WorldWideScience

Sample records for anthroposophic outpatient settings

  1. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2009-06-01

    Full Text Available Abstract Background Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient settings. Methods In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0–10. Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months. Results A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0–16.9 years. Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders, respiratory disorders (14.0%, and neurological disorders (5.7%. Median disease duration at baseline was 3.0 years (interquartile range 1.0–5.0 years. The anthroposophic treatment modalities used were medications (69.2% of patients, eurythmy therapy (54.7%, art therapy (11.3%, and rhythmical massage therapy (6.7%. Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10–20, median therapy duration was 118 days (interquartile range 78–189 days. From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76–3.24 points, p Conclusion Children under anthroposophic treatment had long-term improvement of chronic disease symptoms. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study

  2. Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings

    Directory of Open Access Journals (Sweden)

    Harald J Hamre

    2009-11-01

    Full Text Available Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christof Schnürer3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene11Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Internal Medicine Practice, A Fraenkel Centrum, Badenweiler, Germany; 4Society for Cancer Research, Arlesheim, SwitzerlandBackground: Anthroposophic treatment for asthma includes special artistic and physical therapies and special medications.Methods: We studied consecutive outpatients starting anthroposophic treatment for asthma under routine conditions in Germany. Main outcomes were average asthma severity (0–10, primary outcome; symptoms (1–4; and asthma-related quality of life at 12-month follow-up (Asthma Quality of Life Questionnaire [AQLQ] overall score, 1–7, for adults; KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents, asthma module, 0–100, for children at 12-month follow-up.Results: Ninety patients (54 adults, 36 children were included. Anthroposophic treatment modalities used were medications (88% of patients, n = 79/90; eurythmy therapy (22%; art therapy (10%; and rhythmical massage therapy (1%. Median number of eurythmy/art/massage sessions was 12 (interquartile range 10–20, median therapy duration was 120 days (84–184. From baseline to 12-month follow-up, all outcomes improved significantly (P < 0.001 for all comparisons. Average improvements were: average asthma severity 2.61 points (95% confidence interval CI: 1.90–3.32; cough 0.93 (95% CI: 0.60–1.25; dyspnea 0.92 (95% CI: 0.56–1.28; exertion-induced symptoms 0.95 (95% CI: 0.64–1.25; frequency of asthma attacks 0.78 (95% CI:0.41–1.14; awakening from asthma 0.90 (95% CI: 0.58–1.21; AQLQ overall score 1.44 (95% CI:0.97–1.92; and KINDL asthma module 14.74 (95% CI: 9.70–19

  3. Anthroposophic therapy for attention deficit hyperactivity: A two-year prospective study in outpatients

    Directory of Open Access Journals (Sweden)

    Harald J Hamre

    2010-08-01

    Full Text Available Harald J Hamre1, Claudia M Witt2, Gunver S Kienle1, Christoph Meinecke3, Anja Glockmann1, Renatus Ziegler4, Stefan N Willich2, Helmut Kiene11Institute for Applied Epistemology and Medical Methodology, Freiburg, Germany; 2Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany; 3Pediatric Consultant, Community Hospital Havelhöhe, Berlin, Germany; 4Society for Cancer Research, Arlesheim, SwitzerlandBackground: Anthroposophic treatment for attention deficit hyperactivity disorder (ADHD includes special artistic and physical therapies and special medications.Methods: We studied 61 consecutive children starting anthroposophic treatment for ADHD symptoms under routine outpatient conditions. Primary outcome was FBB-HKS (a parents’ questionnaire for ADHD core symptoms, 0–3, and secondary outcomes were disease and symptom scores (physicians’ and parents’ assessment, 0–10 and quality of life (KINDL® total score, 0–100.Results: A total of 67% of patients fulfilled the DSM-IV criteria for ADHD, 15% had an exclusion diagnosis such as pervasive developmental disorders, while 18% did not fulfill ADHD criteria for another reason. Anthroposophic treatment modalities used were eurythmy therapy (in 56% of patients, art therapy (20%, rhythmical massage therapy (8%, and medications (51%. From baseline to six-month follow-up, all outcomes improved significantly; average improvements were FBB-HKS total score 0.30 points (95% confidence interval [CI]: 0.18–0.43; P < 0.001, FBB-HKS inattention 0.36 (95% CI: 0.21–0.50; P < 0.001, FBB-HKS hyperactivity 0.29 (95% CI: 0.14–0.44; P < 0.001, FBB-HKS impulsivity 0.22 (95% CI: 0.03–0.40; P < 0.001, disease score 2.33 (95% CI: 1.84–2.82; P < 0.001, symptom score 1.66 (95% CI: 1.17–2.16; P < 0.001, and KINDL 5.37 (95% CI: 2.27–8.47; P = 0.001. Improvements were similar in patients not using stimulants (90% of patients at months 0–6 and

  4. Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2010-08-01

    Full Text Available Abstract Background Anthroposophic medicine is a physician-provided complementary therapy system involving counselling, artistic and physical therapies, and special medications. The purpose of this analysis was to identify predictors of symptom improvement in patients receiving anthroposophic treatment for chronic diseases. Methods 913 adult outpatients from Germany participated in a prospective cohort study. Patients were starting anthroposophic treatment for mental (30.4% of patients, n = 278/913, musculoskeletal (20.2%, neurological (7.6%, genitourinary (7.4% or respiratory disorders (7.2% or other chronic indications. Stepwise multiple linear regression analysis was performed with the improvement of Symptom Score (patients' assessment, 0: not present, 10: worst possible after 6 and 12 months as dependent variables. 61 independent variables pertaining to socio-demographics, life style, disease status, co-morbidity, health status (SF-36, depression, and therapy factors were analysed. Results Compared to baseline, Symptom Score improved by average 2.53 points (95% confidence interval 2.39-2.68, p Conclusion In adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms, health status, disease duration, education, and therapy goal. Other variables were not associated with the outcome. This secondary predictor analysis of data from a pre-post study does not allow for causal conclusions; the results are hypothesis generating and need verification in subsequent studies.

  5. Assaults against psychiatrists in outpatient settings.

    Science.gov (United States)

    Dubin, W R; Wilson, S J; Mercer, C

    1988-09-01

    Questionnaires were sent to 3800 psychiatrists in Pennsylvania, New Jersey, and Delaware to investigate assaults against psychiatrists in outpatient settings. Ninety-one questionnaires were returned: 32 psychiatrists reported serious assaults (gun or knife), and 59 reported less serious assaults (object or physical attack). Significantly more personal injury and property damage resulted from the less serious assaults. Coping strategy was significantly related to the type of assault; positive verbal intervention was the most effective. Thirty-one (36%) of 87 respondents stated that they had moderate to strong feelings before the attack that the patient was potentially violent. Experienced psychiatrists were as likely to be victims of assault as were inexperienced psychiatrists. Forty-eight (59%) of 81 psychiatrists continued to treat the patients who had assaulted them. Only 20 (23%) of 87 psychiatrists had security arrangements at the time of the assault. The authors present four case vignettes which typify the different types of assaults, interventions, and outcomes.

  6. Management of hypertension in the outpatient setting.

    Science.gov (United States)

    Sica, Domenic A

    2008-09-01

    The treatment of hypertension on an outpatient basis should be approached in a systematic manner. The diagnosis of hypertension should always be verified first before treatment is initiated and, where indicated, a workup should be done. Lifestyle modifications should be considered in all patients with hypertension. Blood pressure can be brought to goal in the majority of patients if antihypertensive medications are correctly dosed or combined. As blood pressure is brought to goal in the patient with hypertension, ongoing attention should be directed to long-term adherence to therapy.

  7. Move to outpatient settings may boost medical hotels.

    Science.gov (United States)

    Burns, J

    1992-06-08

    The shift of surgeries to outpatient settings could be healthy for medical hotels, those amenity-equipped facilities originally developed to ease patients out of costly acute-care beds. Because fewer hospitals have a pressing need to use such alternative lodging, some medical hotels are hoping to hitch their fortunes to the outpatient trade, keeping patients overnight after surgeries that don't require hospital admission.

  8. Effectiveness of Child Psychoanalytic Psychotherapy in a Clinical Outpatient Setting

    Science.gov (United States)

    Deakin, Elisabeth Kuhn; Tiellet Nunes, Maria Lucia

    2009-01-01

    The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6-11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All…

  9. Anthroposophic therapy for chronic depression: a four-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2006-12-01

    Full Text Available Abstract Background Depressive disorders are common, cause considerable disability, and do not always respond to standard therapy (psychotherapy, antidepressants. Anthroposophic treatment for depression differs from ordinary treatment in the use of artistic and physical therapies and special medication. We studied clinical outcomes of anthroposophic therapy for depression. Methods 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage or started physician-provided anthroposophic therapy (counselling, medication for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points of at least 24 points. Outcomes were CES-D (primary outcome and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005. Results Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22, median therapy duration was 137 (91–212 days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation 34.77 (8.21 to 19.55 (13.12 (p Conclusion In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies.

  10. Student pharmacist initiated medication reconciliation in the outpatient setting

    Directory of Open Access Journals (Sweden)

    Andrus MR

    2012-06-01

    Full Text Available The Joint Commission continues to emphasize the importance of medication reconciliation in all practice settings. Pharmacists and student pharmacists are uniquely trained in this aspect of patient care, and can assist with keeping accurate and complete medication records through patient interview in the outpatient setting.Objective: The objective of this study was to quantify and describe medication reconciliation efforts by student pharmacists in an outpatient family medicine center.Methods: A retrospective review was conducted of all standard medication reconciliation forms completed by student pharmacists during patient interviews from April 2010 to July 2010. The number of reviews conducted was recorded, along with the frequency of each type of discrepancy. A discrepancy was defined as any lack of agreement between the medication list in the electronic health record (EHR and the patient-reported regimen and included any differences in dose or frequency of a medication, duplication of the same medication, medication no longer taken or omission of any medication.Results: A total of 213 standard medication forms from the 4 month period were reviewed. A total of 555 discrepancies were found, including medications no longer taken, prescription medications that needed to be added to the EHR, over-the-counter(OTC and herbal medications that needed to be added to the EHR, medications taken differently than recorded in the EHR, and medication allergies which needed to be updated. An average of 2.6 discrepancies was found per patient interviewed.Conclusion: Student pharmacist-initiated medication reconciliation in an outpatient family medicine center resulted in the resolution of numerous discrepancies in the medication lists of individual patients. Pharmacists and student pharmacists are uniquely trained in medication history taking and play a vital role in medication reconciliation in the outpatient setting.

  11. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

    Science.gov (United States)

    Hamre, Harald Johan; Kiene, Helmut; Ziegler, Renatus; Tröger, Wilfried; Meinecke, Christoph; Schnürer, Christof; Vögler, Hendrik; Glockmann, Anja; Kienle, Gunver Sophia

    2014-01-01

    Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS INCORPORATED TWO FEATURES PROPOSED FOR THE EVALUATION OF INTEGRATIVE THERAPY SYSTEMS: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were

  12. Patients' experiences of NPWT in an outpatient setting in Denmark

    DEFF Research Database (Denmark)

    Ottosen, B; Pedersen, B D

    2013-01-01

    OBJECTIVE: To study patients' experiences of negative pressure wound therapy (NPWT) used for wounds of various aetiologies in the outpatient setting and the influences on daily life. METHOD: In this qualitative study, a phenomenological-hermeneutic approach was used. Ten patients underwent...... delivery of a baby and wound treatment following caesarean section. Some patients were embarrassed due to the appearance and smell of the exudate. CONCLUSION: Use of NPWT clearly influences patients' daily life. Patients have a feeling of being dependent on and attached to the equipment...

  13. Successful administration of quinupristin/dalfopristin in the outpatient setting.

    Science.gov (United States)

    Rehm, S J; Graham, D R; Srinath, L; Prokocimer, P; Richard, M P; Talbot, G H

    2001-05-01

    Intravenous administration of quinupristin/dalfopristin outside the hospital setting has not been reported previously. We describe 37 outpatients receiving quinupristin/dalfopristin iv for infections including osteomyelitis, bacteraemia, abscesses and cellulitis. The most frequent aetiological pathogens found were Enterococcus faecium, Staphylococcus aureus and coagulase-negative staphylococci. Patients received an average of 9 days therapy as inpatients and 22 days as outpatients. Quinupristin/dalfopristin was administered using various access devices, most commonly peripherally inserted central catheters and tunnelled central catheters. The bacteriological and clinical success rates were both 89.2%. Five patients were readmitted to hospital; one patient developed catheter-related bacteraemia. The most frequently reported non-venous adverse events were nausea (18.9% of patients), myalgia (18.9%) and arthralgia (13.5%). Sixteen patients experienced venous access-related events, most commonly infusion pain, oedema and phlebitis. In this group of patients, for those who had difficult-to-treat infections, intravenous quinupristin/dalfopristin therapy was generally effective and safe outside the hospital setting.

  14. Sleep hygiene use in a psychiatry outpatient setting.

    LENUS (Irish Health Repository)

    Lyne, J

    2012-02-01

    Non-pharmacological measures are recommended prior to use of hypnotics in the latest NICE guidance. This study investigated if non-pharmacological measures are utilised prior to hypnotic prescribing in a general adult psychiatry outpatient setting, and further reviewed patient\\'s sleep quality following implementation of sleep hygiene education. Interviews were conducted with 85 patients, and poor adherence with NICE guidance was found among the 74 (87%) patients previously prescribed a hypnotic. Just five (6.8%) patients recalled use of non-pharmacological measures prior to hypnotic prescription, 47 (63.5%) indicated non-pharmacological measures had not been discussed, while a further 22 (29.7%) could not remember. Improvement in Pittsburgh Sleep Quality Index scores following implementation of sleep hygiene education was also noted (P = 0.03). These findings suggest that increased awareness of sleep hygiene education for clinicians may be beneficial.

  15. Use and Safety of Anthroposophic Medications for Acute Respiratory and Ear Infections: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Harald J. Hamre

    2007-01-01

    Full Text Available Objective: Anthroposophic medications (AMED are widely used, but safety data on AMED from large prospective studies are sparse. The objective of this analysis was to determine the frequency of adverse drug reactions (ADR to AMED in outpatients using AMED for acute respiratory and ear infections.Methods: A prospective four-week observational cohort study was conducted in 21 primary care practices in Europe and the U.S.A. The cohort comprised 715 consecutive outpatients aged 1 month, treated by anthroposophic physicians for acute otitis and respiratory infections. Physicians’ prescription data and patient reports of adverse events were analyzed. Main outcome measures were use of AMED and ADR to AMED.Results: Two patients had confirmed ADR to AMED: 1 swelling and redness at the injection site after subcutaneous injections of Prunus spinosa 5%, 2 sleeplessness after intake of Pneumodoron® 2 liquid. These ADR lasted one and two days respectively; both subsided after dose reduction; none were unexpected; none were serious. The frequency of confirmed ADR to AMED was 0.61% (2/327 of all different AMED used, 0.28% (2/715 of patients, and 0.004% (3/73,443 of applications.Conclusion: In this prospective study, anthroposophic medications used by primary care patients with acute respiratory or ear infections were well tolerated.Abbreviations: A-: anthroposophy; ADR: adverse drug reactions; AE: adverse events; AM: anthroposophic medicine; AMED: AM medication; C-: conventional; ENE-patients: eligible, not enrolled patients; IIPCOS: International Primary Care Outcomes Study

  16. Surveillance of fetal arrhythmias in the outpatient setting: current limitations and call for action.

    Science.gov (United States)

    Freire, Grace

    2015-12-01

    Surveillance of fetal arrhythmias in the outpatient setting remains limited by lack of monitoring modalities. Despite technological advances made in the field of obstetrics, existing devices are not currently suitable to monitor fetal arrhythmias. In this report, the author describes the current and developing fetal heart rate monitoring technologies including the recent introduction of hand-held Doppler monitors for outpatient surveillance of fetal arrhythmias.

  17. Clustering of cardiovascular risk factors and hypertension control status among hypertensive patients in the outpatient setting

    Institute of Scientific and Technical Information of China (English)

    刘军

    2014-01-01

    Objective To investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China.Methods This multi-center cross-sectional study was carried out from June to December 2009.Study patients were consecutively recruited from 46

  18. Vitamin D deficiency in Crohn's disease: prevalence, risk factors and supplement use in an outpatient setting.

    LENUS (Irish Health Repository)

    Suibhne, Treasa Nic

    2012-03-01

    Vitamin D deficiency impacts on bone health and has potential new roles in inflammation. We aimed to determine the prevalence of and risk factors for vitamin D deficiency and to explore vitamin D supplement usage in patients with Crohn\\'s disease (CD) in an outpatient setting, compared with controls.

  19. The use of the mini C-arm in the outpatient setting: evolving practice.

    Science.gov (United States)

    Swindells, M G; O'Brien, C M; Armstrong, D J; Arundell, M K; Quinton, D N; Burke, F D

    2011-05-01

    The mini C-arm image intensifier (mini C-arm) has now become an established diagnostic tool in the hand surgery outpatient department. This study reviews the use of the mini C-arm and formal radiographs (X-rays) in the outpatient hand surgery setting. X-rays provide a standard image whereas the mini C-arm can obtain non-standard images to aid diagnosis and treatment. The mini C-arm enables the clinician to obtain dynamic images and perform interventions such as manipulations or injections. The mini C-arm results in a significantly lower radiation exposure for the patients than a formal X-ray. Use of the mini C-arm may be cheaper, and can lead to a shorter outpatient visit with less travel between hospital departments.

  20. Alcohol Withdrawal Syndrome: Symptom-Triggered versus Fixed-Schedule Treatment in an Outpatient Setting

    DEFF Research Database (Denmark)

    Elholm, B.; Larsen, Klaus; Hornnes, N.;

    2011-01-01

    , time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index......Aims: To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. Methods: A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence...... (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms...

  1. Vaccination coverage for measles, mumps and rubella in anthroposophical schools in Gelderland, The Netherlands

    NARCIS (Netherlands)

    Klomp, J.H.; Lier, A. van; Ruijs, W.L.M.

    2015-01-01

    BACKGROUND: Social clustering of unvaccinated children in anthroposophical schools occurs, as inferred from various measles outbreaks that can be traced to these schools. However, accurate vaccination coverage data of anthroposophical schools are not widely available. METHODS: In 2012, we performed

  2. Effects of Antecedent Variables on Disruptive Behavior and Accurate Responding in Young Children in Outpatient Settings

    OpenAIRE

    Boelter, Eric W; Wacker, David P.; Call, Nathan A; Ringdahl, Joel E; Kopelman, Todd; Gardner, Andrew W.

    2007-01-01

    The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to evaluate their influence on disruptive behavior. With a 3rd child, similar procedures were employed at school. Results showed one-step directives set ...

  3. Prasugrel Use in Real Life: A Report From the Outpatient Setting in France.

    Science.gov (United States)

    Sabouret, Pierre; Taiel-Sartral, Magali; Chartier, Florence; Akiki, Sabine; Cuisset, Thomas

    2016-07-01

    The objective of this study was to provide descriptive statistics on patterns of prasugrel usage in the outpatient setting in France. This retrospective study was conducted to describe treatment patterns for prasugrel in the outpatient setting in France using the Intercontinental Marketing Services (IMS) Disease Analyzer database, which collates electronic medical records updated by a nationally representative database of 1200 French general practitioners (GPs). Anonymous data were collected prospectively at each follow-up visit. The study population consisted of patients with ≥1 prescription for prasugrel in the outpatient setting from its launch date to 3 years post-launch. Patients were followed up from the date of the first prescription for prasugrel recorded in the database until they died, changed GP, or reached the end of the study, whichever came first. In France, the IMS Disease Analyzer included 1052 patients receiving ≥1 prescription of prasugrel from January 2010 until October 2012. Eighty-five percent of the population was male. The mean age was 58 years; 94.3% were age Product Characteristics.

  4. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Alosaimi FD

    2016-04-01

    Full Text Available Fahad D Alosaimi,1 Abdulhadi Alhabbad,2 Mohammed F Abalhassan,3 Ebtihaj O Fallata,4 Nasser M Alzain,5 Mohammad Zayed Alassiry,6 Bander Abdullah Haddad71Department of Psychiatry, King Saud University, Riyadh, 2Department of Psychiatry, Prince Mohammed Medical City, Aljouf, 3Department of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 4Department of Psychiatry, Mental Health Hospital, Jeddah, 5Department of Psychiatry, Al-Amal Complex for Mental Health, Dammam, 6Medical Services Department, Abha Psychiatric Hospital, Abha, 7Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi ArabiaObjective: To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia.Method: This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651 and female (n=594 patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient’s type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients.Results: Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004, unmarried (P<0.001, have less number of children (1–3; P=0.002, unemployed (P=0.001, have a lower family income (<3,000 SR; P<0.001, live in rural communities (P<0.001, have a lower body mass index (P=0.001, and are smokers (P<0.001; however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%, antidepressants (41.4%, mood stabilizers

  5. A Simple, Safe Technique for Thorough Seroma Evacuation in the Outpatient Setting

    Directory of Open Access Journals (Sweden)

    Julie E. Park, MD, FACS

    2014-09-01

    Full Text Available Summary: Seroma formation, a common postoperative complication in reconstructive cases, can lead to capsular contracture and increased office visits and expenses. The authors present a safe, novel technique for ensuring the thorough removal of serous fluid in the outpatient setting. By relying on access with an angiocatheter, potential injury to permanent implants is minimized. The use of low continuous wall suction obviates the need of manual suction via multiple syringes and offers a rapid and thorough evacuation of all types of seromas.

  6. Effects of antecedent variables on disruptive behavior and accurate responding in young children in outpatient settings.

    Science.gov (United States)

    Boelter, Eric W; Wacker, David P; Call, Nathan A; Ringdahl, Joel E; Kopelman, Todd; Gardner, Andrew W

    2007-01-01

    The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to evaluate their influence on disruptive behavior. With a 3rd child, similar procedures were employed at school. Results showed one-step directives set the occasion for accurate responding and that other dimensions of the task (e.g., preference) functioned as motivating operations for negative reinforcement.

  7. Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

    Directory of Open Access Journals (Sweden)

    Coluccia A

    2014-09-01

    Full Text Available Anna Coluccia, Fabio Ferretti, Andrea PozzaDepartment of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, University of Siena, Siena, ItalyPurpose: The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course.Patients and methods: The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26 receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses.Results: Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95. Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No

  8. A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Settings.

    Science.gov (United States)

    Garrett, J Hudson

    2015-05-01

    According to the Centers for Disease Control and Prevention (CDC), most health care-associated infections (HAIs) are caused by contamination from the hands of health care providers or patients, contamination from the environment, and contamination from the patient's own skin. To mitigate common sources of infection transmission, frontline health care providers must be compliant with basic infection-prevention interventions, including hand hygiene, environmental cleaning and disinfection, safe injection practices, and designation of a trained health care professional to be responsible for the infection prevention and control program. Integration of CDC recommendations should incorporate a bundled approach to these interventions and should be part of a comprehensive approach to infection prevention and control. Effective infection-prevention practices in outpatient settings are critical for reducing the risk of infection transmission, improving patient safety and patient outcomes, and reducing costs associated with health care delivery.

  9. Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the “spending review” era

    Directory of Open Access Journals (Sweden)

    Nicola Mondaini

    2014-09-01

    Full Text Available Introduction: Penile implant patients are required to remain in the hospital after the operation for monitoring, antibiotic and analgesia administration. Cost containment, however, has resulted in the increased use of ambulatory surgery settings for many surgical procedures. Few studies have studied the feasibility of performing penile prosthesis insertion in an outpatient setting. The results are controversial and nowadays, in the most of centers that deal with prosthetic surgery, patients are still hospitalized. Aim: The aim of our investigation was to compare the feasibility of the performance as well as the complication profiles of penile implant surgery performed in an in-patient and an outpatient setting at a single center by a single surgeon. Methods: From January 2009 to June 2014, 50 patients of the same uro-andrological unit underwent penile prosthesis implantation performed by a single surgeon (N.M.. Twenty implantations were performed in an ambulatory day surgery setting. Main outcome measures: Effectiveness and costs of outpatient setting versus the in-patient setting of the penile prosthesis surgery. Results: There were some differences between the two groups in the intra-operative parameters, such as, operating time. Time lost from work was similar in both groups approximating 14 days. The mean number of analgesic pills ingested by the patients post-operatively was similar in both groups, averaging just under 25 pills per patient. There weren’t post-operative complications in the outpatient group. Cost were 17% less in outpatient clinic. Conclusions: The outpatient setting for this surgery is safe and effective even in patients with comorbidities or in case of secondary procedures. Costs are reduced by 17%.

  10. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    Science.gov (United States)

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  11. Care coordination for patients with complex health profiles in inpatient and outpatient settings.

    Science.gov (United States)

    Berry, Leonard L; Rock, Beth L; Smith Houskamp, Beth; Brueggeman, Joan; Tucker, Lois

    2013-02-01

    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon.

  12. Intimate partner violence perpetrators in a forensic psychiatric outpatient setting : Criminal history, psychopathology, and victimization

    NARCIS (Netherlands)

    Henrichs, J.; Bogaerts, S.; Sijtsema, J.J.; Klerx, F.

    2015-01-01

    This study investigated criminological, psychopathological, and victimological profiles of intimate partner violence (IPV) perpetrators in a sample of 119 Dutch female and male forensic psychiatric outpatients aged 18 to 58 years. In addition, differences in criminological, psychopathological, and v

  13. Anthroposophic lifestyle influences the concentration of metals in placenta and cord blood

    Energy Technology Data Exchange (ETDEWEB)

    Fagerstedt, Sara [The Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm (Sweden); Kippler, Maria [Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm (Sweden); Scheynius, Annika; Gutzeit, Cindy [Department of Medicine Solna, Translational Immunology Unit, Karolinska Institutet and University Hospital, Stockholm (Sweden); Mie, Axel [The Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm (Sweden); Alm, Johan [The Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm (Sweden); Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm (Sweden); Vahter, Marie, E-mail: marie.vahter@ki.se [Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm (Sweden)

    2015-01-15

    Allergic diseases develop in genetically susceptible individuals in a complex interplay with the environment, usually early in life. We have previously shown that the anthroposophic lifestyle is associated with reduced risk of allergic disease in children, but details on the influencing environmental factors are largely unknown. This study aims to elucidate if anthroposophic lifestyle influences fetal exposure to selected toxic and essential elements. Randomly selected non-smoking mothers with (n=40) and without (n=40) anthroposophic lifestyle from the prospective birth cohort ALADDIN were included. Concentrations of 12 toxic and essential elements were analyzed in full term placentas and in the erythrocyte fractions of maternal peripheral blood and of umbilical cord blood, using inductively coupled plasma mass spectrometry. Cadmium concentrations in maternal blood and placenta were significantly higher in mothers with an anthroposophic lifestyle (p<0.001), while concentrations in cord blood were generally low, irrespective of lifestyle. Cobalt concentrations were higher in both maternal blood, placenta and cord blood in the anthroposophic group. Lead concentrations were higher in maternal blood and cord blood, but not placenta, of mothers with anthroposophic lifestyle. Analysis of covariance, including lifestyle, parity, maternal age, gestational age, vegetarian diet, use of herbal medicine and occupation in the model, showed that mainly the anthroposophic lifestyle was significantly associated with cadmium concentrations. In conclusion, women with an anthroposophic lifestyle had higher concentrations of cadmium, cobalt and lead concentrations. Cadmium concentrations might have been influenced by a diet rich in vegetables and/or low iron status of the mothers. - Highlights: • Toxic elements in mother–newborn pairs in relation to anthroposophic lifestyle. • Anthroposophic lifestyle was associated with higher levels of cadmium, cobalt and lead. • A diet rich

  14. Agenda Setting During Follow-Up Encounters in a University Primary Care Outpatient Clinic.

    Science.gov (United States)

    Rey-Bellet, Sarah; Dubois, Julie; Vannotti, Marco; Zuercher, Marili; Faouzi, Mohamed; Devaud, Karen; Rodondi, Nicolas; Rodondi, Pierre-Yves

    2016-07-13

    At the beginning of the medical encounter, clinicians should elicit patients' agendas several times using open-ended questions. Little is known, however, about how many times physicians really solicit a patient's agenda during follow-up encounters. The objective was to analyze the number of agenda solicitations by physicians, of agendas initiated by physicians, and of patients' spontaneous agendas during the beginning and the entire encounter. We analyzed 68 videotaped follow-up encounters at a university primary care outpatient clinic. The number of different types of agenda setting was searched for and analyzed using negative binomial regression or logistic regression models. Physicians solicited agendas a mean ± SD of 0.8 ± 0.7 times/patient during the first 5 minutes and 1.7 ± 1.2 times/patient during the entire encounter. Physicians in 32.4% of encounters did not solicit the patient agenda, and there were never more than two physician's solicitations during the first 5 minutes. The mean number of physician's solicitations of the patients' agenda was 42% lower among female physicians during the first 5 minutes and 34% lower during the entire encounter. The number of agendas initiated by physicians was 1.2 ± 1.2/patient during the beginning and 3.2 ± 2.3/patient during the entire encounter. In 58.8% of the encounters, patients communicated their agendas spontaneously. There were twice as many patient spontaneous agendas (IRR = 2.12, p = .002) with female physicians than with males. This study showed that agenda solicitation with open-ended questions in follow-up encounters does not occur as often as recommended. There is thus a risk of missing new agendas or agendas that are important to the patient.

  15. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    Directory of Open Access Journals (Sweden)

    Bosmans Judith E

    2012-02-01

    Full Text Available Abstract Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004. Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743 in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434. After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected to €463 (corrected in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.

  16. Developing an outpatient wound care clinic in an acute rehabilitation setting.

    Science.gov (United States)

    Sheehan, Diane Dudas; Zeigler, Mary H

    2010-01-01

    People with disability are at high risk for skin breakdown,which requires ongoing prevention and management. An outpatient rehabilitation wound clinic was developed to handle a variety of acute and chronic wounds for this unique population. This article describes how two advanced practice nurses proposed the idea for the wound care clinic and formulated a business plan, which was critical to successfully administering an outpatient wound care service. Essential components of the business plan included the goals, scope of service, professional practice model, benefits, rationale, marketing analysis, predicted volumes, regulatory imperatives, and financial needs.

  17. Treatment response of an outpatient training for children with enuresis in a tertiary health care setting

    NARCIS (Netherlands)

    Cobussen-Boekhorst, H.J.; Genugten, L.J. van; Postma, J.; Feitz, W.F.J.; Kortmann, B.B.M.

    2013-01-01

    PURPOSE: To evaluate treatment effectiveness for children with enuresis, according to the definitions of the International Children's Continence Society (ICCS, 2006). MATERIAL AND METHODS: Children >/=6 years of age followed a 4-month outpatient treatment consisted of a visit during which history

  18. Setting up a Paediatric Rapid Access Outpatient Unit: views of general practice teams.

    NARCIS (Netherlands)

    Williams, L.; Fryer, J.; Andrew, R.; Powell, C.; Pink, J.; Elwyn, G.

    2008-01-01

    BACKGROUND: Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no quali

  19. Effects of Antecedent Variables on Disruptive Behavior and Accurate Responding in Young Children in Outpatient Settings

    Science.gov (United States)

    Boelter, Eric W.; Wacker, David P.; Call, Nathan A.; Ringdahl, Joel E.; Kopelman, Todd; Gardner, Andrew W.

    2007-01-01

    The effects of manipulations of task variables on inaccurate responding and disruption were investigated with 3 children who engaged in noncompliance. With 2 children in an outpatient clinic, task directives were first manipulated to identify directives that guided accurate responding; then, additional dimensions of the task were manipulated to…

  20. "Ten Commandments" for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting

    DEFF Research Database (Denmark)

    Levy-Hara, Gabriel; Amábile-Cuevas, Carlos F; Gould, Ian;

    2011-01-01

    A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms...

  1. Determinants of smoking cessation in COPD patients treated in the outpatient setting

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Thomsen, Reimar W; Johnsen, Søren P

    2016-01-01

    BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical and sociode......BACKGROUND: The beneficial effects of smoking cessation on the progression of COPD are well established. Nevertheless, many patients with COPD continue to smoke. METHODS: In this nationwide hospital-based prospective follow-up study, we examined rates of smoking cessation and clinical...... and sociodemographic determinants of smoking cessation in 3,233 patients with COPD who smoked on outpatient contact during 2008 to 2012. Using multivariate Cox regression, we calculated hazard ratios (HRs) of quitting. RESULTS: Within 1 and 5 years from first outpatient contact, the probability of quitting was 19...... Medical Research Council (MRC) dyspnea scale score reinforce that young and socioeconomically disadvantaged patients have more difficulties achieving...

  2. Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Lange, Peter; Thomsen, Reimar W

    2017-01-01

    -ever outpatient contact for COPD during 2008-2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression. RESULTS: Quality of care improved...... during the study period. CONCLUSION: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities...

  3. Iv antibiotic therapy in an outpatient setting: report of a joint venture program.

    Science.gov (United States)

    Eron, L J

    1988-05-01

    Intracare, a joint venture between infectious disease consultants and Fairfax Hospital, Virginia, represents an ambulatory model for the delivery of intravenous antibiotics on an outpatient basis. This article reviews the cost effectiveness and clinical effectiveness of the program in the first 2,096 enrollees over a 6-year period. The most commonly treated infection was osteomyelitis and the most frequently used antibiotic was ceftriaxone sodium. The infections responded satisfactorily in 89% of patients in the program. A total of 39,829 hospital days were saved, which represented a cost savings for hospital bed charges alone of $15,931,600. The authors conclude that because of changes in the hospital environment--constraints on the expansion of hospital beds, and the reservation of hospital beds for the most acutely ill patients (a future prediction resulting from an increased elderly population)--Intracare may serve as a prototype of a clinic rendering all types of outpatient care to chronically ill or less acutely ill patients who would ordinarily have been hospitalized.

  4. Combination use of anti-inflammatory drugs and myorelaxants in the treatment of patients with ankylosing spondylitis in outpatient settings

    Directory of Open Access Journals (Sweden)

    Inna Zurabievna Gaidukova

    2015-01-01

    Full Text Available Objective: to assess different treatment regimens for ankylosing spondylitis (AS. The specific features of using topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs and myorelaxants in outpatient settings were retrospectively analyzed.Subjects and methods. The investigation enrolled 96 AS patients admitted to the Department of Rheumatology, Saratov Regional Clinical Hospital, in 2010 to 2012, who took nimesulide during the last year (at least three 14-day cycles. The patients' mean age was 42.6±10.9 years; disease duration was 11.9±8.2 years; 83.33% were male. The diagnosis of AS was based on the 1984 modified New York criteria. Physical examination (clinical blood analysis, clinical urinalysis, C-reactive protein, total protein, albumins, urea, creatinine, glucose, bilirubin, serum aspartate aminotransferase and alanine aminotransferase was made. AS activity was determined using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI. Axial skeleton mobility and cervical spine rotation were evaluated. Therapy received by the patients at the moment of hospitalization and the attending physicians' recommendations for discharging patients from the hospital were analyzed. Saratov outpatient physicians were interviewed using a questionnaire to specify the aims and procedures of using anti-inflammatory drugs.Results. The outpatient physicians (n=100 were shown to use three-, two-, and one-component therapy in 53.12, 45, and 2% of the AS patients, respectively. Higher lumbar spine mobility and comparably reduced pain were established in the patients receiving threecomponent therapy (a combination of nimesulide 200 mg/day, tizanidine 4–8 mg/day, and topical NSAIDs than those who had NSAIDs only.

  5. Setting up a Paediatric Rapid Access Outpatient Unit: Views of general practice teams

    Directory of Open Access Journals (Sweden)

    Pink Jim

    2008-09-01

    Full Text Available Abstract Background Rapid Access Outpatient Units (RAOUs have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs, nurse practitioners and practice nurses on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about

  6. Pain and disease according to integral anthroposophical dentistry

    Directory of Open Access Journals (Sweden)

    Célia Regina Lulo Galitesi

    2012-01-01

    Full Text Available From an academic standpoint, the university format, in general, has been nurturing a "paradigm of expertise" and, consequently, the relationship between specialties has declined. The upshot is that recent college dental graduates have adopted a clinical performance focusing on system parts and their specificities, in detriment to a more comprehensive view of the mouth and of the patient as a whole, with his/her vital, emotional and individual attributes. An interaction between the several different areas of human knowledge is needed imminently to decrease the dichotomy in professional behavior, because the demand for professionals and dental patients interested in a more comprehensive approach are increasing day by day. Patients want to know: "What, in fact, is behind the etiological extrinsic and intrinsic factors that maintain neuropathic pain, recurrent thrush, or persistent halitosis," among other questions, "even under the care of a dentist?" or "Why is this disease affecting me?" There are several issues composing the paradigm of salutogenesis: What are the essential aspects that constitute a healthy individual, overlapping the usual investigation: How to destroy, avoid and quell the pathological agents? A proposed approach is based on salutogenesis, which examines such issues. According to this approach, anthroposophical dentistry includes determinant factors, determinants of health, basic research and the development of oral health promotion, thus connecting dental academia with integrative thinking, while also complementing and gathering information that subsidizes basic research with the primordial concepts on laws governing the parameters involved in the vital processes of nature.

  7. The History and Basic Tenets of Anthroposophical Music Therapy

    Directory of Open Access Journals (Sweden)

    Jane Edwards

    2012-07-01

    Full Text Available The approach known as Anthroposophical Music Therapy (AnMt was developed throughout the 20th century. In this paper we provide an historical and descriptive overview of the  foundations, techniques and methods of AnMt for readers who are not familiar with this model of music therapy training and practice. We trace AnMt's origins from the systematic application of music in curative education in Germany, Austria and Switzerland through to its use in many countries of the world, with training programmes available in German and English speaking countries currently.  We examined literature sources in German and English to glean information about the main foundations of this model. Course materials available from one programme of study were consulted to provide information about how this model is taught. This information was closely reviewed in order to be able to synthesise and present information about a. AnMt's development and current scope of practice, b. the contents of AnMt training, c. the therapeutic process in AnMt, and d. the use of music in AnMt. It is recommended that further efforts be undertaken from the leaders in AnMt, as well as the current professional associations in countries where it is practised, to consider the potential for its inclusion in the list of recognised trainings and models, if such a step would be considered useful for AnMt practitioners.

  8. Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study

    Directory of Open Access Journals (Sweden)

    Bockelbrink Angelina

    2010-07-01

    Full Text Available Abstract Background Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care. Methods Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions. Results In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female were included. The most frequent diagnoses were hypertension (11.1%, breast cancer (3.5%, and heart failure (3.0%. In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic. The adjusted odds ratio (AOR for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79, treatment by an internist (AOR = 1.49; CI: 1.40-1.58, female patients (AOR = 1.35; CI: 1.27-1.43, cancer (AOR = 4.54; CI: 4.12-4.99, arthropathies (AOR = 1.36; CI: 1.19-1.55, or dorsopathies (AOR = 1.34; CI: 1.16-1.55 and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98. The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39, diabetes mellitus (AOR = 0.17; CI: 0

  9. Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions

    Directory of Open Access Journals (Sweden)

    Harald J. Hamre

    2014-01-01

    Full Text Available Children with acute respiratory or ear infections (RTI/OM are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A- or conventional (C- treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P<0.001; unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56; after adjustment for demographics and morbidity 6.33 (3.17–12.64. Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

  10. 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

    opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed. Keywords: outpatient surgery analgesia, ambulatory surgery pain control, acute pain, ­ambulatory surgery center, opioids, substance abuse

  11. Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

    Directory of Open Access Journals (Sweden)

    Paul Gilbert

    Full Text Available BACKGROUND: Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors. METHODOLOGY AND FINDINGS: We conducted a parallel groups randomized controlled trial (December 2003-September 2006 at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476 were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months. Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months. CONCLUSIONS: The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and

  12. The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.

    LENUS (Irish Health Repository)

    Clayton, Evelyn M

    2009-05-01

    Comorbidity with Clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (IBD) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. Retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of C. difficile carriage in IBD patients using molecular methods specifically in an outpatient setting.

  13. Use of antibiotics within the IMCI guidelines in outpatient settings in Papua New Guinean children: an observational and effectiveness study.

    Directory of Open Access Journals (Sweden)

    Nicolas Senn

    Full Text Available There is a need to investigate the effectiveness and appropriateness of antibiotics prescription within the Integrated Management of Childhood Illness (IMCI strategy in the context of routine outpatient clinics.Making use of a passive case detection system established for a malaria prevention trial in outpatient clinics in Papua New Guinea, the appropriateness and effectiveness of the use of antibiotics within the IMCI was assessed in 1605 young children. Main outcomes were prescription of antibiotics and re-attendances within 14 days for mild pneumonia, mild diarrhoea and uncomplicated malaria whether they were managed with or without antibiotics (proxy of effectiveness. Appropriateness was assessed for both mild and severe cases, while effectiveness was assessed only for mild diseases.A total of 6975 illness episodes out of 8944 fulfilled inclusion criteria (no previous attendance <14 days+full medical records. Clinical incidence rates (episodes/child/year; 95% CI were 0.85 (0.81-0.90 for pneumonia, 0.62 (0.58-0.66 for malaria and 0.72 (0.65-0.93 for diarrhoea. Fifty three percent of 6975 sick children were treated with antibiotics, 11% were not treated with antibiotics when they should have been and in 29% antibiotics were prescribed when they should not have been. Re-attendance rates within 14 days following clinical diagnosis of mild pneumonia were 9% (126/1401 when managed with antibiotics compared to 8% (56/701 when managed without (adjusted Hazard Ratio (aHR = 1.00 (0.57-1.76, p = 0.98. Rates for mild diarrhoea were 8% (73/874 and 9% (79/866 respectively (aHR = 0.8 (0.42-1.57, p = 0.53.Non-adherence to IMCI recommendations for prescription of antibiotics is common in routine settings in Papua New Guinea. Although recommended, the use of antibiotics in young children with mild pneumonia as defined by IMCI criteria did not impact on their outcome. Better tools and new strategies for the identification of bacterial

  14. Attitudes and Beliefs towards Disease and Treatment in Patients with Advanced Cancer Using Anthroposophical Medicine.

    Science.gov (United States)

    von Rohr, E.; Pampallona, S.; van Wegberg, B.; Cerny, T.; Hürny, C.; Bernhard, J.; Helwig, S.; Heusser, P.

    2000-12-01

    BACKGROUND: In Switzerland, anthroposophical medicine has a long tradition, offers a special tumor treatment, is frequently used by cancer patients, and has been approved in 1998 by the Swiss government to be reimbursed by health insurances. This popularity contrasts with the fact that to date no sound evidence of the effectiveness of anthroposophical cancer treatments exists. In this study we draw a profile on a population of patients with advanced disease attending treatment at the anthroposophical Lukas Clinic (LC) regarding patients' attitudes, experiences and expectations. PATIENTS AND METHODS: All newly admitted patients with a diagnosis of locally advanced or metastasized breast, gastrointestinal, lung or gynecological cancer were recruited into a registration study. In parallel, a population of patients with the same inclusion criteria attending a conventional institution (Institute of Medical Oncology, University of Bern, IMO) was taken as a reference sample. Data were collected by means of a fully structured interview, and simple descriptive statistics was used for evaluation. RESULTS: 221 and 280 patients accrued at LC and at IMO, respectively. LC patients were mainly women (87%), had a good education (36% with completed college or university education), and were admitted on average 3.5 months after the diagnosis of advanced disease. With respect to their advanced cancer, they put very little hope in the effectiveness of conventional medicine, but expected great help from anthroposophical treatment. Compared with the reference population they cared more for psychological well-being and quality of life, but an important factor for choosing treatment at the LC was clearly the patients' strong belief in the effectiveness of anthroposophical treatment. CONCLUSIONS: With its holistic approach, anthroposophical medicine intends to provide tumor treatment together with supportive care throughout the course of the illness. To some patients this is an attractive

  15. Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings

    DEFF Research Database (Denmark)

    Mikkelsen, Anders Pretzmann; Hansen, Morten Lock; Olesen, Jonas Bjerring;

    2016-01-01

    AIMS: Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting....... METHODS AND RESULTS: Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox...... regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients...

  16. Evaluation of isosorbide mononitrate for cervical ripening prior to induction of labor at term pregnancy in an outpatient setting

    Directory of Open Access Journals (Sweden)

    Neelam Meena

    2016-03-01

    Conclusions: IMN self-administered at home is safe and effective for cervical ripening prior to induction of labor in women with term pregnancies. It is the very effective method for cervical ripening in outpatient setup. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 793-797

  17. The Stichting Ambulante Preventie Projecten method : A comparative study of recidivism in first offenders in a Dutch outpatient setting

    NARCIS (Netherlands)

    Ruddijs, F; Timmerman, H

    2000-01-01

    In this study, a comparison was made between 56 first-time sex offenders in an outpatient treatment program and 56 offenders who did not receive any treatment in an attempt to determine the difference in recidivism between the two groups. No significant difference was found between the two groups. T

  18. Outpatient Surgery

    Science.gov (United States)

    ... thirds of all operations are performed in outpatient facilities, according to the Centers for Disease Control and Prevention. Outpatient surgery provides patients with the convenience of recovering at home, and can cost less. ...

  19. Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

    Directory of Open Access Journals (Sweden)

    Eran Ben-Arye

    2015-11-01

    Full Text Available Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient’s involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients’ supportive care.

  20. Eva Between Anxiety and Hope: Integrating Anthroposophic Music Therapy in Supportive Oncology Care.

    Science.gov (United States)

    Ben-Arye, Eran; Ben-Arye, Yotam; Barak, Yael

    2015-11-30

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music therapy goals are discussed in regard to two modes of treatment: receptive listening and clinical composition. Next, these two treatment modes are discussed in a broader context by reviewing conventional music therapy interventions during chemotherapy on two axes: a. standardized vs. individualized treatment; b. patient's involvement on a passive to active continuum. In conclusion, psycho-oncology care can be enriched by adding anthroposophic medicine-oriented music therapy integrated within patients' supportive care.

  1. Eva between anxiety and hope: integrating anthroposophic music therapy in supportive oncology care

    OpenAIRE

    Eran Ben-Arye; Yotam Ben-Arye; Yael Barak

    2015-01-01

    Music therapy is a significant modality in the treatment of patients with cancer, who suffer emotional and spiritual distress as well as chemotherapy side effects that impair their quality of life. In this article, we present a case study of a patient challenged with recurrent ovarian cancer who received, concomitant with chemotherapy, a special form of music therapy based on anthroposophic medicine (AM) aimed at alleviating anxiety and improving her general well-being. AM-centered music ther...

  2. Moon phase at the dates of birth and decease of anthroposophic pioneers.

    Science.gov (United States)

    Verhulst, J

    2000-04-01

    Early adherents of Rudolf Steiner, the founder of the anthroposophical movement, tend to be born and to die during the dark half of the lunar month. There is significant correlation (P = 0.03) between the distributions of the lunar elongation at birth and at decease. However, this correlation does not operate at the level of individuals, suggesting that the effects of birth date and death date are statistically independent.

  3. The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program.

    Science.gov (United States)

    Brosig, Cheryl; Yang, Kai; Hoffmann, Raymond G; Dasgupta, Mahua; Mussatto, Kathleen

    2014-12-01

    The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.

  4. Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support

    DEFF Research Database (Denmark)

    Mejdahl, Caroline; Nielsen, Berit Kjærside; Hjøllund, Niels Henrik Ingvar

    2016-01-01

    -management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients complete a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PROs influenced the interaction between patients and clinicians...... during the consultation. Methods: Through participant observations of 9 consultations and 12 semi-structured interviews with patients after the consultation this interpretive description study explored patients’ experiences with the PROs system. The PRO included self-assessment on health-related quality...... of life, symptoms and wellbeing. Patients who visited the outpatient clinic at the Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach...

  5. Determinants of acceptance of an illness in the case of patients suffering from psoriasis treated in the hospital and outpatient clinic settings

    Directory of Open Access Journals (Sweden)

    Marta Adamska

    2015-09-01

    Full Text Available Background Psoriasis is one of the most commonly occurring cutaneous conditions. In connection with its chronic character, and with the presence of defacing pathological changes on the skin, this medical condition reduces the quality of life in the physical, mental and social aspects. It is also an illness whose course is substantially influenced by psychological factors. The level of acceptance of an illness in the case of psoriasis patients may exert a significant influence on their level of adjustment to their medical condition and psycho-social functioning. The objective of this research was to estimate the level of acceptance of the illness, and to determine the correlations between acceptance of the illness and the way in which it is perceived, the exacerbation of symptoms, and the health locus of control in groups of patients with psoriasis treated in the hospital and outpatient clinic settings. Participants and procedure The research included a group of 61 patients suffering from psoriasis. The following research tools were applied: the Acceptance of Illness Scale (AIS, the Multidimensional Health Locus of Control Scale (MHLC, the Disease Rating Scale (DRS, the Self-Administered Psoriasis Area Severity Index (SAPASI, and the Visual Analogue Scale (VAS. Results The studied patients accepted their illness to an average degree. No significant differences were found for that variable between the studied individuals treated in the hospital setting and those treated in the outpatient clinic setting. In the group of hospitalized patients, the perception of the illness in the categories of a threat, harm, life balance disturbance and an obstacle/a loss was negatively correlated with the acceptance of it. In the group of patients treated in the outpatient clinic setting, the assessment of the illness in the categories of a threat and harm, and the subjective assessment of exacerbation of symptoms of the illness, measured using the VAS, were

  6. Self-administered outpatient parenteral antimicrobial therapy: a report of three years experience in the Irish healthcare setting.

