  5. An Anesthetist’s Experience and the Incidence of Critical Cases in Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    R. V. Bolshedvorov

    2009-01-01

    Full Text Available Objective: to evaluate the impact of experience on the quality of anesthesia in ambulatory surgery. Materials and methods. The authors undertook a study of the role of experience and specialization on the occurrence of complications in ambulatory anesthesia care. By using the internal audit and calculating the frequency of critical cases, they examined the results of the work of two groups of anesthetists: 1 medical beginners after 2-year adjunct practice and 2 one-day hospital specialists having an at least 7-year practice length. Results. In the beginner group, the number of critical cases per operation was twice higher than that in the experienced specialists. The paper shows the detrimental pattern of the residual principle in selecting anesthetists for work at a one-day hospital and provides evidence that specialization is required in the area under discussion. Key words: ambulatory anesthesiology, role of an anesthetist’s experience, critical cases.

  6. Physician Networks and Ambulatory Care-sensitive Admissions.

    Science.gov (United States)

    Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Nyweide, David J; Iwashyna, Theodore J; Sun, Xuming; Mendelsohn, Jayme; Moody, James

    2015-06-01

    Research on the quality and cost of care traditionally focuses on individual physicians or medical groups. Social network theory suggests that the care a patient receives also depends on the network of physicians with whom a patient's physician is connected. The objectives of the study are: (1) identify physician networks; (2) determine whether the rate of ambulatory care-sensitive hospital admissions (ACSAs) varies across networks--even different networks at the same hospital; and (3) determine the relationship between ACSA rates and network characteristics. We identified networks by applying network detection algorithms to Medicare 2008 claims for 987,000 beneficiaries in 5 states. We estimated a fixed-effects model to determine the relationship between networks and ACSAs and a multivariable model to determine the relationship between network characteristics and ACSAs. We identified 417 networks. Mean size: 129 physicians; range, 26-963. In the fixed-effects model, ACSA rates varied significantly across networks: there was a 46% difference in rates between networks at the 25th and 75th performance percentiles. At 95% of hospitals with admissions from 2 networks, the networks had significantly different ACSA rates; the mean difference was 36% of the mean ACSA rate. Networks with a higher percentage of primary-care physicians and networks in which patients received care from a larger number of physicians had higher ACSA rates. Physician networks have a relationship with ACSAs that is independent of the physicians in the network. Physician networks could be an important focus for understanding variations in medical care and for intervening to improve care.

  7. Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review.

    Science.gov (United States)

    Chan, Raymond J; Marx, Wolfgang; Bradford, Natalie; Gordon, Louisa; Bonner, Ann; Douglas, Clint; Schmalkuche, Diana; Yates, Patsy

    2018-02-21

    With the increasing burden of chronic and age-related diseases, and the rapidly increasing number of patients receiving ambulatory or outpatient-based care, nurse-led services have been suggested as one solution to manage increasing demand on the health system as they aim to reduce waiting times, resources, and costs while maintaining patient safety and enhancing satisfaction. The aims of this review were to assess the clinical effectiveness, economic outcomes and key implementation characteristics of nurse-led services in the ambulatory care setting. A systematic review was conducted using the standard Cochrane Collaboration methodology and was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and PsycINFO Ovid (from inception to April 2016). Data were extracted and appraisal undertaken. We included randomised controlled trials; quasi-randomised controlled trials; controlled and non-controlled before-and-after studies that compared the effects of nurse-led services in the ambulatory or community care setting with an alternative model of care or standard care. Twenty-five studies of 180,308 participants were included in this review. Of the 16 studies that measured and reported on health-related quality of life outcomes, the majority of studies (n = 13) reported equivocal outcomes; with three studies demonstrating superior outcomes and one demonstrating inferior outcomes in comparison with physician-led and standard care. Nurse-led care demonstrated either equivalent or better outcomes for a number of outcomes including symptom burden, self-management and behavioural outcomes, disease-specific indicators, satisfaction and perception of quality of life, and health service use. Benefits of nurse-led services remain inconclusive in terms of economic outcomes. Nurse

  8. Cervical spine surgery performed in ambulatory surgical centers: Are patients being put at increased risk?

    Science.gov (United States)

    Epstein, Nancy E

    2016-01-01

    Spine surgeons are being increasingly encouraged to perform cervical operations in outpatient ambulatory surgical centers (ASC). However, some studies/data coming out of these centers are provided by spine surgeons who are part or full owners/shareholders. In Florida, for example, there was a 50% increase in ASC (5349) established between 2000-2007; physicians had a stake (invested) in 83%, and outright owned 43% of ASC. Data regarding "excessive" surgery by ASC surgeon-owners from Idaho followed shortly thereafter. The risks/complications attributed to 3279 cervical spine operations performed in 6 ASC studies were reviewed. Several studies claimed 99% discharge rates the day of the surgery. They also claimed major complications were "picked up" within the average postoperative observation window (e.g., varying from 4-23 hours), allowing for appropriate treatment without further sequelae. Morbidity rates for outpatient cervical spine ASC studies (e.g. some with conflicts of interest) varied up to 0.8-6%, whereas morbidity rates for 3 inpatient cervical studies ranged up to 19.3%. For both groups, morbidity included postoperative dysphagia, epidural hematomas, neck swelling, vocal cord paralysis, and neurological deterioration. Although we have no clear documentation as to their safety, "excessive" and progressively complex cervical surgical procedures are increasingly being performed in ASC. Furthermore, we cannot rely upon ASC-based data. At least some demonstrate an inherent conflict of interest and do not veridically report major morbidity/mortality rates for outpatient procedures. For now, cervical spine surgery performed in ASC would appear to be putting patients at increased risk for the benefit of their surgeon-owners.

  9. Measuring hot flash phenomenonology using ambulatory prospective digital diaries

    Science.gov (United States)

    Fisher, William I.; Thurston, Rebecca C.

    2016-01-01

    Objective This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary. Methods This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of 3 consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred. Results Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the on the face (78.9%), neck (74.7%), and chest (61.3%). Prickly skin was reported concurrently with 32% of hot flashes, 7% with anxiety and 5% with nausea. A novel finding, 38% of hot flashes were accompanied by a premonitory aura. Conclusion A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly employed retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience. PMID:27404030

  10. Impact on hypertension reclassification by Ambulatory Blood Pressure Monitoring (ABPM) according to the V Brazilian Guidelines on ABPM.

    Science.gov (United States)

    Forestiero, Daniel; Mauad, Juliana Lustoza; Forestiero, Camila; Peixoto, Mario Lins; Ganassin, Fabio Peixoto; Gonzaga, Carolina; Cordeiro, Antonio Carlos; Rodrigues, Gabriel Doreto; Silveira, Tiago Bueno da; Amodeo, Celso

    2013-02-01

    New recommendations on reference values for normal test results in ambulatory blood pressure monitoring (ABPM) were proposed by the V Brazilian Guidelines on Ambulatory Blood Pressure Monitoring, based mainly on the IDACO study. This epidemiological study is aimed at evaluating the impact of adopting these new standards in an arterial hypertension referral center. The results of 1,567 ABPM tests carried out between 2005 and 2010 were analyzed; 481 patients were excluded from the sample for not meeting minimum quality criteria of the test. Reference values from the IV Brazilian Guidelines on ABPM (2005) were used for the classification of these tests regarding the abnormality and compared with the changes proposed by the V Brazilian Guidelines on ABPM (2011). Statistical analysis was performed by Pearson's chi-square method and p values ABPM results, especially for the variable systolic pressure in the sleeping period: 49% when adopting the cutoff values of 2005 and 71% when adopting the values of 2011, with statistical significance, p ABPM test results in the study population. The question of thresholds of these tests for therapeutic targets of patients known to be hypertensive is still open and requires further studies, preferably national ones, for better definition of the subject.

  11. PONV in Ambulatory surgery: A comparison between Ramosetron and Ondansetron: a prospective, double-blinded, and randomized controlled study

    Directory of Open Access Journals (Sweden)

    Debasis Banerjee

    2014-01-01

    Full Text Available Background: postoperative nausea and vomiting (PONV frequently hampers implementation of ambulatory surgery in spite of so many antiemetic drugs and regimens. Aims: the study was carried out to compare the efficacy of Ramosetron and Ondansetron in preventing PONV after ambulatory surgery. Setting and Design: it was a prospective, double blinded, and randomized controlled study. Methods: 124 adult patients of either sex, aged 25-55, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A [(n=62 receiving (IV Ondansetron (4 mg] and Group B [(n=62 receiving IV Ramosetron (0.3 mg] prior to the induction of general anesthesia in a double-blind manner. Episodes of PONV were noted at 0.5, 1, 2, 4 h, 6 , 12, and 18 h postoperatively. Statistical Analysis and Results: statistically significant difference between Groups A and B (P <0.05 was found showing that Ramosetron was superior to Ondansetron as antiemetic both regarding frequency and severity. Conclusion: it was evident that preoperative prophylactic administration of single dose IV Ramosetron (0.3 mg has better efficacy than single dose IV Ondansetron (4 mg in reducing the episodes of PONV over 18 h postoperatively in patients undergoing day-care surgery under general anesthesia.

  12. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  13. A rare case of watermelon stomach in woman with continuous ambulatory peritoneal dialysis and systemic lupus erythematosus.

    Science.gov (United States)

    Jinga, Mariana; Checheriţă, I A; Becheanu, G; Jinga, V; Peride, Ileana; Niculae, A

    2013-01-01

    We report a case of a 42-year-old woman with systemic lupus erythematosus and chronic kidney disease stage 5 undergoing continuous ambulatory peritoneal dialysis, presenting asthenia, dizziness, abdominal pain and small efforts dyspnea. After a complete physical and clinical examination, including laboratory tests, esophagogastroduodenal endoscopy and gastric lesions biopsy, she was diagnosed with gastric antral vascular ectasia. We are facing a rare case of antral vascular ectasia in a patient associating both chronic kidney disease and autoimmune disease.

  14. Amino-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein but not cystatin C predict cardiovascular events in male patients with peripheral artery disease independently of ambulatory pulse pressure.