    LENUS (Irish Health Repository)

    Kieran, J

    2012-02-01

    Outpatient parenteral antibiotic therapy (OPAT) was first reported in 1972. OPAT programmes are not well established in Ireland, with no reported outcomes in the literature. An OPAT programme was established at St. James Hospital in 2006. Demographics, diagnoses and outcomes of the first 60 courses are reported. A retrospective analysis of prospectively recorded data was performed on patients treated from March 2006 to February 2009. The data was analysed using SPSS v.17. Sixty OPAT courses were administered to 56 patients, 57 percent of which were male. The median age was 50 years, the median inpatient stay was 19 days, the median duration of OPAT was 16 days and 1,289 inpatient bed days were saved. The additional cost per day of OPAT was 167.60 euros. Vancomycin was the most prescribed antimicrobial, administered to 35%. Musculoskeletal infection was the indication for treatment in 50%. Confirmatory microbiological diagnosis was identified in 72%, most frequently due to Staphylococcus aureus (68%). Only minor adverse events were recorded. Clinical cure was achieved in 92.8%. A patient satisfaction survey showed high satisfaction. OPAT is a safe and effective way of providing parenteral antibiotic therapy in the Irish healthcare system. Better integration of funding and the appointment of Infectious Diseases specialists will facilitate its expansion.

  7. Bryophyllum pinnatum and Related Species Used in Anthroposophic Medicine: Constituents, Pharmacological Activities, and Clinical Efficacy.

    Science.gov (United States)

    Fürer, Karin; Simões-Wüst, Ana Paula; von Mandach, Ursula; Hamburger, Matthias; Potterat, Olivier

    2016-07-01

    Bryophyllum pinnatum (syn. Kalanchoe pinnata) is a succulent perennial plant native to Madagascar that was introduced in anthroposophic medicine in the early 20th century. In recent years, we conducted a large collaborative project to provide reliable data on the chemical composition, pharmacological properties, and clinical efficacy of Bryophyllum. Here, we comprehensively review the phytochemistry, as well as the pharmacological and clinical data. As to the pharmacology, special emphasis is given to properties related to the use in anthroposophic medicine as a treatment for "hyperactivity diseases", such as preterm labor, restlessness, and sleep disorders. Studies suggesting that B. pinnatum may become a new treatment option for overactive bladder syndrome are also reviewed. Tolerability is addressed, and toxicological data are discussed in conjunction with the presence of potentially toxic bufadienolides in Bryophyllum species. The few data available on two related species with medicinal uses, Bryophyllum daigremontianum and Bryophyllum delagoense, have also been included. Taken together, current data support the use of B. pinnatum for the mentioned indications, but further studies are needed to fully understand the modes of action, and to identify the pharmacologically active constituents.

  8. Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities

    Directory of Open Access Journals (Sweden)

    Italo Paolini

    2008-12-01

    Full Text Available It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.

  9. Hospital Outpatient Prospective Payment System (OPPS) Lim...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

  10. 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.

  11. A Group-Administered social Skills Training for 8- to 12- Year-Old, high-Functioning Children With Autism Spectrum Disorders : An Evaluation of its Effectiveness in a Naturalistic Outpatient Treatment Setting

    NARCIS (Netherlands)

    Deckers, Anne; Muris, Peter; Roelofs, Jeffrey; Arntz, Arnoud

    2016-01-01

    A social skills training (SST) for high-functioning children with autism spectrum disorders (ASD) was evaluated in an outpatient setting using a combined between- and within-subject design in which SST and a waiting list condition were compared. According to parents and teachers, the SST produced gr

  12. Management of high-risk patients with hypertension and left ventricular hypertrophy in Germany: differences between cardiac specialists in the inpatient and outpatient setting

    Directory of Open Access Journals (Sweden)

    Wegscheider Karl

    2006-10-01

    Full Text Available Abstract Background Among patients with hypertension, those with established left ventricular hypertrophy (LVH represent a high risk cohort with poor prognosis. We aimed to investigate differences in characteristics and health care management of such patients treated as inpatients or outpatients by cardiac specialists. Methods Prospective cross-sectional study in patients with hypertension and LVH who were referred to either inpatient care (rehabilitation hospitals or to outpatient care (cardiology practices. Results A total of 6358 inpatients (59.6% males; mean age 66.6 years and 2246 outpatients (59.5% males; mean age 63.2 years were followed up for a mean of 23 vs. 52 days, respectively. Inpatients compared to outpatients had a significantly higher prevalence of coronary heart disease, history of stroke, renal failure or diabetes. Mean blood pressure of inpatients compared to outpatients was significantly lower both at entry (150/84 vs. 161/93 mmHg and at end of follow-up (129/75 vs. 139/83 mmHg. After adjustment for baseline blood pressure and a propensity score, differences between out- and inpatients at end of follow-up were 8.0/5.1 mmHg in favour of inpatients. Blood pressure goals as specified by guidelines were not met by 32% of inpatients and 55% of outpatients. Conclusion Inpatients had a higher rate of comorbidities and more advanced atherosclerotic disease than outpatients. Control of hypertension of inpatients was already better on admission than in outpatients, and treatment intensity in this group was also higher during the observation period. While blood pressure lowering was substantial in both groups, there were still a high proportion of patients who did not achieve treatment goals at discharge.

  13. Measles transmission from an anthroposophic community to the general population, Germany 2008

    Directory of Open Access Journals (Sweden)

    Krenn-Lanzl Irene

    2011-06-01

    Full Text Available Abstract Background In Germany, measles vaccination coverage with two doses is not yet sufficient to prevent regional outbreaks. Among the 16 German federal states, vaccination coverage was lowest in Bavaria with 85% in 2008. From March to mid-April 2008, four neighbouring Bavarian counties reported 55 measles-cases mostly linked to an ongoing measles outbreak in an anthroposophic school in Austria. We investigated this outbreak to guide future public health action. Methods We applied the German national case-definition for measles and collected data using the national surveillance system and a questionnaire. Measles cases with disease onset a maximum of 18 days apart and spatial contact (e.g. same household, same school were summed up in clusters. Two different interventions, which were implemented in schools and kindergartens in Bavaria, were compared by their impact on the size and duration of measles clusters. Susceptible persons were excluded from schools or kindergartens either with the first (intervention A or second (intervention B measles case occurring in the respective institution. Results Among the 217 Bavarian measles cases identified from March-July 2008, 28 (13% cases were attendees of the anthroposophic school in Austria. In total, vaccination status was known in 161 (74% cases and 156 (97% of them were not vaccinated. The main factor for non-vaccination was "fear of vaccine-related adverse events" (33%. Twenty-nine (18% of 161 cases suffered complications. Exclusively genotype D5 was detected. Overall, 184 cases could be epidemiologically grouped into 59 clusters. Of those, 41 clusters could be linked to households and 13 to schools or kindergartens. The effect of intervention A and B was analysed in 10 school or kindergarten clusters. Depending on the respective intervention A or B, the median number of cases per cluster was 3 versus 13 (p = 0.05, and the median duration of a cluster was 3 versus 26 days (p = 0.13. Conclusions

  14. The longer-term cognitive effects of adjunctive antiepileptic treatment with lacosamide in comparison with lamotrigine and topiramate in a naturalistic outpatient setting.

    Science.gov (United States)

    Helmstaedter, Christoph; Witt, Juri-Alexander

    2013-02-01

    In this retrospective controlled study, the impact of adjunctive lacosamide (LCM) on cognition in patients with epilepsy was evaluated and compared with that of topiramate (TPM) and lamotrigine (LTG) in a naturalistic outpatient setting. Cognition was investigated by means of objective assessment of executive functions (EpiTrack®) and verbal memory and by subjective ratings of self-perceived side effects (cognition, mood, and vegetative). Quality of life was assessed using the QOLIE-10 questionnaire. Patients underwent assessment at baseline and after a median follow-up interval of 32 weeks. Forty-four patients were treated with LCM, 11 with LTG, and 15 with TPM. Treatment arms differed with regard to the age at onset of epilepsy (LTG>TPM) and to seizure control from baseline to follow-up, which was best in patients whose seizures were treated with LTG (55% vs. 16% in patients whose seizures were treated with LCM and 13% in patients whose seizures were treated with TPM). Groups did not differ in the type of epilepsy, daily drug load or drug load change, nor in baseline seizure frequency. Repeated measures statistics controlling for epilepsy onset and seizure outcome showed deteriorated executive functions with TPM (F=7.5, p=0.001). On an individual level (reliable change indices), 53% of the patients whose seizures were treated with TPM showed losses in this domain (LCM 14%, LTG 27%) and none of the patients showed improvement (LCM 23%, LTG 27%; χ(2)=11.8, p=0.019). No differences in memory, quality of life, or mood were noted among patients in the three treatment arms. Subjective cognitive complaints increased in 5 of the 9 patients whose seizures were treated with TPM (LCM 1/9, LTG 0/9; χ(2)=11.9, p=0.025). The findings of this study demonstrate for the first time that the cognitive side effect profile of LCM is comparable to that of LTG and superior to that of TPM. This is indicated by both subjective and objective measures. Given the naturalistic setting and

  15. Treatment effects of rivastigmine on cognition, performance of daily living activities and behaviour in Alzheimer's disease in an outpatient geriatric setting

    NARCIS (Netherlands)

    Frankfort, S V; Appels, B A; De Boer, A; Tulner, L R; Van Campen, J P C M; Koks, C H W; Beijnen, J H

    2006-01-01

    We investigated rivastigmine effectiveness in 84 Alzheimer outpatients, with a special focus on behavioural problems. Cognition, activities in daily living (ADL) and behaviour were assessed during 30 months. Changes in test results between 6 months and baseline were compared with a historical contro

  16. Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011.

    Science.gov (United States)

    Gillesberg Lassen, S; Schuster, M; Stemmler, M; Steinmüller, A; Matysiak-Klose, D; Mankertz, A; Santibanez, S; Wichmann, O; Falkenhorst, G

    2014-04-01

    Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

  17. Reflecting on the methodological challenges of recruiting to a United Kingdom-wide, multi-centre, randomised controlled trial in gynaecology outpatient settings

    OpenAIRE

    2013-01-01

    Background Successful recruitment of participants to any trial is central to its success. Trial results are routinely published, and recruitment is often cited to be slower and more difficult than anticipated. This article reflects on the methodological challenges of recruiting women with prolapse attending United Kingdom (UK) gynaecology outpatient clinics to a multi-centre randomised controlled trial (RCT) of physiotherapy, and the systems put in place in an attempt to address them. Methods...

  18. The oil-dispersion bath in anthroposophic medicine – an integrative review

    Directory of Open Access Journals (Sweden)

    Bornhöft Gudrun

    2008-12-01

    Full Text Available Abstract Background Anthroposophic medicine offers a variety of treatments, among others the oil-dispersion bath, developed in the 1930s by Werner Junge. Based on the phenomenon that oil and water do not mix and on recommendations of Rudolf Steiner, Junge developed a vortex mechanism which churns water and essential oils into a fine mist. The oil-covered droplets empty into a tub, where the patient immerses for 15–30 minutes. We review the current literature on oil-dispersion baths. Methods The following databases were searched: Medline, Pubmed, Embase, AMED and CAMbase. The search terms were 'oil-dispersion bath' and 'oil bath', and their translations in German and French. An Internet search was also performed using Google Scholar, adding the search terms 'study' and 'case report' to the search terms above. Finally, we asked several experts for gray literature not listed in the above-mentioned databases. We included only articles which met the criterion of a clinical study or case report, and excluded theoretical contributions. Results Among several articles found in books, journals and other publications, we identified 1 prospective clinical study, 3 experimental studies (enrolling healthy individuals, 5 case reports, and 3 field-reports. In almost all cases, the studies described beneficial effects – although the methodological quality of most studies was weak. Main indications were internal/metabolic diseases and psychiatric/neurological disorders. Conclusion Beyond the obvious beneficial effects of warm bathes on the subjective well-being, it remains to be clarified what the unique contribution of the distinct essential oils dispersed in the water can be. There is a lack of clinical studies exploring the efficacy of oil-dispersion baths. Such studies are recommended for the future.

  19. Progress of Ischemic Stroke Medical Care Quality Improvement Program in Outpatient Setting in China and the USA%中美缺血性卒中门诊医疗质量改进项目进展

    Institute of Scientific and Technical Information of China (English)

    陈盼; 王拥军

    2015-01-01

    美国指南优势(The Guideline Advantage,TGA)医疗质量改进项目为“跟着指南走”(Get With the Guideline,GWTG)项目的门诊延伸,其数据直接通过电子病历和卫生技术平台进行收集,以体现循证医学指南的依从性。中国门诊医疗质量改进项目刚起步,其中中国金桥工程中的中国城市神经科门诊缺血性卒中登记研究拟对全国约100家医院门诊的1.5万例缺血性卒中患者进行调查和随访,评估缺血性卒中的医疗服务现状、二级预防的长期依从性、临床结局等,为进一步的医疗质量改进提供基础数据。%The Guideline Advantage quality improvement program (TGA) is an extended program of Get With the Guideline (GWTG) in outpatient setting in USA. TGA utilizes data from electronic health records (EHRs) or health technology platforms to report on adherence to evidence-based guidelines. Outpatient medical care quality improvement program has just started in China. Registry of outpatients with ischemic stroke in urban China (ROOTS) study evaluates the secondary prevention status, adherence and long-term persistence to secondary prevention and clinical outcome of 15 000 outpatients with ischemic stroke in 100 hospitals in China. ROOTS provides basic data for further medical care quality improvement process.

  20. Influence of spirituality on cool down reactions, work engagement, and life satisfaction in anthroposophic health care professionals.

    Science.gov (United States)

    Büssing, Arndt; Lötzke, Désirée; Glöckler, Michaela; Heusser, Peter

    2015-01-01

    This study aimed to analyse whether spirituality is a resource for health care professionals to deal with increasing stress and work burden, specifically to analyse associations between "cool down reactions" (which describe an emotional distancing towards patients and/or reduced engagement as a strategy to protect their own functionality), work burden, and life satisfaction. We specifically focussed on anthroposophic health care professionals because of their unique approach to distinct aspects of spirituality. In a cross-sectional survey using standardized questionnaires, 489 persons were enrolled (66% women, mean age 53 ± 10 years, 41% physicians, 12% nurses, and 47% other health care professionals). They scored very high on all measures of spirituality and moderate to low with respect to "cool down reactions." Significant predictors of "cool down reactions" were low work vigor, perceived work burden, alcohol consumption, low life satisfaction, and religious orientation (R (2) = 0.20). In contrast, their life satisfaction was explained best (R (2) = 0.35) by vigor, with further positive influences of being a physician, conscious interactions, and living with a partner on one hand and negative influences of "cool down reactions," work burden, and transcendence convictions on the other hand. Thus, specific aspects of spirituality have only a small influence on anthroposophic health care professionals' "cool down reactions," but might buffer against a loss of vigor and dedication in their work.

  1. Factors that influence vaccination decision-making by parents who visit an anthroposophical child welfare center: a focus group study.

    Science.gov (United States)

    Harmsen, Irene A; Ruiter, Robert A C; Paulussen, Theo G W; Mollema, Liesbeth; Kok, Gerjo; de Melker, Hester E

    2012-01-01

    In recent years, parents have become more disparaging towards childhood vaccination. One group that is critical about the National Immunization Program (NIP) and participates less comprises parents with an anthroposophical worldview. Despite the fact that various studies have identified anthroposophists as critical parents with lower vaccination coverage, no research has been done to explore the beliefs underlying their childhood vaccination decision-making. We conducted a qualitative study using three focus groups (n = 16) of parents who visit an anthroposophical child welfare center. Our findings show that participants did not refuse all vaccinations within the Dutch NIP, but mostly refused the Mumps, Measles, and Rubella (MMR) vaccination. Vaccination decisions are influenced by participants' lifestyle, perception of health, beliefs about childhood diseases, perceptions about the risks of diseases, perceptions about vaccine effectiveness and vaccine components, and trust in institutions. Parents indicated that they felt a need for more information. Sufficient references should be provided to sources containing more information about childhood vaccination, especially about the effectiveness of vaccines and vaccine components and the risks, such as possible side effects and benefits of vaccination. This may satisfy parents' information needs and enable them to make a sufficiently informed choice whether or not to vaccinate their child.

  2. One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting.

    Science.gov (United States)

    Rosling, Agneta; Salonen Ros, Helena; Swenne, Ingemar

    2016-01-01

    Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006. Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr. Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18. Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.

  3. Post-marketing surveillance of the safety profile of iodixanol in the outpatient CT setting. A prospective, multicenter, observational study of patient risk factors, adverse reactions and preventive measures in 9953 patients

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Frank Hugo Heinz [Radiology and Nuclear Medicine Center, Ludwigshafen (Germany)

    2014-11-15

    Non-interventional study in outpatient, contrast-enhanced CT: 1. to determine the extent of preventive measures for risk reduction of adverse drug reactions after contrast-enhanced CT examinations. 2. to prospectively determine the incidence and severity of adverse drug reactions occurring after administration of the iso-osmolar contrast medium iodixanol. 3. to determine a possible influence of preventive measures on the incidence/severity of adverse drug reactions. Evaluable documentation was provided for 9953 patients from 66 radiology centers across Germany. Patient characteristics, aspects of iodixanol administration, and adverse events with an at least 'possible' relationship were documented on a standardized case report form (CRF) and were evaluated up to seven days after contrast medium administration. About 55.5% of patients showed one or more risk factors (e.g. impaired renal function 4.4%, diabetes mellitus 8.5%, hypertension 20.6%). One third of the sites did not implement any preventive measures. Patients with a known risk for an allergy-like reaction were more likely to receive pharmacologic preventive treatment (0.5-50.5%). Oral hydration was the main preventive measure in patients with renal risk factors (<8%) followed by intravenous hydration (1%). Adverse drug reactions, mainly hypersensitivity reactions, occurred in 77 patients (0.74%), but were classified as serious in only 3 patients (0.03%). No statistically significant correlation between risk factors, preventive measures, and adverse reactions could be found. The use of preventive measures for CT examinations in this outpatient setting was generally low with risk patients being pre-medicated more often, depending on their history. In the routine outpatient setting, iso-osmolar iodixanol was very well tolerated in almost 10 000 patients undergoing diagnostic CT. The rate of acute and delayed adverse reactions was low. No correlation could be found between risk factors, preventive

  4. Screening for renal insufficiency following ESUR (European Society of Urogenital Radiology) guidelines with on-site creatinine measurements in an outpatient setting

    Energy Technology Data Exchange (ETDEWEB)

    Ledermann, H.P.; Mengiardi, B.; Schmid, A. [IMAMED Radiologie Nordwest, Basel (Switzerland); Froehlich, J.M. [Guerbet AG, Medical Affairs, Zurich (Switzerland); University of Bern, Radiology Department, Bern (Switzerland)

    2010-08-15

    To report the results and implications for workflow following introduction of ESUR guidelines to screen for potential renal insufficiency (RI) in private practice with on-site creatinine measurements. A total of 1,766 consecutive outpatients scheduled for contrast-enhanced CT (CECT) completed the ESUR questionnaire enquiring about kidney disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout or use of nephrotoxic drugs. Patients with positive risk factors underwent on-site creatinine measurement and calculation of estimated glomerular filtration rate (eGFR). Attending radiologists adapted subsequent imaging depending on renal function and presence of risk factors. One or more ESUR risk factors were present in 796 (45.1%) patients, including hypertension (37.7%), nephrotoxic medication (21.3%), diabetes mellitus (8.0%), proteinuria (3.9%), renal disease (4.1%), gout (3.1%) and renal surgery (2.6%). Pre-procedural creatinine measurements revealed severe RI (eGFR < 30 ml min{sup -1} 1.73 m{sup -2}) in 10 (1.3%) and moderate RI (eGFR 30-59 ml min{sup -1} 1.73 m{sup -2}) in 106 (13.8%). Imaging work-up was adapted in 132 (16.6%) as follows: reduction of contrast material dose (n = 85), CT without contrast (n = 40), changeover to MRI (n = 3) or scintigraphy (n = 4). Screening for RI following ESUR guidelines requires creatinine measurements in nearly half of outpatients scheduled for CECT and reveals moderate to severe renal impairment in 6.6%. (orig.)

  5. The burden and spectrum of vitreo-retinal diseases among ophthalmic outpatients in a resource-deficient tertiary eye care setting in South-Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Eze Boniface

    2010-01-01

    Full Text Available Purpose: This study was designed to determine the rate and pattern of vitreo-retinal diseases at a tertiary eye care center in South-eastern Nigeria. Materials and Methods: The outpatient register at the Eye Clinic of the University of Nigeria Teaching Hospital, Enugu, was retrospectively examined to identify all new patients registered between January 2004 and December 2008. A chart review of subjects with vitreo-retinal disease was conducted to record relevant demographic and clinical data including the needs for vitreo-retinal care. Descriptive and analytical statistics were performed. A P-value < 0.001 (one degree of freedom was considered statistically significant. Results: Of the 8,239 new patients reported during the period, 326 subjects (males- 59.3%; females- 40.7%; sex ratio = 1.1:1 aged 49.3 ± 16.8 years (range 3-82 years had vitreo-retinal disease. The rate of vitreo-retinal disease was 3.9%. The rate was higher in subjects above 40 years old (P < 0.001, but did not differ between sexes (P = 0.469. Diabetic retinopathy (24.9%, hypertensive retinopathy (13.3%, and age-related macular degeneration (10.7% were the leading vitreo-retinal diseases. Blindness from vitreo-retinal disease was bilateral in 6.1% of subjects and unilateral in 17.5% of subjects. The common co-morbidities were ocular conditions such as refractive error (19.8%, cataract (14.2%, and glaucoma (10.4%; and systemic conditions such as diabetes mellitus (14.6% and hypertension (13.2%. Conclusions: The rate of vitreo-retinal diseases among new ophthalmic outpatients at UNTH, Enugu, is 3.9%. Retinal vascular disorders and age-related maculopathy are the leading retinal diseases. At UNTH, resource needs for vitreo-retinal care are urgent including retinal photography/angiography, laser photocoagulation, intra-vitreal pharmacotherapy, and vitreo-retinal surgery.

  6. Comparison of the bedside head impulse test with the video head impulse test in a clinical practice setting: a prospective study of 500 outpatients.

    Directory of Open Access Journals (Sweden)

    Chun Wai eYip

    2016-04-01

    Full Text Available Objectives: The primary aim was to determine the sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of the bedside head impulse test (bHIT using the video HIT (vHIT as the gold standard for quantifying the function of the vestibulo-ocular reflex (VOR. Secondary aims were to determine the bHIT inter-rater reliability, and sensitivity in detecting unilateral and bilateral vestibulopathy.Methods: In this prospective study, 500 consecutive outpatients presenting to a tertiary neuro-otology clinic with vertigo or dizziness of various vestibular etiologies who did not have any of the pre-defined exclusion criteria were recruited. Bedside HITs were done by three experienced neuro-otology clinicians masked to the diagnosis, and the results were compared with the vHIT. The patients were likewise blinded to the bHIT and vHIT findings. Patients with VOR deficits were identified on the vHIT by referencing to the pre-selected pathological gain of 40%, the bHIT sensitivity = 51.7% and 83%, respectively. For bilateral vestibulopathy, overall bHIT sensitivity = 66.3%, reaching 86.84% for severely reduced bidirectional gains.Conclusions: For the primary outcome, the bHIT had moderate sensitivity and low PPV. While the study did not elucidate the best choice for vHIT reference, it demonstrated how the bHIT test properties varied with vHIT thresholds: selecting a lower threshold improved the sensitivity but diminished the PPV, while a higher threshold had the opposite effect. The VOR was most likely normal if the bHIT was negative due to its high NPV. The bHIT was moderately sensitive for detecting unilateral and bilateral vestibulopathy overall, but better for certain subgroups.

  7. Thyroid Function and Prevalence of Anti-Thyroperoxidase (TPO and Anti-Thyroglobulin (Tg Antibodies in Outpatients Hospital Setting in an Area with Sufficient Iodine Intake: Influences of Age and Sex

    Directory of Open Access Journals (Sweden)

    Dimitra Nikita

    2013-01-01

    Full Text Available In order to examine the prevalence of thyroid disease in a hospital outpatient setting, in an area of sufficient iodine intake, serum levels of TSH, T4, T3, anti-Tg and anti-TPO antibodies were examined in 909 individuals with an age range of 12.4 to 88.5 years, participating in a checkup outpatient setting. The study was conducted in Henry Dynant Hospital located in the metropolitan area of Athens, Greece, during a 2 year period. Hormonal parameters were determined by chemiluminescence immunoassay. Overt thyrotoxicosis was found in 4.95% of the total population and subclinical thyrotoxicosis in 5.5%. Overt hypothyroidism was found in 1.43% and subclinical hypothyroidism in 4.51%. In male population, overt thyrotoxicosis was found in 4.4 % and subclinical thyrotoxicosis was also found in 4.4%. On the other hand, overt hypothyroidism was found in 1.4% and subclinical hypothyroidism was found in 3.7% in males. In female population, overt thyrotoxicosis was found in 5.2% whereas subclinical thyrotoxicosis was found in 6.0%. Overt hypothyroidism was found in 1.5% and subclinical hypothyroidism was found in 4,9% in females. Positive anti-TPO antibodies were detected more often (30.4% than anti-Tg (15.4% in the tested population. The positivity in both anti-TPO and anti-Tg antibodies was correlated with abnormally high TSH concentrations after the age of 50 years, especially in female population. In conclusion distinct profile of thyroid hormonal parameters was observed in inhabitants in the metropolitan area of Athens, with overt thyrotoxicosis strikingly overcome overt hypothyroidism while subclinical forms of each dysfunction also exhibit analogous results

  8. Thyroid function and prevalence of anti-thyroperoxidase (TPO) and anti-thyroglobulin (Tg) antibodies in outpatients hospital setting in an area with sufficient iodine intake: influences of age and sex.

    Science.gov (United States)

    Legakis, Ioannis; Manousaki, Mina; Detsi, Stela; Nikita, Dimitra

    2013-01-01

    In order to examine the prevalence of thyroid disease in a hospital outpatient setting, in an area of sufficient iodine intake, serum levels of TSH, T4, T3, anti-Tg and anti-TPO antibodies were examined in 909 individuals with an age range of 12.4 to 88.5 years, participating in a checkup outpatient setting. The study was conducted in Henry Dynant Hospital located in the metropolitan area of Athens, Greece, during a 2 year period. Hormonal parameters were determined by chemiluminescence immunoassay. Overt thyrotoxicosis was found in 4.95% of the total population and subclinical thyrotoxicosis in 5.5%. Overt hypothyroidism was found in 1.43% and subclinical hypothyroidism in 4.51%. In male population, overt thyrotoxicosis was found in 4.4 % and subclinical thyrotoxicosis was also found in 4.4%. On the other hand, overt hypothyroidism was found in 1.4% and subclinical hypothyroidism was found in 3.7% in males. In female population, overt thyrotoxicosis was found in 5.2% whereas subclinical thyrotoxicosis was found in 6.0%. Overt hypothyroidism was found in 1.5% and subclinical hypothyroidism was found in 4,9% in females. Positive anti-TPO antibodies were detected more often (30.4%) than anti-Tg (15.4%) in the tested population. The positivity in both anti-TPO and anti-Tg antibodies was correlated with abnormally high TSH concentrations after the age of 50 years, especially in female population. In conclusion distinct profile of thyroid hormonal parameters was observed in inhabitants in the metropolitan area of Athens, with overt thyrotoxicosis strikingly overcome overt hypothyroidism while subclinical forms of each dysfunction also exhibit analogous results.

  9. Blood cultures in ambulatory outpatients

    Directory of Open Access Journals (Sweden)

    Laupland Kevin B

    2005-05-01

    Full Text Available Abstract Background Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients. Methods Blood cultures drawn at community-based collection sites in the Calgary Health Region (population 1 million in 2001 and 2002 were included in this study. These patients were analyzed by linkages to acute care health care databases for utilization of acute care facilities within 2 weeks of blood culture draw. Results 3102 sets of cultures were drawn from 1732 ambulatory outpatients (annual rate = 89.4 per 100,000 population. Significant isolates were identified from 73 (2.4% sets of cultures from 51 patients, including Escherichia coli in 18 (35% and seven (14% each of Staphylococcus aureus and Streptococcus pneumoniae. Compared to patients with negative cultures, those with positive cultures were older (mean 49.6 vs. 40.1 years, p Conclusion Blood cultures drawn in outpatient settings are uncommonly positive, but may define patients for increased intensity of therapy. Strategies to reduce utilization without excluding patients with positive cultures need to be developed for this patient population.

  10. Prescribing pattern of anti-epileptic drugs in an Italian setting of elderly outpatients: a population-based study during 2004–07

    Science.gov (United States)

    Oteri, Alessandro; Trifirò, Gianluca; Gagliostro, Maria Silvia; Tari, Daniele Ugo; Moretti, Salvatore; Bramanti, Placido; Spina, Edoardo; Caputi, Achille Patrizio; Arcoraci, Vincenzo

    2010-01-01

    AIMS The aims of the study were to assess the trend of older and newer anti-epileptic drugs (AEDs) in the elderly population and to analyze the effects of a health-policy intervention with regard to AED use in general practice in a setting in Southern Italy. METHODS Data were extracted from the ‘Caserta-1’ Local-Health-Unit Arianna database in the years 2004–07. Patients aged over 65 years, receiving at least one AED prescription and registered in the lists of 88 general practitioners, were selected. The use of older and newer AEDs was calculated as 1 year prevalence and incidence of use and defined daily dose (DDD) per 1000 inhabitants day−1. Sub-analyses by gender, age and indication of use were performed. RESULTS Most of AED users were treated because of neuropathic pain (64.8%). However, the main indication of use for older AEDs (57.8%) was epilepsy, whereas newer AEDs (79.5%) were used for neuropathic pain. Prevalence and incidence of newer AED use increased until 2006, followed by a reduction in 2007. Newer AEDs, particularly gabapentin and pregabalin, were used in the treatment of more patients than older AEDs. However phenobarbital, accounting for more than 50% of total AED volume, was the most prescribed medication during the entire study period. CONCLUSIONS An increasing use of AEDs has been observed during 2004–07, mostly due to the prescription of newer compounds for neuropathic pain. The fall in the use of newer AEDs during 2007 coincides with revised re-imbursement criteria for gabapentin and pregabalin. The large use of phenobarbital in the elderly should be considered in the light of a risk of adverse drug reactions. PMID:20840443

  11. A 64-week, multicenter, open-label study of aripiprazole effectiveness in the management of patients with schizophrenia or schizoaffective disorder in a general psychiatric outpatient setting

    Directory of Open Access Journals (Sweden)

    Chiu Nan-Ying

    2010-09-01

    Full Text Available Abstract Objective To evaluate the overall long-term effectiveness of aripiprazole in patients with schizophrenia in a general psychiatric practice setting in Taiwan. Methods This was a prospective, open-label, multicenter, post-market surveillance study in Taiwanese patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV diagnosis of schizophrenia or schizoaffective disorder requiring a switch in antipsychotic medication because current medication was not well tolerated and/or clinical symptoms were not well controlled. Eligible patients were titrated to aripiprazole (5-30 mg/day over a 12-week switching phase, during which their previous medication was discontinued. Patients could then enter a 52-week, long-term treatment phase. Aripiprazole was flexibly dosed (5-30 mg/day at the discretion of the treating physicians. Efficacy was assessed using the Clinical Global Impression scale Improvement (CGI-I score, the Clinical Global Impression scale Severity (CGI-S score, The Brief Psychiatry Rating Scale (BPRS, and the Quality of Life (QOL scale, as well as Preference of Medicine (POM ratings by patients and caregivers. Safety and tolerability were also assessed. Results A total of 245 patients were enrolled and switched from their prior antipsychotic medications, and 153 patients entered the 52-week extension phase. In all, 79 patients (32.2% completed the study. At week 64, the mean CGI-I score was 3.10 and 64.6% of patients who showed response. Compared to baseline, scores of CGI-S, QOL, and BPRS after 64 weeks of treatment also showed significant improvements. At week 12, 65.4% of subjects and 58.9% of caregivers rated aripiprazole as better than the prestudy medication on the POM. The most frequently reported adverse events (AEs were headache, auditory hallucinations and insomnia. A total of 13 patients (5.3% discontinued treatment due to AEs. No statistically significant changes were noted with respect to

  12. Outpatient Imaging Efficiency - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - national data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...

  13. Outpatient Imaging Efficiency - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - provider data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...

  14. Outpatient Imaging Efficiency - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - state data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical imaging...

  15. Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?

    Science.gov (United States)

    Casey, Michelle M.; Prasad, Shailendra; Klingner, Jill; Moscovice, Ira

    2012-01-01

    Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…

  16. Otolaryngologic emergencies in the outpatient setting.

    Science.gov (United States)

    Belleza, Walter G; Kalman, Suzanne

    2006-03-01

    Disease processes involving the ear, nose, and throat account for millions of office visits to primary care physicians per year. Because of their proximity to the airway as well as critical neurologic and vascular structures, the disease process in each individual case carries the potential for significant complications. Fortunately, improvements in medical care have significantly reduced the prevalence of these complications. As a result of their relative rarity, most physicians may be unfamiliar with the clinical presentation of these entities. This article familiarizes the physician with the pathophysiology and clinical presentation of the more commonly encountered otolaryngologic complications. The physician should seek to rule out the presence of the aforementioned complications in each patient who presents with an otolaryngologic complaint. Any suggestion of their presence should prompt an immediate referral to a subspecialist or an emergency department. It is hoped that continued familiarization with these' disease processes will maintain them as rare entities of medical practice.

  17. The health care setting rather than medical speciality impacts on physicians adherence to guideline-conform anticoagulation in outpatients with non-valvular atrial fibrillation: a cross sectional survey

    Directory of Open Access Journals (Sweden)

    Gerber Bernhard

    2012-02-01

    initiation regimens in NVAF was significantly lower when compared to long-term treatment and health care setting rather than medical speciality explained guideline-conform OAC initiation. The majority of the physicians did not consider the initiation of anticoagulation to be a major obstacle in outpatient care.

  18. Infections in outpatient surgery.

    Science.gov (United States)

    Nazarian Mobin, Sheila S; Keyes, Geoffrey R; Singer, Robert; Yates, James; Thompson, Dennis

    2013-07-01

    In the plastic surgery patient population, outpatient surgery is cost effective and will continue to grow as the preferred arena for performing surgery in healthy patients. Although there is a widespread myth that outpatient surgery centers may suffer from increased infection rates due to lax infection control, the data presented from American Association for Accreditation of Ambulatory Surgery Facilities-accredited facilities prove the contrary. There is a lack of data investigating infection prevention in the perioperative period in plastic surgery patients. As data collection becomes more refined, tracking the postoperative care environment should offer additional opportunities to lower the incidence of postoperative infections.

  19. 78 FR 43533 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Science.gov (United States)

    2013-07-19

    ..., Ninth Revision, Clinical Modification ICD Implantable cardioverter defibrillator ICU Intensive care unit...: Cardiac Rehabilitation Measure: Patient Referral From an Outpatient Setting D. Quality Measures...

  20. Outpatient coronary angioplasty: feasible and safe.

    Science.gov (United States)

    Slagboom, Ton; Kiemeneij, Ferdinand; Laarman, Gert Jan; van der Wieken, Ron

    2005-04-01

    This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either transradial or transfemoral PTCA using 6 Fr equipment. Patients were triaged to outpatient management based on a predefined set of predictors of an adverse outcome in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five patients (58%) were discharged 4-6 hr after PTCA; 42% stayed in hospital overnight. In the outpatient group, one adverse event occurred (subacute stent thrombosis 7 hr postdischarge, nonfatal myocardial infarction). There were no major vascular complications. In the hospital group, 19 patients (7%) sustained an adverse cardiac even in the first 24 hr; 1 patient died. Patients treated via the femoral route had more (minor) bleeding complications (19 patients; 6%); in 17 of these, this was the sole reason that discharge was delayed. PTCA on an outpatient basis, performed via the radial or the femoral artery with low-profile equipment, is safe and feasible in a considerable part of a routine PTCA population. A larger proportion of transradial patients can be discharged due to a reduction in (minor) bleeding complications.

  1. Applying Telemedicine to Outpatient Physical Therapy

    OpenAIRE

    Jacobs, Joshua L.; Davis, Daniel C.

    2002-01-01

    Few studies have specifically addressed telemedicine applied to physical rehabilitation. This ongoing pilot study examines the role of Internet-based, World Wide Web electronic communication, including textual, audio, and video, over a HIPAA-compliant network configuration, to enhance patient care in an outpatient physical therapy rehabilitation setting. Areas that can benefit from telemedicine are targeted, and include communication between physical therapist and specialty therapist, between...

  2. Disparities in internet use among orthopedic outpatients.

    Science.gov (United States)

    Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie

    2014-02-01

    Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races.

  3. Length of outpatient treatment affected by extraversion : Still waters run long

    NARCIS (Netherlands)

    Spinhoven, P; VanderDoes, AJW; Sanderman, R; van der Does, A.J.W.

    1996-01-01

    It has often been shown that in outpatient settings, about half of the treatments are terminated after only a few sessions. The present study sought to investigate the contribution of personality traits to length of treatment in a behaviour therapy-oriented outpatient treatment setting. All patients

  4. Medical Mishap and Negligence: It happens in the Outpatients too

    LENUS (Irish Health Repository)

    Murphy, JFA

    2011-06-01

    When we consider medical negligence and clinical error we think of busy hospitals late at night and at week-ends. We think of crowded emergency medicine departments, complex surgery and the critically ill ICU patient. We think of prescribing errors in the administration of potent intravenous therapy. We think of high risk specialties such as obstetrics, anaesthesia and surgery. We are less likely to think of outpatients\\/ ambulatory care or a non-interventionist specialty as an important source of litigation. This is remiss on our part. Risks in this setting have gone relatively unnoticed. There 30 times more outpatients than inpatients annually. In the US there are 900 million outpatient visits compared with 30 million inpatients. It is not surprising that this quantum of patient-doctor interaction should also be a source of litigation claims. Furthermore it is likely to continue rising with the increased numbers of procedures now being undertaken at outpatients.

  5. Comparison of effectiveness between two HIV screening strategies in outpatient setting%医疗机构门诊艾滋病筛查策略实施效果比较

    Institute of Scientific and Technical Information of China (English)

    曾刚; 吕繁; 罗夏; 周啟芳; 刘伟; 黄爱林; 吴尊友

    2013-01-01

    目的 比较在门诊患者中实施病症筛查和抽血患者全员筛查策略在促进HIV感染者多发现、早发现方面的效果.方法 于2011年7-11月,采用流行病学类实验设计方法,在广西壮族自治区选取艾滋病流行水平、人口和医疗资源均相近的L县和J县的县医院门诊部为研究现场,分别实施HIV病症筛查策略和抽血患者全员筛查策略,并选取两所医院15岁以上的就诊患者为研究对象,分别为62 106和58 057人次.在实施策略期间,收集两所医院各科室门诊逐月就诊人次数,通过医院HIV筛查实验室检测记录获取不同科室患者检测情况、初筛阳性结果.采用x2检验比较两种策略在新发现HIV阳性者比例、HIV阳性检出率和HIV阳性者早期感染等指标上的差异.结果 实施抽血患者全员筛查策略的J县县医院和实施病症筛查策略的L县县医院门诊患者中,接受HIV检测的比例分别为9.69% (527/58 057)和1.38%(859/62 106);年龄分别为(46.23±16.81)、(40.75±15.48)岁,差异有统计学意义(t=8.81,P<0.05);J县县医院新发现HIV阳性者比例[0.03%(19/58 057)]高于L县[0.02%(10/62 106)](P<0.05),而J县县医院HIV阳性检出率[0.34%(19/5627)]低于L县[1.16% (10/859)](x2=9.66,P<0.05).结论 医疗机构实施抽血患者全员筛查策略相对病症筛查策略可以发现更多HIV感染者.%Objective To determine whether non-targeted testing strategy (screening all patients with blood sample withdrawn) could identify more patients with newly diagnosed HIV infection than symptom and risk behavior based targeted testing strategy or not.Methods Controlled trial design was applied in this study.From July to November 2011,outpatient department of L and J county hospital in Guangxi province were selected to conduct the targeted strategy and non-targeted strategy respectively.The two counties had similar population,outpatient volume,previous testing rate and number of newly

  6. Osteoarthrosis in outpatient practice

    Directory of Open Access Journals (Sweden)

    Elena Andreyevna Galushko

    2012-01-01

    Full Text Available Objective: to elucidate the awareness of osteoarthrosis - OA (the most common location and treatment methods among primary care physicians. Subjects and methods. The questionnaire developed at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, was used to interview 1912 specialists (therapists, rheumatologists, neurologists, and surgeons who made a primary outpatient reception in the local polyclinics of 25 Russian Federation’s cities with a population of more than 500,000. Results. In the opinion of the physicians of all specialties, knee joints turned out to be the most location of OA. In practice, the rheumatologists encountered knee, hip, and hand joint lesions in OA in 92, 42, and 38%, respectively. Analysis of therapeutic preferences has shown that virtually all the physicians prescribe nonsteroidal anti-inflammatory drugs and only two thirds do structure-modifying drugs (chondroprotectors for OA patients. When treating OA, only the rheumatologists use slow-acting drugs in practically 100% of cases, by preferring chondroitin sulfate. The physicians of all specialties use topical glucocorticoid therapy extensively. The rheumatologists use this therapy most probably due to the fact that patients with severe polyarticular OA come to see them. Notwithstanding the fact that new guidelines for the treatment of OA were published in 2008, most physicians are oriented to the 1995 guidelines, frequently giving rise to therapeutic errors and wrong treatment.

  7. Outpatient laser tonsillar ablation under local anaesthetic.

    Science.gov (United States)

    Andrews, Peter J; Latif, Abdul

    2004-11-01

    Outpatient laser ablation of the palatine tonsils under local anaesthetic is an alternative technique to capsular tonsillectomy for recurrent tonsillitis under general anaesthetic. Laser tonsillotomy ablates up to 70% of the tonsillar tissue and is performed when patients choose not to have a conventional tonsillectomy, or are unfit for a general anaesthetic. The technique described here is an adaptation of Krespis' laser-assisted serial tonsillectomy (LAST) whereby only one sitting is required. Krespis' technique effectively eliminates recurrent tonsillitis in 96% of the cases over a 4-year follow-up period and represents the only substantial study looking at treating recurrent tonsillitis with outpatient laser ablation. This study is a retrospective postal survey of 19 patients who underwent laser tonsillar ablation under local anaesthetic for recurrent chronic tonsillitis from 1997 to 2001 and was performed in liaison with the clinical audit department at Basildon Hospital. We had a response rate of 74% and an admission rate of 0%, which compares favourably with day case tonsillectomy surgery. Of the patients, 75% did not experience further episodes of tonsillitis 12 months after the procedure and 77% of the patients were glad they had the operation. Although this technique does not completely eliminate tonsillitis, it offers an alternative for those patients who prefer a procedure that is done quickly in an outpatient setting without the additional problems of general anaesthesia, overnight hospital admission and long waiting lists.

  8. Nurse practitioner role in preparing families for pediatric outpatient surgery.

    Science.gov (United States)

    Frisch, Ashley M; Johnson, Arlene; Timmons, Shirley; Weatherford, Carol

    2010-01-01

    Due to medical advances in surgery and anesthesia and cost of hospital stays, more elective pediatric surgical procedures are being performed in outpatient settings. One proposed advantage of outpatient surgery is decreased anxiety or a shorter period of anxiety for pediatric patients and their families because they are able to go home shortly after the surgery. A literature review was conducted to describe anxiety experienced by pediatric patients and their families in the outpatient surgery setting and to explore ways to decrease that anxiety. Both children and parents reported not feeling emotionally and educationally prepared for outpatient surgery. Developmentally appropriate pre-surgical educational programs and parental involvement in the surgical experience can help alleviate the anxiety of both children and parents during the pediatric surgical experience. Nurse practitioners (NPs) are currently being used in pre-operative outpatient settings to conduct physical examinations and provide pre-op education. Pre-op education programs provided by NPs are beneficial in decreasing the anxiety state among children and parents prior to surgery.

  9. Study on the Feasibility and Effectiveness of Strategy to Provide HIV Test for all Outpatients with Blood Withdrawn for Other Tests in Healthcare Settings%门诊全部抽血患者艾滋病检测策略可行性及效果研究

    Institute of Scientific and Technical Information of China (English)

    曾刚; 吕繁; 黄爱林; 罗夏; 吴尊友

    2012-01-01

    目的 探索对由于其他临床目的抽血化验的门诊患者进行HIV筛查策略的可行性,并评价该策略的实施效果,为进一步扩大HIV检测提供新的思路.方法 采用自身前后对照的类实验设计,选择某县人民医院门诊部前瞻性实施该策略4个月,同时选择实施前相同长度的时间段作为对照,收集策略实施前后的HIV检测数和新检出HIV阳性数,比较实施前后的效果.结果 实施该策略后门诊患者HIV检测量增加22.3倍,新检出HIV阳性人数从5人增加到19人(P=0.002),早期检出HIV阳性人数从1人增加到7人(P=0.025).结论 医疗机构门诊全部抽血患者实施艾滋病筛查策略可行性较好,能够显著增加门诊患者检测率,有力促进了HIV感染者的多发现和早发现.%Objective To study the feasibility and effectiveness of a new provider- initiated HIV testing and counselling (PITC) strategy, in which all patiens in an outpatient department with blood withdrawn for any clinical reason were tested for HIV. Methods Quasi experiment design with pre - and post - comparison was applied. The outpatient department of a oounty hospital was selected to oonduct the new PITC strategy in a period of 4 months, and the same time span before PITC strategy was set as control period. Main outcome measure was number of patients with newly identified HIV infection. Results HIV testing volume increased 22.3 folds after the implementation of the new PITC strategy. Newly identified HIV cases increased from 5 to 19(P = 0.002) and those with early diagnosis increased from 1 to 7(P = 0.025). Conclusions The new PITC strategy works fairly well in clinical settings and it can dramatically increase the testing rate among patients in the outpatient department, which subsequently contributes to more and earlier identification of latent HIV cases.

  10. Elderly alcoholics in outpatient treatment

    DEFF Research Database (Denmark)

    Nielsen, Bent; Nielsen, Anette Søgaard; Lolk, Anette

    2010-01-01

    In Denmark, the treatment of alcoholics is provided by public outpatient alcohol clinics. The purpose of this study was to investigate whether elderly patients differ from younger patients with regards to sociodemographic data, drinking pattern and psychiatric comorbidity which may affect...

  11. Clostridium difficile Infection in Outpatients

    Centers for Disease Control (CDC) Podcasts

    2011-11-07

    Dr. Jon Mark Hirshon, Associate Professor of Emergency Medicine at the University of Maryland School of Medicine, discusses Clostridium difficile infection in outpatients.  Created: 11/7/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/21/2011.

  12. Basic Stand Alone Medicare Outpatient Procedures PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Outpatient Procedures Public Use Files (PUF) with information from Medicare outpatient claims. The CMS BSA...

  13. Comparison of Antibiograms Developed for Inpatients and Primary Care Outpatients

    Science.gov (United States)

    McGregor, Jessina C.; Bearden, David T.; Townes, John M.; Sharp, Susan E.; Gorman, Paul N.; Elman, Miriam R.; Mori, Motomi; Smith, David H.

    2013-01-01

    To support antimicrobial stewardship, some healthcare systems have begun creating outpatient antibiograms. We developed inpatient and primary care outpatient antibiograms for a regional health maintenance organization (HMO) and academic healthcare system (AHS). Antimicrobial susceptibilities from 16,428 Enterococcus, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa cultures from 2010 were summarized and compared. Methicillin susceptibility among S. aureus was similar in inpatients and primary care outpatients (HMO: 61.2% vs. 61.9%, p=0.951; AHS: 62.9% vs. 63.3%, p>0.999). E. coli susceptibility to trimethoprim/sulfamethoxazole was also similar (HMO: 81.8% vs. 83.6%, p=0.328; AHS: 77.2% vs. 80.9%, p=0.192), but ciprofloxacin susceptibility differed (HMO: 88.9% vs. 94.6%, p<0.001; AHS: 81.2% vs. 90.6%, p<0.001). In the HMO, ciprofloxacin-susceptible P. aeruginosa were more frequent in primary care outpatients than inpatients (91.4% vs. 79.0%, p=0.007). Comparison of cumulative susceptibilities across settings yielded no consistent patterns; therefore, outpatient primary care antibiograms may more accurately inform prudent empiric antibiotic prescribing. PMID:23541690

  14. Evaluation and comparison of the nutrition care process for persons with diabetes among inpatient and outpatient dietitians.

    Science.gov (United States)

    Meyer, G R; Gates, G E

    1993-01-01

    The purpose of this study was to compare the problem-solving skills used by dietitians when planning care for inpatient and outpatient persons with type II diabetes. Telephone interviews were conducted with 44 inpatient dietitians and 45 outpatient dietitians. Inpatient dietitians used more information from the medical record to make clinical judgments than outpatient dietitians. Inpatient dietitians reported condensing their assessment more frequently due to time pressure than outpatient dietitians. Inpatient dietitians were more likely to identify nutrition-related problems via information from the medical record while outpatient dietitians reported using diet history information. Outpatient dietitians more frequently identified specific behavioral goals whereas inpatient dietitians recommended general goals. The increased availability of objective, detailed information necessary for a thorough nutritional assessment is an advantage of inpatient care planning. However, outpatient diabetes education may be a preferred setting because of more time available for education and better learning effectiveness.

  15. 78 FR 74825 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical...