    Science.gov (United States)

    Skoglund, Per H; Arpegård, Johannes; Ostergren, Jan; Svensson, Per

    2014-03-01

    Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular (CV) events. We have previously shown that ambulatory pulse pressure (APP) predicts CV events in PAD patients. The biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cystatin C are related to a worse outcome in patients with CV disease, but their predictive values have not been studied in relation to APP. Blood samples and 24-hour measurements of ambulatory blood pressure were examined in 98 men referred for PAD evaluation during 1998-2001. Patients were followed for a median of 71 months. The outcome variable was CV events defined as either CV mortality or any hospitalization for myocardial infarction, stroke, or coronary revascularization. The predictive values of log(NT-proBNP), log(hs-CRP), and log(cystatin C) alone and together with APP were assessed by multivariable Cox regression. Area under the curve (AUC) and net reclassification improvement (NRI) were calculated compared with a model containing other significant risk factors. During follow-up, 36 patients had at least 1 CV event. APP, log(NT-proBNP), and log(hs-CRP) all predicted CV events in univariable analysis, whereas log(cystatin C) did not. In multivariable analysis log(NT-proBNP) (hazard ratio (HR) = 1.62; 95% confidence interval (CI) = 1.05-2.51) and log(hs-CRP) (HR = 1.63; 95% CI = 1.19-2.24) predicted events independently of 24-hour PP. The combination of log(NT-proBNP), log(hs-CRP), and average day PP improved risk discrimination (AUC = 0.833 vs. 0.736; P < 0.05) and NRI (37%; P < 0.01) when added to other significant risk factors. NT-proBNP and hs-CRP predict CV events independently of APP and the combination of hs-CRP, NT-proBNP, and day PP improves risk discrimination in PAD patients.

  15. Reprodutibilidade da medida ambulatorial da pressão arterial em pacientes hipertensos com diabete melito tipo 2 Reproducibility of ambulatory blood pressure monitoring in hypertensive patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    João Soares Felício

    2007-02-01

    Full Text Available OBJETIVO: Avaliar a reprodutibilidade e o efeito placebo sobre a monitorização ambulatorial da pressão arterial (MAPA (SpaceLabs-90207. MÉTODOS: Mensurou-se a PA no consultório e por meio de duas MAPA, realizadas em um intervalo de 1 a 10 meses (média de 4,9 meses, de 26 pacientes com diabetes tipo 2 e hipertensão. Onze pacientes (G1 realizaram as duas MAPA sem medicação anti-hipertensiva por 15 dias, enquanto o G2 (N = 15 fez a segunda MAPA em uso de placebo pelo mesmo período. RESULTADOS: Ao avaliarmos os coeficientes de variação (CV da PA sistólica na vigília (PASV, PA diastólica na vigília (PADV, PA sistólica nas 24h (PAS24h e PA diastólica nas 24h (PAD24h, encontramos valores de 4,6%, 3,9%, 5,0% e 4,0% no G1 e 4,3%, 5,1%, 3,7% e 5,1% no G2, respectivamente. Quanto ao CV da PA sistólica e diastólica durante o sono (PASS e PADS, encontramos 7,7% e 8,2% para G1, e 5,6% e 6,3% para G2, respectivamente. O CV da freqüência cardíaca na vigília e durante o sono foram: G1 = 5,9% e 9,0%, G2 = 6,9% e 5,8%, respectivamente. Analisando o total dos pacientes, todas as variáveis mostraram fortes correlações entre a primeira e a segunda MAPA (PASV, r=0,76; POBJECTIVE: To evaluate the reproducibility of ambulatory blood pressure monitoring (ABPM (SpaceLabs-90207 and placebo effect on ABPM. METHODS: Blood pressure was measured in the office and over two ABPM periods with an interval from one to ten months (mean 4.9 months, in 26 patients with type 2 diabetes mellitus and hypertension. Eleven patients (G1 had two ABPMs without taking antihypertensive drugs for 15 days, whereas G2 (N=15 had the second ABPM after administration of a placebo for 15 days. RESULTS: In the evaluation of the coefficient of variation (CV of diurnal (awake systolic BP (DSBP, of diurnal (awake diastolic BP (DDBP, of 24-hour systolic BP (24hSBP and of 24-hour diastolic BP (24hDBP, the values found were 4.6%, 3.9%, 5.0%, 4.0% for G1 and 4.3%, 5.1%, 3.7%, 5

  16. [Evaluation of blood pressure changes by 24-hours ambulatory blood pressure monitoring (ABPM) in young, normotensive patients with diabetes mellitus type I].

    Science.gov (United States)

    Markuszewski, Leszek; Ruxer, Monika; Szadkowska, Agnieszka; Bodalska, Joanna; Bissinger, Andrzej

    2006-01-01

    The aim of this study was to evaluate usefulness of ambulatory blood pressure monitoring (ABPM) to examine circadian patterns of blood pressure (BP) alterations in young, normotensive patients with type I diabetes mellitus (DM1). We studied 43 patients with DM1 aged 18-28 years, with 9-23 years of DM1, without long-term complications. Control group consisted of 32 healthy persons, matched to the DM1 group. 24h ABPM was performed by a Spacelab 90207 device to obtain daytime (7 AM to 11 PM, readings at 20-min interval) and nighttime (11 PM to 7 AM, readings at 30-min interval) measurements in both groups. During the daytime systolic BP (sBP) and diastolic BP (dBP) were not significantly different from the control group. We noted nighttime sBP and dBP higher in DM1 group: sBE 119.7+/-12.6 mmHg vs. 103.817.1; p = 0.001 l dBP 65.5+/-6.2 vs. 61.5+/-3.1; p = 0.001. The loss of fall in BP ('non-dippers') was more prevalent in DM1 group: 49% vs. 9%; p = 0.003. Pulse pressure (PP) was significantly higher in DM1 patients: 50.9+/-6.9 mmHg vs. 44.8+/-5.6 mmHg; p = 0.0001. ABPM is a useful method in detecting early BP alterations in young normotensive patients with diabetes mellitus type 4 1. Increased PP and suppressed diurnal BP variations could represent a increased risk of cardiovascular complications in young patients with diabetes mellitus type 1.

  17. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

    Science.gov (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A

    2011-04-01

    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  18. [Pediatric anesthesia emergence delirium after elective ambulatory surgery: etiology, risk factors and prevalence].

    Science.gov (United States)

    Gololobov, Alik; Todris, Liat; Berman, Yakov; Rosenberg-Gilad, Zipi; Schlaeffer, Pnina; Kenett, Ron; Ben-Jacob, Ron; Segal, Eran

    2015-04-01

    Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. The aim of the current retrospective study was to determine the prevalence rate of ED in 3947 children recovering from general anesthesia after short elective ambulatory surgery, and to map the influence of various risk factors on this phenomenon. Data were collected using electronic medical records. ED severity was assessed using the Pediatric Anesthesia Emergence Delirium Scale. Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.

  19. Effectiveness of transmucosal sedation for special needs populations in the ambulatory care setting.

    Science.gov (United States)

    Tetef, Sue

    2014-12-01

    Transmucosal is an alternative route for administering medications (ie, dexmedetomidine, midazolam, naloxone) that can be effective for procedural or moderate sedation in patients with special needs when other routes are not practical or are contraindicated. Special needs populations include children, older adults, pregnant and breast-feeding women, and people with disabilities or conditions that limit their ability to function and cope. Understanding the perioperative nurse's role in the care of patients receiving medications via the transmucosal route can lead to better clinical outcomes. Successful use of the transmucosal route requires knowledge of when to administer a medication, how often and how much of a medication should be administered, the onset and duration of action, the adverse effects or contraindications, and the key benefits. In addition, a case study approach suggests that transmucosal sedation can decrease patient stress and anxiety related to undergoing medical procedures or surgery in the ambulatory care setting. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  20. The financial and health burden of diabetic ambulatory care sensitive hospitalisations in Mexico.

    Science.gov (United States)

    Lugo-Palacios, David G; Cairns, John

    2016-01-01

    To estimate the financial and health burden of diabetic ambulatory care sensitive hospitalisations (ACSH) in Mexico during 2001-2011. We identified ACSH due to diabetic complications in general hospitals run by local health ministries and estimated their financial cost using diagnostic related groups. The health burden estimation assumes that patients would not have experienced complications if they had received appropriate primary care and computes the associated Disability-Adjusted Life Years (DALYs). The financial cost of diabetic ACSH increased by 125% in real terms and their health burden in 2010 accounted for 4.2% of total DALYs associated with diabetes in Mexico. Avoiding preventable hospitalisations could free resources within the health system for other health purposes. In addition, patients with ACSH suffer preventable losses of health that should be considered when assessing the performance of any primary care intervention.

  1. Comparison of clinical features in patients with eosinophilic esophagitis living in an urban and rural environment.

    Science.gov (United States)

    Lee, Y-J; Redd, M; Bayman, L; Frederickson, N; Valestin, J; Schey, R

    2015-01-01

    Eosinophilic esophagitis (EoE) has been associated with exposure to aeroallergens. Living in different locations (urban vs. rural) could potentially expose individuals to different environmental factors. Currently, there is limited data on the matter, and all was based on small population studies that did not exclude proton pump inhibitor (PPI)-responsive esophageal eosinophilia in their cohort. The primary aim of this study was to determine the prevalence of EoE in an urban versus rural population and compare demographic and clinical characteristics in patients that had been treated with high-dose PPI prior to diagnosis. Esophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, globus sensation, and heartburn during a 10-year period. Only patients who had biopsies from the mid and distal esophagus with ≥20 eosinophils per high-power field while on high-dose PPI treatment during endoscopy were included. Urban population was defined as >1000 people/square mile, and rural population was defined as ≤1000 people/square mile (U.S. Census Bureau). Demographic data from each group was analyzed for age, sex, body mass index, duration of symptoms, and tobacco use. Chi-square analysis was used for frequencies with statistical significance defined as P ≤ 0.05. A total of 20 718 patients were identified and their records evaluated. From this cohort, 57 (0.28%) symptomatic patients (male/female: 39/18, mean age = 29.5 years) had biopsy-proven EoE (≥20 eosinophils/hpf) while on PPI treatment. Of those EoE patients, 29 (50.9%) reported living in rural area versus 28 (49.1%) living in the urban area. The most common medical history components included asthma (12.3%), and the most common presenting symptoms included dysphagia (50.9%), heartburn (26.3%), and nausea/vomiting (22.8%). The average duration of symptoms, body mass index, and smoking habits did not differ between the groups. Dysphagia was significantly

  2. Bidirectional peritoneal transport of albumin in continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Joffe, P; Henriksen, Jens Henrik Sahl

    1995-01-01

    The present study was undertaken in order to assess bidirectional peritoneal kinetics of albumin after simultaneous i.v. and i.p. injection of radioiodinated albumin tracers (125I-RISA and 131I-RISA) in eight clinically stable uraemic patients undergoing continuous ambulatory peritoneal dialysis...... (CAPD). The plasma volume, intravascular albumin mass (IVM), and overall extravasation rate of albumin were not significantly different from that found in healthy controls. Albumin flux from the plasma into the peritoneal cavity was 3.71 +/- 0.82 (SD) mumol/h, which was only 3% of the overall...... extravasation rate (137 +/- 52 mumol/h). Albumin flux from the peritoneal cavity into the plasma was substantially lower (0.22 +/- 0.07 mumol/h, P peritoneal accumulation of the albumin from plasma over 4 h was 14 +/- 3.2 mumol, which was significantly lower than the intraperitoneal albumin...