    Science.gov (United States)

    2013-12-10

    ..., Clinical Modification ICD Implantable cardioverter defibrillator ICU Intensive care unit IHS Indian Health... (APC 0415) b. Direct Laryngoscopy (APC 0074) c. Pulmonary Rehabilitation Services (APC 0077) 10. Other... OP-24: Cardiac Rehabilitation Measure: Patient Referral from an Outpatient Setting D....

  16. Outpatient pulmonary rehabilitation – rehabilitation models and shortcomings in outpatient aftercare

    Directory of Open Access Journals (Sweden)

    Dietl, Markus

    2010-01-01

    Full Text Available Background: The chronic obstructive pulmonary disease (COPD and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. Objectives: The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Methods: Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI. In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Results: Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C. The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based, by the length of intervention (from two weeks to 36 months, by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Discussion: Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction

  17. Outpatients. A pretty little sum.

    Science.gov (United States)

    Jones, R

    2001-02-01

    Achieving the government's target of a maximum wait of 13 weeks for a first outpatient appointment requires a greater appreciation of randomness in the GP referral rate and non-attendance rate. It is possible to analyse what effect randomness will have on waiting times. The number of GP referrals received in December is a critical factor in determining end-of-year performance in meeting the 13-week target.

  18. [Outpatient rheumatologic treatment in Germany].

    Science.gov (United States)

    Edelmann, E

    2014-03-01

    Outpatient rheumatologic treatment in Germany is managed by rheumatologists in private practice (n = 557), by authorized rheumatism outpatient centers (n = 116), by rheumatism centers according to §116b (n = 43) and by university outpatient departments. A total number of 975 rheumatologists were registered by the end of 2012 of whom approximately 830 were active in outpatient care. With this number of rheumatologists Germany is in the middle range in comparison to eight industrial nations including the USA. This number is not sufficient to provide adequate medical care and the consequences are too long waiting times for an appointment with a rheumatologist. Statistical data of the Kassenärztliche Bundesvereinigung (KBV, National Association of Statutory Health Insurance Physicians) showed 688,000 general insurance patients with rheumatoid arthritis (RA). As some 68.9 % of the population are in this insurance scheme there are some 770,000 RA patients in Germany (almost 1 % of the population). One way to improve rheumatology care in spite of the lack of rheumatologists could be special agreements with the general health insurance providers to improve cooperation and division of responsibilities between rheumatologists and general practitioners, to implement patient education, tighter control and treat to target in rheumatology care. Another way could be a new treatment level called "ambulant specialist care", with no budget for medical care and no budget for the number of patients treated and therefore the chance for rheumatologists to treat more patients and have a better income. To achieve that more young doctors receive approval as a specialist in rheumatology, more chairs of rheumatology at universities and a nationwide stipendium for training assistants are needed.

  19. Can bariatric surgery be done as an outpatient procedure?

    Science.gov (United States)

    McCarty, Todd M

    2006-01-01

    It has become increasing clear that some types of bariatric surgery can be performed as outpatient operations. This is currently limited to lap-band, lap-RYGB, and some lap-revision operations, but may soon be applicable to other bariatric procedures. In fact, most lap-band procedures are currently performed in ambulatory surgical centers that often lack the capacity for an overnight stay. Lap-RYGB has been recently reported with 23-hour outpatient admission requiring an overnight stay. Careful patient selection, surgeon experience, and integrating the appropriate perioperative care components are associated with clinical success. Surgeon recognition of these possibilities and patient demand are already pushing this care across the nation. Only time will tell how many other bariatric operations will be performed as outpatient procedures, but if the past is any indication of the future, this trend should continue to increase. The question thus is not whether bariatric surgery can be done as an outpatient procedure, but rather by whom and in what setting can patient outcome be optimized. In the end, rhetoric is rhetoric and data are data, and we should let documented patient outcome, the crown jewel of bariatric surgery, guide the future.

  20. TV Outpatient Department Is Welcomed

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    A middle school teacher living in Huairou, located on the outskirts of Beijing, dialed the number of the "Outpatient Department" on the Beijing TV Station. She asked the medical specialists about cervical cancer. A woman professor answered: "Of all the pernicious tumors, cervical cancer responds the best to treatment. After an operation the five-year survival rate is 60 percent. Commonly speaking, the earlier the cancer is found, the better the chance for cure. The five-year survival rate of the first stage of cervical cancer call be more than 90 percent."

  1. Screening for mental disorders in cardiology outpatients

    DEFF Research Database (Denmark)

    Birket-Smith, M.; Rasmussen, A.

    2008-01-01

    The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86......, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment Udgivelsesdato: 2008...

  2. 42 CFR 419.22 - Hospital outpatient services excluded from payment under the hospital outpatient prospective...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospital outpatient services excluded from payment under the hospital outpatient prospective payment system. 419.22 Section 419.22 Public Health CENTERS... PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and...

  3. Patient agenda setting in respiratory outpatients: A randomized controlled trial.

    Science.gov (United States)

    Early, Frances; Everden, Angharad Jt; O'Brien, Cathy M; Fagan, Petrea L; Fuld, Jonathan P

    2015-11-01

    Soliciting a patient's agenda (the reason for their visit, concerns and expectations) is fundamental to health care but if not done effectively outcomes can be adversely affected. Forms to help patients consider important issues prior to a consultation have been tested with mixed results. We hypothesized that using an agenda form would impact the extent to which patients felt their doctor discussed the issues that were important to them. Patients were randomized to receive an agenda form to complete whilst waiting or usual care. The primary outcome measure was the proportion of patients agreeing with the statement 'My doctor discussed the issues that were important to me' rated on a four-point scale. Secondary outcomes included other experience and satisfaction measures, consultation duration and patient confidence. There was no significant effect of agenda form use on primary or secondary outcomes. Post hoc exploratory analyses suggested possible differential effects for new compared to follow-up patients. There was no overall benefit from the form and a risk of detrimental impact on patient experience for some patients. There is a need for greater understanding of what works for whom in supporting patients to get the most from their consultation.

  4. New Chronic Pain Treatments in the Outpatient Setting: Review Article.

    Science.gov (United States)

    Grandhe, R; Souzdalnitski, D; Gritsenko, K

    2016-05-01

    Chronic pain is an issue encountered by many health care providers in their routine clinical practice. In addition to generalized patient suffering, this condition has significant clinical, psychological, and socioeconomic impact due to its widespread occurrence. The landscape of chronic pain management has been changing rapidly with an array of treatment innovations, better understanding of established therapies, and care coordination across specialties. In this article, we have reviewed emerging new modalities as well as transformation of established therapies by interventional, pharmacologic, rehabilitative, psychological, complimentary, and interdisciplinary approaches.

  5. Management of plantar fasciitis in the outpatient setting.

    Science.gov (United States)

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-04-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality.

  6. Management of plantar fasciitis in the outpatient setting

    OpenAIRE

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-01-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-li...

  7. An association between air pollution and daily outpatient visits for respiratory disease in a heavy industry area.

    Directory of Open Access Journals (Sweden)

    Kuo-Ying Wang

    Full Text Available In this work we used daily outpatient data from the Landseed Hospital in a heavily industrial area in northern Taiwan to study the associations between daily outpatient visits and air pollution in the context of a heavily polluted atmospheric environment in Chung-Li area during the period 2007-2011. We test the normality of each data set, control for the confounding factors, and calculate correlation coefficient between the outpatient visits and air pollution and meteorology, and use multiple linear regression analysis to seek significance of these associations. Our results show that temperature and relative humidity tend to be negatively associated with respiratory diseases. NO and [Formula: see text] are two main air pollutants that are positively associated with respiratory diseases, followed by [Formula: see text], [Formula: see text], [Formula: see text], CO, and [Formula: see text]. Young outpatients (age 0-15 years are most sensitive to changing air pollution and meteorology factors, followed by the eldest (age [Formula: see text]66 years and age 16-65 years of outpatients. Outpatients for COPD diseases are most sensitive to air pollution and meteorology factors, followed by allergic rhinitis, asthma, and pneumonia diseases. In the context of sex difference to air pollution and meteorological factors, male outpatients are more sensitive than female outpatients in the 16-65 age groups, while female outpatients are more sensitive than male outpatients in the young 0-15 age groups and in the eldest age groups. In total, female outpatients are more sensitive to air pollution and meteorological factors than male outpatients.

  8. Anthroposophical Reflections on Basic Income

    DEFF Research Database (Denmark)

    Christensen, Erik; Birnbaum, Simon

    2007-01-01

    In the 1930s Danish author and painter Johannes Hohlenberg (1881-1960) published several essays in defense of an unconditional income for all. These original writings, strongly influenced by Rudolf Steiner's anthroposophy, are not widely known. This article makes two of Hohlenberg's essays...

  9. Anesthesia for outpatient female sterilization.

    Science.gov (United States)

    Fishburne, J I

    1983-04-01

    This issue of the Bulletin deals with the principles of anesthesia for outpatient female sterilization with emphasis on techniques for laparoscopy and minilaparotomy. General anesthesia techniques provide analgesia, amnesia, and muscle relaxation and are particularly useful for managing the anxious patient. Disadvantages include increased expense, need for specialized equipment, and highly trained personnel, and delayed recovery. Complications, though relatively rare, can be life-threatening and include aspiration of stomach contents, hypoxia, hypercarbia, hypotension, hypertension, cardiac arrhythmias, cardiorespiratory arrest, and death. There is no single preferred technique of general anesthesia, athough most anesthetists employ methods that allow rapid recovery of faculties, enabling the patient to be discharged soon after surgery. To accomplish this end, light anesthesia with sodium thiopental induction and nitrous oxide maintenance is often used. Short duration muscle relaxation with an agent such as succinylcholine supplements this technique. Other techniques include light anesthesia with inhalational anesthetic agents and the use of intravenous ketamine. Local anesthesia augmented by systemic and/or inhalational analgesia is supplanting general anesthesia techniques for laparoscopy in many locales. This approach is also particularly well-suited for minilaparotomy in developing countries, where it has achieved its greatest popularity. The local technique carries with it reduced morbidity and mortality but may not entirely relieve discomfort. The primary danger of local anesthesia is respiratory depression due to excessive narcosis and sedation. The operator must be alert to the action of the drugs and should always use the minimal effective dose. Although toxicity due to overdosage with local anesthetic drugs is occasionally experienced, allergic reactions to the amide-linkage drugs such as lidocaine or bupivacaine are exceedingly rare. For outpatient

  10. CLINICAL STATISTICAL STUDIES ON HEMATURIA IN OUTPATIENTS

    OpenAIRE

    青木, 正治; 熊本, 悦明

    1982-01-01

    Clinical statistical studies on hematuria were performed in outpatients who were seen at our Department, during the 7-year period from 1974 through 1980. Of the 11,574 outpatients studied, the total number of outpatients with hematuria 1,705; macroscopic hematuria was found in 446 cases (3.9%) and microscopic hematuria was in 1,259 cases (10.9%). The most frequent cause of macroscopic hematuria was malignant urinary tumors and that of microscopic hematuria was urinary tract infections. Macros...

  11. Effectiveness of outpatient, day hospital, and inpatient psychotherapeutic treatment for patients with Cluster B personality disorders

    NARCIS (Netherlands)

    A. Bartak; H. Andrea; M.D. Spreeuwenberg; U.M. Ziegler; J. Dekker; B.V. Rossum; E.F.M Hamers; W. Scholte; J. Aerts; J.J.V. Busschbach; R. Verheul; T. Stijnen; P.M.G. Emmelkamp

    2011-01-01

    Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital

  12. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  13. Dexamethasone for pain after outpatient shoulder surgery

    DEFF Research Database (Denmark)

    Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld

    2014-01-01

    Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....

  14. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis : pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

    NARCIS (Netherlands)

    Koek, Mayke B. G.; Buskens, Erik; van Weelden, Huib; Steegmans, Paul H. A.; Bruijnzeel-Koomen, Carla A. F. M.; Sigurdsson, Vigfus

    2009-01-01

    Objective To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis. Design Pragmatic multicentre single blind randomised clinical trial (PLUTO study). Setting Dermatology departmen

  15. Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series

    Directory of Open Access Journals (Sweden)

    Friedman Jonathan A

    2009-03-01

    Full Text Available Abstract Background Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P. Methods All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care. Results 64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14, older age (1, and patient preference (2. At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia. Conclusion In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.

  16. Seasonal Influenza Vaccine Uptake in a Respiratory Outpatients Clinic

    LENUS (Irish Health Repository)

    Rossiter, A

    2017-02-01

    Influenza is an acute viral respiratory illness that continues to cause significant morbidity and mortality in Ireland. Despite well-established national and international guidelines1 and increased public awareness campaigns, vaccine uptake rates are well below target worldwide2. We performed an audit of influenza vaccine uptake at a Respiratory outpatient clinic in a tertiary referral centre. 54% (n=41) of patients received the annual vaccine, well below the target of 75% set by the European Centre for Disease Prevention and Control (ECDC).

  17. Intensive Behavioral Treatment of Urinary Incontinence of Children with Autism Spectrum Disorders: An Archival Analysis of Procedures and Outcomes from an Outpatient Clinic

    Science.gov (United States)

    Hanney, Nicole M.; Jostad, Candice M.; LeBlanc, Linda A.; Carr, James E.; Castile, Allison J.

    2013-01-01

    LeBlanc, Crossett, Bennett, Detweiler, and Carr (2005) described an outpatient model for conducting intensive toilet training with young children with autism using a modified Azrin and Foxx, protocol. In this article, we summarize the use of the protocol in an outpatient setting and the outcomes achieved with a large sample of children with autism…

  18. Success and safety in outpatient microlumbar discectomy.

    Science.gov (United States)

    Best, Natalie M; Sasso, Rick C

    2006-07-01

    Currently, many spine surgeons perform microlumbar discectomies on an outpatient basis. Yet, it is often customary for patients to have a 1-night stay in the hospital. Many studies have shown the efficacy of microlumbar discectomy (MLD) and its preference among surgeons for the treatment of lumbar disc herniation. It has also been shown to be safe, successful, and cost-effective. However, a large comprehensive study of this magnitude, gauging safety, success, and patient satisfaction for these procedures on an outpatient basis has not yet been done. One thousand three hundred seventy-seven MLD procedures have been done from 1992 to 2001 by 1 surgeon. A retrospective chart review was done on all procedures. Patients were then contacted by either telephone or mail to complete an outcome questionnaire. Seven hundred thirteen patients (53.9%) completed the questionnaire. Follow-up questionnaires were not completed due to deaths, incorrect contact information, and refused responses. Out of all MLD procedures, 55 (4.0%) were done with a hospital stay-only 24 of these (1.7%) were originally intended outpatient procedures. Of those that were done on an outpatient basis, 8.6% had a complication, including 6.4% who had a recurrent disc herniation. When asked, 81.6% said they would undergo the procedure again as an outpatient. In 82.1% the surgery's outcome was good, very good, or excellent. MLD is a routine procedure that can be performed on an outpatient basis safely, successfully, and with high patient satisfaction.

  19. Climbing Stairs After Outpatient Rehabilitation for a Lower-Limb Amputation

    NARCIS (Netherlands)

    de Laat, Fred A.; Rommers, Gerardus M.; Dijkstra, Pieter U.; Geertzen, Jan H.; Roorda, Leo D.

    2013-01-01

    Objective: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: Persons with an

  20. Group Outpatient Physical and Behavioral Therapy for Chronic Low Back Pain.

    Science.gov (United States)

    Cohen, Michael J.; And Others

    1983-01-01

    Compared the effectiveness of behavioral (BT) or physical therapy (PT) for treating chronic low back pain (CLBP), for 13 BT patients and 12 PT patients. Treatments were conducted in a group outpatient setting. Posttreatment results showed general improvement for patients in both groups, but few treatment-specific differences in outcome measures.…

  1. The Use of a Token Economy to Improve Patient Responsibility in an Outpatient Methadone Maintenance Clinic.

    Science.gov (United States)

    Kelly, John S.; Gambatese, Richard J.

    Previous studies have shown that the use of behavior modification techniques, specifically the use of token reinforcement systems, can produce positive changes in the behavior of heroin addicts within a hospital setting. A token economy program was assessed to determine the effectiveness of such a program with patients in an outpatient methadone…

  2. 42 CFR 413.124 - Reduction to hospital outpatient operating costs.

    Science.gov (United States)

    2010-10-01

    ... surgical center approved surgical procedures performed in the hospital outpatient setting under § 413.118.... 413.124 Section 413.124 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

  3. Developing a nurse led hospice outpatient clinic to improve palliative care services.

    Science.gov (United States)

    Lawton, Catherine

    A team of palliative care clinical nurse specialists at the Phyllis Tuckwell Hospice in Farnham, Surrey, set up a hospice based outpatient clinic to improve services for patients with cancer. This article examines how the team used clinical audit, a staff questionnaire and patient feedback to evaluate the service and make recommendations for the future development of the clinic.

  4. Aggression Replacement Training for Violent Young Men in a Forensic Psychiatric Outpatient Clinic

    NARCIS (Netherlands)

    Hornsveld, R.H.; Kraaimaat, F.W.; Muris, P.; Zwets, A.J.; Kanters, T.

    2015-01-01

    The effects of Aggression Replacement Training (ART) were explored in a group of Dutch violent young men aged 16 to 21 years, who were obliged by the court to follow a treatment program in a forensic psychiatric outpatient clinic. To evaluate the training, patients completed a set of self-report que

  5. Effectiveness of Intensive Outpatient Programming in Private Practice: Integrating Practice, Outcomes, and Business

    Science.gov (United States)

    Wise, Edward A.

    2005-01-01

    The development of a model for treating acutely depressed patients on a frequent basis in an independent practice setting is described. Strategies to collaborate with managed care organizations, employee assistance programs, and local provider networks to recruit these patients are outlined. The patients treated in the intensive outpatient program…

  6. [Dimensional modeling analysis for outpatient payments].

    Science.gov (United States)

    Guo, Yi-zhong; Guo, Yi-min

    2008-09-01

    This paper introduces a data warehouse model for outpatient payments, which is designed according to the requirements of the hospital financial management while dimensional modeling technique is combined with the analysis on the requirements. This data warehouse model can not only improve the accuracy of financial management requirements, but also greatly increase the efficiency and quality of the hospital management.

  7. Motivation to change drinking behavior: the differences between alcohol users from an outpatient gastroenterology clinic and a specialist alcohol treatment service

    Directory of Open Access Journals (Sweden)

    Neliana Buzi Figlie

    Full Text Available CONTEXT AND OBJECTIVE: For some patients who have developed significant alcohol-related physical disease, total abstinence from alcohol may offer the best chance of survival. The aim of this study was to investigate motivation for treatment in two groups of alcohol users: outpatients from the gastroenterology clinic and outpatients from the specialist alcohol treatment service. DESIGN AND SETTING: Cross-sectional study, at a federally funded public teaching hospital. METHODS: The sample studied was 151 outpatients from the gastroenterology clinic and 175 from the specialist alcohol treatment service. The interview was conducted in the outpatient clinics at the first appointment, and consisted of demographic questions and scales for measuring quality of life, alcohol dependence, pattern of alcohol, motivation for treatment and consequences of alcohol consumption. RESULTS: The results suggested that outpatients from the gastroenterology clinic were less dependent on alcohol, had suffered fewer consequences from alcohol and had fewer emotional and mental health problems than did the outpatients from the alcohol treatment service. In relation to their stages of change, the gastroenterology outpatients presented high precontemplation scores at the beginning of treatment while outpatients of alcohol treatment service showed higher scores in contemplation, action and maintenance. CONCLUSION: The medical treatment may be a reason for the temporary alcohol abstinence behavior among the gastroenterology outpatients.

  8. Resident physicians' perspectives on effective outpatient teaching: a qualitative study.

    Science.gov (United States)

    Kisiel, John B; Bundrick, John B; Beckman, Thomas J

    2010-08-01

    Learning theories, which suggest that experienced faculty use collaborative teaching styles, are reflected in qualitative studies of learners in hospital settings. However, little research has used resident focus groups to explore characteristics of successful teachers in outpatient clinics. Therefore, focus group discussions with first through third-year internal medicine residents at a large academic medical center were conducted to better understand residents' perspectives on effective outpatient teaching. A group facilitator solicited residents' reflections, based on their lived experiences, on teaching domains from previous factor analytic studies: interpersonal, clinical-teaching, and efficiency. Researchers coded focus group transcripts and identified themes within the domains. Final themes were determined by consensus. Leading themes were "kindness" and "teacher-learner relationships." Junior residents were sensitive to faculty who were brusque, harsh, and degrading. Senior residents respected faculty who were humble, collaborative, and allowed residents to co-manage teaching encounters. Seniors emphasized the importance of faculty role-modelling and preferentially staffed with experts to "gain wisdom from experience." Overall, residents expressed that effective learning requires grounded teacher-learner relationships. These findings support learning theories and previous factor analytic studies. However, this qualitative study provided insights that could not be gleaned from assessment scores alone.

  9. Utilization of outpatient mental health services after inpatient alcoholism treatment.

    Science.gov (United States)

    Booth, B M; Cook, C A; Blow, F C; Bunn, J Y

    1992-01-01

    It is generally agreed that use of aftercare services following discharge from alcoholism treatment is optimum for patients to achieve long-term recovery. However, the quantity and duration of utilization of such services in non-experimental settings are generally unknown. Using secondary data sources, we studied 5,635 alcoholics completing formal extended inpatient treatment and 1,860 alcoholics discharged from brief inpatient hospitalizations in Department of Veterans Affairs medical centers. Weekly use of outpatient mental health services (OPMH) prior to hospital admission was equally low for both patient groups (approximately 2-3% of patients) until four weeks prior to admission, at which time OPMH use increased, particularly for the extended treatment group. In the four weeks after discharge, use of OPMH services was substantially higher for patients with extended treatment compared to those with brief hospitalizations (40% vs. 18%), with 22% of patients completing treatment utilizing such services in the first week after discharge. Utilization steadily decreased until only 8% and 4% of both groups, respectively, were using OPMH services at the end of six months after discharge. Study results suggest the need to examine barriers to outpatient mental health utilization after discharge as well as interventions to increase compliance with long-term aftercare.

  10. Views on treatment adherence among psychoactive substance-dependent women in the outpatient setting: a qualitative study Significados atribuídos por mulheres dependentes de substâncias psicoativas à adesão ao tratamento no contexto ambulatorial: um estudo qualitativo

    Directory of Open Access Journals (Sweden)

    Dione Viégas Almeida Ribeiro

    2012-01-01

    Full Text Available INTRODUCTION: In the female population, adherence to specialist clinical treatment for psychoactive substance dependence has peculiar characteristics in terms of therapeutic approaches available to addicts in general. A smaller number of women seek specialist treatment in comparison with men. Traditionally, most health care services specializing in chemical dependence provide similar therapies to both men or women, including the use of mixed-sex groups at some facilities. OBJECTIVE: To discuss the views or psychological meanings attributed by women with substance use disorders to phenomena associated with adherence to treatment at a specialist university outpatient clinic. METHODS: The qualitative-clinical method was used, i.e., an approach characterized by the typically qualitative focus of human sciences adapted to health care settings. The semi-structured interview technique with open questions was used for data collection, combined with observation of the women interviewed. Data were processed using qualitative content analysis. RESULTS: Three categories of treatment outcomes emerged: 1 significant motivations to seek and follow the treatment proposed; 2 symbolic meanings attributed to the drug; 3 psychological representations of lack of motivation to explain difficulties adhering to treatment. CONCLUSIONS: Our findings suggest that the motivations of addicted women to seek treatment vary, but highlight the fact that the substance used becomes perceived as something that causes significant losses and hinders the proper exercise of women’s role in family and social contexts. A warm welcoming is considered essential for a patient to adhere to treatment, offsetting the strong physical pleasure associated with psychoactive substance use.INTRODUÇÃO: Na população feminina, a adesão a tratamentos clínicos especializados em dependência de substâncias psicoativas tem características peculiares quando se considera as abordagens terap

  11. Outpatient experience with oesophageal endoscopic dilation.

    Science.gov (United States)

    Jani, P G; Mburugu, P G

    1998-07-01

    Between March 1990 and August 1997, outpatient endoscopic balloon dilation was performed for oesophageal strictures which developed secondary to malignancies, peptic strictures, post surgical narrowing, achalasia cardia, corrosive ingestion and other causes. A total of 169 dilations were performed in the 92 cases with an average of 1.8 dilation/case (Range 1 to 8). Dilation was possible in all 92 cases without the need for fluoroscopic monitoring. Twenty three (13.6%) of the dilations were performed using pneumatic balloon while in 146(86.4%) cases wire guided metal olives were used. There were nine minor complications which were treated with medication on an outpatient basis and four major complications which required inpatient care. Three of these had perforation of the oesophagus and one died. One other patient developed aspiration pneumonia and subsequently died.

  12. Medical Savings Account balance and outpatient utilization: Evidence from Guangzhou, China.

    Science.gov (United States)

    Zhang, Hui; Yuen, Peter P

    2016-02-01

    Medical Savings Account (MSA) is a financing instrument designed to reduce consumer-side moral hazards. The Urban Employee Basic Medical Insurance (UEBMI) scheme in China has an MSA component in addition to a Social Risk-pooling Fund. This study examines the association between MSA balance and outpatient utilization in Guangzhou, China, and determines MSA's impact on utilization under different circumstances. It also seeks to ascertain whether MSA has achieved its intended functions of "Cost-containment", "Saving for the future" and "Enabling utilization". The first group of 114,657 MSA account-holders, including both employees and retirees, who consistently insured with UEBMI from 2002 to 2007, are selected for this study. A two-part model is employed to estimate the effect of the MSA balance on the probability of outpatient services utilization and on the level of outpatient expenditure. Results show that MSA balance is significantly associated with the likelihood of using outpatient services as well as the level of outpatient expenditure. The association is a non-linear U-shaped relationship for working individuals, and an inverted U-shaped relationship for the retirees. The observed U-shaped relationship for working individuals implies that at lower MSA balance levels, a negative balance-expenditure relation exits, while at higher MSA balance levels, the relationship is positive--suggesting possible improper utilization when MSA balance reaches high levels. Setting a maximum MSA balance limit and/or allowing enrollees to use MSA funds to purchase private insurance appears to be desirable. The observed inverted U-shaped relationship for retirees suggests that many retirees have to spend whatever funds they have in their MSA for outpatient care, but the less healthy individuals are able to shift the spending to inpatient care which is mainly financed by the Social Risk-pooling Fund. The results of this study also affirm the usefulness of MSA in performing its

  13. Value and Clinical Impact of an Infectious Disease-Supervised Outpatient Parenteral Antibiotic Therapy Program

    Science.gov (United States)

    Petrak, Russell M.; Skorodin, Nathan C.; Fliegelman, Robert M.; Hines, David W.; Chundi, Vishnu V.; Harting, Brian P.

    2016-01-01

    Background. Outpatient parenteral antibiotic therapy (OPAT) is a safe and effective modality for treating serious infections. This study was undertaken to define the value of OPAT in a multicentered infectious disease (ID) private practice setting. Methods. Over a period of 32 months, 6120 patients were treated using 19 outpatient ID offices in 6 states. Analysis included patient demographics, indications of OPAT, diagnoses, therapeutic agent, duration of therapy, and site of therapy initiation. Outcomes were stratified by therapeutic success, clinical relapse, therapeutic complications, and hospitalizations after initiating therapy. Statistical analysis included an ordinal logistic regression analysis. Results. Forty-three percent of patients initiated therapy in an outpatient office, and 57% began therapy in a hospital. Most common diagnoses treated were bone and joint (32.2%), abscesses (18.8%), cellulitis (18.5%), and urinary tract infection (10.8%). Ninety-four percent of patients were successfully treated, and only 3% were hospitalized after beginning therapy. Most common cause of treatment failure was a relapse of primary infection (60%), progression of primary infection (21%), and therapeutic complication (19%). Conclusions. An ID-supervised OPAT program is safe, efficient, and clinically effective. By maximizing the delivery of outpatient care, OPAT provides a tangible value to hospitals, payers, and patients. This program is a distinctive competency available to ID physicians who offer this service to patients.

  14. Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-07-01

    Full Text Available Juraj Artner, Stephan Kurz, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain.Methods: The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation.Results: Based on Oswestry Disability Index (ODI and Numeric Rating Scale (NRS scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks.Conclusion: This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results.Keywords: chronic back pain, intense, multidisciplinary, program, outpatient

  15. A comparative analysis of coverage decisions for outpatient pharmaceuticals: evidence from Denmark, Norway and Sweden.

    Science.gov (United States)

    Grepstad, Mari; Kanavos, Panos

    2015-02-01

    This study analyses the reasons for differences and similarities in coverage recommendations for outpatient pharmaceuticals in Denmark, Norway and Sweden, following HTA appraisals. A comparative analysis of all outpatient drug appraisals carried out between January 2009 and December 2012, including an analysis of divergent coverage recommendations made by all three countries was performed. Agreement levels between HTA agencies were measured using kappa scores. Consultations with stakeholders in the three countries were carried out to complement the discussion on HTA processes and reimbursement outcomes. Nineteen outpatient drug-indication pairs appraised in each of the three countries were identified, of which 6 pairs (32%) had divergent coverage recommendations. An uneven distribution of coverage recommendations was observed, with the highest overlap in appraisals between Norway and Sweden (free-marginal kappa 0.89). Similarities were found in priority setting principles, mode of appraisal and reasoning for coverage recommendations. The study shows that health economic evaluation is less prominent or explicit in outpatient drug appraisals in Denmark than in Norway and Sweden, that all three countries could benefit from improved communication between appraisers and manufacturers, and that final coverage recommendations rely on factors other than safety, comparative efficacy or cost-effectiveness.

  16. Involuntary outpatient treatment (IOT) in Spain.

    Science.gov (United States)

    Hernández-Viadel, M; Cañete-Nicolás, C; Bellido-Rodriguez, C; Asensio-Pascual, P; Lera-Calatayud, G; Calabuig-Crespo, R; Leal-Cercós, C

    2015-01-01

    In recent decades there have been significant legislative changes in Spain. Society develops faster than laws, however, and new challenges have emerged. In 2004, the Spanish Association of Relatives of the Mentally Ill (FEAFES) proposed amending the existing legislation to allow for the implementation of involuntary outpatient treatment (IOT) for patients with severe mental illness. Currently, and after having made several attempts at change, there is no specific legislation governing the application of this measure. Although IOT may be implemented in local programmes, we consider legal regulation to be needed in this matter.

  17. Contingency management is effective across cocaine-dependent outpatients with different socioeconomic status.

    Science.gov (United States)

    Secades-Villa, Roberto; García-Fernández, Gloria; Peña-Suárez, Elsa; García-Rodríguez, Olaya; Sánchez-Hervás, Emilio; Fernández-Hermida, José Ramón

    2013-03-01

    Contingency management (CM) has demonstrated its efficacy for treating cocaine dependence, but there is still some controversy with regard to its dissemination. Understanding how individual differences affect CM outcomes is important for detecting barriers to its dissemination. The aim of this study is to examine the impact of socioeconomic variables in cocaine-dependent outpatients on the effectiveness of CM in a community setting. Cocaine-dependent outpatients (N=118) were randomized to community reinforcement approach (CRA) treatment or a CRA plus vouchers program. The impact of baseline economic variables, alone and in combination with treatment conditions, on abstinence and retention outcomes after 6 months of treatment was assessed. Results showed that income had no effect on retention or abstinence outcomes after 6 months of treatment in either treatment condition. The addition of a CM component was beneficial for individuals with any socioeconomic status. These results support the generalizability of CM strategies with patients of different socioeconomic status in community settings.

  18. Florida's outpatient commitment law: a lesson in failed reform?

    Science.gov (United States)

    Petrila, John; Christy, Annette

    2008-01-01

    An involuntary outpatient commitment law became effective in Florida in January 2005. However, only 71 orders for outpatient commitment have been issued in three years, even though during that period 41,997 adults had two or more 72-hour involuntary emergency examinations under Florida's civil commitment law. This column describes the criteria for outpatient commitment in the Florida statute and discusses possible reasons for its low rate of use, including additional statutory criteria that make filing a petition for outpatient commitment difficult, lack of community treatment resources, and lack of enforcement mechanisms.

  19. Outpatient provider concentration and commercial colonoscopy prices.

    Science.gov (United States)

    Pozen, Alexis

    2015-01-01

    The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  20. Outpatient Provider Concentration and Commercial Colonoscopy Prices

    Directory of Open Access Journals (Sweden)

    Alexis Pozen PhD

    2015-04-01

    Full Text Available The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178 433 claims from 169 providers (104 systems. The mean system market share was 76% (SD = 0.34 and the mean real (deflated price was US$1363 (SD = 374, ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility’s bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  1. National trends in outpatient surgical treatment of degenerative cervical spine disease.

    Science.gov (United States)

    Baird, Evan O; Egorova, Natalia N; McAnany, Steven J; Qureshi, Sheeraz A; Hecht, Andrew C; Cho, Samuel K

    2014-08-01

    Study Design Retrospective population-based observational study. Objective To assess the growth of cervical spine surgery performed in an outpatient setting. Methods A retrospective study was conducted using the United States Healthcare Cost and Utilization Project's State Inpatient and Ambulatory Surgery Databases for California, New York, Florida, and Maryland from 2005 to 2009. Current Procedural Terminology, fourth revision (CPT-4) and International Classification of Diseases, ninth revision Clinical Modification (ICD-9-CM) codes were used to identify operations for degenerative cervical spine diseases in adults (age > 20 years). Disposition and complication rates were examined. Results There was an increase in cervical spine surgeries performed in an ambulatory setting during the study period. Anterior cervical diskectomy and fusion accounted for 68% of outpatient procedures; posterior decompression made up 21%. Younger patients predominantly underwent anterior fusion procedures, and patients in the eighth and ninth decades of life had more posterior decompressions. Charlson comorbidity index and complication rates were substantially lower for ambulatory cases when compared with inpatients. The majority (>99%) of patients were discharged home following ambulatory surgery. Conclusions Recently, the number of cervical spine surgeries has increased in general, and more of these procedures are being performed in an ambulatory setting. The majority (>99%) of patients are discharged home but the nature of analyzing administrative data limits accurate assessment of postoperative complications and thus patient safety. This increase in outpatient cervical spine surgery necessitates further discussion of its safety.

  2. Prospective controlled assessment of impact of feedback on gastroenterology trainees in outpatient practice.

    LENUS (Irish Health Repository)

    Harewood, Gavin C

    2012-02-01

    BACKGROUND AND AIMS: Previous studies have demonstrated the value of systematic feedback in enhancing endoscopic procedure performance. It remains unknown whether feedback may play a role in modifying physician performance in outpatient practice. This study aimed to assess the impact of systematic feedback on duration of office visits of gastroenterology (GI) trainees in outpatient practice. METHODS: Patients attending a GI outpatient department in an academic medical center were prospectively followed over 4 months. The duration of office visits for consecutive patients seen by five GI fellows of similar experience level were recorded for 2 months (pre-feedback); confidential feedback was then provided to each fellow on a weekly basis for 2 months detailing their individual consultation times and the comparative, anonymous times of the other fellows (post-feedback). RESULTS: Over the course of the study, 1,647 outpatients were seen by five GI fellows. Pre-feedback consultation durations differed significantly with one fellow taking 2.5 times longer than their colleague. Following feedback, times shortened significantly for all fellows, with the greatest impact observed in those trainees taking longer at baseline. There were no significant differences in satisfaction levels among patients seen by each trainee. CONCLUSIONS: There was a wide disparity in the consultation times among GI fellows. Systematic feedback shortened times among all trainees and enhanced uniformity by having the greatest impact among those fellows taking longer at baseline. Routine provision of feedback may be valuable in enhancing uniformity of outpatient practice although clinicians should ensure that shortening consultation visits does not compromise quality of patient care. Future larger studies of feedback in this setting will be enhanced by incorporating objective measures of quality of care and patient satisfaction.

  3. Prospective Controlled Assessment of Impact of Feedback on Gastroenterology Trainees in Outpatient Practice.

    LENUS (Irish Health Repository)

    Harewood, Gavin C

    2011-03-29

    BACKGROUND AND AIMS: Previous studies have demonstrated the value of systematic feedback in enhancing endoscopic procedure performance. It remains unknown whether feedback may play a role in modifying physician performance in outpatient practice. This study aimed to assess the impact of systematic feedback on duration of office visits of gastroenterology (GI) trainees in outpatient practice. METHODS: Patients attending a GI outpatient department in an academic medical center were prospectively followed over 4 months. The duration of office visits for consecutive patients seen by five GI fellows of similar experience level were recorded for 2 months (pre-feedback); confidential feedback was then provided to each fellow on a weekly basis for 2 months detailing their individual consultation times and the comparative, anonymous times of the other fellows (post-feedback). RESULTS: Over the course of the study, 1,647 outpatients were seen by five GI fellows. Pre-feedback consultation durations differed significantly with one fellow taking 2.5 times longer than their colleague. Following feedback, times shortened significantly for all fellows, with the greatest impact observed in those trainees taking longer at baseline. There were no significant differences in satisfaction levels among patients seen by each trainee. CONCLUSIONS: There was a wide disparity in the consultation times among GI fellows. Systematic feedback shortened times among all trainees and enhanced uniformity by having the greatest impact among those fellows taking longer at baseline. Routine provision of feedback may be valuable in enhancing uniformity of outpatient practice although clinicians should ensure that shortening consultation visits does not compromise quality of patient care. Future larger studies of feedback in this setting will be enhanced by incorporating objective measures of quality of care and patient satisfaction.

  4. Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

    Directory of Open Access Journals (Sweden)

    Henry Amanda

    2013-01-01

    Full Text Available Abstract Background Induction of labour (IOL is one of the commonest obstetric interventions, with significant impact on both the individual woman and health service delivery. Outpatient IOL is an attractive option to reduce these impacts. To date there is little data comparing outpatient and inpatient IOL methods, and potential safety concerns (hyperstimulation if prostaglandins, the standard inpatient IOL medications, are used in the outpatient setting. The purpose of this study was to assess feasibility, clinical effectiveness and patient acceptability of outpatient Foley catheter (OPC vs. inpatient vaginal PGE2 (IP for induction of labour (IOL at term. Methods Women with an unfavourable cervix requiring IOL at term (N = 101 were randomised to outpatient care using Foley catheter (OPC, n = 50 or inpatient care using vaginal PGE2 (IP, n = 51. OPC group had Foley catheter inserted and were discharged overnight following a reassuring cardiotocograph. IP group received 2 mg/1 mg vaginal PGE2 if nulliparous or 1 mg/1 mg if multiparous. Main outcome measures were inpatient stay (prior to birth, in Birthing Unit, total, mode of birth, induction to delivery interval, adverse reactions and patient satisfaction. Results OPC group had shorter hospital stay prior to birth (21.3 vs. 32.4 hrs, p  Conclusions OPC was feasible and acceptable for IOL of women with an unfavourable cervix at term compared to IP, however did not show a statistically significant reduction in total inpatient stay and was associated with increased oxytocin IOL. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN:12609000420246.

  5. Creative Art Therapy Groups: A Treatment Modality for Psychiatric Outpatients

    Science.gov (United States)

    Drapeau, Marie-Celine; Kronish, Neomi

    2007-01-01

    This brief report examines the benefits of a creative art therapy group program for outpatients suffering from psychiatric disorders. Included is a review of relevant treatment outcomes literature on the effectiveness of group art therapy. The authors describe the Creative Art Therapy Group Program offered to adult psychiatric outpatients that is…

  6. Outpatient antibiotic prescriptions from 1992 to 2001 in The Netherlands

    NARCIS (Netherlands)

    Kuyvenhoven, MM; van Balen, FAM; Verheij, TJM

    2003-01-01

    Objectives: Although Dutch outpatient antibiotic prescription rates are low compared with other European countries, continuing to scrutinize trends in outpatient antibiotic use is important in order to identify possible increases in antibiotic use or inappropriate increases in the use of particular

  7. Evidence-Based Practices in Outpatient Treatment for Eating Disorders

    Science.gov (United States)

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

    This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…

  8. Problems in outpatients with laryngeal hyperplastic lesions.

    Science.gov (United States)

    Goldman, N C

    1997-01-01

    The care of outpatients with epithelial hyperplastic lesions of the larynx presents problems of classification, treatment, continued surveillance and prognosis. One hundred patients who underwent microlaryngoscopy and vocal cord stripping from 1990 through 1995 were studied retrospectively with a follow-up period of 8-156 months. Twenty-eight patients with biopsy proven epithelial hyperplastic lesions were given 21 different pathological diagnoses exclusive of invasive carcinoma following 52 operative microlaryngoscopies. Prognosis was inferred and treatment commenced primarily on the basis of the pathology report. Microlaryngoscopy and stripping with and without the carbon dioxide laser, "watchful waiting," radiation therapy, and partial laryngectomy were all used as treatment modalities. Controversy remains as of choice of treatment. Encouraging the patient to discontinue smoking is an integral part of treatment; however, most patients continue to smoke. Recent changes in the United States health care delivery system present additional problems in surveillance of the patient.

  9. Clozapine prescribing in a Canadian outpatient population.

    Directory of Open Access Journals (Sweden)

    Silvia Alessi-Severini

    Full Text Available OBJECTIVE: Description of demographics of an outpatient population of clozapine users. METHODS: Retrospective chart review study of an urban population diagnosed with schizophrenia. Assessment of therapeutic histories in relation to clinical practice guidelines. RESULTS: Seventy-seven of the 467 patients were on clozapine therapy. Average patients' age was 39.4 ± 11.8 years and 68% were males. The majority of patients (68% had tried 3 or more antipsychotics before switching to clozapine, 21% had tried two and 11% had tried one. Median length of therapy prior to clozapine initiation was 8.9 years in males and 7.7 years in females. CONCLUSION: Until 2010, the use of clozapine was often delayed and more than 2 antipsychotic medications were tried for relatively long periods of time before patients were switched to this effective agent.

  10. Correlates of fractures in elderly, diabetic outpatients.

    Science.gov (United States)

    Snacken, M; Crenier, L; Fery, F; Praet, J-P; Pepersack, T

    2015-10-01

    It is widely recognized that patients presenting diabetes are at increased risk for fractures. In a retrospective case-control study, 101 cases were selected from medical charts of outpatients older than 70 with diabetes mellitus and a fracture within the past 5 years. Glycosylated hemoglobin (HbA1c) had been measured within 4 months around the assessment. Each case was matched for sex and age with one control, diabetic patient with no fracture. HbA1c level was similar in both groups. Patients with fractures presented significantly lower BMIs than controls, and had a higher rate of declared osteoporosis and comorbidity. A small number of cases were using vitamin D supplements while more were treated with benzodiazepine, opiates and Selective serotonin reuptake inhibitors (SSRI). This study suggests that, rather than the tight control of blood glucose, other factors such as medication and comorbidity could be associated with fracture risk in elderly diabetics.

  11. Errors associated with outpatient computerized prescribing systems

    Science.gov (United States)

    Rothschild, Jeffrey M; Salzberg, Claudia; Keohane, Carol A; Zigmont, Katherine; Devita, Jim; Gandhi, Tejal K; Dalal, Anuj K; Bates, David W; Poon, Eric G

    2011-01-01

    Objective To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them. Materials and methods This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system. Results Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors). Discussion About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others. Conclusions Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors. PMID:21715428

  12. Pure analgesics in a rheumatological outpatient clinic

    Directory of Open Access Journals (Sweden)

    M.A. Cimmino

    2011-09-01

    Full Text Available Objective: Pure analgesics are only rarely used by Italian clinicians and this holds true also for rheumatologists. This work is concerned with an evaluation of the use of analgesics in a rheumatological outpatient clinic during the period 1989-1999. Methods: The records of 1705 patients consecutively seen at the clinic were downloaded on a specifically built website. Results: 4469 visits were considered. In 260 of them (5.8%, analgesics were prescribed to 234 (13.7% patients. The number of patients with a prescription of analgesics steadily increased during the years 1989-1999. The diagnoses in patients assuming analgesics were: osteoarthritis (47.1%, inflammatory arthritis (24.2%, soft tissue rheumatisms (13.7%, nonspecific arthralgia/myalgia (7.5%, and connective tissue diseases (2.6%. Peripheral analgesics were used in 188 (82.5% patients and central analgesics were used in the remaining 40 patients (17.5%. Analgesic drugs were used mainly in degenerative joint conditions. The indications for analgesics in the 55 patients with inflammatory arthrits were: (a partial or total remission of arthritis; for this reason non-steroidal anti-inflammatory drugs were no longer required in 18 patients; (b to increase the analgesic effect of NSAIDs in 23 patients; (c contraindications to NSAIDs in 14 patients (renal failure in 2 patients, gastritis in 10, allergy and bleeding in the remaining two. Conclusions: About 14% of our outpatients were treated with analgesics with an increasing trend in the examined period. The main indications for analgesics are degenerative conditions but they can be used also in selected patients with arthritis.

  13. Using soft systems methodology to develop a simulation of out-patient services.

    Science.gov (United States)

    Lehaney, B; Paul, R J

    1994-10-01

    Discrete event simulation is an approach to modelling a system in the form of a set of mathematical equations and logical relationships, usually used for complex problems, which are difficult to address by using analytical or numerical methods. Managing out-patient services is such a problem. However, simulation is not in itself a systemic approach, in that it provides no methodology by which system boundaries and system activities may be identified. The investigation considers the use of soft systems methodology as an aid to drawing system boundaries and identifying system activities, for the purpose of simulating the outpatients' department at a local hospital. The long term aims are to examine the effects that the participative nature of soft systems methodology has on the acceptability of the simulation model, and to provide analysts and managers with a process that may assist in planning strategies for health care.

  14. Observational study identifies non-attendance characteristics in two hospital outpatient clinics

    DEFF Research Database (Denmark)

    Blæhr, Emely; Søgaard, Rikke; Kristensen, Thomas;

    2016-01-01

    INTRODUCTION: Non-attended hospital appointments are receiving increasing attention in times when rapid access and efficient service delivery at public hospitals are on the agenda. The aim of this study was to investigate the extent of non-attendance in a Danish outpatient setting and its...... association with user-level and provider-level characteristics. METHODS: The study was based on appointments scheduled from June 2013 to March 2015 at an orthopaedic and a radiologic outpatient clinic. Data on outcomes of cancellation on the part of the user or the provider, and non-attendance without giving...... unattended without notice. The latter was significantly associated with male gender, younger age and longer time since referral. Other characteristics were identified as significant, but differed between departments. CONCLUSION: There seems to be a potential for a targeted effort aiming to reduce non-attendance...

  15. Inpatients' and outpatients' satisfaction: the mediating role of perceived quality of physical and social environment.

    Science.gov (United States)

    Campos Andrade, Cláudia; Lima, Maria Luísa; Pereira, Cícero Roberto; Fornara, Ferdinando; Bonaiuto, Marino

    2013-05-01

    This study analyses the processes through which the physical environment of health care settings impacts on patients' well-being. Specifically, we investigate the mediating role of perceptions of the physical and social environments, and if this process is moderated by patients' status, that is, if the objective physical environment impacts inpatients' and outpatients' satisfaction by different social-psychological processes. Patients (N=206) evaluated the physical and social environments of the care unit where they were receiving treatment, and its objective physical conditions were independently evaluated by two architects. Results showed that the objective environmental quality affects satisfaction through perceptions of environmental quality, and that patients' status moderates this relationship. For inpatients, it is the perception of quality of the social environment that mediates the relationship between objective environmental quality and satisfaction, whereas for outpatients it is the perception of quality of the physical environment. This moderated mediation is discussed in terms of differences on patients' experiences of health care environments.

  16. Ethnic diversity outpatient clinic in paediatrics

    Directory of Open Access Journals (Sweden)

    Dahhan Nordin

    2012-01-01

    Full Text Available Abstract Background The health status of chronic sick ethnic minority children in the Netherlands is unequal compared with indigenous Dutch children. In order to optimize the health care for these children a specific patient-oriented clinic in ethnic-cultural diversity: the Mosaic Outpatient Clinic (MOC was integrated in the general Paediatric Outpatient Departments (POPD of three hospitals in Amsterdam. Methods Feasibility of the MOC, factors influencing the health care process and encountered bottlenecks in health care were studied in ethnic minority children with asthma, diabetes type 1 or metabolic disease originating from Morocco, Turkey and Surinam. Feasibility was determined by the number of patients attended, support from the paediatric medical staff and willingness of the patients to participate. Influences on the health care process comprised parents' level of knowledge of disease, sense of disease severity, level of effort, linguistic skills, health literacy, adherence to treatment and encountered bottlenecks in the health care process. Moreover, the number of admissions and visits to the POPD in the years before, during and after the MOC were analysed. Results In 2006 a total of 189 ethnic minority children were seen. Integration of the MOC within the general POPD of the hospital is feasible. The ability of the parents to speak and understand Dutch was found to be 58%, functional health literacy was 88%; sufficient knowledge of disease and sense of disease severity were 59% and 67%, respectively. The main bottlenecks in the healthcare process: poor knowledge of disease, limited sense of disease severity and low health literacy in the parents proved to be the best predictors for decreased adherence. After attending the MOC there was a decrease in the number of admissions and visits to the POPD for asthma while the number of visits increased in patients with diabetes and the amount of no-shows decreased in patients with a metabolic

  17. Satisfaction with care among low-income female outpatients.

    Science.gov (United States)

    Rubio, Ruby Navarro; Pearson, Heidi C; Clark, Aubrey A; Breitkopf, Carmen Radecki

    2007-05-01

    Patient satisfaction correlates with important health behaviors and outcomes. Little is known about satisfaction in disadvantaged populations of different racial/ethnic backgrounds. The current study evaluated demographic and psychological correlates of patient satisfaction among a low-income, multiethnic sample of female outpatients attending cervical cancer screening. Participants included 338 African American, Latina, and white women ages 18 - 49 years attending University of Texas Medical Branch Regional Maternal & Child Health Clinics. Data were obtained via self-report and chart review. Patient satisfaction was assessed using the Patient Satisfaction Questionnaire (PSQ). Total PSQ scores reflected two distinct underlying subscales (satisfaction and dissatisfaction), which differed from the original factor structure of the PSQ. Satisfaction was predicted by patient beliefs that their health is self-determined, beliefs that doctors control their health, self-esteem, and education. Dissatisfaction was predicted by patient beliefs that good health is a matter of chance/luck, self-esteem, social desirability, and income. Higher self-esteem, education, and beliefs that health is controlled by oneself or doctors correlated with higher satisfaction with care in the clinic setting. Understanding the influence of patient characteristics on perceptions of care is important for physicians to foster relationships with patients that increase feelings of satisfaction, decrease dissatisfaction, and ultimately, improve health outcomes.