  3. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome

    DEFF Research Database (Denmark)

    Brader, Lea Johanne; Uusitupa, M; Dragsted, Lars Ove

    2014-01-01

    Background/objectives:Dietary pattern is central in the prevention of hypertension and blood pressure (BP)-related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have...... beneficial effects on ambulatory BP in subjects with metabolic syndrome (MetS).Subjects/methods:In total, 37 subjects were randomized to either a healthy Nordic diet or a control diet. A healthy Nordic diet embraced whole grains, rapeseed oil, berries, fruits, vegetables, fish, nuts and low-fat dairy...... weeks of intervention.Results:After 12 weeks, ambulatory diastolic BP (-4.4 mm Hg; P=0.001) and mean arterial pressure (-4.2 mm Hg; P=0.006) were lowered by the healthy Nordic diet compared with the control diet, whereas changes in ambulatory systolic BP did not differ significantly between diets (-3...

  4. Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

    Directory of Open Access Journals (Sweden)

    D. P. Ramaema

    2014-01-01

    Full Text Available Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD, with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion. Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD, which was confirmed on peritoneal scintigraphy. Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

  5. Assessment of pedometer-determined physical activity in Danish adults: the importance of non-ambulatory activities

    DEFF Research Database (Denmark)

    Rothausen, Berit Worm; Gille, Maj-Britt; Biltoft-Jensen, Anja Pia

    and Physical Activity 2007-08, wore a pedometer (Yamax SW-200 Tokyo, Japan) and recorded daily steps and non-ambulatory activities for seven consecutive days. Time spent on non-ambulatory activities was converted to step equivalents using 1) a simple conversion method (SCM) adding 200 step equivalents...... assessing pedometer-determined physical activity. Adding activity-specific step equivalents/min, or simply adding 200 step equivalents/min, provides very similar results. Furthermore, when accounting for cycling an adjustment for double-counting should be considered.......Purpose To estimate mean values of steps/day in a representative sample of Danish adults (15-75 years) using two different conversion methods for non-ambulatory (non-step) activities. Methods A simple random sample comprising 229 adults (52% men) from the Danish National Survey of Dietary Habits...

  6. Multidisciplinary team approach to improved chronic care management for diabetic patients in an urban safety net ambulatory care clinic.

    Science.gov (United States)

    Tapp, Hazel; Phillips, Shay E; Waxman, Dael; Alexander, Matthew; Brown, Rhett; Hall, Mary

    2012-01-01

    Since the care of patients with multiple chronic diseases such as diabetes and depression accounts for the majority of health care costs, effective team approaches to managing such complex care in primary care are needed, particularly since psychosocial and physical disorders coexist. Uncontrolled diabetes is a leading health risk for morbidity, disability and premature mortality with between 18-31% of patients also having undiagnosed or undertreated depression. Here we describe a team driven approach that initially focused on patients with poorly controlled diabetes (A1c > 9) that took place at a family medicare office. The team included: resident and faculty physicians, a pharmacist, social worker, nurses, behavioral medicine interns, office scheduler, and an information technologist. The team developed immediate integrative care for diabetic patients during routine office visits.

  7. Non-infectious complications of continuous ambulatory peritoneal dialysis: evaluation with peritoneal computed tomography

    International Nuclear Information System (INIS)

    Camsari, T.; Celik, A.; Ozaksoy, D.; Salman, S.; Cavdar, C.; Sifil, A.

    1998-01-01

    The purpose of the study was to evaluate the non-infectious complications of continuous ambulatory peritoneal dialysis (CAPD) using peritoneal computed tomography (PCT). Twenty symptomatic patients were included in the study. Initially 2000 ml of dialysate fluid was infused into the peritoneal cavity and standard peritoneal computed cavity and standard peritoneal computed tomography (SPCT) serial scans with 10 mm thickness were performed from the mid-thoracic region to the genital organs. Afterwards, 100 ml of non-ionic contrast material containing 300 mg/ml iodine was injected through the catheter and was distributed homogeneously in the intra-abdominal dialysate fluid by changing the positions of the patients; after waiting for 2-4 h, the CT scan was repeated as peritoneal contrast computed tomography (PCCT). In patients (n = 20) both SPCT and PCCT revealed 90 % (n = 18) pathological findings. But PCCT showed 60 % (n = 12) additional pathological findings. We believe that PCT is beneficial for evaluation of non-infectious complications of CAPD. But PCCT is superior to SPCT in evaluating non-infectious complications encountered in patients on CAPD treatment. (author)

  8. Evaluation of cardiac autonomic nerves by iodine-123 metaiodobenzylguanidine scintigraphy and ambulatory electrocardiography in patients after arterial switch operations

    Energy Technology Data Exchange (ETDEWEB)

    Sakurai, Hajime; Maeda, Masanobu; Miyahara, Ken [Shakaihoken Chukyo Hospital, Nagoya (Japan)] [and others