  18. The digital divide phenomenon in a hand surgery outpatient clinic.

    Science.gov (United States)

    Parekh, Selene G; Sodha, Samir; McGuire, Kevin J; Bozentka, David J; Rozental, Tamara D; Beredjiklian, Pedro K

    2004-04-01

    The Internet has become an important source of medical information for patients. However, the availability of this resource for individuals in the lower socioeconomic groups is limited, a concept termed the digital divide. To evaluate this phenomenon, we conducted a survey study to quantify the accessibility and use of the Internet for obtaining medical information in an outpatient hand surgery clinic population. A 28-question survey was distributed to 207 patients concerning computer accessibility, Internet use for medical and nonmedical information, Internet trust and security, and patient economic demographics. After analysis of the data, we found individuals in households with higher incomes had a greater likelihood of owning computers than those in lower income brackets. As income increases, the time spent on the Internet also increases. Another statistically significant trend was that higher income patient households thought that Internet information was trustworthy, secure, and private compared with the lower income brackets. We concluded that clinical settings where the predominant patient population earns less than $18,000 may not benefit or use physician Internet-based services or information. The concept of the digital divide seems to be a real phenomenon in the clinical practice of orthopaedics.

  19. Outpatient management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Muncie, Herbert L; Yasinian, Yasmin; Oge', Linda

    2013-11-01

    Approximately 2% to 9% of patients seen in a family physician's office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of alcohol, and the signs and symptoms include tremors, agitation, nausea, sweating, vomiting, hallucinations, insomnia, tachycardia, hypertension, delirium, and seizures. Treatment aims to minimize symptoms, prevent complications, and facilitate continued abstinence from alcohol. Patients with mild or moderate alcohol withdrawal syndrome can be treated as outpatients, which minimizes expense and allows for less interruption of work and family life. Patients with severe symptoms or who are at high risk of complications should receive inpatient treatment. In addition to supportive therapy, benzodiazepines, either in a fixed-dose or symptom-triggered schedule, are recommended. Medication should be given at the onset of symptoms and continued until symptoms subside. Other medications, including carbamazepine, oxcarbazepine, valproic acid, and gabapentin, have less abuse potential but do not prevent seizures. Typically, physicians should see these patients daily until symptoms subside. Although effective treatment is an initial step in recovery, long-term success depends on facilitating the patient's entry into ongoing treatment.

  20. Blood glucose concentration in pediatric outpatient surgery.

    Science.gov (United States)

    Somboonviboon, W; Kijmahatrakul, W

    1996-04-01

    Blood glucose concentration was measured in 84 pediatric patients who were scheduled for outpatient surgery at Chulalongkorn Hospital. They were allocated into 3 groups according to their ages, group 1:less than 1 year of age, group 2:1 to 5 years of age and group 3:over 5 years. The fasting times were approximately 8-12 hours. All patients received standard general anesthesia under mask. No glucose solution was given during operation. Preoperative mean blood glucose were 91.09 +/- 17.34, 89.55 +/- 18.69 and 82.14 +/- 16.14 mg/dl in group 1, 2 and 3 while the postoperative mean glucose values were 129.07 +/- 37.90, 115.62 +/- 29.63 and 111.53 +/- 23.07 mg/dl respectively. The difference between pre- and post-operative values were statistically significant difference (P postoperative glucose values may be due to stress response from surgery and anesthesia. We would suggest that the parents give the fluid to their children according to our instructions in order to prevent dehydration and hypoglycemia especially in small infants.

  1. Correlates of psychotic symptoms among elderly outpatients.

    Science.gov (United States)

    Holroyd, S; Laurie, S

    1999-05-01

    Psychotic symptoms presenting in late life can offer a diagnostic challenge to the clinician. In this study, 140 geriatric outpatients were prospectively examined for psychotic symptoms and assessed on a number of demographic and clinical variables. Cognition was assessed using the Mini-Mental State Exam. Psychiatric diagnoses were made by DSM-III-R criteria. Twenty-seven per cent (N = 38) had psychotic symptoms, delusions being the most common type. Patients with psychosis were significantly more likely to have a previous history of psychosis, to have a lower MMSE and to live in a nursing home. Four diagnoses accounted for 79.5% of all psychotic patients. In order of frequency, these were dementia, major depression, delirium and organic psychosis (organic hallucinosis, organic delusional disorder). Psychotic patients were significantly more likely to have a diagnosis of dementia, delirium or organic psychosis than non-psychotics, but depression was significantly more likely to occur in patients without psychosis. Although psychotic symptoms occur in a variety of illnesses, elderly patients with psychosis should be carefully evaluated for these disorders.

  2. Outpatient varicocelectomy performed under local anesthesia

    Institute of Scientific and Technical Information of China (English)

    Geng-Long Hsu; Pei-Ying Ling; Cheng-Hsing Hsieh; Chii-Jye Wang; Cheng-Wen Chen; Hsien-Sheng Wen; Hsiu-Mei Huang; E. Ferdinand Einhorn; Guo-Fang Tseng

    2005-01-01

    Aim: To report a series of varicocelectomy performed under pure local anesthesia. Methods: From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale (VAS)was used to assess whether the pain level was acceptable. Results: The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % (567/575) of men could go back to work by the end of the first post-operative week and only 8 (1.4 %) men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of (18.5 ± 11.3) mm that was regarded as tolerable. Conclusion: This study has shown varicocelectomy under local anesthesia to be possible,simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

  3. Chlamydia trachomatis cervicitis in gynecologic outpatients.

    Science.gov (United States)

    Ripa, K T; Svensson, L; Mårdh, P A; Weström, L

    1978-12-01

    Symptoms suggestive of a lower genital tract infection (LGTI) are common complaints in women who consult gynecologists. Sexually transmitted microorganisms, such as Chlamydia trachomatis. Neisseria gonorrhoeae, and Trichomonas vaginalis, are responsible for a substantial proportion of LGTI. This study was performed to establish the frequency of LGTI caused by C trachomatis in women attending a gynecologic outpatient clinic. Of 170 women with LGTI, 32.9% harbored one or more of these organisms: C trachomatis was found in 19.3%, N gonorrhoeae in 4.7%, and T vaginalis in 25.9%. The results of the isolation studies were correlated with clinical signs and symptoms. In women under 25 years of age, chlamydial cervicitis was found significantly more often in users of oral contraceptives than in nonusers. In women not taking such drugs, cervical erosion was found more often in Chlamydia-positive than Chlamydia-negative women. Since clinical examination failed to reveal any characteristic signs in cases of chlamydial infection, it was not possible to distinguish a chlamydial from a gonococcal infection. This study also reports the successful treatment of 15 women affected by chlamydial cervicitis with doxycycline or trimethoprim sulphamethoxazole.

  4. Validation and results of a questionnaire for functional bowel disease in out-patients

    Directory of Open Access Journals (Sweden)

    Skordilis Panagiotis

    2002-05-01

    Full Text Available Abstract Background The aim was to evaluate and validate a bowel disease questionnaire in patients attending an out-patient gastroenterology clinic in Greece. Methods This was a prospective study. Diagnosis was based on detailed clinical and laboratory evaluation. The questionnaire was tested on a pilot group of patients. Interviewer-administration technique was used. One-hundred-and-forty consecutive patients attending the out-patient clinic for the first time and fifty healthy controls selected randomly participated in the study. Reliability (kappa statistics and validity of the questionnaire were tested. We used logistic regression models and binary recursive partitioning for assessing distinguishing ability among irritable bowel syndrome (IBS, functional dyspepsia and organic disease patients. Results Mean time for questionnaire completion was 18 min. In test-retest procedure a good agreement was obtained (kappa statistics 0.82. There were 55 patients diagnosed as having IBS, 18 with functional dyspepsia (Rome I criteria, 38 with organic disease. Location of pain was a significant distinguishing factor, patients with functional dyspepsia having no lower abdominal pain (p Conclusions This questionnaire for functional bowel disease is a valid and reliable instrument that can distinguish satisfactorily between organic and functional disease in an out-patient setting.

  5. Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.

    Science.gov (United States)

    García-Fernández, Gloria; Secades-Villa, Roberto; García-Rodríguez, Olaya; Peña-Suárez, Elsa; Sánchez-Hervás, Emilio

    2013-12-01

    Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence, few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes, and there is even less research in the context of Contingency Management (CM). The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes. Cocaine-dependent individuals (N = 108) were randomized to Community Reinforcement Approach (CRA) or CRA plus CM in two outpatient community clinical settings. Participants were categorized according to depression symptoms, self-reported by means of the BDI at treatment entry. Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period. Depressive symptoms were more commonly found in females and in unemployed participants, and were associated with more drug-related, social, and psychiatric problems at treatment entry. Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms. The addition of CM to CRA made the program more effective than with CRA alone, regardless of depressive symptoms. CM was associated with better abstinence treatment outcomes, while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes. This study supports the efficacy of CM for cocaine-dependent outpatients with and without depressive symptoms, and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals.

  6. Advancing Medication Reconciliation in an Outpatient Internal Medicine Clinic through a Pharmacist-Led Educational Initiative

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg, Pharm.D.

    2010-01-01

    Full Text Available Objectives: To develop and deliver an effective pharmacist-led educational initiative to clinic staff to advance medication reconciliation in the electronic medical record of an outpatient internal medicine clinic.Methods: An educational initiative designed to improve the ability of nursing staff in medication reconciliation was launched in the outpatient internal medicine clinic of a regional healthcare system. The education was provided by the pharmacist to clinic nursing staff, including registered nurses, licensed practical nurses, and certified medical assistants. The impact of this training was measured through pre-initiation and post-implementation surveys, competency assessments and an audit. Results: The educational initiative was successfully designed and delivered to clinic nursing staff. Assessment of the initiative found that all nursing staff completing competency assessments successfully passed. Pre-initiation- and post-implementation- survey responses on the self-assessed ability to gather and document accurate medication lists did not show significant changes. Informal observations in the clinic indicated that this initiative changed the culture of the clinic, creating increased awareness of the importance of accurate medications and increased emphasis on medication reconciliation.Conclusions: The expertise of pharmacists can be utilized to educate nursing staff on the skills and abilities necessary to gather and document accurate medication lists. This study did not find measurable changes in the accuracy of medication lists in this clinic. Future research is needed to determine the best methods to train health professionals in medication reconciliation to ensure accurate medication lists in the outpatient setting.

  7. 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 < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC 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 < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  8. 76 FR 49458 - TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments

    Science.gov (United States)

    2011-08-10

    ... of the Secretary TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments AGENCY... hospitals of an opportunity for net adjusted payments for radiology services for which TRICARE payments were... radiology services specified in the regulation as being reimbursed under the allowable charge...

  9. VA Outpatient Visits by Administrative Parent, FY2010-2014

    Data.gov (United States)

    Department of Veterans Affairs — Outpatient visits by Administrative Parent. A visit is counted as a visit to one or more clinics or units within 1 calendar day at the site of care level. A patient...

  10. Transportation and retention in outpatient drug abuse treatment programs.

    Science.gov (United States)

    Friedmann, P D; Lemon, S C; Stein, M D

    2001-09-01

    To determine whether certain types of transportation assistance improve outpatient treatment retention beyond thresholds shown to have therapeutic benefits, we analyzed data from 1,144 clients in 22 outpatient methadone maintenance (OMM) programs and 2,031 clients in 22 outpatient drug-free (ODF) programs in the Drug Abuse Treatment Outcomes Study (DATOS), a national, 12-month, longitudinal study of drug abuse treatment programs. Directors' surveys provided information about provision of car, van, or contracted transportation services or individual vouchers/payment for public transportation. Chart-abstracted treatment retention was dichotomized at 365 days for OMM and 90 days for ODF. Separate multivariate hierarchical linear models revealed that provision of car, van, or contracted transportation services improved treatment retention beyond these thresholds for both OMM and ODF, but individual vouchers or payment for public transportation did not. Future research should validate whether car, van, or contracted transportation services improve retention and other treatment outcomes in outpatient drug abuse treatment.

  11. Using simulation in out-patient queues: a case study.

    Science.gov (United States)

    Huarng, F; Lee, M H

    1996-01-01

    Overwork and overcrowding in some periods was an important issue for the out-patient department of a local hospital in Chia-Yi in Taiwan. The hospital administrators wanted to manage the patient flow effectively. Describes a study which focused on the utilization of doctors and staff in the out-patient department, the time spent in the hospital by an out-patient, and the length of the out-patient queue. Explains how a computer simulation model was developed to study how changes in the appointment system, staffing policies and service units would affect the observed bottleneck. The results show that the waiting time was greatly reduced and the workload of the doctor was also reduced to a reasonable rate in the overwork and overcrowding periods.

  12. Exposure to environmental tobacco smoke (ETS) and determinants of support for complete smoking bans in psychiatric settings.

    NARCIS (Netherlands)

    Willemsen, M.C.; Gorts, C.A.; Soelen, P. van; Jonkers, R.E.; Hilberink, S.R.

    2004-01-01

    OBJECTIVE: To measure environmental tobacco smoke (ETS) exposure in psychiatric settings and to assess determinants of support for complete smoking bans. DESIGN: Cross sectional study SETTING: Dutch psychiatric hospitals, outpatient care institutions, and sheltered home facilities. SUBJECTS: A rando

  13. The Role of Outpatient Reception Service Center%论门诊前台服务中心的作用

    Institute of Scientific and Technical Information of China (English)

    宣婉茹; 骆包明

    2013-01-01

    设立门诊前台服务中心,优化门诊服务流程,提供高效、便捷、人性化的就医环境和畅通的医患沟通平台,提供患者所需要的各种人性化服务,构建和谐的医患关系,患者满意率从90.75%上升至96.50%;同期门诊投诉率从0.069‰下降至0.010‰.门诊前台服务中心的设立优化了门诊医疗服务流程,提高了门诊患者的满意度,降低了门诊投诉率,改善了医患关系.%The practice of setting up the outpatient reception service center,optimizing the outpatient service process,providing efficient,convenient and humanistic medical environment and doctor-patient communication platform,providing all kinds of humanized service for patients,improving the doctor-patient relationship,made the patients'satisfaction rate increase from 90.75% to 96.50% and the outpatient service complaint rate decrease from 0.069‰ to 0.069‰.The experience showed that the outpatient reception service center could optimize outpatient service process,improve the patients'satisfaction,reduce the outpatient service complaint rate and improve the doctor-patient relationship.

  14. Feasibility and safety of outpatient brachytherapy in 37 patients with brain tumors using the GliaSite Radiation Therapy System.

    Science.gov (United States)

    Chino, Kazumi; Silvain, Daniel; Grace, Ana; Stubbs, James; Stea, Baldassarre

    2008-07-01

    Temporary, low dose rate brachytherapy to the margins of resected brain tumors, using a balloon catheter system (GliaSite Radiation Therapy System) and liquid I-125 radiation source (Iotrex), began in 2002 at the University of Arizona Medical Center. Initially, all patients were treated on an inpatient basis. For patient convenience, we converted to outpatient therapy. In this article we review the exposure data and safety history for the 37 patients treated as outpatients. Proper patient selection and instruction is crucial to having a successful outpatient brachytherapy program. A set of evaluation criteria and patient instructions were developed in compliance with the U.S. Nuclear Regulatory Commission's document NUREG-1556 Volume 9 (Appendix U) and Arizona State Nuclear regulatory guidelines, which specify acceptable exposure rates for outpatient release in this setting. Of the 37 patients monitored, 26 patients were treated for recurrent glioblastoma multiforme (GBM), six for primary GBM, and five for metastatic brain tumors. All 37 patients and their primary caregivers gave signed agreement to follow a specific set of instructions and were released for the duration of brachytherapy (3-7 days). The typical prescription dose was 60 Gy delivered at 0.5 cm from the balloon surface. Afterloaded activities in these patients ranged from 90.9 to 750.0 mCi and measured exposure rates at 1 m from the head were less than 14 mR/h. The mean exposure to the caretaker measured by personal radiation Landauer Luxel + whole body dosimeters for 25 caretakers was found to be 9.6 mR, which was significantly less than the mean calculated exposure of 136.8 mR. For properly selected patients, outpatient brachytherapy is simple and can be performed within established regulatory guidelines.

  15. User-driven innovation of an outpatient department

    DEFF Research Database (Denmark)

    Broberg, Ole; Edwards, Kasper

    2012-01-01

    This paper presents experiences from a user-driven innovation process of an outpatient department in a hospital. The mixing of methods from user-driven innovation and participatory design contributed to develop an innovative concept of the spatial and organizational design of an outpatient depart...... department in a hospital. Design games and tabletop simulation seem to be powerful tools in facilitating such a participatory process....

  16. Profile and analysis of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, Jakarta

    Directory of Open Access Journals (Sweden)

    Tri J.E. Tarigan

    2015-11-01

    Full Text Available Background: Chronic complications of diabetes mellitus have a significant role in increasing morbidity, mortality, disability, and health cost. In the outpatient setting, the availability of data regarding to the chronic complications of type 2 diabetes is useful for evaluation of prevention, education, and patient’s treatment. This study aimed to describe the characteristic of type 2 diabetes chronic complications in outpatient diabetes clinic.Methods: A cross-sectional study was done using 155 patients in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital (RSCM, Jakarta in 2010. Secondary data were used from medical record based on history taking, physical examination, diabetic foot assessment, laboratory, neurologic, cardiology, opthalmology, ankle brachial index, and electrography of the patients. Characteristic profiles of the subjects, prevalence of the chronic complications, and its association with diabetes risk factors, such as glycemic control using HbA1c, fasting blood glucose, duration of diabetes, and LDL cholesterol were analyzed using chi square test.Results: Among 155 subjects participated in the study, most of them were women (59% and elderly (46%. The prevalence of diabetes chronic complications was 69% from all subjects. These chronic complications included microangiopathy, macroangiopathy and mixed complications, with prevalence of 56%, 7% and 27% respectively. Microangiopathy included nephropathy (2%, retinopathy (7%, neuropathy (38% and mixed complications (53%. Macroangiopathy included coronary heart disease (46%, peripheral arterial disease (19%, stroke (18%, and mixed complication (17%. From the analysis, we found significant association between duration of diabetes and diabetic neuropathy (p = 0.003.Conclusion: Prevalence of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, mainly dominated by microvascular-related complications including nephropathy, retinopathy

  17. Unexpected deaths in cardiology outpatients – what can we learn from case review?

    Science.gov (United States)

    Kitz, Thomas Michael; Burnand, Nikki; Ortner, Astrid; Rudd, Ian G; Sampson, Rod; Rushworth, Gordon F

    2016-01-01

    Objectives A proportion of cardiac patients managed at a cardiology outpatient clinic will die between clinic visits. This study aimed to identify the cause of death, to determine if case review occurred and if a formal review of such cases might be useful. Design Single-centre retrospective cohort study. Setting A remote regional centre in the North of Scotland. Participants All patients who had been removed from the cardiology outpatient clinic due to death in the community. Main outcome measures Cause of death, comorbidities and treatments were collected from hospital records and the national register of deaths. Chi-squared test and Student’s t-test were used with significance taken at the 5% level. Results Of 10,606 patients who attended the cardiology outpatient clinic, 75 (0.7%) patients died in the community. The majority (57.0%) died from a non-cardiac cause. Eleven patients (14.9%) died due to an unexpected cardiac death. A detailed case note review was undertaken. In only two (18.2%) cases was any note made as to the cause of death in the hospital records and in only one was there details of post mortem discussion between primary and secondary care. Conclusions A small proportion of patients attending a cardiology outpatient clinic died in the community. Documentation of the death in the hospital notes was very poor and evidence of post mortem communication between primary and secondary care was absent in all but one case. Better documentation and communication between primary and secondary care would seem desirable. PMID:27928509

  18. An outpatient multifactorial falls prevention intervention does not reduce falls in high-risk elderly Danes

    DEFF Research Database (Denmark)

    Vind, Ane B; Andersen, Hanne E; Pedersen, Kirsten D

    2009-01-01

    OBJECTIVES: To evaluate the effect of multifactorial fall prevention in community-dwelling people aged 65 and older in Denmark. DESIGN: Randomized, controlled clinical trial. SETTING: Geriatric outpatient clinic at Glostrup University Hospital. PARTICIPANTS: Three hundred ninety-two elderly people......% CI 0.81-1.79), frequent falls (OR=0.97, 95% CI=0.60-1.56), or injurious falls (OR=0.97, 95% CI=0.57-1.62). CONCLUSION: A program of multifactorial fall prevention aimed at elderly Danish people experiencing at least one injurious fall was not effective in preventing further falls....

  19. Do "Virtual" and "Outpatient" Public Health Tuberculosis Clinics Perform Equally Well? A Program-Wide Evaluation in Alberta, Canada.

    Directory of Open Access Journals (Sweden)

    Richard Long

    Full Text Available Meeting the challenge of tuberculosis (TB elimination will require adopting new models of delivering patient-centered care customized to diverse settings and contexts. In areas of low incidence with cases spread out across jurisdictions and large geographic areas, a "virtual" model is attractive. However, whether "virtual" clinics and telemedicine deliver the same outcomes as face-to-face encounters in general and within the sphere of public health in particular, is unknown. This evidence is generated here by analyzing outcomes between the "virtual" and "outpatient" public health TB clinics in Alberta, a province of Western Canada with a large geographic area and relatively small population.In response to the challenge of delivering equitable TB services over long distances and to hard to reach communities, Alberta established three public health clinics for the delivery of its program: two outpatient serving major metropolitan areas, and one virtual serving mainly rural areas. The virtual clinic receives paper-based or electronic referrals and generates directives which are acted upon by local providers. Clinics are staffed by dedicated public health nurses and university-based TB physicians. Performance of the two types of clinics is compared between the years 2008 and 2012 using 16 case management and treatment outcome indicators and 12 contact management indicators.In the outpatient and virtual clinics, respectively, 691 and 150 cases and their contacts were managed. Individually and together both types of clinics met most performance targets. Compared to outpatient clinics, virtual clinic performance was comparable, superior and inferior in 22, 3, and 3 indicators, respectively.Outpatient and virtual public health TB clinics perform equally well. In low incidence settings a combination of the two clinic types has the potential to address issues around equitable service delivery and declining expertise.

  20. Relocation consequences on an ophthalmology consultation service from an inpatient to outpatient facility

    Directory of Open Access Journals (Sweden)

    Singh JS

    2015-10-01

    Full Text Available Jorawer S Singh,1 Vincent M Imbrogno,2 Mary K Howard,3 Amandip S Cheema,3 Ausra D Selvadurai,4 Surbhi Bansal5 1Department of Ophthalmology, George Washington University, Washington, DC, 2Contemporary Ophthalmology of Erie, Erie, PA, 3Department of Ophthalmology, University at Buffalo, Buffalo, NY, 4OcuSight Eye Care Center, Rochester, NY, 5Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Importance: This study shows that relocation of an academic ophthalmology residency program from an inpatient to an outpatient setting in western New York does not affect the consult volume but affects management patterns and follow-up rates.Objective: To investigate the effects on the ophthalmology consultation service of an academic program with relocation from a Regional Level-1 Trauma center to an outpatient facility.Design: Consultation notes from 3 years before and 3 years after the University at Buffalo’s (UB Department of Ophthalmology relocation from a Regional Level-1 Trauma center (Erie County Medical Center to an outpatient facility (Ross Eye Institute were obtained from hospital electronic medical records and analyzed.Setting: Hospitalized care and institutional practice.Participants: All inpatient or Emergency Room Ophthalmology consultation patients from the Department of Ophthalmology at UB from 2004 to 2010 (1,379 patients.Exposures: None, this was a retrospective chart review.Main outcome measures: Patient demographics, reason for consult, diagnoses, and ophthalmic procedures performed by the UB Department of Ophthalmology before and after its relocation.Results: Relocation to the outpatient facility did not affect consult volume (P=0.15. The number of consults focusing on ophthalmic conditions, as a percentage of the yearly total, rose 460% (P=0.0001, while systemic condition consults with ocular manifestations fell 83% (P=0.0001. Consults for ocular trauma decreased 65% (P=0.0034. Consults ending with a

  1. The use of spirometry in a primary care setting

    OpenAIRE

    Elizabeth A Blain; Craig, Timothy J.

    2009-01-01

    Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1) Do you have spirometry in your office? 2) Do you use spirometry for asthma patients? 3) In what situation do you use spirometry for? 4) Do you use s...

  2. Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey

    Directory of Open Access Journals (Sweden)

    Ying-Xiu Dai

    2016-09-01

    Full Text Available (1 Background: Limited studies have utilized nationwide data to assess the patterns of psychiatric practice in other countries. In this study, data from the National Health Insurance Research Database in Taiwan (NHIRD-TW for 2012 was analyzed to determine the patterns of psychiatric outpatient practice in Taiwan; (2 Methods: To determine the patterns of psychiatric outpatient practice in Taiwan, the data were drawn from the datasets of Taiwan’s National Health Insurance Research Database for 2012, with 619,760 records of outpatient visits representing 1/500 of all the claims in Taiwan for that year. The analysis of psychiatric outpatient visits included patient demographics, diagnoses, and prescribed medications; (3 Results: Neurotic disorders were the most prevalent diagnoses (43.1%, n = 5714. Hypnotics-sedatives and anxiolytics were prescribed in 51.7% (n = 6850 and 39.1% (n = 5181 of psychiatric visits, respectively, with zolpidem being the most commonly prescribed drug (22.6%, n = 2998; and (4 Conclusion: Hypnotics and sedatives were widely prescribed for the outpatient population, and zolpidem had the highest annual prevalence of use. These findings deserve the attention of clinicians and policy makers for monitoring the abuse and dependence of these agents and subsequent adverse events.

  3. Intensive Outpatient Cognitive Behaviour Therapy for Eating Disorder

    Directory of Open Access Journals (Sweden)

    Riccardo Dalle Grave

    2008-12-01

    Full Text Available The aim of this paper is to describe a novel model of intensive outpatient cognitive-behaviour therapy (CBT indicated for eating disorder patients who are having difficulty modifying their eating habits in response to conventional outpatient CBT. Intensive outpatient CBT is a manual based treatment derived by the CBT-Enhanced (CBT-E for eating disorders. The treatment has four features that distinguish it from the conventional outpatient CBT-E: (1 it is designed to be suitable for both adult and adolescent patients, (2 it is delivered by a multidisciplinary non-eclectic team trained in CBT, (3 there is assistance with eating, (4 there is a family therapy module for patients under the age of 18 years. Preliminary outcome of intensive outpatient CBT-E are encouraging. The treatment has been applied to 20 consecutive underweight eating disorder patients (age 18.2 ± 6.5 years; BMI 14.6 ± 1.5 kg/m2. Thirteen patients (65% concluded the treatment, five (25% were admitted at an eating disorder inpatient unit, and two (10% prematurely interrupted the treatment. Completers obtained significant weight regain and improvement of eating disorder and general psychopathology. Most of the improvements were maintained at six-month follow-up.

  4. Outpatient and Home Chemotherapy with Novel Local Control Strategies in Desmoplastic Small Round Cell Tumor

    Directory of Open Access Journals (Sweden)

    Holly Green

    2008-06-01

    Full Text Available Desmoplastic Small Round Cell Tumor (DSRCT has a very poor prognosis. This report illustrates novel chemotherapy and local control interventions in a 5-year old patient. The patient was treated in the outpatient setting, achieved remission, with excellent quality of life. The patient presented with massive ascites and >1000 abdominal tumors. Neoadjuvant chemotherapy included vincristine (1.5 mg/m2, ifosfamide (3 g/m2/day×3, dexrazoxane/doxorubicin (750/75 mg/m2, and etoposide (150 mg/m2. Continuous hyperthermic peritoneal perfusion (CHPP with cisplatin (100 mg/m2 was given after extensive cytoreductive surgery. This was followed by irinotecan (10 mg/m2/day×5×2  weeks + temozolomide monthly × 2, then abdominal radiation 30 Gy with simultaneous temozolomide (100 mg/m2/day×5. A total of 12 cycles of irinotecan and temozolamide were given. Except for initial chemotherapy, subsequent courses were in the outpatient setting. Focal retroperitoneal relapse at 18 months was treated with IMRT with bevacizumab (5 mg/kg and 2 perihepatic metastases with radio frequency ablation/cryoablation followed by chronic outpatient maintenance chemotherapy (valproic acid, cyclophosphamide, and rapamycin. Almost 2 years from diagnosis, the patient maintained an excellent quality of life. This is a novel approach to the treatment of children with massive abdomino-pelvic DSRCT.

  5. Economic grand rounds: Can states implement involuntary outpatient commitment within existing state budgets?

    Science.gov (United States)

    Swartz, Marvin S; Swanson, Jeffrey W

    2013-01-01

    Many states have not implemented involuntary outpatient commitment, possibly believing that the program is too costly. A review of New York State's experience found that even though the state had appropriated funds for implementing outpatient commitment, overall cost savings were realized. This column presents an analysis in which net costs of outpatient commitment were calculated by using data from a randomized controlled study in North Carolina, where court-ordered treatment was implemented without additional appropriations. The analysis found that outpatient commitment in North Carolina was relatively cost-neutral when relevant costs for persons on outpatient commitment were compared with costs for persons not on outpatient commitment, regardless of commitment duration. Outpatient commitment of six months or more, combined with provision of outpatient services, appeared to result in cost savings of 40%. Findings suggest that states with adequate services to provide consumers on outpatient commitment may implement a program without new funding.

  6. Adjunctive Self-hypnotic Relaxation for Outpatient Medical Procedures: A Prospective Randomized Trial with Women Undergoing Large Core Breast Biopsy

    OpenAIRE

    Lang, Elvira V.; Berbaum, Kevin S.; Faintuch, Salomao; Hatsiopoulou, Olga; Halsey, Noami; Li, Xinyu; Berbaum, Michael L.; Laser, Eleanor; Baum, Janet

    2006-01-01

    Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. 236 women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n= 82), or self-hypnotic relaxatio...

  7. Relationships among structural empowerment, psychological empowerment, and burnout in registered staff nurses working in outpatient dialysis centers.

    Science.gov (United States)

    O'Brien, Janice L

    2011-01-01

    This study explored relationships among structural empowerment, psychological empowerment, and burnout in registered staff nurses working in outpatient hemodialysis settings. The sample consisted of 233 registered staff nurses. The Emotional Exhaustion Subscale of the Maslach Burnout Inventory, the Conditions for Work Effectiveness II Questionnaire, and Psychological Empowerment Instrument were used to measure variables. Findings indicate that in this population of nurses, there is a significant inverse relationship between structured empowerment and burnout.

  8. A cross-sectional study to assess the feasibility of a short message service to improve adherence of outpatients undergoing sedation gastrointestinal endoscopy in the People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Deng XQ

    2014-09-01

    Full Text Available Xiaoqian Deng, Ling Ye, Yuting Wang, Tao Zhu Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of ChinaBackground: Adherence to the prescribed preparation regimen for patients scheduled for sedation gastrointestinal endoscopy (SGIE often fails to meet health care providers’ expectations. Therefore, the feasibility of using mobile phones to improve the adherence of outpatients was assessed among outpatients scheduled for SGIE.Methods: The study was designed as a cross-sectional study using survey questionnaires. Outpatients who would be undergoing SGIE were enrolled. The main outcomes included proportions of outpatients who have access to mobile phones, and the use of text-messaging among outpatients. Willingness to receive text messages and personal opinions about short message service (SMS were also investigated. Characteristics of outpatients, including socio-demographic factors, with a mobile phone (or those who could receive and read messages compared with those without a mobile phone (or those who could not receive and read messages were compared using the chi-square test. Logistic regression was used to analyze significant contributing factors associated with mobile phone ownership and the use of text messages.Results: A large majority of outpatients owned personal mobile phones (94.9% and could receive and read the messages (78.9%. Most of the outpatients were willing to receive a pre-procedure education via text message (81.9%. Outpatients aged 16–39 years old and those with a college education or higher were more likely to use mobile phones and read SMS than outpatients aged 60–80 years old and those with only a primary education level (P<0.0001. Outpatients who lived in an urban setting were more likely to own a mobile phone than outpatients who lived in a rural setting (P=0.002.Conclusion: The accessibility of mobile phones and the frequent use of message functions

  9. Efficacy, safety, and applicability of outpatient treatment for diverticulitis

    Directory of Open Access Journals (Sweden)

    Tursi A

    2014-03-01

    Full Text Available Antonio TursiGastroenterology Service, ASL BAT, Andria BT, ItalyAbstract: Acute diverticulitis of the colon represents a significant burden for national health systems, in terms of direct and indirect costs. Although current guidelines recommend use of antibiotics for the outpatient treatment of acute uncomplicated diverticulitis, evidence for this is still lacking. Hence, significant effort is now being made to identify the appropriate therapeutic approach to treat and prevent relapses of diverticulitis. Outpatient treatment has been identified as a safe and effective therapeutic approach in up to 90% of patients with uncomplicated diverticulitis. It allows important costs saving to health systems without a negative influence on quality of life for patients with uncomplicated diverticulitis, and reduces health care costs by more than 60%.Keywords: diverticulitis, 5-aminosalycilic acid, antibiotics, probiotics, outpatient treatment

  10. [Outpatient anesthesia--the office-based anesthetist].

    Science.gov (United States)

    Fischer, Guntram

    2013-03-01

    The aim of the present article is to describe the field of activity and prevailing conditions for office-based anesthetists in Germany. From the introduction of outpatient operations on the basis of actual numbers, data and facts, we present the project profile and the structures of the different fields of activity and practice constellations for office-based anesthesiology. Particular emphasis is placed on the requirements for room space and technical facilities, the criteria for patient selection, and the structural and procedural quality as well as quality management of outpatient anesthesia. With the aid of current numerical data the anesthetic procedures performed in the outpatient field through to the possibilities for development of continuous regional anesthetic procedures in catheter technique are illustrated. In conclusion, we discuss the economic conditions and the health-care economic significance together with a description of the current health-care quality of ambulant anesthesiology and the possibilities for participation in an error-reporting system.

  11. Measurement of nurses' workload in an oncology outpatient clinic

    Directory of Open Access Journals (Sweden)

    Célia Alves de Souza

    2014-02-01

    Full Text Available The growing demand and the degree of patient care in oncological outpatient services, as well as the complexity of treatment have had an impact on the workload of nurses. This study aimed at measuring the workload and productivity of nurses in an oncological outpatient service. An observational study using a work sampling technique was conducted and included seven nurses working in an oncological outpatient service in the south-eastern region of Brazil. A total of 1,487 intervention or activity samples were obtained. Nurses used 43.2% of their time on indirect care, 33.2% on direct care, 11.6% on associated activities, and 12% on personal activities. Their mean productivity was 88.0%. The findings showed that nurses in this service spend most of their time in indirect care activities. Moreover, the productivity index in this study was above that recommended in the literature.

  12. Outpatient health care statistics data warehouse--logical design.

    Science.gov (United States)

    Natek, S

    1999-01-01

    Outpatient Health Care Statistics on a state level is a central point where all relevant statistic data are collected from various sources from all over the country. Various and complex requirements for processing and reporting data makes Outpatient Health Care Statistics on a state level a perfect example for efficient implementing of Data warehouse technology. The research investigates logical design of data warehouse with a special attention on a different data modeling technique in various phases of a logical data warehouse design. The research shows that a requirement for processing statistical data determines the design decision and thus the scope and semantic value of final data warehouse.

  13. Outpatient chemotherapy, family-centered care, electronic information, and education in adolescents and young adults with osteosarcoma

    Directory of Open Access Journals (Sweden)

    Anderson P

    2013-01-01

    Full Text Available Pete Anderson, Patricia Wells, Theresa Lazarte, Laura Gore, Laura Salvador, Maritza Salazar-AbshireMD Anderson Cancer Center, Pediatrics, Houston TX, USAAbstract: Current osteosarcoma chemotherapy is “standard” (doxorubicin, cisplatin, high-dose methotrexate ± ifosfamide-mesna, and etoposide ± mifamurtide, but current regimens have many short-term, medium-term, and long-term side effects. Generally 12–15 cycles of chemotherapy are given in the hospital over 7–10 months. Even in the absence of new research protocols, improvement in quality of life is now possible, with all osteosarcoma chemotherapy agents now being able to be administered in the outpatient setting. Outpatient chemotherapy is not only less expensive, but in the adolescent and young adult population can result in better quality of life for some. In this paper, we share information to help reduce the frequency of hospitalization and review some tools and strategies to facilitate communication when providing outpatient chemotherapy, family-centered care, and information/education. These include antiemetics with both longer-acting 5HT antagonists and aprepitant, outpatient chemotherapy guidelines, and a 5-week editable calendar that is part of our electronic medical record. Sharing information on absolute lymphocyte count recovery is another means of maintaining hope and increasing understanding of the prognosis of osteosarcoma. Finally, this paper shares an advanced directive/palliative care “checklist” of issues for patients and caregivers to consider at end of life, ie, when “cure of cancer is not the answer”. In summary, better communication at all stages of osteosarcoma care can help reduce hospitalization, improve quality of life, and maintain hope in the adolescent and young adult population with osteosarcoma.Keywords: family-centered care, adolescent and young adult, flash drives, chemotherapy calendars, outpatient, osteosarcoma, chemotherapy

  14. Estudo comparativo da evolução e sobrevida de pacientes com claudicação intermitente, com ou sem limitação para exercícios, acompanhados em ambulatório específico Comparative study of evolution and survival of patients with intermittent claudication, with or without limitation for exercises, followed in a specific outpatient setting

    Directory of Open Access Journals (Sweden)

    Ricardo de Alvarenga Yoshida

    2008-06-01

    established, as well as the benefits of physical training in the treatment of intermittent claudication (IC. However, current data do not provide enough information about the relationship between clinical limitations and risk factors and the performance of physical training and its implications on the evolution and mortality of these patients. OBJECTIVE: To compare the claudication distance and survival of patients with IC throughout time in a specific outpatient setting, with or without limitation for exercises. METHODS: A retrospective cohort study was performed to review the protocols of 185 patients and 469 returns, from 1999 to 2005, evaluating demographic data, average claudication distance and death. The data were analyzed using the software Epi-Info, version 3.2, and SAS, version 8.2. RESULTS: Mean age was 60.9±11.1 years; 61.1% were males and 38.9% were females; 87% were Caucasians and 13% were non-Caucasians. Associated risk factors were hypertension (69.7%, smoking (44.3%, dyslipidemia (32.4%, and diabetes (28.6%. For the patients with claudicating distance lower than 500 m, mean initial distance was 154.0±107.6 m and final distance was 199.8±120.5 m. About 45% of the patients had some clinical limitation to perform the prescribed exercise program, such as angina (26.0%, stroke (4.3%, osteoarthrosis (3.8%, previous minor or major amputation (2.1%, or chronic obstructive pulmonary disease (1.6%. About 11.4% of the patients had previous myocardial infarction, and 5.4% of them were using cardiotonic drugs. Mean follow-up time was 16.0±14.4 months. Mean claudication distance increased 100% (418.47 to 817.74 m throughout 2 years in the group without limitation (p < 0.001 and in nonsmokers (p < 0.001. Survival rate of patients with IC was significantly reduced in the group with limitation for exercises. Logistic regression analysis showed that limitation to exercises was the single factor significantly influencing mortality (p < 0.001. CONCLUSION: Proper and regular

  15. Medication errors in outpatient setting of a tertiary care hospital: classification and root cause analysis

    Directory of Open Access Journals (Sweden)

    Sunil Basukala

    2015-12-01

    Conclusions: Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. Hence, A focus on easy-to-use and inexpensive techniques for medication error reduction should be used to have the greatest impact. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1235-1240

  16. Teaching Interpersonal Skills to Psychiatric Outpatients: Using Structured Learning Therapy in a Community-Based Setting

    Science.gov (United States)

    Sprafkin, Robert P.; And Others

    1978-01-01

    The Structured Learning Therapy (SLT), a type of treatment used to assist psychiatric patients to learn skills they need for effective and satisfying living in the community, is described in this article. A description of the community-based treatment facility in which SLT may be utilized and the results of the evaluation studies are also…

  17. Resistant gram-negative infections in the outpatient setting in Latin America.

    Science.gov (United States)

    Salles, M J C; Zurita, J; Mejía, C; Villegas, M V

    2013-12-01

    Latin America has a high rate of community-associated infections caused by multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the literature over the last 10 years indicates that urinary tract infections (UTIs) by Escherichia coli, and intra-abdominal infections (IAIs) by E. coli and Klebsiella pneumoniae, were characterized by high rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and fosfomycin. In addition, preliminary data indicate an increase in IAIs by Enterobacteriaceae producing extended-spectrum β-lactamases, with reduced susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians in Latin America should recognize the public health threat associated with UTIs and IAIs by resistant Gram-negative bacteria. As the number of therapeutic options become limited, we recommend that antimicrobial prescribing be guided by infection severity, established patient risk factors for multidrug-resistant infections, acquaintance with local antimicrobial susceptibility data, and culture collection.

  18. A practical approach to dementia in the outpatient primary care setting.

    Science.gov (United States)

    Darrow, Mark D

    2015-06-01

    As the population ages, fear of memory loss and potential diagnosis of dementia increases. Primary care providers, with their medical knowledge, familiarity with patients and their loved ones, and knowledge of the community and its resources, are perfectly placed to diagnose and treat commonly presenting types of dementia. As knowledge of the types of dementia and their categorization, presentation, and course has increased, diagnosis and treatment of this problem have become more understandable and amenable to primary care intervention. Diagnosis and work-up use common techniques and studies to assist providers. Treatment and management have evolved over time to include nonpharmacologic or behavioral interventions.

  19. Development of a Computerized Adverse Drug Event (ADE) Monitor in the Outpatient Setting

    Science.gov (United States)

    2005-01-01

    attack) related to beta - blockers . The monitor was programmed to ignore symptom terms appearing within six words after a negation term (“not,” “no...as angiotensin converting enzyme inhibitors, beta - blockers , and hypoglycemic medications (both oral and injected insulin). It was determined that...bupropion) AND anorexia Benzodiazepines AND confusion Beta Blockers AND bradycardia Calcium channel blockers AND peripheral edema Diuretics AND

  20. Longer Time Spent for Patient in Outpatient Setting is Associated with Lower Antibiotic Prescription

    Directory of Open Access Journals (Sweden)

    Özge Serçe

    2013-08-01

    Full Text Available Introduction: In order to guide the improvement in the national judicious antibiotic use policy, the socio-cultural, socio-demographic, and cognitive factors that may potentially influence the prescribing habits of pediatricians, family physicians and general practitioners to upper respiratory tract infections in children were investigated.Materials and Methods: After receiving approval from ethic committee, questionnaire was sent to 7421 physicians who had been practicing in the different regions of the country. Responses obtained from 1477 of them were evaluated by multivariate analysis to demonstrate independent effect of each factor influencing the prescribing habits.Results: Our results have shown that being a pediatrician, working in medical school, and spending enough time for physical examination were independently associated with less antibiotic prescription. Family physicians and general practitioners were more likely to prescribe antibiotics for viral upper respiratory infections in children.Conclusions: The most important modifying factors about antibiotic prescription habits for upper respiratory tract infections in children were physical examination period and quality of education. (Journal of Current Pediatrics 2013;11:45-50

  1. Understanding the management of electronic test result notifications in the outpatient setting

    Directory of Open Access Journals (Sweden)

    Singh Hardeep

    2011-04-01

    Full Text Available Abstract Background Notifying clinicians about abnormal test results through electronic health record (EHR -based "alert" notifications may not always lead to timely follow-up of patients. We sought to understand barriers, facilitators, and potential interventions for safe and effective management of abnormal test result delivery via electronic alerts. Methods We conducted a qualitative study consisting of six 6-8 member focus groups (N = 44 at two large, geographically dispersed Veterans Affairs facilities. Participants included full-time primary care providers, and personnel representing diagnostic services (radiology, laboratory and information technology. We asked participants to discuss barriers, facilitators, and suggestions for improving timely management and follow-up of abnormal test result notifications and encouraged them to consider technological issues, as well as broader, human-factor-related aspects of EHR use such as organizational, personnel, and workflow. Results Providers reported receiving a large number of alerts containing information unrelated to abnormal test results, many of which were believed to be unnecessary. Some providers also reported lacking proficiency in use of certain EHR features that would enable them to manage alerts more efficiently. Suggestions for improvement included improving display and tracking processes for critical alerts in the EHR, redesigning clinical workflow, and streamlining policies and procedures related to test result notification. Conclusion Providers perceive several challenges for fail-safe electronic communication and tracking of abnormal test results. A multi-dimensional approach that addresses technology as well as the many non-technological factors we elicited is essential to design interventions to reduce missed test results in EHRs.

  2. Patient satisfaction in outpatient healthcare services at secondary level vs. tertiary level

    Directory of Open Access Journals (Sweden)

    Velikj-Stefanovska Vesna

    2014-01-01

    Full Text Available Introduction. Patients satisfaction is a very important part of any clinical practice both for evaluation and improvement of healthcare services. Objective. The aim of this study was to determine patient satisfaction with public outpatient healthcare services at secondary and tertiary level and to assess possible differences between the two levels. Methods. In a quantitative cross-sectional study, a convenient sample of 646 patients who experienced public outpatient healthcare services at the secondary and tertiary level during the last two months were interviewed. Patient satisfaction questionnaires, with statements regarding various aspects of satisfaction, were completed during face-to-face interviews (response rate 84.6%. The research instrument was tested for internal consistency using the Cronbach’s coefficient alpha estimate. Results. The patients were significantly more satisfied in tertiary than in secondary outpatient healthcare facilities in almost all aspects of assessment related to general settings, nurse/administrative staff performance and physician performance (p<0.001. The patients in the secondary healthcare services (SHCS were more satisfied than in the tertiary healthcare services (THCS but only regarding the information on location (83.9% vs.78.3% and possibilities to enter and move inside the department (88.8% vs. 83.3%. Analysis of data for SHCS and THCS showed that there was no significant difference between the mean overall satisfaction scores with regard to patients’ gender, age, marital status, educational level, employment and number of visits. Conclusion. There is a need to improve the current level of patient-provider relationship and communication, as well as that of hospital environment, while special efforts should be made to address the problem of patient waiting time and hospital bureaucracy.

  3. Safety of Outpatient Closed-Loop Control: First Randomized Crossover Trials of a Wearable Artificial Pancreas

    Science.gov (United States)

    Renard, Eric; Cobelli, Claudio; Zisser, Howard C.; Keith-Hynes, Patrick; Anderson, Stacey M.; Brown, Sue A.; Chernavvsky, Daniel R.; Breton, Marc D.; Mize, Lloyd B.; Farret, Anne; Place, Jérôme; Bruttomesso, Daniela; Del Favero, Simone; Boscari, Federico; Galasso, Silvia; Avogaro, Angelo; Magni, Lalo; Di Palma, Federico; Toffanin, Chiara; Messori, Mirko; Dassau, Eyal; Doyle, Francis J.

    2014-01-01

    OBJECTIVE We estimate the effect size of hypoglycemia risk reduction on closed-loop control (CLC) versus open-loop (OL) sensor-augmented insulin pump therapy in supervised outpatient setting. RESEARCH DESIGN AND METHODS Twenty patients with type 1 diabetes initiated the study at the Universities of Virginia, Padova, and Montpellier and Sansum Diabetes Research Institute; 18 completed the entire protocol. Each patient participated in two 40-h outpatient sessions, CLC versus OL, in randomized order. Sensor (Dexcom G4) and insulin pump (Tandem t:slim) were connected to Diabetes Assistant (DiAs)—a smartphone artificial pancreas platform. The patient operated the system through the DiAs user interface during both CLC and OL; study personnel supervised on site and monitored DiAs remotely. There were no dietary restrictions; 45-min walks in town and restaurant dinners were included in both CLC and OL; alcohol was permitted. RESULTS The primary outcome—reduction in risk for hypoglycemia as measured by the low blood glucose (BG) index (LGBI)—resulted in an effect size of 0.64, P = 0.003, with a twofold reduction of hypoglycemia requiring carbohydrate treatment: 1.2 vs. 2.4 episodes/session on CLC versus OL (P = 0.02). This was accompanied by a slight decrease in percentage of time in the target range of 3.9–10 mmol/L (66.1 vs. 70.7%) and increase in mean BG (8.9 vs. 8.4 mmol/L; P = 0.04) on CLC versus OL. CONCLUSIONS CLC running on a smartphone (DiAs) in outpatient conditions reduced hypoglycemia and hypoglycemia treatments when compared with sensor-augmented pump therapy. This was accompanied by marginal increase in average glycemia resulting from a possible overemphasis on hypoglycemia safety. PMID:24929429

  4. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    Science.gov (United States)

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  5. Understanding clinician influences and patient perspectives on outpatient discharge decisions: a qualitative study

    Science.gov (United States)

    Harun, N A; Salek, S

    2017-01-01

    Objective To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision. Design Qualitative study involving observations of consultations and semistructured interviews with outpatients. Setting National Health Service outpatient clinics at a university hospital secondary referral centre. Participants 64 consultations were observed followed by 56 interviews with patients aged over 18 years. Main outcome measure Analysis of patients' perspectives and expectations concerning whether or not they were discharged. Results 25 types of influences were observed to be influencing the discharge decision process. All 31 discharged patients appeared to accept the clinicians' decision; however, 10 (22%) of those patients later expressed disappointment. Patients' discontent was due to perceived clinicians' uncertainty in diagnosis (patients mentioning=2), poor acceptance of the diagnosis (2), disease not ‘cured’ (4), differing perception on medical needs (2), lack of concern for job demands (1), felt uninvolved in the decision-making (4), feeling rushed (3), prolonged open appointment (2), pushed to seek private care due to healthcare budget constraints (2), language barrier (1) and not keen to continue follow-up with general practitioner (2). Patients were happy when there was certainty of the diagnosis (19), clear treatment plan (16), advised on treatment side effects (7), given a contact number if symptoms recurred (4), considering their travelling and job demands (3). Conclusions This study highlights the importance of accurately perceiving patients' perspectives in ensuring the appropriateness of outpatient discharge. There was a disparity between patients' and clinicians' perception on what was an appropriate discharge. This included discrepancies concerning diagnostic

  6. Improving the Quality of Outpatient Diabetes Care Using an Information Management System

    Science.gov (United States)

    Weissmann, Joerg; Mueller, Angelika; Messinger, Diethelm; Parkin, Christopher G.; Amann-Zalan, Ildiko

    2015-01-01

    Background: This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings. Methods: In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented. Results: Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (–0.61[1.03]% (–6.7[11.3] mmol/mol), n = 213; –0.88[1.22]% (–9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (–0.64[1.02]% (–7.0[11.1] mmol/mol), n = 219; –0.93[1.27]% (–10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4. Conclusions: Integration of the IMS into outpatient care facilitates significant improvements in glycemic control. PMID:26224760

  7. Bloodstream infection among children presenting to a general hospital outpatient clinic in urban Nepal.

    Directory of Open Access Journals (Sweden)

    Rahul Pradhan

    Full Text Available BACKGROUND: There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. METHODS: We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter. Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. RESULTS: Putative etiological agents for fever were identified in 164 (15% patients. Salmonella enterica serovar Typhi (S. Typhi was identified in 107 (10%, S. enterica serovar Paratyphi A (S. Paratyphi in 30 (3%, Streptococcus pneumoniae in 6 (0.6%, S. enterica serovar Typhimurium in 2 (0.2%, Haemophilus influenzae type b in 1 (0.1%, and Escherichia coli in 1 (0.1% patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2% patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. CONCLUSIONS: Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

  8. Out-Patient Nurse Involvement--An Answer to Success

    Science.gov (United States)

    Monaco, Ruth J.

    1976-01-01

    The article describes the planning and implementation of a continuing education inservice program for out-patient clinic nursing staff. Educational needs were assessed through interviews. Brief, twice-monthly seminar sessions stressed participant involvement. Copies of evaluation instruments are included which indicate favorable participant…

  9. Age, Gender, and Treatment Attendance among Forensic Psychiatric Outpatients.

    Science.gov (United States)

    Hadley, Dianne C.; Reddon, John R.; Reddick, Robert D.

    2001-01-01

    Uses the records of forensic psychiatry outpatients (N=6,299) to evaluate absenteeism from treatment in relation to age and gender. Results reveal that females had a significantly higher absentee rate than males in all age groups. For both males and females, missed appointments declined significantly with age. (Contains 34 references and 1 table.)…

  10. Outpatient treatment of alcohol use disorders among subjects 60+ years

    DEFF Research Database (Denmark)

    Andersen, Kjeld; Bogenschutz, Michael P; Bühringer, Gerhard;

    2015-01-01

    disorders (AUD). We present the rationale and design of a multisite, multinational AUD treatment study for subjects aged 60+ years. METHODS/DESIGN: 1,000 subjects seeking treatment for AUD according to DSM-5 in outpatient clinics in Denmark, Germany, and New Mexico (USA) are invited to participate in a RCT...

  11. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with bette

  12. Helicobacter pylori in out-patients of a general practitioner

    DEFF Research Database (Denmark)

    Rothenbacher, D; Bode, G; Winz, T

    1997-01-01

    Data on prevalence and determinants of Helicobacter pylori infection in well-defined populations are scarce. We investigated the prevalence and determinants of active H. pylori infection in a population of out-patients attending a general practitioner in Southern Germany. Infection status...

  13. 42 CFR 410.155 - Outpatient mental health treatment limitation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient mental health treatment limitation. 410.155 Section 410.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Payment of SMI...

  14. Outpatient Treatment of Primary Anorexia Nervosa in Adult Males.

    Science.gov (United States)

    Ziesat, Harold A., Jr.; Ferguson, James M.

    1984-01-01

    Describes three cases of adult-onset primary anorexia nervosa in males. For each case, the history and diagnostic patterns are considered, followed by a discussion of the course of outpatient treatment. The therapy was multimodal and included elements of behavioral contingency management, cognitive therapy, and dynamic psychotherapy. (JAC)

  15. Identifying Outpatients with Entrenched Suicidal Ideation Following Hospitalization

    Science.gov (United States)

    O'Connor, Stephen S.; Jobes, David A.; Comtois, Katherine Anne; Atkins, David C.; Janis, Karin; Chessen, Chloe E.; Landes, Sara J.

    2012-01-01

    The purpose of this study was to identify outpatients who experience entrenched suicidal ideation following inpatient psychiatric hospitalization. Our findings suggest that the use of a suicidal ambivalence index score was helpful at discriminating those who reported significantly greater ratings of suicidal ideation across a 1-year period of…

  16. Perceived Mental Illness Stigma among Youth in Psychiatric Outpatient Treatment

    Science.gov (United States)

    Elkington, Katherine S.; Hackler, Dusty; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.

    2012-01-01

    This research explores the experiences of mental illness stigma in 24 youth (58.3% male, 13-24 years, 75% Latino) in psychiatric outpatient treatment. Using Link and Phelan's (2001) model of stigmatization, we conducted thematic analysis of the interview texts, examining experiences of stigma at individual and structural levels, in addition to the…

  17. Self-Esteem and Suicide Ideation in Psychiatric Outpatients

    Science.gov (United States)

    Bhar, Sunil; Ghahramanlou-Holloway, Marjan; Brown, Gregory; Beck, Aaron T.

    2008-01-01

    Depression, hopelessness, and low self-esteem are implicated as vulnerability factors for suicide ideation. The association of self-esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self-esteem, suicide ideation, hopelessness, and…

  18. [Efficacy of Levofloxacin Hydrate in Febrile Neutropenia for Outpatient Chemotherapy].

    Science.gov (United States)

    Inagaki, Manato; Sato, Junya; Nihei, Satoru; Kashiwaba, Masahiro; Kudo, Kenzo

    2016-05-01

    Management of febrile neutropenia (FN) is important for the safety of patients undergoing outpatient chemotherapy. Oral antimicrobials are usually prescribed as the initial treatment for FN, and outpatients are instructed to begin medication prior to chemotherapy. However, the effectiveness and safety of the use of these oral antibiotics have not yet been established. In this study, we investigated the effectiveness and safety of levofloxacin hydrate (LVFX) for breast cancer patients with FN, and the factors associated with the onset of FN in 134 breast cancer patients who underwent chemotherapy including the anticancer drug anthracycline (total, 513 courses), in an outpatient chemotherapy department. The effectiveness and safety of LVFX were defined respectively as defervescence within 5 days, and the appearance of side effects such as diarrhea and rashes. Fever was observed in 89 (66%) of the 134 patients, and during 164 (32%) of 513 courses. Defervescence was observed with the LVFX medication in 149 (93%) of 160 courses. The primary side effect was the development of rashes, and only 2 (1%) of the 160 courses were discontinued. Onset of stomatitis during chemotherapy was observed as a factor of FN (odds ratio: 1.36, p<0.05). Our results suggest that the use of LVFX according to the patients' discretion might be an effective and safe option for the management of FN during outpatient chemotherapy.

  19. Behaviour Profile of Hungarian Adolescent Outpatients with a Dual Diagnosis

    Science.gov (United States)

    Dinya, Elek; Csorba, Janos; Suli, Agota; Grosz, Zsofia

    2012-01-01

    The behaviour dimensions of 244 Hungarian adolescent psychiatric outpatients with a dual diagnosis (intellectual disability and psychiatric diagnosis) were examined by means of the adapted version of the Behaviour Problem Inventory (BPI, Rojahn, Matson, Lott, Esbensen, & Smalls, 2001). Four IQ subgroups were created: borderline, mild, moderate…

  20. Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

    Directory of Open Access Journals (Sweden)

    J. Bueno Lledó

    Full Text Available Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC. Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%, most of them for "social" causes. Five patients required admission (between 24 and 48 hours for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications. Six patients (1.1% were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.

  1. Patient Satisfaction in Malaysia’s Busiest Outpatient Medical Care

    Directory of Open Access Journals (Sweden)

    Kurubaran Ganasegeran

    2015-01-01

    Full Text Available This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR, Malaysia, being the country’s busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18 scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly “technical quality” and “accessibility and convenience,” but satisfaction was low in terms of service orientation of doctors, particularly the “time spent with doctor,” “interpersonal manners,” and “communication” during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country’s health service satisfaction.

  2. Groups as a part of integrated treatment plans : Inpatient psychotherapy for outpatients?

    NARCIS (Netherlands)

    Staats, H

    2005-01-01

    Group psychotherapy in Germany is well established as part of an integrative treatment plan in inpatient treatment. Outpatient group psychotherapy, however, is conceptualized as a separate treatment option in competition with individual therapy. German guidelines for outpatient psychotherapy exclude

  3. Changes in quality of life following group CBT for anxiety and depression in a psychiatric outpatient clinic.

    Science.gov (United States)

    Oei, Tian Po; McAlinden, Niamh May

    2014-12-30

    The present study examined the relationship between quality of life and symptom change following group CBT treatment for anxiety or depression in a psychiatric hospital outpatient setting. One hundred seventy seven outpatients undergoing eight sessions of group CBT for anxiety (n=124) or mood disorders (n=53) participated. The Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (Zung-SRDS), Quality of Life Inventory (QOLI), and Satisfaction with Life Scale (SWLS) were administered at baseline and post-treatment. Additionally, the QOLI and SWLS scores of those who achieved reliable improvement or clinically significant symptom change were compared to those who experienced no reliable symptom improvement. There were significant changes across the QOLI, SWLS, BAI and Zung-SRDS outcome measures between baseline and post-treatment, with moderate to very large effect sizes observed. Patients with reliable or clinically significant change in their symptoms experienced significant increases in QOLI and SWLS scores when compared to those whose symptoms did not change reliably. Overall, in a psychiatric hospital outpatient setting, group CBT appeared to be successful in increasing quality of life and satisfaction with life in addition to reducing anxiety and depression symptoms.

  4. 数字化门诊建设中的精益管理%Lean Management during the Construction of Digital Outpatient Unit

    Institute of Scientific and Technical Information of China (English)

    杨骅; 王志勇; 陈珏; 魏民

    2012-01-01

    目的 在数字化门诊建设中引入精益管理理论和方法,为门诊患者和出诊医师提供人性化服务.方法 成立精益管理团队,运用精益工具评估存在问题,采取系列措施优化流程、完善服务.结果 达到了精益管理的预期效果.结论 流程改善是数字化门诊建设的先导,门诊管理者应全程参与数字化门诊建设过程,充分重视门诊信息数据的挖掘和分析.%Objective To introduce the theory and methods of lean management during the construction of digital outpatient clinical unit, to provide humanized service for patients and doctors. Method Setting up the lean management team. Then, using lean tools to assess existing problems, takeing a series of measures to optimize process and service. Results The expected effect of lean management has been achieved. Conclusion The process improvement is the most important part of the construction of digital outpatient service. The managers of outpatient clinical units should participate in the construction of digital outpatient service process, and pay fully attention to mining and analysis of outpatient information data.

  5. [The outpatient care in the Latium region (Italy) in 2001].

    Science.gov (United States)

    Torri, C; Balducci, M; Silvestri, I; Trifelli, S; Pasquarella, A; Guasticchi, G

    2004-01-01

    The Region of Latium has been operating an Outpatient Care Information System (SIAS) since 1997 to monitor the supply of outpatient care in a territory with a population of over five million. The present work has the aim of describing the outpatient care in the region, in terms of number of facilities involved by category (public and private, operating in the regional public health system) and volume of procedures rendered to residents in 2001. Of the 971 outpatient facilities operating in hospitals and elsewhere--37% state managed and 67% private--distributed in a non-uniform manner throughout the region, the majority is concentrated in the city of Rome, which by itself accounts for 49% of its total amount of facilities, and in a lesser measure in the other provincial capitals (Viterbo, Rieti, Frosinone, Latina). In 2001, 71 million procedures were performed, comprising 17 million prescriptions, for an economic value of over 400 million Euros. The three specialties of greatest use were Lab Analysis, Physical Therapy and Rehabilitation, and Radiology, making up 88% of the total outpatient procedures performed within the precinct of the regional health service, in respective measures of 57%, 27%, and 4%. It is noted that the public facilities are prevalently polyspecialistic while a great number of private facilities are monospecialistic and perform procedures almost exclusively (96%) in the three specialties of greatest use. The other specialties which receive notable use are Cardiology, Eye Care, Orthopedics and Neurology. In general, the greater the number of facilities there are in either the public or private sector, the greater the level of activity in terms of procedures performed, with the exception of the area of Physical Therapy and Rehabilitation where the correlation is inversely proportioned; in fact, for this specialty the public facilities, which are represented in a much greater number throughout the region, supply only 7% of the volume of activity.

  6. Oritavancin: a new opportunity for outpatient therapy of serious infections.

    Science.gov (United States)

    Tice, Alan

    2012-04-01

    Oritavancin is a new antibiotic for the treatment of serious infections with Gram-positive bacteria. It has been shown to be effective against methicillin-susceptible and -resistant Staphylococcus aureus as well as enterococci. With a terminal half-life of 393 hours, oritavancin lends itself to a convenient and potentially cost-effective single-dose regimen. The single-dose regimen is currently being evaluated in pivotal phase 3 studies. This unique property provides an opportunity to assure consistent, effective, and safe treatment for serious infections while reducing the costs of care through the elimination of multiple infusions, reduced medical care staff, shorter hospital stays, and avoidance of hospital-acquired infections. These features seem ideal for the use of oritavancin in the outpatient management of serious infections. The impact that oritavancin will have on outpatient therapy is unclear. Current models will need to change with only a single infusion. Physician monitoring of the infection and underlying diseases may not be as frequent despite the need for close follow-up and frequent evaluations. There will be less need for a team of outpatient infusion specialists. Outpatient therapy will be compensated less without multiple infusions. With the possibility of fewer physician and other medical visits, there will be more responsibility for the patient and family and a reliance on patients to care for themselves. Although oritavancin offers tremendous theoretical advantages in the outpatient treatment of serious infections, care should be taken to assure the quality of care through changes in reimbursement, patient education, and development of systems to monitor care and outcomes.

  7. Prevalence of depressive and anxiety disorders in Chinese gastroenterological outpatients

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jing Li; Yan-Ling He; Hong Ma; Zhe-Ning Liu; Fu-Jun Jia; Ling Zhang; Lan Zhang

    2012-01-01

    AIM:To investigate the prevalence and physicians'detection rate of depressive and anxiety disorders in gastrointestinal (GI) outpatients across China.METHODS:A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13general hospitals.A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS).The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results.SubJects with HADS scores ≥ 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses.RESULTS:There were 1059 patients with HADS score ≥ 8 and 674 (63.64%) of them undertook the MINI interview by psychiatrists.Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition),the adjusted current prevalence for depressive disorders,anxiety disorders,and comorbidity of both disorders in the GI outpatients was 14.39%,9.42% and 4.66%,respectively.Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ≥ 1] was 5.84% in women and 1.64% in men.The GI physicians' detection rate of depressive and anxiety disorders accounted for 4.14%.CONCLUSION:While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients,the detection rate of depressive and anxiety disorders by physicians is low.

  8. An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.

    LENUS (Irish Health Repository)

    Doran, J-P

    2012-02-01

    INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent\\'s University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.

  9. Behavioral Analytic Approach to Placement of Patients in Community Settings.

    Science.gov (United States)

    Glickman, Henry S.; And Others

    Twenty adult psychiatric outpatients were assessed by their primary therapists on the Current Behavior Inventory prior to placing them in community settings. The diagnoses included schizophrenia, major affective disorder, dysthymic disorder, and atypical paranoid disorder. The inventory assessed behaviors in four areas: independent community…

  10. 42 CFR 413.198 - Recordkeeping and cost reporting requirements for outpatient maintenance dialysis.

    Science.gov (United States)

    2010-10-01

    ... outpatient maintenance dialysis. 413.198 Section 413.198 Public Health CENTERS FOR MEDICARE & MEDICAID... § 413.198 Recordkeeping and cost reporting requirements for outpatient maintenance dialysis. (a) Purpose... will enable CMS to determine the costs incurred in furnishing outpatient maintenance dialysis...

  11. 42 CFR 410.141 - Outpatient diabetes self-management training.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient diabetes self-management training. 410... HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Outpatient Diabetes Self-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management...

  12. 42 CFR 414.63 - Payment for outpatient diabetes self-management training.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for outpatient diabetes self-management... SERVICES Physicians and Other Practitioners § 414.63 Payment for outpatient diabetes self-management..., payment for outpatient diabetes self-management training is made under the physician fee schedule...

  13. Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia

    Directory of Open Access Journals (Sweden)

    Chola Lumbwe

    2009-10-01

    Full Text Available Abstract Background Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia. Methods Annual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs. Results The total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78. Conclusion In the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions.

  14. Fuzzy logic-based approach to detecting a passive RFID tag in an outpatient clinic.

    Science.gov (United States)

    Min, Daiki; Yih, Yuehwern

    2011-06-01

    This study is motivated by the observations on the data collected by radio frequency identification (RFID) readers in a pilot study, which was used to investigate the feasibility of implementing an RFID-based monitoring system in an outpatient eye clinic. The raw RFID data collected from RFID readers contain noise and missing reads, which prevent us from determining the tag location. In this paper, fuzzy logic-based algorithms are proposed to interpret the raw RFID data to extract accurate information. The proposed algorithms determine the location of an RFID tag by evaluating its possibility of presence and absence. To evaluate the performance of the proposed algorithms, numerical experiments are conducted using the data observed in the outpatient eye clinic. Experiments results showed that the proposed algorithms outperform existing static smoothing method in terms of minimizing both false positives and false negatives. Furthermore, the proposed algorithms are applied to a set of simulated data to show the robustness of the proposed algorithms at various levels of RFID reader reliability.

  15. Residency training in advance care planning: can it be done in the outpatient clinic?

    Science.gov (United States)

    Alderman, Jeffrey S; Nair, Baishali; Fox, Mark D

    2008-01-01

    Resident physicians are expected to assist their outpatients to understand and complete advance directives, but their efficacy in doing so remains uncertain. After receiving educational training, internal medicine residents identified at-risk patients and solicited them about advance directives. Residents completed pretest and posttest questionnaires that assessed their knowledge, skills, attitude, and comfort with advance directives. Patients were also surveyed about their attitudes regarding advance directives. Ten internal medicine residents and 88 patients participated. Residents' self-assessed knowledge rose from 6.0 to 9.2 on a 10-point Likert scale. Skills using advance directives increased from 4.0 to 7.9, attitudes improved from 6.0 to 8.4, and comfort rose from 5.4 to 8.9. Eighty-four percent of patients expressed interest in completing advance directives, and 16% actually completed documents. An educational intervention improved knowledge, skills, attitudes, and comfort with advance directives among internal medicine residents practicing in the outpatient setting. Meanwhile, patients demonstrated a strong interest in completing advance directives.

  16. Deep procedural sedation by a sedationist team for outpatient pediatric renal biopsies.

    Science.gov (United States)

    Kamat, Pradip P; Ayestaran, Frank W; Gillespie, Scott E; Sanders, Rebecca D; Greenbaum, Larry A; Simon, Harold K; Stockwell, Jana A

    2016-05-01

    To date, no study has analyzed the use of deep PS for pediatric renal biopsies by a dedicated sedation team in an outpatient setting. Retrospective analysis of renal biopsies performed at CHOA from 2009 to 2013. Patient demographics, procedure success, and sedation-related events were analyzed. Logistic regression techniques were applied to identify characteristics associated with procedure safety and success. A total of 174 biopsies from 136 patients, aged 2-21 yr, were reviewed. Of the 174 biopsies, 63 of 174 (36%) were from native, and 111 of 174 (64%) were from transplanted kidneys, respectively. No deaths, allograft losses, or unanticipated hospital admissions occurred. The most commonly utilized interventions during sedation were blow-by oxygen (29.9%) and CPAP (12.1%). Children receiving the combination of F + P had significantly higher biopsy success rates vs. other drug combinations (96.1% vs. 79%; p = 0.014). There was no difference in complication rates regardless of drug combination or biopsy type (transplanted vs. native). The combination of F + P yields a high procedural success rate for outpatient native and transplanted kidney biopsies. We identified a number of sedation-related events that can be easily managed by a well-trained sedationist team.

  17. National Ambulatory Medical Care Survey: tobacco intervention practices in outpatient clinics.

    Science.gov (United States)

    Payne, Thomas J; Chen, Chieh-I; Baker, Christine L; Shah, Sonali N; Pashos, Chris L; Boulanger, Luke

    2012-09-01

    Tobacco use remains the leading cause of preventable death. The outpatient medical clinic represents an important venue for delivering evidence-based interventions to large numbers of tobacco users. Extensive evidence supports the effectiveness of brief interventions. In a retrospective database analysis of 11,827 adult patients captured in the 2005 National Ambulatory Medical Care Survey (of which 2,420 were tobacco users), we examined the degree to which a variety of patient demographic, clinical and physician-related variables predict the delivery of tobacco counseling during a routine outpatient visit in primary care settings. In 2005, 21.7% of identified tobacco users received a tobacco intervention during their visit. The probability of receiving an intervention differed by gender, geographic region and source of payment. Individuals presenting with tobacco-related health conditions were more likely to receive an intervention. Most physicians classified as specialists were less likely to intervene. The provision of tobacco intervention services appears to be increasing at a modest rate, but remains well below desirable levels. It is a priority that brief interventions be routinely implemented to reduce the societal burden of tobacco use.

  18. Constructive Sets in Computable Sets

    Institute of Scientific and Technical Information of China (English)

    傅育熙

    1997-01-01

    The original interpretation of the constructive set theory CZF in Martin-Loef's type theory uses the‘extensional identity types’.It is generally believed that these‘types’do not belong to type theory.In this paper it will be shown that the interpretation goes through without identity types.This paper will also show that the interpretation can be given in an intensional type theory.This reflects the computational nature of the interpretation.This computational aspect is reinforced by an ω-Set moel of CZF.

  19. Sensitivity and specificity of the Major Depression Inventory in outpatients

    Directory of Open Access Journals (Sweden)

    Noteboom Annemieke

    2007-08-01

    Full Text Available Abstract Background The Major Depression Inventory (MDI is a new, brief, self-report measure for depression based on the DSM-system, which allows clinicians to assess the presence of a depressive disorder according to the DSM-IV, but also to assess the severity of the depressive symptoms. Methods We examined the sensitivity, specificity, and psychometric qualities of the MDI in a consecutive sample of 258 psychiatric outpatients. Of these patients, 120 had a mood disorder (70 major depression, 49 dysthymia. A total of 139 subjects had a comorbid axis-I diagnosis, and 91 subjects had a comorbid personality disorder. Results Crohnbach's alpha of the MDI was a satisfactory 0.89, and the correlation between the MDI and the depression subscale of the SCL-90 was 0.79 (p Conclusion The MDI is an attractive, brief depression inventory, which seems to be a reliable tool for assessing depression in psychiatric outpatients.

  20. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation which is crucial knowledge in regards of patient compliance, decision making and general patient satisfaction. Despite good communication skills among clinicians...... the communication is challenged by the fact that patients tend to forget or misunderstand a great deal of the information given. The primary objective of this study is to investigate the effects of providing patients with an audio recording of the consultation. Methods A randomized controlled trial involving four...

  1. Monitoring of psychological well-being in outpatients with diabetes

    DEFF Research Database (Denmark)

    Pouwer, F; Snoek, Frank J; Van Der Ploeg, Henk M

    2001-01-01

    OBJECTIVE: To investigate whether monitoring and discussing psychological well-being in outpatients with diabetes improves mood, glycemic control, and the patient's evaluation of the quality of diabetes care. RESEARCH DESIGN AND METHODS: This study was a randomized controlled trial of 461...... outpatients with diabetes who were randomly assigned to standard care or to the monitoring condition. In the latter group, the diabetes nurse specialist assessed and discussed psychological well-being with the patient (with an interval of 6 months) in addition to standard care. The computerized Well...... nurse. The two groups did not differ for HbA(1c) or in their overall evaluation of the quality of diabetes care. In the monitoring condition, significantly more subjects were referred to the psychologist. CONCLUSIONS: Monitoring and discussing psychological well-being as part of routine diabetes...

  2. Actual outpatient PTCA: results of the OUTCLAS pilot study.

    Science.gov (United States)

    Slagboom, T; Kiemeneij, F; Laarman, G J; van der Wieken, R; Odekerken, D

    2001-06-01

    This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Included were 159 patients treated with balloon angioplasty or intracoronary stent placement, all performed via the radial artery with 6 French guiding catheters. Patients were selected for same-day discharge based on the absence of any adverse predictor for subacute occlusion or unfavorable clinical outcome during the first 24 hr after successful PTCA. One hundred and six (66%) patients were discharged 4-6 hr after PTCA. Stents were used in 40% of patients. There were no cardiac or vascular complications. We conclude that outpatient PTCA, performed via the radial artery, is both safe and feasible in a large part of a routine PTCA population.

  3. Use of sevoflurane inhalation sedation for outpatient third molar surgery.

    OpenAIRE

    Ganzberg, S.; Weaver, J.; Beck, F. M.; McCaffrey, G

    1999-01-01

    This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. In addition to measuring patient, surgeon, and dentist anesthesiologist subj...

  4. Drug adherence behavior among hypertensive out-patients at a tertiary health institution in Manicaland province, Zimbabwe, 2011

    Directory of Open Access Journals (Sweden)

    Mukora-Mutseyekwa FN

    2013-01-01

    Full Text Available Fadzai NN Mukora-Mutseyekwa, Elizabeth M ChadambukaFaculty of Health Sciences, Africa University, Mutare, ZimbabweObjectives: This study investigated the level of drug adherence among hypertensive outpatients at a tertiary hospital in Zimbabwe. Specific objectives included measurement of blood pressure (BP control achievement, estimating prevalence of drug adherence behavior, and establishing the association between drug adherence behavior and achievement of BP control.Methods and materials: An analytic cross sectional design was applied on a convenience sample of 102 participants using an interviewer administered questionnaire. Self-reported adherence was assessed using the Morisky Medication Adherence Scale.Findings: The median age of participants was 68.5 years (Q1 61; Q3 76. The majority were female (n = 71; 69.6%. BP control (<140/90 mmHg was achieved in 52% (n = 53. Self-reported drug adherence was 40.2% (n = 42. After multivariate logistic regression analysis, participants with normal BP measurements were more than three times as likely to report maximal adherence to prescribed drug schedules (odds ratio 3.37; 95% confidence interval: 1.38–8.24.Conclusion: Poor drug adherence behavior prevails among hypertensive outpatients. This contributes to poor achievement of BP control. The hospital is recommended to set up a specialized hypertension clinic in the Out-patients' Department where an intensified health education package can be introduced as well as community awareness programs on the importance of medication adherence.Keywords: drug adherence, behavior, hypertension

  5. Prevalence of co-morbid depression in out-patients with type 2 diabetes mellitus in Bangladesh

    Directory of Open Access Journals (Sweden)

    Roy Tapash

    2012-08-01

    Full Text Available Abstract Background Little is known about the prevalence of depression in people with diabetes in Bangladesh. This study examined the prevalence and factors associated with depression in out-patients with Type 2 diabetes in Bangladesh. Methods In this cross-sectional study a random sample of 483 diabetes out-patients from three diabetes clinics in Bangladesh was invited to participate. Of them 417 patients took part. Depressive symptoms were measured using previously developed and culturally standardized Bengali and Sylheti versions of the World HealthOrganization-5 Well Being Index (WHO-5 and the Patient Health Questionairre-9 (PHQ-9 with predefined cut-off scores. Data was collected using two different modes; e.g. standard assisted collection and audio questionnaire methods. Associations between depression and patient characteristics were explored using regression analysis. Results The prevalence of depressive symptoms was 34% (PHQ-9 score ≥ 5 and 36% (WHO-5 score  Conclusions This study demonstrated that depression prevalence is common in out-patients with type 2 diabetes in Bangladesh. In a setting where recognition, screening and treatment levels remain low, health care providers need to focus their efforts on diagnosing, referring and effectively treating this important disease in order to improve service delivery.

  6. Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients

    Directory of Open Access Journals (Sweden)

    Hatzaki Despina

    2012-09-01

    Full Text Available Abstract Background To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients. Methods During a multicenter survey of Enterobacteriaceae causing UTIs in outpatients during 2005–2007, Cefditoren MICs were determined by agar dilution method in a randomly selected sample of uropathogens. Susceptibility against 18 other oral/parenteral antimicrobials was determined according to Clinical and Laboratory Standards Institute methodology. Results A total of 563 isolates (330 Escherichia coli, 142 Proteus mirabilis and 91 Klebsiella spp was studied; MIC50/MIC90 of Cefditoren was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were resistant to cefditoren. Susceptibility rates (% for amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were 93.1- 94.1- 96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was significantly higher in nalidixic/ciprofloxacin non-susceptible strains; resistance to cefditoren was not associated with resistance to mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate analysis demonstrated history of urinary infection in the last two weeks or three months as risk factors for cefditoren resistance. Conclusions Cefditoren exhibited enhanced in vitro activity against the most common uropathogens in the outpatient setting, representing an alternative oral treatment option in patients with risk factors for resistance to first-line antibiotics.

  7. An audit of influenza and pneumococcal vaccination in rheumatology outpatients

    Directory of Open Access Journals (Sweden)

    Mitchell William S

    2007-07-01

    Full Text Available Abstract Background Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients. Method We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling. Results Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p Conclusion Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.

  8. Hepatic cystic echinococcosis:Percutaneous treatment as an outpatient procedure

    Institute of Scientific and Technical Information of China (English)

    Mert Krolu; Okan Akhan; Bekir Erol; Cemil Grses; Bar Trkbey; Cem Yunus Ba; Ahmetkr Alparslan; Banu Kale Krolu; clal Erdem Toslak; Blenteki

    2014-01-01

    Objective:To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) technique for outpatients.Methods:Percutaneous treatment withUS guidance was applied to33 patients for44 cysts.Patients treated with thePAIR technique, were outpatients. PAIR and catheterization technique were evaluated for efficacy and safety of procedure and complication rates.Results:Thirty-five of44 cysts were treated with thePAIR and9 of44 were treated with the catheterization technique.The success rate of the cystsGharbi type1(CE1) and type2(CE3a) treated with thePAIR technique was100%.In the follow up of9 cysts treated with the catheterization technique,2 of them(22%) developed cyst infection and1(11%) developed a biliary fistula.Conclusions:ThePAIR technique was found to be an effective and safe approach in order to treatGharbi type1 and type2 cysts percutaneously for outpatients.It has a very low complication rate in comparison with the catheterization technique.So every effort should be made to finish the treatment withPAIR technique.

  9. Clostridium difficile Carriage Rate in Outpatients with Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Mohammad Hosain Salari

    2013-10-01

    Full Text Available Abstract Background and objective: Closteridium difficile is a gram positive, anaerobic and spore-forming bacillus. Inflammatory bowel disease or IBD includes Crohn's disease and ulcerative colitis. Inflammation of the intestinal mucosa in these patients can be as a risk factor for colonization of Clostridium difficile. The purpose of this study was to analysis of Clostridium difficile carriage in the IBD outpatients. Materials and methods: Stool specimens were obtained from 50 outpatients with IBD. Stools were cultured on selective media under anaerobic conditions. Filtered extract of bacteria was exposed to HeLa cell culture for analysis of toxin production after identification of Clostridium difficile isolates. Results: The results showed that 3 IBD patients (6% had stool cultures positive for Clostridium difficile. Stool cultures were negative in all patients with Crohn's disease. All 3 patients had ulcerative colitis. Only one isolate was positive for toxin production. Conclusion: The ulcerated colitis than Crohn's patients had higher carriage. In general IBD outpatients carriage rates for Clostridium difficile was low.

  10. Association between human resources and risk of hospitalisation in end-stage renal disease outpatients receiving haemodialysis: a longitudinal cohort study using claim data during 2013–2014

    Science.gov (United States)

    Choi, Hoon-Hee; Han, Kyu-Tae; Nam, Chung Mo; Moon, Ki Tae; Kim, Woorim; Park, Eun-Cheol

    2016-01-01

    Objective The number of patients requiring haemodialysis has gradually increased in South Korea. Owing to this growth, concerns have been raised regarding haemodialysis quality of care, and healthcare professionals must consider alternatives for appropriate management of patients with chronic kidney disease (CKD). Therefore, we investigated the association between risk of hospitalisation of outpatients who received haemodialysis due to end-stage renal disease (ESRD) and the human resources of the haemodialysis unit. Setting We used data from National Health Insurance (NHI) claims during October 2013 to September 2014. Participants These data comprised 40 543 outpatients with ESRD (4 751 047 outpatient cases) who received haemodialysis. Interventions No interventions were made. Outcome measure We performed Poisson regression analysis using a generalised estimating equation that included both patient and haemodialysis unit characteristics to examine the factors associated with hospitalisation of outpatients with ESRD. Results Among 4 751 047 outpatient cases, 27 997 (0.59%) were hospitalised during the study period. A higher proportion of haemodialysis patient care specialists and a higher number of nurses experienced in haemodialysis were inversely associated with the risk of hospitalisation (per 10% increase in haemodialysis patient care specialists: relative risk (RR)=0.987, 95% CI 0.981 to 0.993; per 10-person increase in nurses who provided haemodialysis: RR=0.876, 95% CI 0.833 to 0.921). In addition, such associations were greater in severe patients. Conclusions Our findings suggest that haemodialysis units with high-quality, haemodialysis-specialised human resources could positively affect the outcomes of outpatients with ESRD. Based on our findings, health policymakers and professionals should implement strategies for the optimal management of patients with CKD. PMID:27534988

  11. The functional assessment measure (FAM) in closed traumatic brain injury outpatients: a Rasch-based psychometric study.

    Science.gov (United States)

    Tesio, L; Cantagallo, A

    1998-01-01

    The Functional Assessment Measure (FAM) has been proposed as a measure of disability in post-acute Traumatic Brain Injury (TBI) outpatients. It is comprised of the 18 items of The Functional Independence Measure (FIMSM), scored in terms of dependence, and of 12 newly designed items, scored in terms of dependence (7 items) or performance (5 items). The FIMSM covers the domains of self-care, sphincter management, mobility, locomotion, communication and social cognition. The 12 new items explore the domains of community integration, emotional status, orientation, attention, reading/writing skills, swallowing and speech intelligibility. By addressing a set of problems quite specific for TBI outpatients the FAM was intended to raise the ceiling of the FIMSM and to allow a more precise estimate of their disability. These claims, however, were never supported in previous studies. We administered the FAM to 60 TBI outpatient, 2-88 months (median 16) from trauma. Rasch analysis (rating scale model) was adopted to test the psychometric properties of the scale. The FAM was reliable (Rasch item and person reliability 0.91 and 0.93, respectively). Two of the 12 FAM-specific items were severely misfitting with the general construct, and were deleted. Within the 28-item refined FAM scale, 4 new items and 2 FIMSM items still retained signs of misfit. The FAM was on average too easy. The most difficult item (a new one, Employability) did not attain the average ability of the subjects. Also, it was only slightly more difficult than than the most difficult FIMSM item (Memory). The FAM does not seem to improve the FIMSM as a far as TBI outpatients are to be assessed.

  12. An outpatient multifactorial falls prevention intervention does not reduce falls in high-risk elderly Danes

    DEFF Research Database (Denmark)

    Vind, Ane B; Andersen, Hanne E; Pedersen, Kirsten D

    2009-01-01

    OBJECTIVES: To evaluate the effect of multifactorial fall prevention in community-dwelling people aged 65 and older in Denmark. DESIGN: Randomized, controlled clinical trial. SETTING: Geriatric outpatient clinic at Glostrup University Hospital. PARTICIPANTS: Three hundred ninety-two elderly people......, mean age 74, 73.7%women, who had visited the emergency department or had been hospitalized due to a fall. INTERVENTION: Identification of general medical, cardiovascular, and physical risk factors for falls and individual intervention in the intervention group. Participants in the control group...... received usual care. MEASUREMENTS: Falls were registered prospectively in falls diaries, with monthly telephone calls for collection of data. Outcomes were fall rates and proportion of participants with falls, frequent falls, and injurious falls in 12 months. RESULTS: Groups were comparable at baseline...

  13. Implementing cognitive behavioral therapy in specialty medical settings.

    Science.gov (United States)

    Magidson, Jessica F; Weisberg, Risa B

    2014-11-01

    This article is an introduction to the second issue of a two-part Special Series on integrating cognitive behavioral therapy (CBT) into medical settings. The first issue focused on integrating CBT into primary care, and this issue focuses on implementing CBT in other specialty medical settings, including cancer treatment, HIV care, and specialized pediatric medical clinics. Models for treatment delivery to improve ease of implementation are also discussed, including telehealth and home-delivered treatment. The six articles in this series provide examples of how to transport CBT techniques that are largely designed for implementation in outpatient mental health settings to specialized medical settings, and discuss unique considerations and recommendations for implementation.

  14. Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

    Science.gov (United States)

    Elewa, Usama; Fernandez-Fernandez, Beatriz; Alegre, Raquel; Sanchez-Niño, Maria D; Mahillo-Fernández, Ignacio; Perez-Gomez, Maria Vanessa; El-Fishawy, Hussein; Belal, Dawlat; Ortiz, Alberto

    2015-01-01

    Arterial stiffness, as measured by pulse wave velocity (PWV), is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5%) patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV) was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV) - (upper limit of the age-adjusted PWV values for the general population). Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

  15. Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    N. V. Bestuzheva

    2014-01-01

    Full Text Available Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV is most frequently encountered.Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice.Patients and methods. The investigation enrolled 80 patients, including 55 (68.7% women and 25 (31.3% men, aged 18 to 75 years (mean age 53.8±12.8 years, who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University.Results. The most common causes of dizziness in outpatient practice were BPPV (46.2% and postural phobic vertigo (35%. The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5% of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3% patients.Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted.

  16. Correlates of depressive symptoms in individuals attending outpatient stroke clinics.

    Science.gov (United States)

    Vermeer, Julianne; Rice, Danielle; McIntyre, Amanda; Viana, Ricardo; Macaluso, Steven; Teasell, Robert

    2017-01-01

    Background and purpose Depressive symptoms are common post-stroke. We examined stroke deficits and lifestyle factors that are independent predictors for depressive symptomology. Methods A retrospective chart review was performed for patients' post-stroke who attended outpatient clinics at a hospital in Southwestern Ontario between 1 January 2014 and 30 September 2014. Demographic variables, stroke deficits, secondary stroke risk factors and disability study measures [Patient Health Questionnaire-9 (PHQ-9) and Montreal Cognitive Assessment (MoCA)] were analyzed. Results Of the 221 outpatients who attended the stroke clinics (53% male; mean age = 65.2 ± 14.9 years; mean time post-stroke 14.6 ± 20.1 months), 202 patients were used in the final analysis. About 36% of patients (mean = 5.17 ± 5.96) reported mild to severe depressive symptoms (PHQ-9 ≥ 5). Cognitive impairment (CI), smoking, pain and therapy enrollment (p depressive symptoms. Patients reporting CI were 4 times more likely to score highly on the PHQ-9 than those who did not report CI (OR = 4.72). While controlling for age, MoCA scores negatively related to depressive symptoms with higher PHQ-9 scores associated with lower MoCA scores (r= -0.39, p depressive symptoms are common in the chronic phase post-stroke and were partially related to cognition, pain, therapy enrollment and lifestyle factors. Implications for Rehabilitation Stroke patients who report cognitive deficits, pain, tobacco use or being enrolled in therapy may experience increased depressive symptoms. A holistic perspective of disease and lifestyle factors should be considered while assessing risk of depressive symptoms in stroke patients. Patients at risk for depressive symptoms should be monitored at subsequent outpatient visits.

  17. Modifiable risk factors for increased arterial stiffness in outpatient nephrology.

    Directory of Open Access Journals (Sweden)

    Usama Elewa

    Full Text Available Arterial stiffness, as measured by pulse wave velocity (PWV, is an independent predictor of cardiovascular events and mortality. Arterial stiffness increases with age. However, modifiable risk factors such as smoking, BP and salt intake also impact on PWV. The finding of modifiable risk factors may lead to the identification of treatable factors, and, thus, is of interest to practicing nephrologist. We have now studied the prevalence and correlates of arterial stiffness, assessed by PWV, in 191 patients from nephrology outpatient clinics in order to identify modifiable risk factors for arterial stiffness that may in the future guide therapeutic decision-making. PWV was above normal levels for age in 85/191 (44.5% patients. Multivariate analysis showed that advanced age, systolic BP, diabetes mellitus, serum uric acid and calcium polystyrene sulfonate therapy or calcium-containing medication were independent predictors of PWV. A new parameter, Delta above upper limit of normal PWV (Delta PWV was defined to decrease the weight of age on PWV values. Delta PWV was calculated as (measured PWV - (upper limit of the age-adjusted PWV values for the general population. Mean±SD Delta PWV was 0.76±1.60 m/sec. In multivariate analysis, systolic blood pressure, active smoking and calcium polystyrene sulfonate therapy remained independent predictors of higher delta PWV, while age, urinary potassium and beta blocker therapy were independent predictors of lower delta PWV. In conclusion, arterial stiffness was frequent in nephrology outpatients. Systolic blood pressure, smoking, serum uric acid, calcium-containing medications, potassium metabolism and non-use of beta blockers are modifiable factors associated with increased arterial stiffness in Nephrology outpatients.

  18. Evaluation of Skin Findings in Adult Obese Dermatology Outpatients

    Directory of Open Access Journals (Sweden)

    Hilal

    2011-12-01

    Full Text Available Background: The relationship between systemic diseases and obesity is well-known, but the dermatological effects of obesity are ignored. In the literature, a few articles have appeared concerning the skin findings related to obesity. Our objective was to evaluate the skin findings in obese patients who applied to dermatology outpatient clinic and to compare obese and non-obese outpatients. Material and Method: A total 640 patients (300-in study group, 340-in control group were included in the study. All subjects were asked questions about socio-demographic features and presence of coexisting systemic diseases. Body mass index was calculated, dermatologic examination was performed, and diagnosis was recorded. Data were evaluated statistically. Results: Three-hundred obese patients (study group; 229 females, 71 males, mean age: 45.89 years and 340 non-obese outpatients (control group; 160 females, 180 males, mean age: 38.99 years were included in our study. There were more females in the study group and the mean age was higher than the control group. Most common skin findings of obese patients were: Skin tag (53.3%, plantar hyperkeratosis (29.6%, fungal infections (25.3%, striae (20.3% and acanthosis nigricans (15.3%. Fungal infections, intertrigo, varicose veins and keratosis pilaris were more common in females than males in the study group. Within the study group, patients with skin tag, acanthosis nigricans and plantar hyperkeratosis had higher BMI.Conclusion: Skin tag, plantar hyperkeratosis, fungal infections, striae and acanthosis nigricans were found to be the most common skin diseases in obese patients in our study. Studies related with pathophysiologic features of the skin of obese patients will give more information about the development and treatment of these diseases. (Turk­derm 2011; 45: 184-7

  19. ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY

    Directory of Open Access Journals (Sweden)

    A. V. Zagrebelnyi

    2015-01-01

    Full Text Available Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings. Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Forty­nine patients after acute myocardial infarction (AMI and/or percutaneous coro­ nary interventions (PCI with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT according to current clinical guidelines (CG, were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra­ indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared. Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 % cases and that was not in 3 (6.1 % patients in the presence of contraindications, 25 (51.0 % did not receive DAT in the absence of contraindications and 6 (12.3 % patients received the therapy in the presence of contraindications. Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications. 

  20. Clinical research: making it work in the outpatient dialysis facility.

    Science.gov (United States)

    Doss, Sheila; Schiller, Brigitte; Fox, Rosemary; Moran, John

    2009-01-01

    Performing clinical research in the outpatient dialysis facility can be very challenging. Research protocols define time-specific and detailed procedures to be performed. In dialysis units where staff members are responsible for the delivery of life-sustaining therapy to an aging end stage renal disease patient population with multiple co-morbidities, these requirements can easily be considered too burdensome to be implemented successfully. In the authors'facility, clinical research has been successfully implemented with a close team approach supported by a dedicated research group and unit staff

  1. Symptom prevalence and longitudinal follow-up in cancer outpatients receiving chemotherapy.

    Science.gov (United States)

    Yamagishi, Akemi; Morita, Tatsuya; Miyashita, Mitsunori; Kimura, Fukuko

    2009-05-01

    Palliative care for cancer patients receiving chemotherapy in the outpatient setting is important. The aims of this study were 1) to identify symptom prevalence and intensity in cancer patients receiving chemotherapy and 2) to describe longitudinal follow-up data obtained from repeated assessment using the distress thermometer (DT). Questionnaires were distributed to consecutive cancer outpatients newly starting chemotherapy at the first appointment and at every hospital visit. The questionnaire included the severity of 11 symptoms (M. D. Anderson Symptom Inventory [MDASI], Japanese version), the DT, and the need for help in four psychosocial areas (decision-making, economic problems, nutrition, and daily activities). In total, 4000 questionnaires were returned by 462 patients. The frequently identified problems were oral problems (21%), insomnia (19%), psychological distress (defined as a DT score of 6 or more; 15%), help with information and decision-making (14%), severe fatigue (8.2%), and severe appetite loss (6.3%). Cluster analysis identified four symptom clusters: 1) fatigue and somnolence; 2) pain, dyspnea, and numbness; 3) nausea, appetite loss, and constipation; and 4) psychological distress. Of 165 patients with a DT of score 6 or more, 115 patients (70%) demonstrated a DT score below 6 at a median of 17 days follow-up. In the remaining 50 patients who had a DT score of 6 or more at follow-up, 34 patients (68%) had one or more physical symptoms rated at 7 or more on an 11-point numeric rating scale. Compared with patients with a DT score below 6 at follow-up, patients with a DT score of 6 or more at follow-up had higher levels of all physical symptoms. Frequent symptoms experienced by cancer outpatients receiving chemotherapy may be categorized as: 1) psychosocial issues (insomnia, psychological distress, decision-making support); 2) nutrition-gastrointestinal issues (oral problems, appetite loss, nausea); 3) fatigue; and 4) pain, dyspnea, and numbness

  2. Outpatient approaches to elective induction of labor: past, present, and future.

    Science.gov (United States)

    Rauf, Zubair; Alfirevic, Zarko

    2014-06-01

    Assessing the feasibility, acceptability and safety of outpatient labour induction. MEDLINE database was searched for "outpatient labor induction" from January 1, 1986 to February 28, 2013. Main outcomes of interest included hyperstimulation, cesarean births, Apgar scores induction agent. Overall, maternal satisfaction is high. Outpatient labor induction is feasible and important adverse events are rare. However, paucity of available data and heterogeneity of different studies make it difficult to quantify adverse events or identify a preferred induction method.

  3. Do subjective cognitive complaints correlate with cognitive impairment in systemic lupus erythematosus? A Danish outpatient study

    DEFF Research Database (Denmark)

    Vogel, A; Bhattacharya, S; Larsen, J L

    2011-01-01

    This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive neuropsyc......This study examined the prevalence of cognitive impairment and its association with depressive symptoms and self-reported cognitive complaints in Danish outpatients with systemic lupus erythematosus (SLE). Fifty-seven consecutive female SLE-outpatients were examined with a comprehensive...

  4. Outpatient management of febrile neutropenia: time to revise the present treatment strategy

    DEFF Research Database (Denmark)

    Carstensen, M.; Sørensen, Jens Benn

    2008-01-01

    We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low-risk febr......We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low...

  5. [Clinical substantiation of nootropic preparation use for premedication in outpatient stomatology].

    Science.gov (United States)

    Novikova, S G

    2008-01-01

    The clinico-pharmacological description of nooclerin is given. The premedication effectiveness in patients with various individual typological features in out-patient stomatologic treatment was studied.