    2000-05-01

    The autonomic cardiac nerves reach the heart after passing through the vicinity of the aortic root and the pulmonary trunk. The arterial switch operation (ASO) completely transects the ascending aorta and the pulmonary trunk. Therefore, this surgical procedure virtually denerves the heart. Cardiac sympathetic denervation and reinnervation were evaluated in patients after ASO using iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and parasympathetic denervation and reinnervation using ambulatory electrocardiography [Holter electrocardiogram (ECG)]. MIBG scintigraphy was performed in 14 patients who underwent ASO (ASO group) and 3 patients who underwent other open heart surgery (control group). All patients in the ASO group underwent the operation in the neonatal or infantile period. Planar and single photon emission computed tomography (SPECT) images of the myocardium were obtained. Defect score was determined by the SPECT images as a semi-quantitative index. The mean interval between ASO and MIBG scintigraphy was 25.6{+-}14.6 months. Holter ECG was also performed in 14 patients in the ASO group and 19 age-matched normal children. The Holter ECGs were plotted on a Lorenz plot. The H index, which is related to vagal tone for the cardiovascular system, was calculated from the R-R intervals. The mean interval between the ASO and Holter ECG was 8.3{+-}9.7 months. MIBG scintigraphy in the control group demonstrated an almost normal homogeneous tracer uptake, but showed extremely reduced tracer uptake and significantly higher defect score in the ASO group. The extent and degree of the reduction of MIBG uptake improved with time after the ASO. The heart-to-mediastinum MIBG count ratio tended to increase with time. The H index of the ASO group was lower than that of normal children (<12 months: Control group 0.0280{+-}0.0068 vs ASO group 0.0219{+-}0.0083), and gradually increased with time (1-3 years: 0.0470{+-}0.0157 vs 0.0314{+-}0.0124). (author)

  9. Evaluation of cardiac autonomic nerves by iodine-123 metaiodobenzylguanidine scintigraphy and ambulatory electrocardiography in patients after arterial switch operations

    International Nuclear Information System (INIS)

    Sakurai, Hajime; Maeda, Masanobu; Miyahara, Ken

    2000-01-01

    The autonomic cardiac nerves reach the heart after passing through the vicinity of the aortic root and the pulmonary trunk. The arterial switch operation (ASO) completely transects the ascending aorta and the pulmonary trunk. Therefore, this surgical procedure virtually denerves the heart. Cardiac sympathetic denervation and reinnervation were evaluated in patients after ASO using iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy and parasympathetic denervation and reinnervation using ambulatory electrocardiography [Holter electrocardiogram (ECG)]. MIBG scintigraphy was performed in 14 patients who underwent ASO (ASO group) and 3 patients who underwent other open heart surgery (control group). All patients in the ASO group underwent the operation in the neonatal or infantile period. Planar and single photon emission computed tomography (SPECT) images of the myocardium were obtained. Defect score was determined by the SPECT images as a semi-quantitative index. The mean interval between ASO and MIBG scintigraphy was 25.6±14.6 months. Holter ECG was also performed in 14 patients in the ASO group and 19 age-matched normal children. The Holter ECGs were plotted on a Lorenz plot. The H index, which is related to vagal tone for the cardiovascular system, was calculated from the R-R intervals. The mean interval between the ASO and Holter ECG was 8.3±9.7 months. MIBG scintigraphy in the control group demonstrated an almost normal homogeneous tracer uptake, but showed extremely reduced tracer uptake and significantly higher defect score in the ASO group. The extent and degree of the reduction of MIBG uptake improved with time after the ASO. The heart-to-mediastinum MIBG count ratio tended to increase with time. The H index of the ASO group was lower than that of normal children (<12 months: Control group 0.0280±0.0068 vs ASO group 0.0219±0.0083), and gradually increased with time (1-3 years: 0.0470±0.0157 vs 0.0314±0.0124). (author)

  10. The demand for ambulatory mental health services from specialty providers.

    Science.gov (United States)

    Horgan, C M

    1986-01-01

    A two-part model is used to examine the demand for ambulatory mental health services in the specialty sector. In the first equation, the probability of having a mental health visit is estimated. In the second part of the model, variations in levels of use expressed in terms of visits and expenditures are examined in turn, with each of these equations conditional on positive utilization of mental health services. In the second part of the model, users are additionally grouped into those with and without out-of-pocket payment for services. This specification accounts for special characteristics regarding the utilization of ambulatory mental health services: (1) a large part of the population does not use these services; (2) of those who use services, the distribution of use is highly skewed; and (3) a large number of users have zero out-of-pocket expenditures. Cost-sharing does indeed matter in the demand for ambulatory mental health services from specialty providers; however, the decision to use mental health services is affected by the level of cost-sharing to a lesser degree than is the decision regarding the level of use of services. The results also show that price is only one of several important factors in determining the demand for services. The lack of significance of family income and of being female is notable. Evidence is presented for the existence of bandwagon effects. The importance of Medicaid in the probability of use equations is noted. PMID:3721874

  11. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents.

    Science.gov (United States)

    Melgarejo, Jesus D; Maestre, Gladys E; Thijs, Lutgarde; Asayama, Kei; Boggia, José; Casiglia, Edoardo; Hansen, Tine W; Imai, Yutaka; Jacobs, Lotte; Jeppesen, Jørgen; Kawecka-Jaszcz, Kalina; Kuznetsova, Tatiana; Li, Yan; Malyutina, Sofia; Nikitin, Yuri; Ohkubo, Takayoshi; Stolarz-Skrzypek, Katarzyna; Wang, Ji-Guang; Staessen, Jan A

    2017-07-01

    Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues. © 2017 American Heart Association, Inc.

  12. "My Favourite Day Is Sunday": Community Perceptions of (Drug-Resistant Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan.