  6. High rate of smoking in female patients with Mondor's disease in an outpatient clinic in Japan

    Directory of Open Access Journals (Sweden)

    Okumura T

    2012-09-01

    Full Text Available Toshikatsu Okumura,1 Masumi Ohhira,1 Tsukasa Nozu21Department of General Medicine, 2Department of Regional Medicine and Education, Asahikawa Medical University, Asahikawa, Hokkaido, JapanPurpose: Little is known about the epidemiology of Mondor's disease. The aim of this study was to analyze the clinical features of Mondor's disease in an outpatient clinic where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease.Patients and methods: The data for consecutive outpatients who were new visitors to the Department of General Medicine in the teaching hospital (Asahikawa Medical University Hospital at Asahikawa Medical University, Asahikawa, Hokkaido, Japan, between April 2004 and March 2012 were analyzed. Parameters such as age, sex, diagnosis, and clinical presentation were investigated.Results: During the 8-year period covered in this study, six (0.07% out of 8767 patients were diagnosed as having Mondor's disease. All of these patients with Mondor's disease were female, and the mean age was 41 plus or minus 12 years; the overall rate of Mondor's disease in all female patients involved in this study was 0.12%. The patients complained of pain and a cord-like structure in the anterolateral thoracoabdominal wall. The painful mass had persisted for 1–4 weeks before presenting at the Department of General Medicine and it disappeared within a couple of weeks. Current smoking was significantly higher in the patients with Mondor's disease than in the age-matched female patients without Mondor's disease who were also evaluated in this study.Conclusion: These results suggest that a high rate of smoking in middle-aged females may be a characteristic feature of Mondor's disease. These epidemiological data may be useful in detection of the disease in the primary care setting in Japan.Keywords: primary care, epidemiology, current smoking, women

  7. Effect of Onsite Dietitian Counseling on Weight Loss and Lipid Levels in an Outpatient Physician Office

    Science.gov (United States)

    Welty, Francine K.; Nasca, Melita M.; Lew, Natalie S.; Gregoire, Sue; Ruan, Yuheng

    2009-01-01

    We examined the effect of an outpatient office-based diet and exercise counseling program on weight loss and lipid levels with an onsite dietitian who sees patients at the same visit with the physician and is fully reimbursable. Eighty overweight or obese patients (average age 55 ± 12 years, baseline body mass index 30.1 ± 6.4 kg/m2) with ≥1 cardiovascular risk factor (86%) or coronary heart disease (14%) were counseled to exercise 30 minutes/day and eat a modified Dietary Approaches to Stop Hypertension (DASH) diet (saturated fat <7%, polyunsaturated fat to 10%, monounsaturated fat to 18%, low in glycemic index and sodium and high in fiber, low-fat dairy products, fruits, and vegetables). Weight, body mass index, lipid levels, and blood pressure were measured at 1 concurrent follow-up visit with the dietitian and physician and ≥1 additional follow-up with the physician. Maximum weight lost was an average of 5.6% (10.8 lb) at a mean follow-up of 1.75 years. Sixty-four (81%) of these patients maintained significant weight loss (average weight loss 5.3%) at a mean follow-up of 2.6 years. Average decrease in low-density lipoprotein cholesterol was 9.3%, average decrease in triglycerides was 34%, and average increase in high-density lipoprotein cholesterol was 9.6%. Systolic blood pressure was lowered from 129 to 126 mm Hg (p = 0.21) and diastolic blood pressure from 79 to 75 mm Hg (p = 0.003). In conclusion, having a dietitian counsel patients concurrently with a physician in the out-patient setting is effective in achieving and maintaining weight loss and is fully reimbursable. PMID:17599444

  8. Carotid lesions in outpatients with nonalcoholic fatty liver disease

    Institute of Scientific and Technical Information of China (English)

    Stefano Ramilli; Stefano Pretolani; Antonio Muscari; Barbara Pacelli; Vincenzo Arienti

    2009-01-01

    AIM: To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US). METHODS: One hundred and fifty-four consecutive outpatients (age range 24-90 years, both sexes) referred by general practitioners for abdominal US, and drinking less than 20 g alcohol/day, underwent carotid US for an assessment of carotid intima-media thickness (c-IMT) and carotid plaque prevalence. Hepatic steatosis, visceral fat thickness and subcutaneous fat thickness were also assessed at ultrasonography. RESULTS: Higher c-IMT values were found in the presence of NAFLD (90 patients), even after adjustment for indices of general and abdominal obesity and for the principal cardiovascular risk factors (0.84 ± 0.10 mm vs 0.71 ± 0.10 mm, P < 0.001). The prevalence of carotid plaques was 57.8% in the patients with NAFLD vs 37.5% in the patients without this condition ( P = 0.02). The adjusted relative risk of having carotid plaques for paients with NAFLD was 1.85 (95% CI: 1.33-2.57, P < 0.001). CONCLUSION: An incidental finding of hepatic steatosis may suggest the presence of silent carotid atherosclerotic lesions.

  9. AB38. Microorganisms in Chronic prostatitis in outpatient clinic Mongolia

    Science.gov (United States)

    Samdankhuu, Khongorzul; Sanjmyatav, Purevjal; Damiran, Naransukh; Naidan, Nansalmaa

    2014-01-01

    Background Recent years, morbidity of chronic prostatis is increasing in Mongolia. Most common cause of the chronic prostatis is Non-Gonococcal Urethritis (NGU) such as chlamydia trachomatis, mycoplasma hominis, mycoplasma genitalium, ureaplasma urealyticum and ureaplasma parvum or mixed infections. Purpose The purpose of the study was to research possible relationships between signs or symptoms of the chronic prostatitis and its cause. Method A total of 466 males who have possible signs of chronic prostatitis were enrolled in the study. All patients were checked for urinalysis and expressed prostate secretion (EPS) and Polymerase Chain Reaction (PCR) of EPS detection for neisser a gonorrhea, chlamydia trachomatis, mycoplasma hominis, mycoplasma genitalium, ureaplasma urealyticum and ureaplasma parvum at an outpatient center of andrology office, Ulaanbaatar, Mongolia. Results Two hundred and eighty three of all participants have positive PCR results. Mean age of in our study was 33.1±8 years. U. realyticum was the most common (48.6%), followed by M. hominis and C. trachomatis mixed infection. In Mach, April and August were highest episodes of morbidity were registered 16.2%, 11.69% and 10.71%. Chronic pelvic pain syndrome and lower urinary tract symptoms were the most common complaints of main reason to visit outpatient clinic. Conclusions U. urealyticum was most common infection detected by PCR analyses among men who have chronic prostatitis, who have chronic pelvic pain syndrome. Further research is needed to determine if there are associations between signs or symptoms and cause of the chronic prostatis.

  10. "Drop in" gastroscopy outpatient clinic - experience after 9 months

    Directory of Open Access Journals (Sweden)

    Huppertz-Hauss Gert

    2012-02-01

    Full Text Available Abstract Background Logistics handling referrals for gastroscopy may be more time consuming than the examination itself. For the patient, "drop in" gastroscopy may reduce uncertainty, inadequate therapy and time off work. Methods After an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with "drop in" gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated. Results 112 patients had "drop in" gastroscopy and 101 gastroscopy by appointment. The number of "drop in" patients varied between 3 and 12 per day (mean 6.5. Mean time from first GP consultation to gastroscopy was 3.6 weeks in the "drop in" group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing "drop in" to 1022 after (47% increase and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with "drop in". Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff. Conclusions "Drop in" gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise "drop in" outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.

  11. Executive attention and working memory in narcoleptic outpatients

    Directory of Open Access Journals (Sweden)

    Mirleny Moraes

    2012-05-01

    Full Text Available OBJECTIVE: This pioneering study aimed to evaluate executive attention and working memory in Brazilian narcoleptic outpatients. METHODS: Narcoleptic group: 19 treated narcoleptic outpatients (13 F; 6 M (mean age=37.58; SD = 8.93; control group: 19 subjects (15 F; 4 M (mean age=34.42; SD=12.31. INSTRUMENTS: Epworth Sleepiness Scale - Brazilian Portuguese Version (ESS-BR, Victoria Stroop Test (VST, Trail Making Test (TMT and Letter-Number Sequencing (LNS of WAIS-III. RESULTS: Significant difference at Excessive Daytime Sleepiness (EDS (p<0.001 and at working memory (p=0.009 with worse results for narcoleptic patients. Patients were slower at VST-1 (p=0.002, VST-2 (p=0.045 and at TMT-A (p=0.016, TMT-B (p=0.006 and B-A (p=0.024. CONCLUSION: Narcoleptic patients showed higher degrees of EDS, an impaired executive attention at a temporal level and lower performance in working memory when compared to normal controls.

  12. Diabetes Mellitus in Outpatients in Debre Berhan Referral Hospital, Ethiopia

    Directory of Open Access Journals (Sweden)

    Tesfa Dejenie Habtewold

    2016-01-01

    Full Text Available Introduction. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most people with diabetes live in low- and middle-income countries and these will experience the greatest increase in cases of diabetes over the next 22 years. Objective. To assess the prevalence and associated factors of diabetes mellitus among outpatients of Debre Berhan Referral Hospital. Methods and Materials. A cross-sectional study was conducted from April to June 2015 among 385 patients. Random quota sampling technique was used to get individual patients and risk factors assessment. Patients diabetes status was ascertained by World Health Organization Diabetes Mellitus Diagnostic Criteria. The collected data were entered, cleaned, and analyzed and Chi-square test was applied to test any association between dependent and independent variable. Result. Out of the total 385 study patients, 368 have participated in the study yielding a response rate of 95.3%. Concerning clinical presentation of diabetes mellitus, 13.3% of patients reported thirst, 14.4% of patients declared polyurea, and 14.9% of patients ascertained unexplained weight loss. The statistically significant associated factors of diabetes mellitus were hypertensive history, obesity, the number of parities, and smoking history. Conclusion. The prevalence of diabetes mellitus among outpatients in Debre Berhan Referral Hospital was 0.34% and several clinical and behavioral factors contribute to the occurrence of diabetes mellitus which impose initiation of preventive, promotive, and curative strategies.

  13. Reinforcement-based outpatient treatment for opiate and cocaine abusers.

    Science.gov (United States)

    Katz, E C; Gruber, K; Chutuape, M A; Stitzer, M L

    2001-01-01

    A reinforcement-based intensive outpatient treatment was delivered to 37 recently detoxified, inner city, heroin and/or cocaine abusers who did not want methadone treatment. Attendance was scheduled and urine collected daily for the first 2 weeks, four times weekly for the next 2 weeks, and then thrice weekly for the final 8 weeks. As attendance incentives, patients received transportation assistance (bus tokens), and $28-$30 per week in vouchers to be spent on activities/items chosen and agreed upon with their counselor. As abstinence incentives, patients received weekend supported recreational activities, lunches, $42-$45 per week in vouchers, and rent or utilities payment ($150 over 4 weeks). Total potential earnings was $1,435 per patient; actual mean earnings was $583. Forty-three percent (n=16) completed 10 or more weeks of treatment. These 16 long-stay patients submitted 92% (SD=19) opiate- and cocaine-negative urines during their enrollment compared with 56% (SD=42) drug-negative urines submitted by 21 drop-outs, F(1,35)=9.99, p=0.003. Overall, 32% of clients became employed during their treatment episode; 94% of long-stay patients were employed at the end of their treatment episode. Patients who were drug-positive at intake were highly likely to drop out. Treatment outcomes compare favorably with those reported in the literature for outpatient nonmethadone treatment of opiate and cocaine abusers. Continued evaluation of this new treatment appears warranted.

  14. Bilevel Fuzzy Chance Constrained Hospital Outpatient Appointment Scheduling Model

    Directory of Open Access Journals (Sweden)

    Xiaoyang Zhou

    2016-01-01

    Full Text Available Hospital outpatient departments operate by selling fixed period appointments for different treatments. The challenge being faced is to improve profit by determining the mix of full time and part time doctors and allocating appointments (which involves scheduling a combination of doctors, patients, and treatments to a time period in a department optimally. In this paper, a bilevel fuzzy chance constrained model is developed to solve the hospital outpatient appointment scheduling problem based on revenue management. In the model, the hospital, the leader in the hierarchy, decides the mix of the hired full time and part time doctors to maximize the total profit; each department, the follower in the hierarchy, makes the decision of the appointment scheduling to maximize its own profit while simultaneously minimizing surplus capacity. Doctor wage and demand are considered as fuzzy variables to better describe the real-life situation. Then we use chance operator to handle the model with fuzzy parameters and equivalently transform the appointment scheduling model into a crisp model. Moreover, interactive algorithm based on satisfaction is employed to convert the bilevel programming into a single level programming, in order to make it solvable. Finally, the numerical experiments were executed to demonstrate the efficiency and effectiveness of the proposed approaches.

  15. 42 CFR 410.62 - Outpatient speech-language pathology services: Conditions and exclusions.

    Science.gov (United States)

    2010-10-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.62 Outpatient speech-language pathology services: Conditions and... to qualify under Medicare as a supplier of outpatient speech-language pathology services,...

  16. 42 CFR 403.321 - State systems for hospital outpatient services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false State systems for hospital outpatient services. 403.321 Section 403.321 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Control Systems § 403.321 State systems for hospital outpatient services. CMS may approve a...

  17. 75 FR 26683 - Hospital and Outpatient Care for Veterans Released From Incarceration to Transitional Housing

    Science.gov (United States)

    2010-05-12

    ...-26685] [FR Doc No: 2010-11177] DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN41 Hospital and... its regulations to authorize VA to provide hospital and outpatient care to a veteran in a program that... 2900-AN41 Hospital and Outpatient Care for Veterans Released from Incarceration to Transitional...

  18. Gaps in health care for the somatic health of outpatients with severe mental illness

    NARCIS (Netherlands)

    van Hasselt, Fenneke M.; Schorr, Susanne G.; Mookhoek, Evert J.; Brouwers, Jacobus R. B. J.; Loonen, Anton J. M.; Taxis, Katja

    2013-01-01

    The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health-care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting

  19. Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital.

    Science.gov (United States)

    Spivak, Emily Sydnor; Kendall, Brian; Orlando, Patricia; Perez, Christian; De Amorim, Marina; Samore, Matthew; Pavia, Andrew T; Hersh, Adam L

    2015-09-01

    We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation.

  20. A chance for change : building an outcome monitoring feedback system for outpatient mental health care

    NARCIS (Netherlands)

    Jong, Kim de

    2012-01-01

    The principal aim of this thesis was to develop an outcome monitoring feedback model for Dutch outpatient mental health care in the Netherlands and to test whether providing feedback to therapists and patients can improve treatment outcomes. Data on patient progress collected in outpatient centers i

  1. Predicting Suicide Risks among Outpatient Adolescents Using the Family Environment Scale: Implications for Practice and Research

    Science.gov (United States)

    Lucey, Christopher F.; Lam, Sarah K. Y.

    2012-01-01

    This study was designed to identify characteristics of family functioning that relate to suicide potential in an outpatient adolescent population. Participants included 51 adolescents between the ages of 14 and 18 who were involved in outpatient counselling. The Family Environment Scale and the Suicide Probability Scale were used to assess…

  2. Uterine artery embolization - inpatient and outpatient therapy: a comparison of cost, safety, and patient satisfaction

    Energy Technology Data Exchange (ETDEWEB)

    Baerlocher, M.O.; Asch, M.R.; Hayeems, E.Z.; Rajan, D.K. [Univ. of Toronto, Radiology Residency Training Program, Toronto, Ontario (Canada)]. E-mail: mark.baerlocher@utoronto.ca

    2006-04-15

    To determine whether uterine artery embolization (UAE) can be safely performed as an outpatient procedure without increased complications and readmission rates or decreased patient satisfaction rates and to determine the Canadian cost difference between performing UAE as an outpatient, compared with inpatient, procedure. We performed a retrospective chart review and patient survey of 2 groups of patients, 132 patients who underwent inpatient UAE and 20 patients who underwent outpatient UAE. Of these, 82 and 18, respectively, were successfully surveyed by telephone. Variables examined included presenting complaints, postprocedural symptoms, patient satisfaction, and readmission or complication rates. We also performed a detailed Canadian cost analysis comparing inpatient with outpatient UAE. We did not find any statistically significant difference between inpatient and outpatient UAE on any of the patient variables measured, including presenting complaints, postprocedural symptoms, patient satisfaction, and readmission or complication rates. We also found that outpatient UAE costs significantly less than inpatient UAE, primarily owing to decreased hospital overhead costs for overnight admission. In Ontario, inpatient UAE costs per patient totalled $3216.22, whereas outpatient costs totalled $2194.53 - a saving of $1021.69, which represents a 31.8% cost reduction. Given these results, we recommend that centres consider performing UAE as an outpatient procedure. A key enabling factor is the ability to have several hours of close nursing supervision of the patient postprocedure, prior to discharge. (author)

  3. Hyponatremia, Cognitive Function, and Mobility in an Outpatient Heart Failure Population

    Science.gov (United States)

    Albabtain, Monirah; Brenner, Michael J.; Nicklas, John M.; Hummel, Scott L.; McCormick, Michael P.; Pawlowski, Jeffrey L.; Remington, Tami L.; Gure, Tanya R.; Dorsch, Michael P.; Bleske, Barry E.

    2016-01-01

    Background The association of hyponatremia with cognitive impairment and mobility in heart failure (HF) patients is unknown. The purpose of this study was to determine if hyponatremia is associated with cognitive and mobility impairment as measured by simple, validated, and time-sensitive tests. Material/Methods This was a prospective study in patients with reduced and preserved ejection fraction (HFrEF, HFpEF) seen in outpatient HF clinics. Hyponatremia was defined as sodium level ≤136 mEq/L. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) tool, and mobility was measured with the Timed Up and Go test (TUG-t). Results A total of 121 patients were evaluated; 30% were hyponatremic (134±1.9 mEq/l, range 128–136 mEq/l). Overall, 92% of hyponatremic patients had cognitive impairment (MoCA HFpEF patients had cognitive impairment (p=0.86). HFrEF patients had significantly lower overall MoCA scores (21.2±3.7 vs. 23.3±3.6, p=0.006) and similar TUG-t times compared to HFpEF patients. Conclusions Most heart failure patients (HFrEF and HFpEF) seen in an ambulatory setting had impairment of cognitive function and mobility, with a higher prevalence among those with hyponatremia. Screening can be done using tests that can be administered in a clinical setting. PMID:27988787

  4. Outpatient health care statistics data warehouse--implementation.

    Science.gov (United States)

    Zilli, D

    1999-01-01

    Data warehouse implementation is assumed to be a very knowledge-demanding, expensive and long-lasting process. As such it requires senior management sponsorship, involvement of experts, a big budget and probably years of development time. Presented Outpatient Health Care Statistics Data Warehouse implementation research provides ample evidence against the infallibility of the above statements. New, inexpensive, but powerful technology, which provides outstanding platform for On-Line Analytical Processing (OLAP), has emerged recently. Presumably, it will be the basis for the estimated future growth of data warehouse market, both in the medical and in other business fields. Methods and tools for building, maintaining and exploiting data warehouses are also briefly discussed in the paper.

  5. Management of patients with back pain in outpatient practice

    Directory of Open Access Journals (Sweden)

    O N Gerasimova

    2010-01-01

    Full Text Available The authors studied the efficiency of drug therapy using the nonsteroidal anti-inflammatory drug (NSAID meloxicam (Movalis for nonspecific back pain and radiculopathy in the outpatient practice (without physio-, reflex, and manual therapies. Examination of 156 patients revealed a specific cause of back pain only in 6 (3.8%. Drug therapy using Movalis in 150 patients with acute, subacute, chronic nonspecific back pain at various sites or radiculopathy resulted in a considerable reduction in pain (as high as 1-3 VAS scores and its complete regression in 97.3% of cases within 2-3 weeks of treatment. Movalis therapy was found to be well tolerated and caused a low frequency of side effects (1.7% as mild gastrointenstinal disorders; Movalis used in combination with antiepileptic agents (pregabalin and gabapentin, myorelaxants (Midocalm and Milgamma in some patents was ascertained to be also well tolerated.

  6. Mortality incidence in outpatient anesthesia for dentistry in Ontario.

    Science.gov (United States)

    Nkansah, P J; Haas, D A; Saso, M A

    1997-06-01

    Studies determining anesthesia mortality rates in dentistry have been published, yet a similar investigation has never been conducted in Canada. Therefore the objective of this study was to determine the incidence of mortality when general anesthesia or deep sedation was administered by qualified dentists in the province of Ontario. Mortality data were obtained from the years 1973 to 1995 inclusive. The number of general anesthetics and deep sedations administered annually by qualified in dental offices was calculated by surveying all oral and maxillofacial surgeons and dental anesthetists in Ontario in 1990 and 1995. The results provided an estimate of 2,830,000 cases from 1973 to 1995 inclusive. Over this time period there were four deaths associated with cases in which either an oral and maxillofacial surgeon or dental anesthetist administered the general anesthetic or deep sedation, yielding a mortality rate of 1.4 per 1,000,000. This mortality incidence is similar to rates already published for outpatient dentistry.

  7. Factor analytic study of the personality of female methadone outpatients.

    Science.gov (United States)

    Duthie, R B

    1980-10-01

    Several researchers have examined the personality of chemical abusers by employing a multivariate clustering strategy. All of these studies focused on hospitalized inpatient addicts. Only one included females in the study. The purpose of this study is to examine the transposed data factor analytically derived profiles of female methadone maintained outpatients. All clients were given the Mini-Mult short form version of the Minnesota Multiphasic Personality Inventory. Seventy profiles were randomly selected from 130 female profiles. Program Factor of the Analyses of Behavioral Sciences Data program series was employed in statistically processing this data. Descriptions of the five factors are provided. Most of the profile types seem to fall into the normal or personality disordered categories. Forth-two percent of the profiles were normal, 24% were Personality Disorders, 6% were Neurotic, and 28% were unclassified using five factors.

  8. A Markov decision model for determining optimal outpatient scheduling.

    Science.gov (United States)

    Patrick, Jonathan

    2012-06-01

    Managing an efficient outpatient clinic can often be complicated by significant no-show rates and escalating appointment lead times. One method that has been proposed for avoiding the wasted capacity due to no-shows is called open or advanced access. The essence of open access is "do today's demand today". We develop a Markov Decision Process (MDP) model that demonstrates that a short booking window does significantly better than open access. We analyze a number of scenarios that explore the trade-off between patient-related measures (lead times) and physician- or system-related measures (revenue, overtime and idle time). Through simulation, we demonstrate that, over a wide variety of potential scenarios and clinics, the MDP policy does as well or better than open access in terms of minimizing costs (or maximizing profits) as well as providing more consistent throughput.

  9. Use of sevoflurane inhalation sedation for outpatient third molar surgery.

    Science.gov (United States)

    Ganzberg, S; Weaver, J; Beck, F M; McCaffrey, G

    1999-01-01

    This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. In addition to measuring patient, surgeon, and dentist anesthesiologist subjective satisfaction with the technique, physiological parameters, amnesia, and psychomotor recovery were also assessed. No statistically significant difference was found between the sevoflurane and midazolam-fentanyl-propofol sedative groups in physiological parameters, degree of amnesia, reported quality of sedation, or patient willingness to again undergo a similar deep sedation. A trend toward earlier recovery in the sevoflurane group was identified. Sevoflurane can be successfully employed as a deep sedative rather than a general anesthetic for extraction of third molars in healthy subjects.

  10. [Sportstherapy for outpatients with eating disorders: a pilot project].

    Science.gov (United States)

    Schlegel, Sabine; Hafner, Donata; Hartmann, Armin; Fuchs, Reinhard; Zeeck, Almut

    2012-12-01

    Many patients with Anorexia and Bulimia Nervosa (AN, BN) engage in sport and physical activity in an excessive and compulsive manner, mostly to influence weight and shape. Many of them experience guilt in case of not exercising. However, sport and physical exercise can also have a positive effect on mental illness by influencing mood, sense of self-esteem and body experience. Until now, only few programs for eating disorder patients exist which aim at changing physical activity behavior and use sport and exercise activities in a therapeutic way. We developed a sport-therapeutic program designed for outpatients with eating disorders. It supervises sport and physical exercise and helps patients to use sport and exercise in a healthy manner. This report presents the program's manual and first experiences based on half-standardized interviews.

  11. Rates of isolated sleep paralysis in outpatients with anxiety disorders.

    Science.gov (United States)

    Otto, Michael W; Simon, Naomi M; Powers, Mark; Hinton, Devon; Zalta, Alyson K; Pollack, Mark H

    2006-01-01

    Initial research suggests that rates of isolated sleep paralysis (ISP) are elevated in individuals with panic disorder and particularly low in individuals with other anxiety disorders. To further evaluate these findings, we examined rates of ISP in a sample outpatients with primary diagnoses of panic disorder (n=24), social anxiety disorder (n=18), or generalized anxiety disorder (n=18). We obtained an overall rate of ISP of 19.7%; rates for patients with panic disorder (20.8%) fell between those with generalized anxiety disorder (15.8%) and social phobia (22.2%). Analysis of comorbidities failed to provide evidence of link between depressive disorders and ISP, but did indicate a significant association between anxiety comorbidity and higher rates of ISP. Results are discussed relative to other variables predicting variability in the occurrence of ISP.

  12. Sex differences in the use of psychiatric outpatient facilities.

    Science.gov (United States)

    Kessler, R C; Reuter, J A; Greenley, J R

    1979-12-01

    Previous research has shown that both symptoms and sociocultural factors are related to use of psychiatric outpatient facilities. However, the utility of using treatment rates from these facilities to make etiological inferences depends on whether sociocultural effects on utilization are trivial or substantial. In this paper data are presented for one such inference, that women are more in need of treatment than men. We find that observed sex differences in the use of a student psychiatric clinic are due both to differential propensities to seek help for problems and also to differential numbers of problems, both of which are higher among women than men. However, the differential propensity to seek help is found to be by far the more important of these two effects.

  13. Validation of the Spanish SIRS with monolingual Hispanic outpatients.

    Science.gov (United States)

    Correa, Amor A; Rogers, Richard; Hoersting, Raquel

    2010-09-01

    Psychologists are faced with formidable challenges in making their assessment methods relevant to growing numbers of Hispanic clients for whom English is not the primary or preferred language. Among other clinical issues, the determination of malingering has profound consequences for clients. In this investigation, we evaluated a Spanish translation of the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) with 80 Spanish-speaking Hispanic American outpatients. Using a between-subjects simulation design, the Spanish SIRS was found to produce reliable results with small standard errors of measurement. Regarding validity, very large effect sizes (mean Cohen's d= 2.00) were observed between feigners and honest responders for the SIRS primary scales. We consider the potential role of the Spanish SIRS with reference to Spanish translations for other assessment instruments.

  14. Dual diagnosis and suicide risk in a Spanish outpatient sample.

    Science.gov (United States)

    Szerman, Nestor; Lopez-Castroman, Jorge; Arias, Francisco; Morant, Consuelo; Babín, Francisco; Mesías, Beatriz; Basurte, Ignacio; Vega, Pablo; Baca-García, Enrique

    2012-03-01

    The present study compares dual-diagnosis patients with other groups of psychiatric patients to determine the differential characteristics in suicide risk and other clinical variables between them. During 2008 in Madrid, 837 outpatients were evaluated in addiction and mental health services. Three comparison groups were created according to current diagnosis: (i) dual patients, (ii) patients with substance use disorders but no other mental disorders, and (iii) patients with mental disorders but no substance use disorders. A multinomial logistic regression model was built to explore the risk associated with dual diagnosis. Criteria for dual diagnosis were met at the time of the study by 440 patients (52.6%). Dual patients showed several demographic and clinical differences and a higher risk for suicide than the other two comparison groups. Further research is needed to define suicide preventive strategies for dual patients.

  15. The use of spirometry in a primary care setting

    Directory of Open Access Journals (Sweden)

    Elizabeth A Blain

    2009-10-01

    Full Text Available Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1 Do you have spirometry in your office? 2 Do you use spirometry for asthma patients? 3 In what situation do you use spirometry for? 4 Do you use spirometry more for chronic obstructive pulmonary disease (COPD or asthma? Results: It was found that pediatricians used spirometry 66% of the time, family practitioners 47% of the time, and internal medicine practitioners 60% of the time. Of those who did not use spirometry, 94% stated that they refer to a hospital if they required spirometry and 6% referred to subspecialists if the patient required spirometry. 10% of pediatricians performed the test on each asthma visit, otherwise the others used it only for exacerbations or as a baseline. No internists used spirometry regularly for asthma patients, and 22% used it more for COPD. In family practice only 14% used spirometry routinely at each visit for asthma patients.Conclusions: Pediatricians used spirometry more often in the outpatient setting than other specialists, followed closely by internal medicine physicians. Family practice physicians were the least likely to use spirometry. Multiple barriers seemed to prevent routine use of spirometry, but no one barrier accounted for the majority.Keywords: spirometry, asthma, primary care

  16. Diagnosis and treatment of dizziness in outpatient practice

    Directory of Open Access Journals (Sweden)

    L. M. Antonenko

    2015-01-01

    Full Text Available Objective: to study the causes of dizziness and instability in patients during an outpatient specialized appointment and to analyze and improve typical management tactics for these patients. Patients and methods. In 2009 to 2014, neurologists, dizziness specialists, examined 300 patients (122 men and 178 women aged 18 to 85 years, who complained of dizziness and instability. Prior to the examination, the patients had been diagnosed as having dyscirculatory encephalopathy (46%, vertebrobasilar insufficiency (30%, cervical osteochondrosis (12%, and vegetative dystonia (7%. Results and discussion. The examination established the causes of dizziness: benign paroxysmal positional vertigo (BPPV (34%, phobic postural instability (22%, multiple sensory insufficiency (15%, Meniere's disease (7%, migraine-associated vertigo (5%, vestibular neuronitis (4%, acute cerebrovascular accident (4%, and other diseases (9%. In accordance with the established diagnosis, adequate treatment which could completely eliminate or substantially reduce the magnitude of dizziness in the majority of cases was performed. The paper describes two clinical cases (BPPV and Meniere's disease. Betahistine dihydrochloride (vesticap, betaserc were most commonly used in a dose of 48 mg/day to treat vestibular vertigo. It gives the results of comparative treatment (with vesticap or betaserc for vestibular vertigo in 62 patients. The authors note the low level of diagnosis and effective treatment in patients with dizziness in outpatient practice. They show the expediency of a specialized examination, the efficiency and safety of current treatments, including medication therapy with betahistine dihydrochloride (betaserc and vesticap and rehabilitation on a stabiligraphic platform with biofeedback, for vestibular vertigo. 

  17. Outpatient- and inpatient-based buckling surgery: a comparative study

    Directory of Open Access Journals (Sweden)

    Lee JC

    2014-04-01

    Full Text Available Jin Cheol Lee,* Yu Cheol Kim*Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea *Both authors contributed equally to this workPurpose: To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery.Methods: The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1 or outpatient (group 2 surgery, and a comparison of several parameters between these two groups was performed.Results: Of the 80 subjects in this study, the average age of group 1 (50 patients was 49.7 years, and that of group 2 (30 patients was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant.Conclusion: Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.Keywords: ambulatory, scleral buckling, rhegmatogenous retinal detachment

  18. Evaluation of outpatient service quality in Eastern Saudi Arabia

    Science.gov (United States)

    Fraihi, Khalid J. Al; FAMCO, Dip; FAMCO, Fellow; Latif, Shahid A.

    2016-01-01

    Objectives: To investigate perceptions and expectations of patients regarding hospital outpatient services by using a service quality gap model and factors influencing such gaps. Methods: In this cross-sectional descriptive study conducted between October and November 2014 in the outpatient waiting areas of a hospital in the Eastern Province of Saudi Arabia, a sample of 306 patients was selected by convenience sampling technique. The data was collected through an Arabic version of the service quality (SERVQUAL) questionnaire consisting of 2 parts: patients’ demographic characteristics, and 22 items scales of patients’ expectations and perceptions of SERVQUAL. The data was analyzed by confirmatory factor analysis, independent, and paired t samples tests and one way analysis of variance test. Results: The results showed that the proposed model for service quality dimensions had a good fit by satisfying the recommended values. The patients’ expectations exceeded perceptions in all service quality dimensions indicating statistically significant service quality gaps (t=26.3, p<0.000). Findings revealed that the empathy dimension contributed most patients’ expectations (4.7 ± 0.5) and perceptions (3.7 ± 0.8) scores, and responsiveness contributed least to expectations (4.5 ± 0.6) and perceptions (3.2 ± 0.8) scores. Prompt services showed highest service quality gap, while observation of privacy showed the smallest service quality gap in the statements. The study showed a significant association between gender, age, education, multiple visits, and service quality dimensions. Conclusion: The proposed model is valid and reliable and significant service quality gaps of all 5 dimensions need to be prioritized and addressed by focused improvement efforts of hospital management. PMID:27052285

  19. The use of intravenous antibiotics at the onset of neutropenia in patients receiving outpatient-based hematopoietic stem cell transplants.

    Directory of Open Access Journals (Sweden)

    Aziz Hamadah

    Full Text Available Empirical antibiotics at the onset of febrile neutropenia are one of several strategies for management of bacterial infections in patients undergoing Hematopoietic Stem Cell Transplant (HSCT (empiric strategy. Our HSCT program aims to perform HSCT in an outpatient setting, where an empiric antibiotic strategy was employed. HSCT recipients began receiving intravenous antibiotics at the onset of neutropenia in the absence of fever as part of our institutional policy from 01 Jan 2009; intravenous Prophylactic strategy. A prospective study was conducted to compare two consecutive cohorts [Year 2008 (Empiric strategy vs. Year 2009 (Prophylactic strategy] of patients receiving HSCT. There were 238 HSCTs performed between 01 Jan 2008 and 31 Dec 2009 with 127 and 111 in the earlier and later cohorts respectively. Infection-related mortality pre- engraftment was similar with a prophylactic compared to an empiric strategy (3.6% vs. 7.1%; p = 0.24, but reduced among recipients of autologous HSCT (0% vs. 6.8%; p = 0.03. Microbiologically documented, blood stream infections and clinically documented infections pre-engraftment were reduced in those receiving a prophylactic compared to an empiric strategy, (11.7% vs. 28.3%; p = 0.001, (9.9% vs. 24.4%; p = 0.003 and (18.2% vs. 33.9% p = 0.007 respectively. The prophylactic use of intravenous once-daily ceftriaxone in patients receiving outpatient based HSCT is safe and may be particularly effective in patients receiving autologous HSCT. Further studies are warranted to study the impact of this Prophylactic strategy in an outpatient based HSCT program.

  20. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study.

    Directory of Open Access Journals (Sweden)

    Agostino Colli

    Full Text Available The performance of pocket mobile ultrasound devices (PUDs is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit.We assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings.We conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians' judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing.The 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%.After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the

  1. Outpatient rehabilitation utilization and medical expenses in children aged 0-7 years with ADHD: analyses of population-based national health insurance data.

    Science.gov (United States)

    Lin, Jin-Ding; Chen, Yi-Hsin; Lin, Lan-Ping

    2013-07-01

    Medical costs of attention-deficit/hyperactivity disorder (ADHD) are substantial and have a large impact on the public health system. The present study presents information regarding outpatient rehabilitation care usage and medical expenditure for children with ADHD. A cross-sectional study was conducted by analyzing data from the Taiwan National Health Insurance claims database for the year 2009. A total of 6643 children aged 0-7 years with ADHD (ICD-9-CM codes 314.0x: attention deficit disorder, 314.00: attention deficit disorder without hyperactivity, or 314.01: attention-deficit disorder with hyperactivity) who had used outpatient rehabilitation care were included in the analyses. Results showed that the mean annual rehabilitation care was 22.24 visits. Among the care users, 76% of patients were male, and 24% were female. More than half of the children with ADHD had comorbid mental illnesses as well. A logistic regression analysis of outpatient rehabilitation expenditure (low vs. high) showed that of those children with ADHD, those aged 0-2 years tended to incur more medical costs than those aged 6-7 years. Other factors such as frequency of rehabilitation visits, hospital medical setting and ownership, location of medical care setting, and types of rehabilitation were also significantly correlated with medical expenditure. The results from this study suggest that health care systems should ensure accurate diagnosis and measurement of impairment to maintain appropriate and successful management of rehabilitation needs for children with ADHD.

  2. Prevention of anaphylaxis in healthcare settings.

    Science.gov (United States)

    Worth, Allison; Sheikh, Aziz

    2013-09-01

    In this paper, we review recent evidence on preventing anaphylaxis in healthcare settings and contexts where the risk of developing anaphylaxis is known to be increased. These include investigation units in which patients are undergoing challenge testing, outpatient clinics undertaking immunotherapy and vaccination, inpatient settings in which patients receive antibiotics, non-steroidal anti-inflammatory drugs, opiates and biological agents and operating theatres in which patients receive general anesthetics. Anaphylaxis may however develop unpredictably in any patient exposed to a wide range of drugs, food and other triggers (e.g., latex, iodinated contrast media and exercise), so it is important that all healthcare professionals and systems have effective, well-rehearsed protocols for risk assessment and management of this allergic emergency. Where available, we consider evidence for the effectiveness of interventions aiming to reduce the risk of developing anaphylaxis.

  3. 42 CFR 484.38 - Condition of participation: Qualifying to furnish outpatient physical therapy or speech pathology...

    Science.gov (United States)

    2010-10-01

    ... outpatient physical therapy or speech pathology services. 484.38 Section 484.38 Public Health CENTERS FOR... furnish outpatient physical therapy or speech pathology services. An HHA that wishes to furnish outpatient physical therapy or speech pathology services must meet all the pertinent conditions of this part and...

  4. 78 FR 62709 - Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2013-10-22

    ... BUDGET Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental and cosmetic surgery services furnished by military treatment... Outpatient Medical, Dental, and Cosmetic Surgery rates referenced are effective upon publication of...

  5. 76 FR 72003 - Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2011-11-21

    ... BUDGET Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental, and cosmetic surgery services furnished by military treatment... outpatient medical, dental, and cosmetic surgery services rates referenced are effective upon publication...

  6. Evaluation of the quality of life between inpatients and outpatients receiving cancer chemotherapy in Japan.

    Science.gov (United States)

    Uramoto, Hidetaka; Kagami, Seiji; Iwashige, Atsushi; Tsukada, Junichi

    2007-01-01

    A quality of life (QOL) assessment has become increasingly common in cancer clinical trials. Seventy-four consecutive patients treated for cancer between August 2005 and January 2006 at the Cancer Chemotherapy Center in the University of Occupational and Environmental Health, Japan, were examined. The 8-Short form health survey (SF-8) was utilized as a comprehensive scale and quality of life questionnaire for cancer patients treated with anticancer drugs (QOL-ACD) as disease specific scale for the QOL evaluation. The QOL for outpatients was investigated in comparison with that for inpatients. All questionnaires were collected and baseline questionnaires were filled in by 98.1% of the subjects. The physical comprehensive score (PCS) of SF-8 for the outpatients was higher than that for the inpatients. The physical condition of the outpatients was better than that of inpatients. There was no difference in the baseline scores of the QOL-ACD scales in daily activity, psychological condition, social attitude, and face scale of the analyzed domains between the two groups. Furthermore, a longitudinal study from admission to outpatient was carried out on 27 patients who were treated on an outpatient basis in our clinic. No difference in the baseline scores of the SF-8 and QOL-ACD scales were observed in any of the analyzed domains. These data suggest that the present QOL study has a sufficient feasibility for the outpatients evaluated in our study, and QOL of outpatients after discharge is equal to that of inpatients receiving cancer chemotherapy.

  7. An Implementation of Outpatient Online Registration Information System of Mutiara Bunda Hospital

    Directory of Open Access Journals (Sweden)

    Masniah

    2015-12-01

    Full Text Available Outpatient care is one of the medical services in Mutiara Bunda hospital. The management of outpatient registration of Mutiara Bunda Hospital used conventional way. Within 1 hour serving, 5 patients were enrolled with an average time of 13 minutes per patient. This caused the registration queue to get outpatient services. The study was conducted with the aim to produce outpatient online registration information system design of Mutiara Bunda Hospital in order to increase outpatient registration service and to manage data in getting medical care. The patients register on Outpatient Online Registration Information System without having to come first to the hospital and get a queue number, so they can estimate the waiting time in the hospital to get medical care at Mutiara Bunda Hospital; while the patients who come to the hospital are served directly by the registrar. From the results of the research, it can be concluded that the application of Outpatient Online Registration Information System help in managing and processing data of patient registration to be able to get medical care immediately at Mutiara Bunda Hospital.

  8. Supplementing claims data with outpatient laboratory test results to improve confounding adjustment in effectiveness studies of lipid-lowering treatments

    Directory of Open Access Journals (Sweden)

    Schneeweiss Sebastian

    2012-11-01

    Full Text Available Abstract Background Adjusting for laboratory test results may result in better confounding control when added to administrative claims data in the study of treatment effects. However, missing values can arise through several mechanisms. Methods We studied the relationship between availability of outpatient lab test results, lab values, and patient and system characteristics in a large healthcare database using LDL, HDL, and HbA1c in a cohort of initiators of statins or Vytorin (ezetimibe & simvastatin as examples. Results Among 703,484 patients 68% had at least one lab test performed in the 6 months before treatment. Performing an LDL test was negatively associated with several patient characteristics, including recent hospitalization (OR = 0.32, 95% CI: 0.29-0.34, MI (OR = 0.77, 95% CI: 0.69-0.85, or carotid revascularization (OR = 0.37, 95% CI: 0.25-0.53. Patient demographics, diagnoses, and procedures predicted well who would have a lab test performed (AUC = 0.89 to 0.93. Among those with test results available claims data explained only 14% of variation. Conclusions In a claims database linked with outpatient lab test results, we found that lab tests are performed selectively corresponding to current treatment guidelines. Poor ability to predict lab values and the high proportion of missingness reduces the added value of lab tests for effectiveness research in this setting.

  9. Mixed-methods approach for measuring the impact of video telehealth on outpatient clinic triage nurse workflow.

    Science.gov (United States)

    Cady, Rhonda G; Finkelstein, Stanley M

    2013-09-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing the efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed-methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage did, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests that the increased depth and breadth of data available during video triage alter the assessment that triage nurses provide physicians. This in turn could affect the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area.

  10. Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy.

    Science.gov (United States)

    Lang, Elvira V; Berbaum, Kevin S; Faintuch, Salomao; Hatsiopoulou, Olga; Halsey, Noami; Li, Xinyu; Berbaum, Michael L; Laser, Eleanor; Baum, Janet

    2006-12-15

    Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, pempathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, pempathy=0.37, hypnosis=0.34; all pempathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.

  11. Psychological distress among dancers seeking outpatient treatment for musculoskeletal injury.

    Science.gov (United States)

    Air, Mary Elizabeth

    2013-09-01

    The purpose of this study was to investigate the incidence and magnitude of clinically significant psychological symptoms among outpatient injured dancers presenting for musculoskeletal issues and to identify features of "at risk" dancer-patients who might require additional psychological support when injured. The Brief Symptom Inventory® (BSI), a highly reliable and valid screening tool for psychological distress, was administered to first- and last-visit injured dancers at an orthopedic clinic in the Netherlands from February to May 2008. In all, 153 BSI surveys were completed, including 82 among first-visit patients and 71 among end-treatment patients. Scores were examined for the influence of age, gender, dance level, style, pain, perceived level of artistic compromise, and anatomic location of injury. Dancers' scores were compared to normative values for adult non-psychiatric patient community members. Ninety-two dancers (60.1%) met requirements for clinical referral to a psychologist or psychiatrist, having scored two or more standard deviations (SD) above the norm in at least one of nine psychopathological symptoms. Across first- and last-visit groups, dancers met referral criteria for an average of four psychopathological symptoms. First-visit dancers demonstrated higher distress than the general population on 90% of BSI dimensional symptoms and last-visit dancers on 50%. On the Global Symptom Index, a summary score for overall distress and the best measure of psychological discomfort, 46.6% of dancers demonstrated "above average" distress (≥ 1 SD) compared to the general population, and 19.6% demonstrated "high" (≥ 2 SD) or "very high" (≥ 2.5 SD) distress. Compared to academy level pre-professional students, professionals showed reduction in BSI scores on somatic, cognitive, interpersonal sensitivity, anxious, hostile, phobic, and global scores following resolution of injury, particularly among those greater than 25 years of age. Students and

  12. Teaching children clean intermittent self-catheterization (CISC) in a group setting.

    NARCIS (Netherlands)

    Cobussen-Boekhorst, H.J.; Kuppenveld, J. van; Verheij, P.P.; Jong, L.W.A.M. de; Gier, R.P.E. de; Kortmann, B.B.M.; Feitz, W.F.J.

    2010-01-01

    OBJECTIVE: To teach children to perform clean intermittent self-catheterization (CISC) at our institution, the nurse practitioner uses a step-by-step approach in combination with an instruction model in an outpatient setting. For a small group of children the procedure remains difficult to learn. Fo

  13. Characterization of Salmonella Enterica Serotype Typhimurium from Outpatients of 28 Hospitals in Henan Province in 2006

    Institute of Scientific and Technical Information of China (English)

    MIN ZHU; ZHI-QIANG XIE; LI-SHI ZHANG; SHENG-LI XIA; WEI-ZHONG YANG; LU RAN; ZI-JUN WANG

    2009-01-01

    Objective To characterize the diarrheal patients with Salmonella typhimurium (S. typhimurium) infections and to set up the first baseline for 5. typhimurium pulsed-field gel electrophoresis (PFGE) patterns in Henan province, thus laying a foundation for comprehensive surveillance of Salmonella in human as well as foods. Methods S. typhimurium isolates recovered from outpatients with diarrhea in Henan province from May to October of 2006 were characterized. Antimicrobial susceptibility tests of 8 antimicrobial agents and PFGE were carried out to analyze the 5. typhimurium isolates. Results Twenty-four (0.9%) S. typhimurium isolates were identified from 2661 stool specimens of diarrheal cases. Eighty-eight percent of isolates showed resistance to at least one antimicrobial agent. The resistance to chloramphenicol (79%) was most common. Fifty-eight percent of isolates were resistant to ciprofloxacin. All the 14 ciprofloxacin-resistant isolates were resistant to more than five antimicrobial agents. Thirty-three percent of 5. typhimurium isolates were resistant to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline (R-type ACSSuT). Eight antimicrobia-resistant phenotypes were found among the 24 isolates in 16 PFGE patterns. Conclusion The rate of multidrug-resistant S. typhimurium is relatively high in S. typhimurium PFGE patterns of Henan province. Multidrug-resistant S. typhimurium should be considered a public health threat.

  14. Implementation of outpatient schema therapy for borderline personality disorder: study design

    Directory of Open Access Journals (Sweden)

    van Asselt Thea

    2009-10-01

    Full Text Available Abstract Background Schema Therapy (ST is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis. Methods/Design Patient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%. Discussion The study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value. Trial Registration The Dutch Cochrane Center, NTR (TC = 1781.

  15. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.

  16. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  17. Quality Management of Outpatient Medical Record of Psychosis Department%精神病专科门诊病案管理

    Institute of Scientific and Technical Information of China (English)

    王爱仙

    2011-01-01

    目的 精神病专科医院的门诊病案需要长期保存是它的特殊性.我院门诊病案保存时限最长已达60年仍在使用,库存340,000份,日门诊量1000余人,意味着每日建立新的门诊病案与查找病案次数.近年来,不少患者因伤残评定、医疗保险而查找首次门诊病案,充分证实门诊病案的作用.由于忽略对门诊病案质量的重视,管理上存在疏漏,示踪流通不畅,病案重号或丢失,给查找和利用带来困难,影响患者使用,造成医患纠纷.因此,加强门诊病案质量管理不可忽略.%0bjective 0utpatient medical records of psychosis hospital need long-term preservation that is its speciality.The maxim um preservation timelim it of outpatient medical record is 60 years and they still in use.The stock of it are 340000 copies; outpatient num ber per day are 1000 people that means setting up new outpatient m edicalrecord and looking-up number of medical record.A trecent years, lots of patients look up their first out patient medical record for disability evaluation and medical insurance that adequately confirm s the role of outpatient medical record.Because of neglecting attention on outpatient m edical record quality , hindered circulation of showing medieal record place in management and repetition number and loss of medical record bring difficulty for looking-up and application, which affect patients' application and cause medical tangle.Quality management of outpatient medical record can not be neglect.

  18. Factors affecting acceptance of provider-initiated HIV testing and counseling services among outpatient clients in selected health facilities in Harar Town, Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Abdurahman S

    2015-05-01

    Full Text Available Sami Abdurahman,1 Berhanu Seyoum,2 Lemessa Oljira,2 Fitsum Weldegebreal2 1Harari Regional Health Bureau, 2Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia Purpose: To improve the slow uptake of HIV counseling and testing, the World Health Organization (WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS have developed draft guidelines on provider-initiated testing and counseling (PITC. Both in low- and high-income countries, mainly from outpatient clinics and tuberculosis settings, indicates that the direct offer of HIV testing by health providers can result in significant improvements in test uptake. In Ethiopia, there were limited numbers of studies conducted regarding PITC in outpatient clinics. Therefore, in this study, we have assessed the factors affecting the acceptance of PITC among outpatient clients in selected health facilities in Harar, Harari Region State, Ethiopia. Materials and methods: Institutional-based, cross-sectional quantitative and qualitative studies were conducted from February 12–30, 2011 in selected health facilities in Harar town, Harari Region State, Ethiopia. The study participants were recruited from the selected health facilities of Harar using a systematic random sampling technique. The collected data were double entered into a data entry file using Epi Info version 3.5.1. The data were transferred to SPSS software version 16 and analyzed according to the different variables. Results: A total of 362 (70.6% clients accepted PITC, and only 39.4% of clients had heard of PITC in the outpatient department service. Age, occupation, marital status, anyone who wanted to check their HIV status, and the importance of PITC were the variables that showed significant associations with the acceptance of PITC upon bivariate and multivariate analyses. The main reasons given for not accepting the tests were self-trust, not being at risk for HIV, not being ready, needing to consult their

  19. Dermatology referrals in a neurological set up

    Directory of Open Access Journals (Sweden)

    Deeptara Pathak Thapa

    2014-07-01

    Full Text Available Introduction: Dermatology is a specialty, which not only deals with dermatological problems with outpatient but also inpatients referrals. The importances of Dermatologist in hospital setting are rising due to changing condition of medical care. Since no peer-reviewed articles are available for dermatological problems in a neurological set up, we conducted this study to know about pattern of skin disorders in neurological patients. Material and Methods: The present study was a prospective study in a neurological setup, which included data from hospital dermatology consultation request forms over a period of one year. The data included demographic profile of the patient investigation where needed, neurological diagnosis and final dermatological diagnosis. The data was analyzed using SPSS. Results: A total of 285 patients who were requested for consultation were included in the study. Face was the commonest site of involvement (19.6%. Laboratory examination of referred patients revealed abnormal blood counts in 2% cases, renal function tests in 0.7% and urine in 0.4% cases. CT scan showed abnormal findings in 65.6% patients. The most common drug used in these patients was phenytoin (29.1%. The most common dermatological diagnosis was Infection and Infestation (34.7% followed by eczema (46.6%. Drug rash was seen in 3.9% cases. Out of which one had phenytoin induced Steven Johnson syndrome. Skin biopsy was done in 5 patients. Topicals was advised in 80%. Upon discharge 10% of inpatients didn’t require any follow-up. The patients who were followed up after 4 weeks, about 48% had their symptoms resolved with topicals and oral treatment as required. About 38% required more than two follow ups due to chronic course of the diseases. Conclusions: This present study discussed about various manifestations of skin disorders in a neurological set up and emphasizes the role of dermatologist in treating skin problems both in outpatient as well as inpatient

  20. PELVIC FLOOR DYSFUNCTIONS: CLINICAL AND SOCIODEMOGRAPHIC PROFILE OF UROGYNECOLOGIC OUTPATIENTS

    Directory of Open Access Journals (Sweden)

    Cássia Fernandes Coelho

    2013-01-01

    Full Text Available This study aimed to assess the socio-demographic and clinical profile of urogynecologic outpatients of a public tertiary hospital in Fortaleza, Ceará. This is a cross-sectional study whose sample consisted of 85 women with pelvic floor dysfunction. The age ranged from 27 to 86 years old (mean: 53.8±14.2. Most patients were married (54.9%, weren’t working formally (40.0% and didn’t smoke (82.4%. Approximately half was in postmenopausal period (48.2%. Most of them were multiparous (89.4% by vaginal delivery (92.9%. The main complaint reported was urinary incontinence (74.1%, and mixed urinary incontinence (MUI was the most frequent (60.0%. Over half of the patients also had pelvic organ prolapse (75.3%, and the most common defect was from the anterior vaginal wall (55.3%. The majority (57.6% had some form of anorectal dysfunction: constipation (40%, tenesmus (37.6%, fecal incontinence (16.5%. Most of the patients lost urine several times a day (57.3%, with impact on quality of life. The risk factors found are in agreement with literature data, as well as the prevalence of MUI. Given the concomitant disorders, it’s important to address all pathologies, because they are prevalent conditions with medical, social, psychological and economic implications.

  1. Factors associated with problematic drug use among psychiatric outpatients 1

    Science.gov (United States)

    Corradi-Webster, Clarissa Mendonça; Gherardi-Donato, Edilaine Cristina da Silva

    2016-01-01

    ABSTRACT Objective: to examine the factors associated with problematic drug use among psychiatric outpatients. Method: a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. Results: the most important independent predictors of problematic drug use were marital status (OR = 0.491), religious practice (OR = 0.449), satisfaction with financial situation (OR = 0.469), having suffered discrimination (OR = 3.821) and practicing sports activities in previous 12 months (OR = 2.25). Conclusion: the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering. PMID:27901217

  2. COPD, stage and treatment in a large outpatient clinic

    Science.gov (United States)

    Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette; Godtfredsen, Nina

    2017-01-01

    ABSTRACT Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62 patients (11.3%) met the criteria for treatment with roflumilast. Among the patients eligible for roflumilast treatment, only 14 patients (22.6%) were receiving treatment. There were no significant differences in FEV1, number of exacerbations, hospitalization due to exacerbation, MRC grade, age, smoking status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients fulfilling the criteria for this therapy. PMID:28326174

  3. Primary caregivers of schizophrenia outpatients: burden and predictor variables.

    Science.gov (United States)

    Grandón, Pamela; Jenaro, Cristina; Lemos, Serafín

    2008-04-15

    This article explores family burden in relation to relatives' coping strategies and social networks, as well as in relation to the patients' severity of positive and negative symptoms. Data on the severity of symptoms (Positive and Negative Syndrome Scale for Schizophrenia [PANSS]), social functioning (Social Functioning Scale [SFS]), caregivers burden (Interview on Objective and Subjective Family Burden or Entrevista de Carga Familiar Objetiva y Subjetiva [ECFOS]), coping skills (Family Coping Questionnaire [FCQ]), and social support (Social Network Questionnaire [SNQ]) were gathered from a randomized sample of 101 Chilean outpatients and their primary caregivers, mostly mothers. Low levels of burden were typically found, with the exception of moderate levels on general concerns for the ill relative. A hierarchical regression analysis with four blocks showed that clinical characteristics, such as higher frequency of relapses, more positive symptoms and lower independence-performance, together with lower self-control attributed to the patient, decrease in social interests, and less affective support, predict burden. The results support the relevance of psychoeducational interventions where families' needs are addressed.

  4. [Effectiveness evaluation of the drug dependency outpatient program "STEM"].

    Science.gov (United States)

    Kondo, Ayumi; Satou, Yoshitaka; Matsumoto, Toshihiko

    2016-02-01

    A cognitive behavioral therapy program entitled "STEM" was implemented with 42 drug dependent outpatients at Okayama Psychiatric Medical Center. Characteristics of 1 group who completed the program were examined, with the effectiveness of the program evaluated through monitoring longitudinal changes over a period of 8.5 months. Results showed that the percentage of patients who completed the program was 52.4% (22 out of 42 people), those who completed had a longer educational history than the dropouts, a high proportion of those who completed held some form of employment and that their motivation to recover was high. Evaluation results of the program effectiveness showed significant improvement in short-term drug self-efficacy, with a tendency for later improvement in feelings and emotions also observed. While a certain level of effectiveness was proven, approximately half the group dropped out; so it is necessary to consider alternative options at an early stage for participants with a high risk of dropout, such as strengthening individual support based on their specific characteristics.

  5. Creating an outpatient center of excellence in CT.

    Science.gov (United States)

    Itri, Jason N; Bakow, Eric; Woods, Jordan

    2014-12-01

    CT examinations represent a substantial portion of the workload for many radiology departments, and optimizing service delivery is a critical function to ensure customer satisfaction. This article describes how the Six Sigma methodology was used in the radiology department at a large academic hospital to improve the patient experience and increase CT capacity while reducing waste and improving staff satisfaction. The 5 distinct phases of Six Sigma are reviewed as they apply to our CT Center of Excellence project: define, measure, analyze, improve, and control. Process metrics used in this project include the percentage of outpatient CT exams started within 5 minutes of the scheduled appointment time, and the number of studies with protocols selected >48 hours before the CT exam is performed. Outcome metrics include monthly department expense per scan and CT Press Ganey "standard test and treatment" mean scores. An approach to developing interventions is described based on identifying critical sources of variation, ranking these by creating risk prioritization numbers, performing root cause analysis, and utilizing the failure mode and effects analysis tool to prioritize possible solutions. Finally, the key features of action plans and a control plan are reviewed.

  6. Pharmacoepidemiological profile and polypharmacy indicators in elderly outpatients

    Directory of Open Access Journals (Sweden)

    André de Oliveira Baldoni

    2013-09-01

    Full Text Available This cross-sectional study was carried out with 1000 elderly outpatients assisted by a Basic Health District Unit (UBDS from the Brazilian Public Health System (SUS in the municipality of Ribeirão Preto. We analyzed the clinical, socioeconomic and pharmacoepidemiological profile of the elderly patients in order to identify factors associated with polypharmacy amongst this population. We used a truncated negative binomial model to examine the association of polypharmacy with the independent variables of the study. The software SAS was used for the statistical analysis and the significance level adopted was 0.05. The most prevalent drugs were those for the cardiovascular system (83.4%. There was a mean use of seven drugs per patient and 47.9% of the interviewees used >7 drugs. The variables that showed association with polypharmacy (P value 75 years, self-medication, number of health problems, number of medical appointments, presence of adverse drug events, use of over-the-counter drugs, use of psychotropic drugs, lack of physical exercise and use of sweeteners. The exposition to all these factors justified the high prevalence of polypharmacy amongst the interviewees. These results showed the need to adopt clinical intervention and educational and managerial measures to analyze and promote rationality in the use of drugs amongst the elderly users of SUS.

  7. Outpatient titration of carbidopa/levodopa enteral suspension (Duopa).

    Science.gov (United States)

    Pahwa, Rajesh; Lyons, Kelly E

    2017-05-01

    Carbidopa/levodopa enteral suspension (CLES; Duopa) is a suspension or gel formulation of carbidopa/levodopa that is approved by the USA Food and Drug Administration for the treatment of advanced Parkinson's disease patients with motor fluctuations. CLES is delivered at a constant rate continuously throughout the day into the jejunum through an infusion pump via a PEG-J tube implanted surgically. The efficacy of CLES was established in the USA based on a randomized, double-blind, double-dummy, active controlled, parallel group and 12-week study, in which mean daily OFF time was reduced by 4.0 h, compared to 1.9 h with oral immediate release carbidopa/levodopa. The CLES hardware consists of a cassette containing the drug, a pump to deliver the drug and tubing to connect the PEG-J to the pump. It is critical to understand the appropriate conversion of the carbidopa/levodopa daily dosages to the CLES dosage and how to program the pump and titrate CLES to achieve the most effective dose. We describe one methodology for patient selection, outpatient titration and pump programming.

  8. Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

    Science.gov (United States)

    Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

    2016-01-01

    Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears.

  9. Effect of music on patients undergoing outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Matthew L Bechtold; Rodney A Perez; Srinivas R Puli; John B Marshall

    2006-01-01

    AIM: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist.SETHODS: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played.RESULTS: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time,endoscopist assessment of scope insertion difficulty,endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure.The music group did report significantly better overall procedure satisfaction as compared to the non music group on two of our three different scales.CONCLUSION: While music does not result in shortened procedure times, lower doses of sedative medications or perceived patient pain, the patients who have music playing during their procedures report modestly greater satisfaction with their procedures.

  10. Factors associated with problematic drug use among psychiatric outpatients

    Directory of Open Access Journals (Sweden)

    Clarissa Mendonça Corradi-Webster

    Full Text Available ABSTRACT Objective: to examine the factors associated with problematic drug use among psychiatric outpatients. Method: a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. Results: the most important independent predictors of problematic drug use were marital status (OR = 0.491, religious practice (OR = 0.449, satisfaction with financial situation (OR = 0.469, having suffered discrimination (OR = 3.821 and practicing sports activities in previous 12 months (OR = 2.25. Conclusion: the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering.

  11. Clinical conditions and memory complaints in outpatient elderly

    Directory of Open Access Journals (Sweden)

    Regina Miksian Magaldi

    Full Text Available Abstract Memory complaints are common in elderly, and may be associated with many clinical problems. Objective: To identify clinical conditions and possible factors related to memory complaints in elderly outpatients presenting at a tertiary unit. Methods: Patients with memory complaints and normal cognitive screening tests were submitted to clinical and laboratorial testing. Radiological evaluation was performed as needed for diagnosis. Results: One hundred and seventy-seven subjects were initially evaluated, 12 were excluded because of poor and inconsistent memory complaints. Of the remainder, seventeen had criteria for dementia diagnosis. Ninety-two (55.4% had one or more comorbid conditions possibly related to their complaints. Major depression was present in 26.0%. Sixteen patients (9.6% had vitamin B12 deficiency, 8 were in use of inappropriate medications, and 7 (4.2% had hypothyroidism. Other conditions diagnosed were: generalized anxiety disorder, obstructive sleep apnea syndrome, hyperparathyroidism, normal pressure hydrocephalus. Three patients had severe hearing loss (in 22 with hearing complaints; one had severe visual impairment (in 22 with visual complaints. Conclusions: Comprehensive evaluation was able to identify treatable conditions possibly related to memory complaints.

  12. Plasma oxytocin and personality traits in psychiatric outpatients.

    Science.gov (United States)

    Bendix, Marie; Uvnäs-Moberg, Kerstin; Petersson, Maria; Gustavsson, Petter; Svanborg, Pär; Åsberg, Marie; Jokinen, Jussi

    2015-07-01

    The oxytocin system is regarded as being of relevance for social interaction. In spite of this, very few studies have investigated the relationship between oxytocin and personality traits in clinical psychiatric populations. We assessed the relationship between personality traits and plasma oxytocin levels in a population of 101 medication-free psychiatric outpatients (men = 37, women = 64). We used the Karolinska Scale of Personality (KSP) and diagnostic and symptomatic testing. Plasma oxytocin levels were analysed with a specific radioimmunoassay at inclusion and after one month for testing of stability. Plasma oxytocin levels were stable over time and did not differ between patients with or without personality disorders, nor were they related to severity of depressive or anxiety symptoms. The KSP factors Impulsiveness and Negative Emotionality were significant independent predictors of plasma oxytocin. A subscale analysis of these personality factors showed significant positive correlations between baseline plasma oxytocin and the KSP subscales monotony avoidance and psychic anxiety. The significant association between the KSP factor Impulsiveness and oxytocin levels observed at baseline was observed also one month later in men. These findings suggest that personality traits such as Impulsiveness and Negative emotionality which are linked to social functioning in several psychiatric disorders seem to be associated with endogenous plasma oxytocin levels. These variations in oxytocin levels might have an impact on social sensitivity or social motivation with possible gender differences.

  13. Interpersonal problems associated with narcissism among psychiatric outpatients.

    Science.gov (United States)

    Ogrodniczuk, John S; Piper, William E; Joyce, Anthony S; Steinberg, Paul I; Duggal, Satna

    2009-06-01

    Narcissistic personality disorder is the subject of extensive discussion in the literature. Yet, the validity of this diagnostic category remains questionable. This is owed, in large part, to the relative absence of empirical work that has examined narcissism in clinical samples. Descriptions and findings from studies involving non-clinical samples suggest that narcissism is associated with considerable interpersonal impairment. The objective of the present study was to examine this possibility in a sample of psychiatric outpatients. Consecutively admitted patients (N=240) to a day treatment program completed measures of narcissism, interpersonal problems, and general psychiatric distress. Patients were categorized into high, moderate, and low narcissism groups. The groups were compared on overall interpersonal impairment, as well as on particular domains of interpersonal behavior. Treatment duration and discharge status were also compared among the three groups. Analysis of covariance and chi-square analyses were used. At baseline, higher levels of narcissism were significantly associated with greater interpersonal impairment. The interpersonal style of the more narcissistic patients was particularly characterized by domineering, vindictive, and intrusive behavior. At post-treatment, only the association between narcissism and intrusive behavior remained significant. Change in interpersonal difficulties following treatment did not differ significantly among the groups. However, failure to complete treatment was associated with narcissism. The results underscore the interpersonal impairment associated with narcissism and support the notion of narcissistic personality disorder as a valid diagnostic category.

  14. Implementation of a clinical pathway for emergency department out-patient management of deep vein thrombosis.

    LENUS (Irish Health Repository)

    Kidney, R

    2010-09-01

    There is good evidence demonstrating that outpatient management of deep venous thrombosis (DVT) is feasible and safe. However, few emergency departments in Ireland have implemented care pathways for outpatient management of DVT. The aim of this study was to examine the safety and efficacy of implementing an Emergency Department (ED)- care pathway for outpatient management of patients with DVT. A retrospective observational study of this care pathway introduced at our institution was performed. The primary outcome measure was the number of hospital admissions avoided by using the care pathway. Two hundred and eighty-four patients presenting to the ED with suspected lower limb DVT, were managed using the care pathway over a 6 month period. Forty-nine patients (17%) had a DVT diagnosed. Thirty-nine patients (81%) were suitable for outpatient DVT management. Ten patients (19%) were admitted to hospital. At 3 months there were no reported cases of the following complications: missed DVT, pulmonary embolism or death.

  15. Compliance to Cell Phone-Based EMA Among Latino Youth in Outpatient Treatment.

    Science.gov (United States)

    Comulada, W Scott; Lightfoot, Marguerita; Swendeman, Dallas; Grella, Christine; Wu, Nancy

    2015-01-01

    Outpatient treatment practices for adolescent substance users utilize retrospective self-report to monitor drug use. Cell phone-based ecological momentary assessment (CEMA) overcomes retrospective self-report biases and can enhance outpatient treatment, particularly among Latino adolescents, who have been understudied with regard to CEMA. This study explores compliance to text message-based CEMA with youth (n = 28; 93% Latino) in outpatient treatment. Participants were rotated through daily, random, and event-based CEMA strategies for 1-month periods. Overall compliance was high (>80%). Compliance decreased slightly over the study period and was less during random versus daily strategies and on days when alcohol use was retrospectively reported. Findings suggest that CEMA is a viable monitoring tool for Latino youth in outpatient treatment, but further study is needed to determine optimal CEMA strategies, monitoring time periods, and the appropriateness of CEMA for differing levels of substance use.

  16. Outpatient and Inpatient Satisfaction in a Public Training and Research Hospital

    OpenAIRE

    Levent Hekimoğlu1; A. Selda Tekiner2; Gülsen Ceyhun Peker2

    2015-01-01

    Objective: The aim of the article is to determine patient satisfaction among outpatients and inpatients in a subspecialty hospital. Methods: The study was carried out at Bursa Yuksek Ihtisas Teaching and Research Hospital between June 2011 and July 2012. This descriptive study is designed as cross-sectional and target population is consisted of 420 outpatients and 240 hospitalized patients. In this study Patient Satisfaction Survey was developed by Performance Management and Quality Devel...

  17. THE INTERVENTION BY THE OCCUPATIONAL THERAPIST IN OUTPATIENT TOY LIBRARY: REPORT OF AN EXPERIENCE

    OpenAIRE

    Marina Soares Bernardes; Maria Paula Panúncio Pinto; Luzia Iara Pfeifer; Amanda Mota Pacciulio Sposito; Mariana Oliveira Leite Silva

    2014-01-01

    Playing children develop essential skills to guarantee the performance of roles and activities, making it essential to maintain the play in different contexts. The objective is to describe and discuss the possible role of the occupational therapist in outpatient toy library. This is an experience report of Occupational Therapy undergraduate students on their activities in field (internship on Care for Children and Adolescents), in outpatients toy libraries based on the analysis of the reports...

  18. Identifying priority actions for improving patient satisfaction with outpatient cancer care.

    Science.gov (United States)

    Gesell, Sabina B; Gregory, Nancy

    2004-01-01

    In parallel to developing new cancer therapies, the healthcare community has the responsibility of creating positive treatment experiences for patients. Data from 5907 cancer outpatients treated at 23 hospitals across the United States were analyzed to identify the top priorities for service improvement in outpatient cancer treatment facilities. They included meeting patients' emotional needs, providing information to patients and family members, reducing waiting times, and providing convenience and coordinated care among physicians and other care providers.

  19. [Outpatient thoracic surgery: Evolution of the indications, current applications and limits].

    Science.gov (United States)

    Bagan, P; Berna, P; De Dominicis, F; Lafitte, S; Zaimi, R; Dakhil, B; Das Neves Pereira, J-C

    2016-12-01

    The objectives of outpatient surgery are to reduce the risks connected to hospitalization, to improve postoperative recovery and to decrease the health costs. Few studies have been performed in the field of thoracic surgery and there remains great scope for progress in outpatient lung surgery. The purpose of this article is to present a revue of the current situation and the prospects for the development of out patient thoracic surgery.

  20. Predictors of Health-Related Quality of Life in Outpatients with Cirrhosis

    DEFF Research Database (Denmark)

    Thiele, Maja; Askgaard, Gro; Timm, Hans Bording;

    2013-01-01

    Background. Cirrhosis may lead to a poor health-related quality of life (HRQOL), which should be taken into consideration when addressing the cirrhotic outpatient. Methods. Prospective cohort study evaluating predictors of HRQOL in outpatients with cirrhosis. Patients with overt hepatic...... encephalopathy at baseline were excluded. HRQOL was evaluated at baseline using the six point Chronic Liver Disease Questionnaire. Predictors of low quality of life scores (...

  1. Multidimensional health status of HIV-infected outpatients at a tertiary care center in north India

    Directory of Open Access Journals (Sweden)

    Wig Naveet

    2008-03-01

    Full Text Available Background : Quality of life (QOL scores inform researchers acquainted with such tools about patients′ perception of various domains of their health. The scores provide a useful denominator for clinical trials, especially in chronic diseases with therapeutic side effects, such as HIV. However, in clinical settings, there is a felt need of description of problems commonly perceived by patients. Aim : This study describes the multidimensional health-related issues of HIV-positive patients. Settings and Design : Cross-sectional design with convenient sampling was used to recruit 138 HIV-positive patients at the outpatient section of the Department of Medicine of a tertiary care hospital in north India. Materials and Methods : A structured questionnaire was used to collect information about health-related problems. Identified problems were assessed using a Likert scale for severity. Results : Out of the 20 assessed problems, the patients reported positive for an average of 12.01 ± 3.78 problems. The most prevalent problems were those related to emotions (98.6%, lack of energy (96.4%, and health perception (92.0%. The most distressing problems were ′feeling that health was not good′ (77.5% and ′health was bad′ (75.4%. The number of problems reported was significantly related to weight loss ( P = 0.006 and clinical category ( P = 0.023. A significant correlation was observed between weight loss and problems in social activities ( P < 0.001, pain ( P < 0.001; clinical class ( P < 0.001; tuberculosis, and problems in job and household work ( P = 0.002.Conclusion : Many patients have significant problems in dimensions other than physical. A physician′s awareness about these problems is important for a holistic patient management.

  2. Factors associated with positive blood cultures in outpatients with suspected bacteremia.

    Science.gov (United States)

    Wildi, K; Tschudin-Sutter, S; Dell-Kuster, S; Frei, R; Bucher, H C; Nüesch, R

    2011-12-01

    Blood cultures are routinely taken in outpatients with fever and suspected bacterial infections. However, in the majority of cases, they are not informative and of limited value for clinical decision making. The aim of this study was therefore to investigate factors associated with positive blood cultures in outpatients presenting to an outpatient clinic and emergency room. This was a case-control study of all outpatients with positive blood cultures from January 1, 2006 to October 31, 2007 and matched control patients with negative blood cultures in the same time period. Microbiology results and medical charts were reviewed to determine factors associated with positive blood cultures. The presence of a systemic inflammation response syndrome (SIRS) (OR 2.7, 95% Cl 1.0-7.2) and increased C-reactive protein (CRP) (OR 1.1 per 10 mg/l, 95% Cl 1.0-1.2) were the most powerful predictive values for the development of positive blood cultures. In positive cases serum albumin was lower (35 mg/l versus 39 mg/l) than in controls. SIRS, increasing CRP and low albumin were associated with positive blood cultures in outpatients. With simple clinical assessment and few laboratory tests indicative of infection, it is possible to define a group at higher risk for bacteremia in outpatients.

  3. Drug-related problems in a sample of outpatients with chronic diseases: a cross-sectional study from Jordan

    Directory of Open Access Journals (Sweden)

    Al-Azzam SI

    2016-02-01

    Full Text Available Sayer I Al-Azzam,1 Karem H Alzoubi,1 Salah AbuRuz,2 Qais Alefan1 1Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 2Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan Abstract: Optimization of drug therapy and preventing drug-related problems (DRPs are major factors to improve health care, reduce expenditure, and potentially save lives. This study aimed at describing the types, numbers, and frequencies of DRPs in the outpatient settings of a group of hospitals in Jordan. The study was set in the cardiology, endocrine, and respiratory outpatient clinics of five major hospitals in Jordan. Patients who visited the above clinics during the period from September 2012 to December 2013, were candidates for this study. Each included subject was fully assessed for DRPs by clinical pharmacists according to a specially designed and validated pharmaceutical care manual. The main outcome measures were the number and types of DRPs. Data were collected from 2,898 patients (mean age ± standard deviation: 56.59±13.5 years. The total number of identified DRPs was 32,348, with an average of 11.2 DRPs per patient. The most common DRPs were a need for additional or more frequent monitoring, a problem in patients’ adherence to self-care activities or nonpharmacological therapy, and that the patient was not given instruction in or did not understand nonpharmacological therapy or self-care advice. The numbers of DRPs per patient in our sample were associated with older age (>57 years, being unmarried, having an education level of high school or less, not having health insurance, and the presence of certain clinical conditions, including hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, cardiac catheterization, heart failure, and gout. In conclusion, implementation of clinical pharmacy services is a strategy to limit DRPs

  4. Use of cotinine urinalysis to verify self-reported tobacco use among male psychiatric out-patients

    Directory of Open Access Journals (Sweden)

    Yatan Pal Singh Balhara

    2012-01-01

    Full Text Available Context: There is a complex and significant correlation between respiratory disorders and psychiatric conditions. Reliability of self-reported tobacco use has been questioned in recent times. Aims: The current study aims at assessment of accuracy of self-reported tobacco use (both smoked and smokeless among psychiatric out-patients. Settings and Design: We recruited 131 consecutive subjects from the out-patient psychiatry department of a tertiary care hospital. Materials and Methods: Male patients meeting the study criteria were approached for participation in the study. They were asked about their recent tobacco use history. Those reporting recent use were assessed for severity of dependence using Fagerstrom Test for Nicotine Dependence (FTND-smoking and FTND-smokeless scales. Quantitative urine cotinine analysis was performed using the Enzyme Linked Immunesorbant Assay (ELISA method. Based on this method, a (50 ng/ml cut off score for urinary cotinine level for tobacco use was set. Statistical Analysis Used: Concordance between the self-report of tobacco use and urinary cotinine level was assessed using the Cohen′s kappa. Additionally, Pearson′s correlation coefficient was used to examine the correlation between the FTND-smoking and FTND-smokeless scales and the urinary cotinine levels. Results: The values of Cohen′s kappa suggest no significant concordance between the self-reported recent tobacco use and urinary cotinine levels for both smoking and smokeless tobacco forms. The discordance was present irrespective of a higher (550 ng/ml or a lower (50 ng/ml cut off score for a urinary cotinine level. Pearson′s correlation coefficient failed to reveal any significant direct correlation between the FTND scores and urinary cotinine levels. Conclusions: It is recommended to use biological markers such as urinary cotinine levels to corroborates the information provided by the patients.

  5. Strategic planning for radiology: opening an outpatient diagnostic imaging center.

    Science.gov (United States)

    Leepson, Evan

    2003-01-01

    Launching a new diagnostic imaging center involves very specific requirements and roadmaps, including five major areas of change that have a direct impact on planning: Imaging and communication technology Finances and reimbursement Ownership structure of imaging entities Critical workforce shortages Imaging is moving outside radiology First, planning must focus on the strategic level of any organization, whether it is a multi-national corporation or a six-person radiology group. Think of all organizations as a triangle with three horizontal levels: strategic, managerial and operational. The strategic level of decision-making is at the top of the triangle, and here is where planning must take place. For strategic planning to work, there must be focused time and energy spent on this activity, usually away from the reading room and imaging center. There are five planning strategies, which must have the explicit goal of developing and growing the imaging center. The five strategies are: Clinical and quality issues, Governance and administration, Technology, Relationships, Marketing and business development. The best way to plan and implement these strategies is to create work groups of radiologists, technologists, and administrative and support staff. Once the group agrees on the strategy and tactic, it takes responsibility for implementation. Embarking on the launch of a new outpatient diagnostic imaging center is no small undertaking, and anyone who has struggled with such an endeavor can readily attest to the associated challenges and benefits. Success depends on many things, and one of the most important factors relates to the amount of time and the quality of effort spent on strategic planning at the outset. Neglecting or skimping on this phase may lead to unforeseen obstacles that could potentially derail the project.

  6. Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

    Science.gov (United States)

    Wright, Fay; Melkus, Gail D’Eramo; Hammer, Marilyn; Schmidt, Brian L.; Knobf, M. Tish; Paul, Steven M.; Cartwright, Frances; Mastick, Judy; Cooper, Bruce A.; Chen, Lee-May; Melisko, Michelle; Levine, Jon D.; Kober, Kord; Aouizerat, Bradley E.; Miaskowski, Christine

    2015-01-01

    Context Fatigue is a distressing, persistent sense of physical tiredness that is not proportional to a person’s recent activity. Fatigue impacts patients’ treatment decisions and can limit their self-care activities. While significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy (CTX). Objectives To determine whether demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of evening fatigue. Methods A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N=586) completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) was used to answer the study objectives. Results A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were White, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, child care responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. Conclusion This study identified both non-modifiable (e.g., ethnicity) and modifiable (e.g., child care responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors. PMID:25828560

  7. Blood pressure associates with standing balance in elderly outpatients.

    Directory of Open Access Journals (Sweden)

    Jantsje H Pasma

    Full Text Available OBJECTIVES: Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment. MATERIALS AND METHODS: In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197 and continuously (subsample, n = 58 before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1 the ability to maintain standing balance; 2 self-reported impaired standing balance; and 3 history of falls, adjusted for age and sex. RESULTS: Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements. CONCLUSION: Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.

  8. Optimization of therapy in outpatients with chronic lumbago

    Directory of Open Access Journals (Sweden)

    A. A. Averchenkova

    2014-01-01

    Full Text Available Lumbago is one of the most common lower back pain syndromes in medical practice, which is benign in the vast majority of cases and caused by spinal osteochondrosis, injury, and muscle strain or spasm. The primary task of examining a patient with lumbago is to be certain that the pain is musculoskeletal and unassociated with a potentially dangerous spinal disease requiring emergency special therapy.Objective: to analyze the efficiency of treatment in outpatients with chronic lumbago.Patients and methods. One hundred and four patients followed up by us in the Smolensk Kinesitherapy Center were examined. A study group comprised 84 patients (34 men and 50 women; mean age 44.2±1.29 years with dorsalgia (pain duration ≥3 months; mean 7.6±6.83 years;a control group included 20 persons (10 men and  10 women; mean age 31.9±1.88 years without pain in the back. Neurological examination and magnetic resonance imaging revealed nonspecific lower back pain in 67 (79.8% patients and radiculopathy in 17 (20.2%. Combination treatment including pharmacotherapy and kinesitherapy was proposed in all the patients.Results. 2.5–3 months after the initiation of therapy, pain regressed completely in 29 (34.5% patients and was considerably alleviated in 27 (32.1%. Quality of life after therapy improved in the majority of patients. The patients in whom therapy was ineffective (n = 26; 31% did not attend kinesitherapy classes and were cautious towards physical rehabilitation.Discussion. The findings indicated the high efficiency of a comprehensive approach to treating chronic lumbago, which is largely associated with rational psychotherapy, early patient activation, and adaptive behavior training.

  9. Interaction effects of treatment setting and client characteristics on retention and completion.

    Science.gov (United States)

    Klein, Chris; di Menza, Salvatore; Arfken, Cynthia; Schuster, Charles R

    2002-01-01

    Client-treatment matching assumes treatment outcome will be improved if characteristics of clients are matched to specific elements of treatment. Few empirical studies, however, have examined matching across different types of treatment settings. The present research examined differences in demographics and substance-related problems in populations admitted to three substance abuse treatment settings--outpatient (n = 1132), intensive outpatient (n = 1190), and residential (n = 149)--and tested whether interactions between client characteristics and type of setting predicted rates of 30-day retention and treatment completion. In addition, three specific hypotheses based on prior theoretical and empirical investigations were tested. Client characteristics included demographic information (e.g., sex, age, race) and Addiction Severity Index (ASI) composite scores. Client-setting interactions were found for both retention and completion. All three hypotheses received at least partial support. Implications for client assignment and future research are discussed.

  10. Prevalence of comorbid depression is high in out-patients with Type 1 or Type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands.

    NARCIS (Netherlands)

    Pouwer, F.; Geelhoed-Duijvestijn, P.H.; Tack, C.J.J.; Bazelmans, E.; Beekman, A.J.; Heine, R.J.; Snoek, F.J.

    2010-01-01

    AIMS: Depression is common in diabetes, but the scope of the problem and associated correlates are not well established in specialist diabetes care. We aimed to determine the prevalence of depression among adult outpatients with Type 1 (T1DM) or Type 2 diabetes (T2DM) using both self-report measures

  11. The fastest of three trials is recommended for Timed Up & Go testing of functional mobility in an outpatient geriatric setting

    DEFF Research Database (Denmark)

    Bloch, Mette Linding

    2012-01-01

    , using an armchair if not able to perform without). Repeated measures with Bonferoni corrections for mass significance was used to evaluate differences between TUG trials, T-Tests to evaluate differences between groups,and Pearson’s Correlation coefficient to evaluate association between variables...... to 5.5 seconds in difference between the two recordings. Subjects using walking aids (n=10) were the oldest (P=0.057, mean age of 87.7 versus 81.5 years), and performed worse (P=0.033, 26.3 versus 17.3seconds) when using the best of the three TUG trials. Also, this score was significantly correlated...... with age (r=0.434, P=0.013) and the modified CST with the use of armchair (n=15, r=-0.600,P=0.018), while no significant correlation was seen in relation to the CST (n=15, r=-0.411, P=0.128). Conclusion: We recommend that the fastest of three timed TUG trials is used instead of the second trial when...

  12. Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: A randomised controlled trial in Western European outpatient settings

    NARCIS (Netherlands)

    H. Rigter (Henk); C.E. Henderson (Craig); I. Pelc (Isidore); P. Tossmann (Peter); O. Phan (Olivier); V. Hendriks (Vincent); M. Schaub (Michael); C. Rowe (Cindy)

    2013-01-01

    textabstractBackground: Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in t

  13. Psychoeducation in an Outpatient Setting--Designing a Heterogeneous Format for a Heterogeneous Population of Juvenile Delinquents.

    Science.gov (United States)

    Carpenter, Patricia; Sugrue, Dennis P.

    1984-01-01

    Describes the G.I.T. (Getting It Together) program, a heterogeneous delinquent treatment program combining affective education and social skills training. Delinquents with immature personalities or neurotic features appeared to benefit more from the program than those with characterological disorders. (JAC)

  14. [Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain].

    Science.gov (United States)

    Raspall-Chaure, Miquel; Martinez-Bermejo, Antonio; Sanchez-Carpintero, Rocío; Ruiz-Falco Rojas, M Luz; Verdu-Perez, Alfonso; Smeyers-Dura, Patricia; Camino-Leon, Rafael; Sanmarti, Francesc X; Santos-Borbujo, José; Pico, Gustavo; Blanco-Barca, Oscar; Cebollero, M Antonia

    2014-06-01

    Introduccion. El tratamiento de las crisis epilepticas prolongadas requiere disponer de una medicacion de rescate comoda, segura y efectiva. Actualmente, el tratamiento estandar en la comunidad es el diacepam rectal. La introduccion de una solucion bucal de midazolam abre una perspectiva nueva en el tratamiento. Objetivo. Evaluar el coste-efectividad del midazolam bucal respecto al diacepam rectal para los niños con un diagnostico de epilepsia que presentan crisis convulsivas prolongadas en la comunidad en España. Materiales y metodos. Modelo coste-efectividad desde la perspectiva del Sistema Nacional de Salud (SNS) español, con resultados presentados en terminos de costes y años de vida ajustados por calidad. Los datos se obtuvieron de varias fuentes, incluidas las estimaciones de efectividad clinica de un ensayo clinico, de un panel Delphi en España y de una encuesta nacional a padres de niños con epilepsia para determinar las practicas actuales. Resultados. El tratamiento con midazolam bucal produce un ahorro de costes en comparacion con el diacepam rectal. El ahorro para el SNS español es de 5.484 euros por paciente al año. El tratamiento con midazolam bucal ofrece una mejora en la calidad de vida relacionada con la salud. Esto, unido al ahorro de costes, hace que el midazolam bucal sea dominante frente al diacepam rectal en todos los escenarios examinados. Conclusion. Los resultados del modelo muestran que el midazolam bucal es mas coste-efectivo que el diacepam rectal debido a una reduccion en la necesidad de llamadas a la ambulancia y estancias en el hospital, asi como a una mejora en la calidad de vida relacionada con la salud.

  15. Patient satisfaction in pediatric outpatient settings from the parents’ perspective - The Child ZAP: A psychometrically validated standardized questionnaire

    Directory of Open Access Journals (Sweden)

    Bitzer Eva

    2012-10-01

    Full Text Available Abstract Background Patient surveys constitute a valuable source of information in patient-focused health care. The objective of this study was to develop and validate a standardized, patient centered, quantitative instrument to assess parent satisfaction in ambulatory pediatric care to be used in quality management and benchmarking activities, the Child-ZAP. Methods A preliminary version of the survey (38 items was conducted in n = 19 pediatric practices. After psychometric testing a modified Child-ZAP was tested in a second survey (n = 20 new pediatric practices. Data from n = 979 patients were available for analysis. Results The final version of the Child-ZAP contains eight dimensions, three "Child-Scales" and five "Parent-Scales". Confirmatory factor analysis confirms the three hypothesized child dimensions as well as the five parent dimensions. The factorial structure is confirmed in subgroups of younger and older children. Conclusions With satisfactory to good results for validity and reliability testing, the final Child-ZAP is applicable in pediatric ambulatory care for children of all age groups.

  16. Sex differences in psychiatric comorbidity and plasma biomarkers for cocaine addiction in abstinent cocaine-addicted subjects in outpatient settings

    Directory of Open Access Journals (Sweden)

    MARIA ePEDRAZ

    2015-02-01

    Full Text Available There are sex differences in the progression of drug addiction, relapse and response to therapies. Because biological factors participate in these differences, they should be considered when using biomarkers for addiction. In the current study, we evaluated the sex differences in psychiatric comorbidity and the concentrations of plasma mediators that have been reported to be affected by cocaine.Fifty-five abstinent cocaine-addicted subjects diagnosed with lifetime cocaine use disorders (40 men and 15 women and 73 healthy controls (48 men and 25 women were clinically assessed with the diagnostic interview ‘Psychiatric Research Interview for Substance and Mental Disorders’. Plasma concentrations of chemokines, cytokines, N-acyl-ethanolamines and 2-acyl-glycerols were analyzed according to history of cocaine addiction and sex.The results showed that the chemokine concentrations of CCL2/MCP-1 and CXCL12/SDF-1 were only affected by history of cocaine addiction. The plasma concentrations of IL-1β, IL-6, IL-10 and TNFα were higher in control women relative to men, but these concentrations were reduced in cocaine-addicted women. Cytokine concentrations were unaltered in addicted men. Regarding fatty acid derivatives, history of cocaine addiction had a main effect on the concentration of each acyl derivative; whereas N-acyl-ethanolamines were increased overall in the cocaine group, 2-acyl-glycerols were decreased. Interestingly, POEA was only increased in cocaine-addicted women.Regarding psychiatric comorbidity in the cocaine group, women had lower incidence rates of comorbid substance use disorders than did men. For example, alcohol use disorders were found in 80% of men and 40% of women. In contrast, the addicted women had increased prevalences of comorbid psychiatric disorders (mood, anxiety and psychosis disorders.These results demonstrate the existence of a sex influence on plasma biomarkers for cocaine addiction and on the presence of comorbid psychopathologies.

  17. Sex Differences in Psychiatric Comorbidity and Plasma Biomarkers for Cocaine Addiction in Abstinent Cocaine-Addicted Subjects in Outpatient Settings

    Science.gov (United States)

    Pedraz, María; Araos, Pedro; García-Marchena, Nuria; Serrano, Antonia; Romero-Sanchiz, Pablo; Suárez, Juan; Castilla-Ortega, Estela; Mayoral-Cleries, Fermín; Ruiz, Juan Jesús; Pastor, Antoni; Barrios, Vicente; Chowen, Julie A.; Argente, Jesús; Torrens, Marta; de la Torre, Rafael; Rodríguez De Fonseca, Fernando; Pavón, Francisco Javier

    2015-01-01

    There are sex differences in the progression of drug addiction, relapse, and response to therapies. Because biological factors participate in these differences, they should be considered when using biomarkers for addiction. In the current study, we evaluated the sex differences in psychiatric comorbidity and the concentrations of plasma mediators that have been reported to be affected by cocaine. Fifty-five abstinent cocaine-addicted subjects diagnosed with lifetime cocaine use disorders (40 men and 15 women) and 73 healthy controls (48 men and 25 women) were clinically assessed with the diagnostic interview “Psychiatric Research Interview for Substance and Mental Disorders.” Plasma concentrations of chemokines, cytokines, N-acyl-ethanolamines, and 2-acyl-glycerols were analyzed according to history of cocaine addiction and sex, controlling for covariates age and body mass index (BMI). Relationships between these concentrations and variables related to cocaine addiction were also analyzed in addicted subjects. The results showed that the concentrations of chemokine (C-C motif) ligand 2/monocyte chemotactic protein-1 (CCL2/MCP-1) and chemokine (C-X-C motif) ligand 12/stromal cell-derived factor-1 (CXCL12/SDF-1) were only affected by history of cocaine addiction. The plasma concentrations of interleukin 1-beta (IL-1β), IL-6, IL-10, and tumor necrosis factor-alpha (TNFα) were affected by history of cocaine addiction and sex. In fact, whereas cytokine concentrations were higher in control women relative to men, these concentrations were reduced in cocaine-addicted women without changes in addicted men. Regarding fatty acid derivatives, history of cocaine addiction had a main effect on the concentration of each acyl derivative, whereas N-acyl-ethanolamines were increased overall in the cocaine group, 2-acyl-glycerols were decreased. Interestingly, N-palmitoleoyl-ethanolamine (POEA) was only increased in cocaine-addicted women. The covariate BMI had a significant effect on POEA and N-arachidonoyl-ethanolamine concentrations. Regarding psychiatric comorbidity in the cocaine group, women had lower incidence rates of comorbid substance use disorders than did men. For example, alcohol use disorders were found in 80% of men and 40% of women. In contrast, the addicted women had increased prevalences of comorbid psychiatric disorders (i.e., mood, anxiety, and psychosis disorders). Additionally, cocaine-addicted subjects showed a relationship between the concentrations of N-stearoyl-ethanolamine and 2-linoleoyl-glycerol and diagnosis of psychiatric comorbidity. These results demonstrate the existence of a sex influence on plasma biomarkers for cocaine addiction and on the presence of comorbid psychopathologies for clinical purposes. PMID:25762940

  18. Fuzzy sets, rough sets, multisets and clustering

    CERN Document Server

    Dahlbom, Anders; Narukawa, Yasuo

    2017-01-01

    This book is dedicated to Prof. Sadaaki Miyamoto and presents cutting-edge papers in some of the areas in which he contributed. Bringing together contributions by leading researchers in the field, it concretely addresses clustering, multisets, rough sets and fuzzy sets, as well as their applications in areas such as decision-making. The book is divided in four parts, the first of which focuses on clustering and classification. The second part puts the spotlight on multisets, bags, fuzzy bags and other fuzzy extensions, while the third deals with rough sets. Rounding out the coverage, the last part explores fuzzy sets and decision-making.

  19. The Partial Fuzzy Set

    OpenAIRE

    Dr.Pranita Goswami

    2011-01-01

    The Partial Fuzzy Set is a portion of the Fuzzy Set which is again a Fuzzy Set. In the Partial Fuzzy Set the baseline is shifted from 0 to 1 to any of its α cuts . In this paper we have fuzzified a portion of the Fuzzy Set by transformation

  20. Clinical management methods for out-patients with alcohol dependence

    Directory of Open Access Journals (Sweden)

    Boulze Isabelle

    2006-02-01

    Full Text Available Abstract Background In France outpatient centres for the care of alcoholics are healthcare establishments providing medical, psychological and social support. Although they meet the practical needs of these patients, their degree of use in each of these domains and the respective mobilisation of different skills by the care team are not well understood. Our aim was therefore to determine in detail the management involved as a function of the severity of alcohol dependence. For this purpose, all the procedures involved were compiled in a thesaurus describing its type (psychological, medical, social, reception, its scheduled or unscheduled nature, its method (face-to-face, telephone, letter and its duration. The severity of dependence was evaluated using the Addiction Severity Index (ASI. Results 45 patients were included and followed-up during 291 ± 114 days. The mean initial ASI scores (± SD were: medical (M = 0.39 ± 0.3, working-income (ER = 0.5 ± 0.3, alcohol (A = 0.51 ± 0.2, illicit drugs (D = 0.07 ± 0.08, legal (L = 0.06 ± 0.13, familial and social environment (FS = 0.34 ± 0.26, psychological (P = 0.39 ± 0.22. The total number of procedures was 1341 (29.8 per patient corresponding to 754.4 hours (16.7 per patient. The intensity of management peaked during the first month of treatment, and then declined rapidly; the maximum incidence of abstinence was observed during the 3rd month of management. Interviews with patients, group therapy and staff meetings represented 68.7%, 9.9% and 13.9% of all procedures, respectively. In patients with severe dependence, as compared to moderate, management was twice as intense in the psychological and social domains, but not in the medical domain. The ASI questionnaire was completed a second time by 24 patients, after an average of 3.2 months. The improvement was significant in the M, A, D and P domains only. Conclusion This study provided an overview of the methods employed in managing a sample of

  1. Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population

    Directory of Open Access Journals (Sweden)

    Eduardo Ruocco Nonato

    2011-06-01

    Full Text Available OBJECTIVE: This study aimed to evaluate oral and maxillofacial trauma caused by falls during epileptic seizures. METHOD: A prospective case-control study was carried out among patients recruited from both the Epileptic Outpatient Clinic and the Emergency Room of Hospital de Base during 2006. The study group was composed of patients with epilepsy that had been diagnosed by a specialist. Oral and maxillofacial trauma was diagnosed using a questionnaire together with physical and radiographic examinations. A control group was formed from non-epileptic relatives or neighbors of the patients. The two groups were compared with regard to the number and type of oral and maxillofacial trauma events suffered. Odds ratios with a 95% confidence interval, dependency analysis and the Pearson c² test were used for statistical analysis, and the significance level was set at p≤0.05. RESULTS: A total of 159 patients with epilepsy (91 males; 57.3% and 68 control individuals (28 males; 41.1% were enrolled in the study. The frequencies of oromaxillary trauma in the study and control groups were 23.9% and 4.4%, respectively. Generalized tonic-clonic, generalized and non-classified seizures were strongly associated with trauma. The commonest lesions were fractures of dental tooth crowns (32.9%, followed by tooth avulsion (7.6%, tooth luxation (5% and fracturing of prostheses in edentulous patients (3.8%. CONCLUSION: This work shows that injuries to the face and teeth are statistically more common in patients with epilepsy than in the general population, and that individuals who suffer seizures without aura are the most affected.

  2. Antidepressant efficacy of sertraline and imipramine for the treatment of major depression in elderly outpatients

    Directory of Open Access Journals (Sweden)

    Orestes Vicente Forlenza

    2000-07-01

    Full Text Available CONTEXT: Most double-blind studies of efficacy and tolerability of sertraline as compared to tricyclics in the treatment of late-life major depression have used amitriptyline as a standard, leading to the inevitable conclusion that the former drug is better tolerated than the latter, with both being equally efficacious. OBJECTIVE: To compare the antidepressant efficacy and tolerability of sertraline (50 mg/day and imipramine (150 mg/day in the first 6 weeks of the treatment of major depression in the elderly. DESIGN: A randomized double-blind parallel study with 6 weeks of follow-up. SETTING: The psychogeriatric clinic at the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo. PARTICIPANTS: 55 severe and moderately depressed non-demented outpatients aged 60 years or more. INTERVENTION: Patients were assigned to sertraline 50 mg/day or imipramine 150 mg/day. MAIN MEASUREMENTS: CAMDEX interview. Psychiatric diagnosis followed the guidelines for "Major Depressive Episode" according to DSM-IV criteria. Severity of symptoms was evaluated using the "CGI" and "MADRS" scales. Cognitive state was assessed using the Mini-Mental State Examination. Side effects were assessed using the "Safetee-Up" schedule. RESULTS: Both groups had a significant decrease in depressive symptoms according to the MADRS scores after 6 weeks of treatment (P = 0.01. No significant differences between groups were detected regarding treatment outcome (t = 0.4; P = 0.7. Although the dropout rate was greater in the imipramine group, the overall tolerability among patients who completed the 6-week trial was similar in both test groups. CONCLUSIONS: Both sertraline and imipramine exhibited good efficacy and an acceptable side-effect profile for elderly depressed patients after 6 weeks of antidepressant treatment.