    Directory of Open Access Journals (Sweden)

    Doris Burtscher

    Full Text Available Kyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF started a drug-resistant tuberculosis (DR-TB project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care.This paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a 'thick' description of the research context, and by presenting deviant cases.Findings show that the general population interprets TB as the 'lungs having a cold' or as a 'family disease' rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude.Health promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will

  13. Hunger and Food Insecurity Among Patients in an Urban Emergency Departmnent

    Directory of Open Access Journals (Sweden)

    Roma Patel

    2013-05-01

    Full Text Available Introduction: To determine the prevalence of hunger and food insecurity among patients presenting to the emergency department (ED over 3 consecutive years.Methods: This was a cross-sectional study of patients presenting to the ED at Hennepin County Medical Center, and urban, Level I trauma center. We prospectively screened adult (age >18 patients presenting to the ED during randomized daily 8-hour periods between June 1 and August 31, 2007 and 2008, and randomized every-other-day periods between June 1 and August 31, 2009. We excluded patients with high acuity complaints, altered mental status, prisoners, those who did not speak Spanish or English, or those considered to be vulnerable. Consenting participants completed a brief demographic survey. The main outcome measures included age, gender, ethnicity, employment, housing status, insurance, access to food, and having to make choices between buying food and buying medicine. All responses were self reported.Results: 26,211 patients presented during the study; 15,732 (60% were eligible, 8,044 (51% were enrolled, and 7,852 (98% were included in the analysis. The rate of patients reporting hunger significantly increased over the 3-year period [20.3% in 2007, 27.8% in 2008, and 38.3% in 2009 (P < 0.001]. The rate of patients reporting ever having to choose between food and medicine also increased [20.0% in 2007, 18.5% in 2008, and 22.6% in 2009 (P = 0.006].Conclusion: A significant proportion of our ED patients experience food insecurity and hunger. Hunger and food insecurity have become more prevalent among patients seen in this urban county ED over the past 3 years. Emergency physicians should be aware of the increasing number of patients who must choose between obtaining food and their prescribed medications, and should consider the contribution of hunger and food insecurity to the development of health conditions for which ED treatment is sought. [West J Emerg Med. 2013;14(3:253–262.

  14. Ambulatory blood pressure monitoring in elderly patients with chronic atrial fibrillation: is it absolutely contraindicated or a useful tool in clinical practice and research?

    Science.gov (United States)

    Giantin, Valter; Perissinotto, Egle; Franchin, Alessandro; Baccaglini, Kareen; Attanasio, Francesca; Maselli, Monica; Grosso, Giorgia; Luisa Corradin, Maria; Tramontano, Alessandra; Manzato, Enzo

    2013-10-01

    The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in elderly patients with atrial fibrillation (AF) is as feasible and reliable as ABPM is in patients with normal sinus rhythm (SR). Studies of ABPM in the elderly remain limited, and the use of this method in patients with AF remains controversial. The Italian SIIA 2008 guidelines consider ABPM 'absolutely contraindicated' for AF patients. This study was conducted on 200 hospitalized patients aged ≥ 65 years (68% females; mean age 82.4 ± 6.3 years): 100 patients with SR and 100 patients with permanent AF. Each patient completed serial blood pressure (BP) measurements with a clinical sphygmomanometer (Sphyg) and ABPM. Differences in mean heart rate (HR) between patient groups were not statistically significant. A total of 99.5% of patients were hypertensive. There were no significant differences between SR and AF patients in mean systolic BP (SBP) and diastolic BP (DBP) values, as measured with the Sphyg or by ABPM. Compared with the Sphyg, errors associated with BP measurements obtained by ABPM did not significantly differ between the two groups. ABPM proved to be as feasible as Sphyg measurements in both AF patients (intraclass correlation coefficients=0.73, 0.67 and 0.74 for SBP, DBP and HR, respectively) and SR patients (intraclass correlation coefficients=0.74, 0.58 and 0.67 for SBP, DBP and HR, respectively). A Bland-Altman plot analysis confirmed that there was good agreement between the two methods. Stable AF (HR 60-100 b.p.m.) should not be considered as an absolute contraindication for the use of ABPM, even in the elderly; it could be a 'relative' contraindication for very unstable AF patients.

  15. Health professionals' beliefs related to parental involvement in ambulatory care: an international inquiry.

    Science.gov (United States)

    Tourigny, Jocelyne; Chartrand, Julie; Massicotte, Julie

    2008-01-01

    Changes in health care delivery in Canada and Europe, especially the shift to ambulatory care, have modified the care that children and parents receive and have prompted the need for a partnership alliance. The objectives of this exploratory study were to identify Canadian and Belgian health professionals' beliefs and attitudes towards parental involvement in their child's ambulatory care and to determine if these beliefs varied according to cultural background. Health professionals from both countries generally were in favor of parental involvement in their child's care, but are uncertain about its advantages and disadvantages. Facilitators and barriers mentioned by the health care providers were related to parents' abilities or their attitudes toward partnership, and they also expressed a need for more education on the subject. Results of this study indicate that health professionals working in ambulatory care are not fully ready to utilize parents as true partners in their interventions with children and families. Staff education is an important step towards the establishment and maintenance of a real partnership.

  16. Challenges to Safe Injection Practices in Ambulatory Care.

    Science.gov (United States)

    Anderson, Laura; Weissburg, Benjamin; Rogers, Kelli; Musuuza, Jackson; Safdar, Nasia; Shirley, Daniel

    2017-05-01

    Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices. Infect Control Hosp Epidemiol 2017;38:614-616.

  17. KNOWLEDGE AND MISCONCEPTIONS OF PULMONARY TUBERCULOSIS PATIENTS AT DOTS CENTRE, URBAN MEERUT.

    Directory of Open Access Journals (Sweden)

    R Bansal

    2013-06-01

    Full Text Available Background: India is the second most populated country in the world; it has more new TB cases annually than any other country. In 2008, 1.98 million were estimated to have occurred in India, of whom 0.87 million were infectious cases, thus amounting to a fifth of the global burden of TB.With the entire country geographically covered under the DOTS program, research into socioeconomic impact of TB on patients and their households is crucial for providing comprehensive patient-friendly TB services and to document the benefits of DOTS. Objective: The present study was undertaken with the following objectives: (1 To determine the socio-demographic variables of registered patients for DOTS Treatment at Urban Health Training center Meerut. (2 To assess knowledge, awareness and attitude regarding Pulmonary Tuberculosis and its treatment among the patients. Materials and Methods: A cross-sectional study of 200 TB patients was done using a pre-tested semi-quantitative questionnaire in UHTC Meerut Period of Study: During 2010-2012. Results: Knowledge and awareness regarding Pulmonary Tuberculosis in patients at DOTS centre, Urban Meerut was very poor. There is a great need to educate the people about misconceptions like food and utensils as mode of transmission. BCC using the person to person contact in community , at health center and awareness campaigns are crucial in educating the ignorance seen in our field practice area. Conclusion: Poor knowledge and misconceptions concerning tuberculosis was quite concern in the patients. TB control program will remain ineffective unless myths and fears of TB patients are addressed related to causation of tuberculosis, mode of spread, and methods of prevention.

  18. KNOWLEDGE AND MISCONCEPTIONS OF PULMONARY TUBERCULOSIS PATIENTS AT DOTS CENTRE, URBAN MEERUT.

    Directory of Open Access Journals (Sweden)

    R Bansal

    2013-08-01

    Full Text Available Background: India is the second most populated country in the world; it has more new TB cases annually than any other country. In 2008, 1.98 million were estimated to have occurred in India, of whom 0.87 million were infectious cases, thus amounting to a fifth of the global burden of TB.With the entire country geographically covered under the DOTS program, research into socioeconomic impact of TB on patients and their households is crucial for providing comprehensive patient-friendly TB services and to document the benefits of DOTS. Objective: The present study was undertaken with the following objectives: (1 To determine the socio-demographic variables of registered patients for DOTS Treatment at Urban Health Training center Meerut. (2 To assess knowledge, awareness and attitude regarding Pulmonary Tuberculosis and its treatment among the patients. Materials and Methods: A cross-sectional study of 200 TB patients was done using a pre-tested semi-quantitative questionnaire in UHTC Meerut Period of Study: During 2010-2012. Results: Knowledge and awareness regarding Pulmonary Tuberculosis in patients at DOTS centre, Urban Meerut was very poor. There is a great need to educate the people about misconceptions like food and utensils as mode of transmission. BCC using the person to person contact in community , at health center and awareness campaigns are crucial in educating the ignorance seen in our field practice area. Conclusion: Poor knowledge and misconceptions concerning tuberculosis was quite concern in the patients. TB control program will remain ineffective unless myths and fears of TB patients are addressed related to causation of tuberculosis, mode of spread, and methods of prevention.

  19. PROFESSIONAL FLASH CONTINUOUS GLUCOSE MONITORING WITH AMBULATORY GLUCOSE PROFILE REPORTING TO SUPPLEMENT A1C: RATIONALE AND PRACTICAL IMPLEMENTATION.

    Science.gov (United States)

    Hirsch, Irl B; Verderese, Carol A

    2017-11-01

    Recent consensus statements strongly advocate downloading and interpreting continuous glucose data for diabetes management in patients with type 1 or 2 diabetes. Supplementing periodic glycated hemoglobin (A1C) testing with intermittent continuous glucose monitoring (CGM) using a standardized report form known as the ambulatory glucose profile (AGP) is an evolving standard of care. The rationale for this approach and its implementation with a recently approved novel monitoring technology are explored. Search of the medical literature, professional guidelines, and real-world evidence guided this introduction of an integrative practice framework that uses AGP in conjunction with intermittent flash continuous glucose monitoring (FCGM) as a supplement to A1C testing. The combination of intermittent continuous glucose pattern analysis, standardized glucose metrics, and a readily interpretable data report has the potential to practically extend the recognized benefits of CGM to more patients and clarify the relationship between A1C and average glucose levels in individual cases. Novel FCGM technologies portend greater use of continuous forms of glucose monitoring and wider adoption of AGP report analysis. Additional formal and empirical evidence is needed to more fully characterize best practice. A1C = glycated hemoglobin; AGP = ambulatory glucose profile; CGM = continuous glucose monitoring; FCGM = flash continuous glucose monitoring; IQR = interquartile range; SMBG = self-monitoring of blood glucose.

  20. Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Siyar Erdogmus

    2018-05-01

    Full Text Available Background/Aims: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP phenotypes at a tertiary care hospital in Turkey. Methods: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1 sustained normotensive (SNT patients (both office BP and ABPM were normal, (2 sustained hypertensive (SHT patients (both office BP and ABPM were high, (3 masked hypertensive (MHT patients (office BP were normal, but ABPM were high, (4 white coat hypertensive (WCHT patients (office BP were above limits, but ABPM were normal. Results: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years. The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001. Hypertension was more frequent in females (p=0.009. The rates of history of diabetes mellitus (DM, hyperlipidemia (HL, and chronic kidney disease (CKD were higher in patients with hypertension (p< 0.0001. Among patients with hypertension (n=853, 81%, ABPM results showed that 388 (45% of patients had SHT, 92 (11% had MHT, and 144 (17% had WCHT, whereas 229 (27% had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025. The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in