  3. EXCESSIVE WEIGHT – MUSCLE DEPLETION PARADOX AND CARDIOVASCULAR RISK FACTORS IN OUTPATIENTS WITH INFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Maria Izabel Siqueira de ANDRADE

    2015-03-01

    Full Text Available Background Evidence suggests a nutritional transition process in patients with inflammatory bowel disease. Obesity, which was once an uncommon occurrence in such patients, has grown in this population at the same prevalence rate as that found in the general population, bringing with it an increased risk of cardiovascular disease. Objective The aim of the present study was to determine the nutritional status and occurrence of cardiovascular risk factors in patients with inflammatory bowel disease. Methods A case-series cross-sectional study was conducted involving male and female adult outpatients with inflammatory bowel disease. Data were collected on demographic, socioeconomic, clinical and anthropometric variables as well as the following cardiovascular risk factors: sedentary lifestyle, excess weight, abdominal obesity, medications in use, comorbidities, alcohol intake and smoking habits. The significance level for all statistical tests was set to 5% (P< 0.05. Results The sample comprised 80 patients with inflammatory bowel disease, 56 of whom (70.0% had ulcerative colitis and 24 of whom (30.0% had Crohn's disease. Mean age was 40.3±11 years and the female genre accounted for 66.2% of the sample. High frequencies of excess weight (48.8% and abdominal obesity (52.5% were identified based on the body mass index and waist circumference, respectively, in both groups, especially among those with ulcerative colitis. Muscle depletion was found in 52.5% of the sample based on arm muscle circumference, with greater depletion among patients with Crohn’s disease (P=0.008. The most frequent risk factors for cardiovascular disease were a sedentary lifestyle (83.8%, abdominal obesity (52.5% and excess weight (48.8%. Conclusion The results of the complete anthropometric evaluation draw one’s attention to a nutritional paradox, with high frequencies of both - muscle depletion, as well as excess weight and abdominal obesity.

  4. Prevalence of and risk factors for MRSA colonization in HIV-positive outpatients in Singapore

    Directory of Open Access Journals (Sweden)

    Kyaw Win

    2012-11-01

    Full Text Available Abstract Background Whilst there have been studies on the risks and outcomes of MRSA colonization and infections in HIV-positive patients, local data is limited on the risk factors for MRSA colonization among these patients. We undertook this study in a tertiary HIV care centre to document the risk factors for colonization and to determine the prevalence of MRSA colonization among HIV-positive outpatients in Singapore. Methods This was a cross-sectional study in which factors associated with MRSA positivity among patients with HIV infection were evaluated. A set of standardized questionnaire and data collection forms were available to interview all recruited patients. Following the interview, trained nurses collected swabs from the anterior nares/axilla/groin (NAG, throat and peri-anal regions. Information on demographics, clinical history, laboratory results and hospitalization history were retrieved from medical records. Results MRSA was detected in swab cultures from at least 1 site in 15 patients (5.1%. Inclusion of throat and/or peri-anal swabs increased the sensitivity of NAG screening by 20%. Predictors for MRSA colonization among HIV-positive patients were age, history of pneumonia, lymphoma, presence of a percutaneous device within the past 12 months, history of household members hospitalized more than two times within the past 12 months, and a most recent CD4 count less than 200. Conclusions This study highlights that a proportion of MRSA carriers would have been undetected without multiple-site screening cultures. This study could shed insight into identifying patients at risk of MRSA colonization upon hospital visit and this may suggest that a risk factor-based approach for MRSA surveillance focusing on high risk populations could be considered.

  5. Obstetrics and gynecology outpatient scenario of an Indian homeopathic hospital: A prospective, research-targeted study.

    Science.gov (United States)

    Saha, Subhranil; Koley, Munmun; Saha, Sangita; Singh, Rakesh; Hossain, Md Monowar; Pramanik, Indrani

    2016-04-01

    The authors aimed to document prescriptions and clinical outcomes in routine homeopathic practice to short list promising areas of targeted research and efficacy trials of homeopathy in obstetrics and gynecology (O&G). Three homeopathic physicians participated in methodical data collection over a 3-month period in the O&G outpatient setting of The Calcutta Homeopathic Medical College and Hospital, West Bengal, India. A specifically designed Excel spreadsheet was used to record data on consecutive appointments, including date, patient identity, socioeconomic status, place of abode, religion, medical condition/complaint, whether chronic/acute, new/follow-up case, patient-assessed outcome (7-point Likert scale: -3 to +3), prescribed homeopathic medication, and whether other medication/s was being taken for the condition. These spreadsheets were submitted monthly for data synthesis and analysis. Data on 878 appointments (429 patients) were collected, of which 61% were positive, 20.8% negative, and 18.2% showed no change. Chronic conditions (93.2%) were chiefly encountered. A total of 434 medical conditions and 52 varieties were reported overall. The most frequently treated conditions were leucorrhea (20.5%), irregular menses (13.3%), dysmenorrhea (10%), menorrhagia (7.5%), and hypomenorrhea (6.3%). Strongly positive outcomes (+3/+2) were mostly recorded in oligomenorrhea (41.7%), leucorrhea (34.1%), polycystic ovary (33.3%), dysmenorrhea (28%), and irregular menses (22.2%). Individualized prescriptions predominated (95.6%). A total of 122 different medicines were prescribed in decimal (2.9%), centesimal (87.9%), and 50 millesimal potencies (4.9%). Mother tinctures and placebo were prescribed in 3.4% and 30.4% instances, respectively. Several instances of medicine-condition pairings were detected. This systematic recording cataloged the frequency and success rate of treating O&G conditions using homeopathy.

  6. Characterization of Escherichia coli isolates from hospital inpatients or outpatients with urinary tract infection.

    Science.gov (United States)

    Toval, Francisco; Köhler, Christian-Daniel; Vogel, Ulrich; Wagenlehner, Florian; Mellmann, Alexander; Fruth, Angelika; Schmidt, M Alexander; Karch, Helge; Bielaszewska, Martina; Dobrindt, Ulrich

    2014-02-01

    Uropathogenic Escherichia coli (UPEC) is the most common cause of community- and hospital-acquired urinary tract infections (UTIs). Isolates from uncomplicated community-acquired UTIs express a variety of virulence traits that promote the efficient colonization of the urinary tract. In contrast, nosocomial UTIs can be caused by E. coli strains that differ in their virulence traits from the community-acquired UTI isolates. UPEC virulence markers are used to distinguish these facultative extraintestinal pathogens, which belong to the intestinal flora of many healthy individuals, from intestinal pathogenic E. coli (IPEC). IPEC is a diarrheagenic pathogen with a characteristic virulence gene set that is absent in UPEC. Here, we characterized 265 isolates from patients with UTIs during inpatient or outpatient treatment at a hospital regarding their phylogenies and IPEC or UPEC virulence traits. Interestingly, 28 of these isolates (10.6%) carried typical IPEC virulence genes that are characteristic of enteroaggregative E. coli (EAEC), Shiga toxin-producing E. coli (STEC), and atypical enteropathogenic E. coli (aEPEC), although IPEC is not considered a uropathogen. Twenty-three isolates harbored the astA gene coding for the EAEC heat-stable enterotoxin 1 (EAST1), and most of them carried virulence genes that are characteristic of UPEC and/or EAEC. Our results indicate that UPEC isolates from hospital patients differ from archetypal community-acquired isolates from uncomplicated UTIs by their spectrum of virulence traits. They represent a diverse group, including EAEC, as well as other IPEC pathotypes, which in addition contain typical UPEC virulence genes. The combination of typical extraintestinal pathogenic E. coli (ExPEC) and IPEC virulence determinants in some isolates demonstrates the marked genome plasticity of E. coli and calls for a reevaluation of the strict pathotype classification of EAEC.

  7. Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients

    Science.gov (United States)

    Carroll, Kathleen M.; Fenton, Lisa R.; Ball, Samuel A.; Nich, Charla; Frankforter, Tami L.; Shi, Julia; Rounsaville, Bruce J.

    2013-01-01

    Context Disulfiram has emerged as a promising treatment for cocaine dependence, but it has not yet been evaluated in general populations of cocaine users. Objectives To compare the effectiveness of disulfiram therapy with that of a placebo condition in reducing cocaine use and to compare the effectiveness of 2 active behavioral therapies—cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT)—in reducing cocaine use. Design Randomized, placebo-controlled, double-masked (for medication condition), factorial (2×2) trial with 4 treatment conditions: disulfiram plus CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT. Setting A community-based outpatient substance abuse treatment program. Patients A total of 121 individuals meeting the criteria for current cocaine dependence. Interventions Patients received either disulfiram (250 mg/d) or placebo in identical capsules. Medication compliance was monitored using a riboflavin marker procedure. Both behavioral therapies (CBT and IPT) were manual guided and were delivered in individual sessions for 12 weeks. Main Outcome Measures Random regression analyses of self-reported frequency of cocaine use and results of urine toxicology screens. Results Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT (P<.01 for both). Findings were consistent across all study samples (eg, intention to treat, treatment initiators, and treatment completers). Benefits of disulfiram use and CBT were most pronounced for participants who were not alcohol dependent at baseline or who fully abstained from drinking alcohol during treatment. Adverse effects experienced by participants who received disulfiram were mild and were not considerably different from those experienced by participants who received placebo. Conclusions Disulfiram and CBT are effective

  8. Quality of malaria case management at outpatient health facilities in Angola

    Directory of Open Access Journals (Sweden)

    Santelli Ana

    2009-12-01

    Full Text Available Abstract Background Angola's malaria case-management policy recommends treatment with artemether-lumefantrine (AL. In 2006, AL implementation began in Huambo Province, which involved training health workers (HWs, supervision, delivering AL to health facilities, and improving malaria testing with microscopy and rapid diagnostic tests (RDTs. Implementation was complicated by a policy that was sometimes ambiguous. Methods Fourteen months after implementation began, a cross-sectional survey was conducted in 33 outpatient facilities in Huambo Province to assess their readiness to manage malaria and the quality of malaria case-management for patients of all ages. Consultations were observed, patients were interviewed and re-examined, and HWs were interviewed. Results Ninety-three HWs and 177 consultations were evaluated, although many sampled consultations were missed. All facilities had AL in-stock and at least one HW trained to use AL and RDTs. However, anti-malarial stock-outs in the previous three months were common, clinical supervision was infrequent, and HWs had important knowledge gaps. Except for fever history, clinical assessments were often incomplete. Although testing was recommended for all patients with suspected malaria, only 30.7% of such patients were tested. Correct testing was significantly associated with caseloads Conclusion By late-2007, substantial progress had been made to implement the malaria case-management policy in a setting with weak infrastructure. However, policy ambiguities, under-use of malaria testing, and distrust of negative test results led to many incorrect malaria diagnoses and treatments. In 2009, Angola published a policy that clarified many issues. As problems identified in this survey are not unique to Angola, better strategies for improving HW performance are urgently needed.

  9. Differences in aerobic fitness between inpatients and outpatients with severe mental disorders

    Directory of Open Access Journals (Sweden)

    Helene Daae-Qvale Holmemo

    2014-08-01

    Full Text Available AbstractBackgroundPatients with severe mental disorders have increased mortality, and cardiovascular disease (CVD accounts for a large part. Physical inactivity and low aerobic fitness have been recognized as significant risk factors for CVD. In this study, we investigated the differences in aerobic fitness and physical activity between in- and outpatients with severe mental disorders. Method and subjectsFifty in- and outpatients from a regional psychiatric department were included. The patients filled in a questionnaire on physical activity and completed a clinical examination. An estimation of aerobic fitness was calculated for each patient, using gender, age, waist circumference, resting heart rate and physical activity level as variables.ResultsInpatients had lower estimated aerobic fitness than outpatients (VO₂peak 42 vs 50 mL•kg-1•min-1, p<0.001. Compared to population data matched for age and gender, inpatients had lower aerobic fitness, while outpatients were not different from the population average.ConclusionInpatients at a psychiatric department had lower estimated aerobic fitness than outpatients, and a lower aerobic fitness compared to the general population. Our findings suggest that inpatients with severe mental disorders should be considered a high risk group for CVD.

  10. Personality of outpatients with malignant tumors: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Wang Zhuo

    2012-09-01

    Full Text Available Abstract Background There have been scarce large-scale studies investigating the personality of patients with malignant tumors. The purpose of this study is to determine the characteristic personality in malignant tumors outpatients. Methods Three thousand and three among 5013 consecutive outpatients who consented to answer the Japanese Maudsley Personality Inventory questionnaires were divided into two groups. 603 outpatients diagnosed with malignant tumors (M group and the other 2400 outpatients (non-M group were enrolled in this study. We determined three scores such as introversion/extroversion (E-score, neuroticism (N-score, and lie detection (L-score. All data were used to compare the two groups. Results Average E-score was slightly higher, and average N-score was slightly lower in M group than that in non-M group, and no significant differences between the two groups. However, the average L-score in M group was significant higher than that in non-M group (p  Conclusion Outpatients with malignant tumors showed a significantly higher L-score on MPI when compared with patients with non-malignant tumors. These results stress the importance of taking the mentality of patients with cancer into consideration when conducting treatment and care.

  11. Toward a More Complete Picture of Outpatient, Office-Based Health Care in the U.S.

    Science.gov (United States)

    Lau, Denys T; McCaig, Linda F; Hing, Esther

    2016-09-01

    The healthcare system in the U.S., particularly outpatient, office-based care, has been shifting toward service delivery by advanced practice providers, particularly nurse practitioners (NPs) and physician assistants (PAs). The National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, is the leading source of nationally representative data on care delivered by office-based physicians. This paper first describes NAMCS, then discusses key NAMCS expansion efforts, and finally presents major findings from two exploratory studies that assess the feasibility of collecting data from NPs and PAs as sampled providers in NAMCS. The first NAMCS expansion effort began in 2006 when the NAMCS sample was expanded to include community health centers and started collecting and disseminating data on physicians, NPs, PAs, and nurse midwives in these settings. Then, in 2013, NCHS included workforce questions in NAMCS on the composition and clinical tasks of all healthcare staff in physician offices. Finally, in 2013-2014, NCHS conducted two exploratory studies and found that collecting data from NPs and PAs as sampled providers in NAMCS is feasible. However, modifications to the current NAMCS procedures may be necessary, for example, changing recruitment strategies, visit sampling procedures, and physician-centric survey items. Collectively, these NCHS initiatives are important for healthcare research, practice, and policy communities in their efforts toward providing a more complete picture of the changing outpatient, office-based workforce, team-based care approach, and service utilization in the U.S.

  12. Slow cortical potential Neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hanna eChristiansen

    2014-11-01

    Full Text Available Background: Treatment for children with attention deficit/hyperactivity disorder (ADHD today is predominantly pharmacological. While it is the most common treatment, it might not always be the most appropriate one. Moreover, long term effects remain unclear. Behavior therapy and non-pharmacological treatments such as neurofeedback (NF are promising alternatives, though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication.Methods/design: This paper presents the protocol of a randomized controlled trial to compare the effectiveness of a Slow Cortical Potential (SCP NF protocol with self-management (SM in a high frequent outpatient care setting. Both groups (NF/SM receive a total of 30 high frequent therapy sessions. Additionally, 6 sessions are reserved for comorbid problems. The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings.Preliminary Results: Untill now 58 children were included in the study (48 males, with a mean age of 8.42 (1.34 years, and a mean IQ of 110 (13.37. Conners-3 parent and teacher ratings were used to estimate core symptom change. Since the study is still ongoing, and children are in different study stages, pre-post and follow-up results are not yet available for all children included. Preliminary results suggest overall good pre-post effects, though. For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects (η2 .175 to .513. Differences between groups (NF vs. SM could not yet be established (p = .81.Discussion: This is the first randomized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication. First preliminary results show positive effects. The rationale for the trial, the design, and the strengths and limitations of the study are

  13. Evidence-based interventions for adolescents with disruptive behaviors in school-based settings.

    Science.gov (United States)

    Kuhn, Tarah M; Ebert, Jon S; Gracey, Kathy A; Chapman, Gabrielle L; Epstein, Richard A

    2015-04-01

    Disruptive behaviors in the school setting can threaten the maintenance of optimal learning environments in schools. Challenging behaviors, such as defiance, hostility, and aggression, often define disruptive classroom behaviors. This article presents a clinical review of existing literature on interventions for adolescent disruptive behavior problems in school-based settings and in outpatient mental health settings and makes recommendations around working with adolescents with disruptive behaviors in school-based settings. Many types of interventions are effective; effective implementation is key to good results.

  14. [Loco-regional chemotherapy at the outpatient clinic for gastric cancer patients with home enteral nutrition].

    Science.gov (United States)

    Maruyama, Michio; Nagahama, Takeshi; Sugano, Norihide; Satoh, Eigo; Maruyama, Shouji; Tanami, Hideo; Chiba, Tetsuma; Murakata, Ayano; Mitsuhashi, Yosuke; Uehira, Daisuke; Akazawa, Naoya; Suzuki, Keiichirou

    2011-11-01

    In over the 10 years from 2000-2010, 21 gastric cancer patients received loco-regional chemotherapy with home enteral nutrition (HEN) at an outpatient clinic because of insufficient oral intake. These loco-regional chemotherapy regimens consisted of 5 intra-aortic chemotherapies, 4 hepato-arterial infusions and 12 intra-peritoneal chemotherapies. Five out of 8 cases that had measurable lesions showed PR, and 3 cases revealed PD. The patients received HEN with peptide central formula, 400-1,200 kcal/day in night time. The average duration of HEN was 12.9 months. The post-operative nutritional management was needed for continuation and securing of outpatient chemotherapy. The author reported an experience of the outpatient loco-regional chemotherapy with HEN for the gastric cancer patients who could not eat a sufficient volume of food.

  15. Exploring the Unmet Needs of the Patient in the Outpatient Respiratory Medical Clinic

    DEFF Research Database (Denmark)

    Jensen, Lone Birgitte; Brinkkjær, Ulf; Larsen, Kristian

    2015-01-01

    Aim. Developing a theoretical framework explaining patients’ behaviour and actions related to unmet needs during interactions with health care professionals in hospital-based outpatient respiratory medical clinics. Background. The outpatient respiratory medical clinic plays a prominent role in many...... patients’ lives regarding treatment and counselling increasing the need for a better understanding of patients’ perspective to the counselling of the health care professionals. Design. The study is exploratory and based on Charmaz’s interpretation of grounded theory. Methods. The study included 65 field...... observations with a sample of 43 patients, 11 doctors, and 11 nurses, as well as 30 interviews with patients, conducted through theoretical sampling from three outpatient respiratory medical clinics in Denmark. Findings. The patients’ efforts to share their significant stories triggered predominantly...

  16. The quality of outpatient antimicrobial prescribing: A comparison between two areas of northern and southern Europe

    DEFF Research Database (Denmark)

    Malo, Sara; Bjerrum, Lars; Feja, Cristina

    2014-01-01

    Institute for Health Data and Disease Control in Denmark, and from the Aragon Information System of Drug Consumption. The number of Defined Daily Doses (DDD) of the different substances were calculated, and the quality of the antimicrobial prescription was analysed using the 'Drug Utilization 90 %' method...... and the European Surveillance of Antimicrobial Consumption (ESAC) quality indicators for outpatient antimicrobial use. RESULTS: The majority of the prescriptions (90 % of total DDD) were comprised of 14 (of 39) different antimicrobials in Denmark, based mainly on narrow spectrum penicillin, and 11 (of 59......PURPOSE: The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragon (in northeastern Spain), with the objective of assessing inappropriate prescribing. METHODS: Outpatient antimicrobial prescription data were obtained from the National...

  17. Telephone reminders reduced the non-attendance rate in a gastroenterology outpatient clinic

    DEFF Research Database (Denmark)

    Jeppesen, Maja Haunstrup; Ainsworth, Mark Andrew

    2015-01-01

    in a gastroenterology outpatient clinic like ours. METHODS: This was a comparative intervention study with a historical control group in a gastroenterology outpatient clinic. The study lasted six months. Patients with a scheduled appointment in the first three-month period received no reminder (control group, n = 2......,705). Patients in the following three-month period were reminded by telephone one weekday in advance of their appointment, when possible (intervention group, n = 2,479). Non-attending patients in the intervention group received a questionnaire. Based on the results, a financial cost-benefit analysis was made......-attendees. The most common explanation for non-attendance in the intervention group was forgetfulness (39%). The reminder telephone call was cost-effective. CONCLUSION: In this outpatient clinic, telephone reminders were cost-effective and significantly reduced the non-attendance rate by 43%....

  18. What physicians need to know about renal function in outpatients with heart failure.

    Science.gov (United States)

    Waldum-Grevbo, Bård

    2015-01-01

    The majority of outpatients with heart failure (HF) have chronic kidney disease (CKD) as an important comorbidity. Both glomerular filtration rate and abnormal urinary albumin excretion are major predictors of outcome in HF patients. Despite this, patients with renal dysfunction have been systematically excluded from the large randomized HF trials. There is lack of evidence for optimal treatment in these cardiorenal patients and treatment nihilism may account in part for their bad prognosis. Identifying and monitoring the progression of renal disease and making an effort to preserve renal function should be an important task in the management of all patients with HF. In this review, the current understanding of the pathophysiology of renal dysfunction in outpatients with HF will be summarized. Furthermore, important principles of the identification and management of cardiorenal patients will be described in order to make the physician more capable of managing outpatients with HF and renal dysfunction.

  19. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.

  20. Evaluation of Atypical Lymphocyte Warnings of Sysmex XE-4000 in Outpatient Children

    Institute of Scientific and Technical Information of China (English)

    Xueling GUO; Tingbo ZHANG; Maofan WANG

    2014-01-01

    This study aimed to evaluate the atypical lymphocyte warnings of Sysmex XE-4000 in outpatient children. [Method] Randomly 280 specimens of outpatient children were selected to analyze atypical lymphocytes with Sysmex XE-4000 and artificial smear microscopy simultaneously. [Result] With artificial smear microscopy as the gold standard, the atypical lymphocyte warnings of Sysmex XE-4000 in outpatient children exhibited a sensitivity of 97.4%, specificity of 69.3%, positive predictive value (PPV) of 55%, and negative predictive value (NPV) of 98.5%. [Conclusion] Sysmex XE-4000 shows a high sensitivity in atypical lymphocyte warnings, which can reduce the number of blood smears, improve the specificity of microscopy, and decline the labor intensity of inspection personnel. However, there are stil certain false positives to be confirmed by artificial microscopy.

  1. Multiaspect Soft Sets

    Directory of Open Access Journals (Sweden)

    Nor Hashimah Sulaiman

    2013-01-01

    Full Text Available We introduce a novel concept of multiaspect soft set which is an extension of the ordinary soft set by Molodtsov. Some basic concepts, operations, and properties of the multiaspect soft sets are studied. We also define a mapping on multiaspect soft classes and investigate several properties related to the images and preimages of multiaspect soft sets.

  2. Social Set Analysis

    DEFF Research Database (Denmark)

    Vatrapu, Ravi; Mukkamala, Raghava Rao; Hussain, Abid

    2016-01-01

    this limitation, based on the sociology of associations and the mathematics of set theory, this paper presents a new approach to big data analytics called social set analysis. Social set analysis consists of a generative framework for the philosophies of computational social science, theory of social data......, conceptual and formal models of social data, and an analytical framework for combining big social data sets with organizational and societal data sets. Three empirical studies of big social data are presented to illustrate and demonstrate social set analysis in terms of fuzzy set-theoretical sentiment...... analysis, crisp set-theoretical interaction analysis, and event-studies-oriented set-theoretical visualizations. Implications for big data analytics, current limitations of the set-theoretical approach, and future directions are outlined....

  3. Clinical audit of COPD in outpatient respiratory clinics in Spain: the EPOCONSUL study

    Science.gov (United States)

    Calle Rubio, Myriam; Alcázar Navarrete, Bernardino; Soriano, Joan B; Soler-Cataluña, Juan J; Rodríguez González-Moro, José Miguel; Fuentes Ferrer, Manuel E; López-Campos, José Luis

    2017-01-01

    Background Chronic obstructive pulmonary disease (COPD) outpatients account for a large burden of usual care by respirologists. EPOCONSUL is the first national clinical audit conducted in Spain on the medical care for COPD patients delivered in outpatient respiratory clinics. We aimed to evaluate the clinical interventions and the degree of adherence to recommendations in outpatients of current COPD clinical practice guidelines. Methodology This is an observational study with prospective recruitment (May 2014–May 2015) of patients with a COPD diagnosis as seen in outpatient respiratory clinics. The information collected was historical in nature as for the clinical data of the last and previous consultations, and the information concerning hospital resources was concurrent. Results A total of 17,893 clinical records of COPD patients in outpatient respiratory clinics from 59 Spanish hospitals were evaluated. Of the 5,726 patients selected, 4,508 (78.7%) were eligible. Overall, 12.1% of COPD patients did not fulfill a diagnostic spirometry criteria. Considerable variability existed in the available resources and work organization of the hospitals, although the majority were university hospitals with respiratory inpatient units. There was insufficient implementation of clinical guidelines in preventive and educational matters. In contrast, quantitative evaluation of dyspnea grade (81.9%) and exacerbation history (70.9%) were more frequently performed. Only 12.4% had COPD severity calculated according to the Body mass index, airflow Obstruction, Dyspnoea and Exercise capacity (BODE) index. Phenotype characteristics according to Spanish National Guideline for COPD were determined in 46.3% of the audited patients, and the risk evaluation according to Global initiative for chronic Obstructive Lung Disease was estimated only in 21.9%. Conclusion The EPOCONSUL study reports the current situation of medical care for COPD patients in outpatient clinics in Spain, revealing

  4. Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China

    Institute of Scientific and Technical Information of China (English)

    Guo-Chao Xu; Yun Luo; Qian Li; Meng-Fan Wu; Zi-Jun Zhou

    2016-01-01

    Background:In recent years,the prevalence of type 2 diabetes among Chinese population has been increasing by years,directly leading to an average annual growth rate of 19.90% of medical expenditure.Therefore,it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China.Therefore,in this study,we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services.Methods:This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012.Based on the analysis of outpatient expenditure and its influential factors,we adopted decision tree approach to conduct a case-mix analysis.In the end,we built a case-mix model to calculate the standard expenditure and the upper limit of each combination.Results:We found that age,job status,and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes.Through the analysis of the decision tree,we used six variables (complication,age,diabetic foot,diabetic nephropathy,cardiac-cerebrovascular disease,and neuropathy) to group the cases,and obtained 11 case-mix groups.Conclusions:We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services.Bundled payment is effective to control the increase of outpatient expenditure.Further improvements are needed for the implementation of bundled payment reimbursement standards,together with relevant policies and measures.

  5. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Hvenegaard, Anne

    2013-01-01

    or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care. CONCLUSIONS: Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.......BACKGROUND: Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS: To assess the effect of treatment in a specialised out-patient mood...... disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD: Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were...

  6. 德国老年人对替代医学疗法、针刺、顺势疗法及人智学疗法的使用情况%Usage of alternative medical systems, acupuncture,homeopathy and anthroposophic medicine,by older German adults

    Institute of Scientific and Technical Information of China (English)

    Arndt Büissing; Thomas Ostermann; Peter Heusser; Peter F. Matthiessen

    2011-01-01

    /traditional Chinese medicine (21%),homeopathy (21%),movement therapies/physical exercises (19%),osteopathy/chiropractic ( 12 % ),herbs/phytotherapy (7 % ),diets/specific food recommendations (6 % )and foot reflexology (5%).Anthroposophic medicine was used only to a minor degree.Acupuncture and homeopathy users were likely to choose more than one CAM treatment simultaneously,particularly the combination of homeopathy and acupuncture.Moreover,this study can confirm significant differences between women and men in the use of the main relevant CAM interventions.Conclusion:The relative proportion of acupuncture usage was similar to homeopathy,which is an alternative whole medical system originating from Western Europe.This means that an Eastern alternative system is established also in Germany.In several cases not only one CAM treatment was used but distinct combinations existed (particularly homeopathy and acupuncture);thus one should be cautious to draw predictive conclusions from studies with broad and unspecific CAM categories,for among them there are several therapies which should not be regarded as CAM.

  7. Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence

    Directory of Open Access Journals (Sweden)

    Watanabe N

    2012-08-01

    Full Text Available Norio Watanabe,1,2 Keiko Yamamura,3 Yusuke Suzuki,4 Hiroyuki Umegaki,4 Katsuro Shigeno,5 Ryo Matsushita,1 Yoshimichi Sai,1 Ken-ichi Miyamoto,1 Kiyofumi Yamada61Department of Clinical Pharmacy, Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa, Japan; 2Department of Pharmacy, Hashima Municipal Hospital, Hashima, Gifu, Japan; 3Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 4Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 5Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 6Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Aichi, JapanAim: Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD, but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS was set up. The influence of this service on medication persistence was assessed in the present study.Methods: Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group. Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.Results: The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73

  8. Transthoracic Adrenal Biopsy Procedure Using Artificial Carbon Dioxide Pneumothorax as Outpatient Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Favelier, Sylvain [CHU (University Hospital), Department of Radiology (France); Guiu, Severine [Georges-Francois Leclerc Cancer Center, Department of Oncology (France); Cherblanc, Violaine; Cercueil, Jean-Pierre; Krause, Denis; Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr [CHU (University Hospital), Department of Radiology (France)

    2013-08-01

    Many routes have been described for percutaneous adrenal gland biopsy. They require either a complex non-axial path or a long hydrodissection or even pass through an organ thereby increasing complications. We describe here an approach using an artificially-induced carbon dioxide (CO{sub 2}) pneumothorax, performed as an outpatient procedure in a 57-year-old woman. Under local anaesthesia, 200 ml of CO{sub 2} was injected in the pleural space through a Veress needle under computed tomography fluoroscopy, to clear the lung parenchyma from the biopsy route. Using this technique, transthoracic adrenal biopsy can be performed under simple local anaesthesia as an safely outpatient procedure.

  9. [Outpatient parenteral antibiotic therapy (OPAT): the Lausanne experience supporting new perspectives].

    Science.gov (United States)

    Moulin, Estelle; Boillata, Noémie; De Vallière, Serge

    2016-04-13

    With the increase of infections without option for an oral treatment, the systematic use of hospitalization overloads the healthcare system and causes growing political concern. For carefully selected patients, outpatient parenteral antibiotic therapy is an interesting alternative, with more than 40 years of experience in several countries. In this perspective, an outpatient parenteral antibiotic therapy (OPAT) unit was established in Lausanne two years ago. This article aims to describe its activity. Its practice, involving especially self-administration, seems to be safe, efficacious and cost-effective, as long as international good practice recommendations are applied.

  10. Outpatient Blind Percutaneous Liver Biopsy in Infants and Children: Is it Safe?

    OpenAIRE

    Mortada H El-Shabrawi; El-Karaksy, Hanaa M.; Okahsa, Sawsan H.; Naglaa M. Kamal; Gamal El-Batran; Badr, Khaled A.

    2012-01-01

    Background/Aim: We aim to investigate the safety of outpatient blind percutaneous liver biopsy (BPLB) in infants and children with chronic liver disease (CLD). Patients and Methods: BPLB was performed as an outpatient procedure using the aspiration Menghini technique in 80 infants and children, aged 2 months to 14 yrs, for diagnosis of their CLD. Patients were divided into three groups: Group 1 (6 hrs due to oversedation in 2.5%. There was a statistically significant rise in the 1-hr post-bio...

  11. Stress, gender, cognitive impairment, and outpatient physician use in later life.

    Science.gov (United States)

    Krause, N

    1996-01-01

    The purpose of this study was to look at the interface between stressful life events, gender, cognitive impairment, and the use of outpatient physician services among older adults. A theoretical rationale is presented, suggesting that older men who are suffering from either mild or moderate levels of cognitive impairment are especially likely to use outpatient physician services when they are confronted by undesirable stressful events. Analyses with data provided by a nationwide sample of elderly people provide support for this complex three-way interaction.

  12. Prevalence of hepatitis B virus infection in out-patient alcoholics

    DEFF Research Database (Denmark)

    Gluud, C; Gluud, B; Aldershvile, J

    1984-01-01

    Sera from 192 out-patient alcoholics attending a clinic for the treatment of alcoholism were tested for hepatitis B surface antigen (HBsAg) and for antibodies to HBsAg and to hepatitis B core antigen (HBcAg). Three sera (1.5%) were positive for HBsAg. Of the remaining 189 alcoholics, 29 (15%) were...... positive for one or both antibodies. This prevalence is not significantly different from that found in 137 hospitalized HBsAg-negative patients with alcoholic liver disease (35/137 [26%] were positive for one or both antibodies). However, the prevalence of hepatitis B antibodies in out-patient alcoholics...

  13. Analysis of Outpatient Serious Disease Covered by Risk-pooling Fund:Taking Jiangsu Province as an Example%纳入门诊大病统筹的病种分析:以江苏省为例

    Institute of Scientific and Technical Information of China (English)

    周绿林; 吴悦; 詹长春

    2013-01-01

      文章以江苏省6市为例,分析了2011年纳入统筹基金支付的门诊大病病种以及几类门诊大病的患病、费用与统筹支付情况,发现建立门诊大病统筹支付制度可以较好地解决门诊大病高额医疗费用所带来的负担问题,也减少了“门诊挤住院”费用情况的发生。为使得统筹基金能发挥最大的效用,建议完善相关政策,合理选择门诊大病病种、合理设置起付线与封顶线。%The article analyzes outpatient serious disease covered by risk-pooling fund as well as sicking suffering, expenses and reimbursement of several outpatient diseases in six cities of Jiangsu Province in 2011. It is found that establishing outpatient reimbursement system can effectively solve burden problem brought by high medical cost of chronic disease and reduce the “outpatient crowds hospital” case. To make risk-pooling fund to maximum effect, It is suggested to make the necessary perfection in policy on selection of outpatient serious disease as well as setting up pay line and top line.

  14. Home-Based Psychiatric Outpatient Care Through Videoconferencing for Depression: A Randomized Controlled Follow-Up Trial

    Science.gov (United States)

    Rössler, Wulf

    2016-01-01

    Background There is a tremendous opportunity for innovative mental health care solutions such as psychiatric care through videoconferencing to increase the number of people who have access to quality care. However, studies are needed to generate empirical evidence on the use of psychiatric outpatient care via videoconferencing, particularly in low- and middle-income countries and clinically unsupervised settings. Objective The objective of this study was to evaluate the effectiveness and feasibility of home-based treatment for mild depression through psychiatric consultations via videoconferencing. Methods A randomized controlled trial with a 6- and 12-month follow-up including adults with mild depression treated in an ambulatory setting was conducted. In total, 107 participants were randomly allocated to the videoconferencing intervention group (n=53) or the face-to-face group (F2F; n=54). The groups did not differ with respect to demographic characteristics at baseline. The F2F group completed monthly follow-up consultations in person. The videoconferencing group received monthly follow-up consultations with a psychiatrist through videoconferencing at home. At baseline and after 6 and 12 months, in-person assessments were conducted with all participants. Clinical outcomes (severity of depression, mental health status, medication course, and relapses), satisfaction with treatment, therapeutic relationship, treatment adherence (appointment compliance and dropouts), and medication adherence were assessed. Results The severity of depression decreased significantly over the 12-month follow-up in both the groups. There was a significant difference between groups regarding treatment outcomes throughout the follow-up period, with better results in the videoconferencing group. There were 4 relapses in the F2F group and only 1 in the videoconferencing group. No significant differences between groups regarding mental health status, satisfaction with treatment, therapeutic

  15. Sets in Coq, Coq in Sets

    Directory of Open Access Journals (Sweden)

    Bruno Barras

    2010-01-01

    Full Text Available This work is about formalizing models of various type theories of the Calculus of Constructions family. Here we focus on set theoretical models. The long-term goal is to build a formal set theoretical model of the Calculus of Inductive Constructions, so we can be sure that Coq is consistent with the language used by most mathematicians.One aspect of this work is to axiomatize several set theories: ZF possibly with inaccessible cardinals, and HF, the theory of hereditarily finite sets. On top of these theories we have developped a piece of the usual set theoretical construction of functions, ordinals and fixpoint theory. We then proved sound several models of the Calculus of Constructions, its extension with an infinite hierarchy of universes, and its extension with the inductive type of natural numbers where recursion follows the type-based termination approach.The other aspect is to try and discharge (most of these assumptions. The goal here is rather to compare the theoretical strengths of all these formalisms. As already noticed by Werner, the replacement axiom of ZF in its general form seems to require a type-theoretical axiom of choice (TTAC.

  16. Sets resilient to erosion

    CERN Document Server

    Pegden, Wesley

    2011-01-01

    The erosion of a set in Euclidean space by a radius r>0 is the subset of X consisting of points at distance >/-r from the complement of X. A set is resilient to erosion if it is similar to its erosion by some positive radius. We give a somewhat surprising characterization of resilient sets, consisting in one part of simple geometric constraints on convex resilient sets, and, in another, a correspondence between nonconvex resilient sets and scale-invariant (e.g., 'exact fractal') sets.

  17. Invariant sets for Windows

    CERN Document Server

    Morozov, Albert D; Dragunov, Timothy N; Malysheva, Olga V

    1999-01-01

    This book deals with the visualization and exploration of invariant sets (fractals, strange attractors, resonance structures, patterns etc.) for various kinds of nonlinear dynamical systems. The authors have created a special Windows 95 application called WInSet, which allows one to visualize the invariant sets. A WInSet installation disk is enclosed with the book.The book consists of two parts. Part I contains a description of WInSet and a list of the built-in invariant sets which can be plotted using the program. This part is intended for a wide audience with interests ranging from dynamical

  18. 38 CFR 17.95 - Outpatient medical services for Department of Veterans Affairs employees and others in emergencies.

    Science.gov (United States)

    2010-07-01

    ... services for Department of Veterans Affairs employees and others in emergencies. 17.95 Section 17.95... Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. Outpatient medical services for which charges shall be made as required by § 17.101 may be authorized...

  19. 42 CFR 410.66 - Emergency outpatient services furnished by a nonparticipating hospital and services furnished in...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency outpatient services furnished by a... SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.66 Emergency outpatient... for payment of emergency inpatient services furnished by a nonparticipating U.S. hospital and...

  20. 76 FR 15349 - Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2011-03-21

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by... the cost of outpatient medical, dental and cosmetic surgery services furnished by military...

  1. History of Interpersonal Violence, Abuse, and Nonvictimization Trauma and Severity of Psychiatric Symptoms among Children in Outpatient Psychiatric Treatment

    Science.gov (United States)

    Ford, Julian D.; Gagnon, Kerry; Connor, Daniel F.; Pearson, Geraldine

    2011-01-01

    In a clinical sample of child psychiatry outpatients, chart review data were collected for 114 consecutive admissions over a 1-year period at a Child and Adolescent Outpatient Psychiatry Clinic. Data included history of documented maltreatment, potentially traumatic domestic or community violence, neglect or emotional abuse, and noninterpersonal…

  2. Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    LENUS (Irish Health Repository)

    McCabe, A

    2013-06-01

    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

  3. Drop-out and treatment outcome of outpatient cognitive-behavioral therapy for anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Schnicker, Katja; Hiller, Wolfgang; Legenbauer, Tanja

    2013-10-01

    In the present study, drop-out-analyses were carried out for a manual-based cognitive-behavioral therapy for 104 females with anorexia nervosa (AN) and bulimia nervosa (BN), in the service setting of a university outpatient clinic (naturalistic setting). A total of 22.9% of patients with AN terminated therapy prematurely (drop-outs), compared to 40.6% of patients with BN. Group differences between drop-outs and completers show that the group of drop-outs with BN had higher values in the depression score at the start of therapy and was almost two times more likely to have a comorbid disorder (odds ratio 1.69), whereas drop-outs with AN had higher values in the outcome-scale drive for thinness and the odds ratio for being employed or living in a partnership was slightly lower. Completers and drop-outs did not differ significantly within groups in regard to age, body mass index at the start and end of therapy, or the number of comorbid disorders. On the whole, the therapy effect in the group of drop-outs was relatively moderate. For patients with AN, even higher therapy effects were observed among the drop-outs than among the completers. These data suggest that moderate therapy effects and responses can be achieved even among the drop-outs.

  4. Value Set Authority Center

    Data.gov (United States)

    U.S. Department of Health & Human Services — The VSAC provides downloadable access to all official versions of vocabulary value sets contained in the 2014 Clinical Quality Measures (CQMs). Each value set...

  5. Altimeter Setting Indicator

    Data.gov (United States)

    Department of Transportation — The Altimeter Setting Indicator (ASI) is an aneroid system used at airports to provide an altimeter setting for aircraft altimeters. This indicator may be an analog...

  6. Landslides, Set 2

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This set expands the topics included in Set 1 and includes (in addition to landslides) rockfalls, rock avalanches, mud flows, debris flows, slumps, creep, and...

  7. 医院门诊部健康管理实践的几点做法%Some methods of health management practice in hospital outpatient department

    Institute of Scientific and Technical Information of China (English)

    曹晶; 张海蕾; 李贤卓

    2014-01-01

    With the update of medical concept and the formation of new biological-psychological-social medical model,the goal of hospital service is constantly updating and upgrading.The outpatient department is the service window and forward position of the hospital.The health management work is an important part of hospital outpatient department work.The activity of health management practice in hospital outpatient department include strengthening the health management idea renewal, setting up and perfect the functions of the health management of science, optimizing the health management professional team, creating good environment and health management throughout the overall comprehensive health management services.Summarized as follows..%随着医学理念更新和新的生物-心理-社会医学模式的形成,医院服务的目标在不断更新和提升。门诊部是医院的服务窗口和前沿阵地。健康管理工作是医院门诊部工作的重要部分。本院门诊部健康管理实践活动包括强化健康管理理念更新,科学设置和完善健康管理职能部门,优化健康管理专业团队,创建良好的健康管理环境,提供全程全方位健康管理的整体服务。

  8. Incidence rate and pattern of clinically relevant potential drug-drug interactions in a large outpatient population of a developing country

    Directory of Open Access Journals (Sweden)

    Ehsan Nabovati

    2016-01-01

    Full Text Available The objective of this study was to determine incidence rate, type, and pattern of clinically relevant potential drug-drug interactions (pDDIs in a large outpatient population of a developing country. A retrospective, descriptive cross-sectional study was conducted on outpatients’ prescriptions in Khorasan Razavi province, Iran, over 12 months. A list of 25 clinically relevant DDIs, which are likely to occur in the outpatient setting, was used as the reference. Most frequent clinically relevant pDDIs, most common drugs contributing to the pDDIs, and the pattern of pDDIs for each medical specialty were determined. Descriptive statistics were used to report the results. In total, out of 8,169,142 prescriptions, 6,096 clinically relevant pDDIs were identified. The most common identified pDDIs were theophyllines-quinolones, warfarin-nonsteroidal anti-inflammatory drugs, benzodiazepines-azole antifungal agents, and anticoagulants-thyroid hormones. The most common drugs contributing to the identified pDDIs were ciprofloxacin, theophylline, warfarin, aminophylline, alprazolam, levothyroxine, and selegiline. While the incidence rate of clinically relevant pDDIs in prescriptions of general practitioners, internists, and cardiologists was the highest, the average pDDI incidence per 10,000 prescriptions of pulmonologists, infectious disease specialists, and cardiologists was highest. Although a small proportion of the analyzed prescriptions contained drug pairs with potential for clinically relevant DDIs, a significant number of outpatients have been exposed to the adverse effects associated with these interactions. It is recommended that in addition to training physicians and pharmacists, other effective interventions such as computerized alerting systems and electronic prescribing systems be designed and implemented.

  9. Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt

    Directory of Open Access Journals (Sweden)

    Hala M. Abou Shady

    2015-02-01

    Full Text Available Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus(CA-MRSA are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureusand MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureusisolates were characterized by antibiotic susceptibility, presence of mecAand PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL+ isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80 were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence.

  10. Staphylococcus aureus nasal carriage among outpatients attending primary health care centers: a comparative study of two cities in Saudi Arabia and Egypt.

    Science.gov (United States)

    Abou Shady, Hala M; Bakr, Alaa Eldin A; Hashad, Mahmoud E; Alzohairy, Mohammad A

    2015-01-01

    Epidemiological and molecular data on community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) are still scarce in both Egypt and Saudi Arabia. There is almost no data regarding methicillin resistant Staphylococcus aureus (MRSA) prevalence in both countries. This study was conducted to investigate the prevalence and molecular epidemiology of S. aureus and MRSA nasal carriage among outpatients attending primary health care centers in two big cities in both countries. A total of 206 nasal swabs were obtained, 103 swabs from each country. S. aureus isolates were characterized by antibiotic susceptibility, presence of mecA and PVL genes, SCCmec-typing and spa typing, the corresponding Multi locus sequence typing clonal complex was assigned for each spa type based on Ridom StaphType database. MRSA was detected in 32% of the Egyptian outpatients while it was found in 25% of the Saudi Arabian outpatients. All MRSA isolates belonged to SCCmec type V and IVa, where some isolates in Saudi Arabia remained nontypeable. Surprisingly PVL(+) isolates were low in frequency: 15% of MRSA Egyptian isolates and 12% of MRSA isolates in Saudi Arabia. Two novel spa types were detected t11839 in Egypt, and t11841 in Saudi Arabia. We found 8 spa types among 20 isolates from Egypt, and 12 spa types out of 15 isolates from Saudi Arabia. Only two spa types t008 and t223 coexisted in both countries. Four clonal complexes (CC5, CC8, CC22, and CC80) were identified in both Egypt and Saudi Arabia. However, the data collected lacked a representation of isolates from different parts of each country as only one health center from each country was included, it still partially illustrates the CA-MRSA situation in both countries. In conclusion a set of control measures is required to prevent further increase in MRSA prevalence.

  11. Vague集%Vague Set

    Institute of Scientific and Technical Information of China (English)

    李凡; 徐章艳; 饶勇

    2000-01-01

    In this paper,we first introduce vague set,then give the definition of intersection and union based on vague set with t-norm and t-conorm of the point value. Thus we gain some properties of intersection and union of vague set.

  12. Paired fuzzy sets

    DEFF Research Database (Denmark)

    Rodríguez, J. Tinguaro; Franco de los Ríos, Camilo; Gómez, Daniel

    2015-01-01

    In this paper we want to stress the relevance of paired fuzzy sets, as already proposed in previous works of the authors, as a family of fuzzy sets that offers a unifying view for different models based upon the opposition of two fuzzy sets, simply allowing the existence of different types...

  13. Axiomatic set theory

    CERN Document Server

    Suppes, Patrick

    1972-01-01

    This clear and well-developed approach to axiomatic set theory is geared toward upper-level undergraduates and graduate students. It examines the basic paradoxes and history of set theory and advanced topics such as relations and functions, equipollence, finite sets and cardinal numbers, rational and real numbers, and other subjects. 1960 edition.

  14. Rough Neutrosophic Sets

    OpenAIRE

    Said Broumi; Florentin Smarandache; Mamoni Dhar

    2013-01-01

     Both neutrosophic sets theory and rough sets theory are emerging as powerful tool for managing uncertainty, indeterminate, incomplete and imprecise information. In this paper we develop an hybrid structure called rough neutrosophic sets and studied their properties. 

  15. Sets, Planets, and Comets

    Science.gov (United States)

    Baker, Mark; Beltran, Jane; Buell, Jason; Conrey, Brian; Davis, Tom; Donaldson, Brianna; Detorre-Ozeki, Jeanne; Dibble, Leila; Freeman, Tom; Hammie, Robert; Montgomery, Julie; Pickford, Avery; Wong, Justine

    2013-01-01

    Sets in the game "Set" are lines in a certain four-dimensional space. Here we introduce planes into the game, leading to interesting mathematical questions, some of which we solve, and to a wonderful variation on the game "Set," in which every tableau of nine cards must contain at least one configuration for a player to pick up.

  16. Domestically and Generally Violent Forensic Psychiatric Outpatients: Personality Traits and Behavior

    Science.gov (United States)

    Hornsveld, Ruud H. J.; Bezuijen, Siemon; Leenaars, Ellie E. M.; Kraaimaat, Floris W.

    2008-01-01

    A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological…

  17. Prevalence and prognostic significance of hyponatraemia in outpatients with chronic heart failure

    DEFF Research Database (Denmark)

    Balling, Louise; Schou, Morten; Videbæk, Lars;

    2011-01-01

    Hyponatraemia has been reported to be a potent predictor of poor outcome in patients hospitalized for heart failure (HF). The aim of the study was to determine the prevalence and prognostic significance of hyponatraemia in a large cohort of HF outpatients followed in clinics participating in the ...

  18. Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

    OpenAIRE

    Berger, Richard A; Sanders, Sheila A.; Thill, Elizabeth S.; Sporer, Scott M.; Della Valle, Craig

    2009-01-01

    Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia ...

  19. Maintaining a Distinction Between Possible and Impossible Topics of Conversation in the Outpatient Respiratory Medical Clinic

    DEFF Research Database (Denmark)

    Birgitte Skov Jensen, Lone; Larsen, Kristian; Konradsen, Hanne

    2016-01-01

    The aim of this study is to generate a grounded theory explaining patterns of behavior among health care professionals (HCPs) during interactions with patients in outpatient respiratory medical clinics. The findings suggest that the HCPs managed contradictory expectations to the interaction...

  20. Risk of Criminal Victimisation in Outpatients with Common Mental Health Disorders

    NARCIS (Netherlands)

    Meijwaard, S. C.; Kikkert, M.; De Mooij, L. D.; Lommerse, N. M.; Peen, J.; Schoevers, R. A.; Verbaten, R.; De Wildt, W.; Bockting, C. L. H.; Dekker, J. J. M.

    2015-01-01

    Background: Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of

  1. 42 CFR 413.123 - Payment for screening mammography performed by hospitals on an outpatient basis.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for screening mammography performed by... SKILLED NURSING FACILITIES Specific Categories of Costs § 413.123 Payment for screening mammography... mammographies performed by hospitals. (b) Payment to hospitals for outpatient services. Payment to hospitals...

  2. European Surveillance of antimicrobial consumption (ESAC) : quality indicators for outpatient antibiotic use in Europe

    NARCIS (Netherlands)

    Coenen, Samuel; Ferech, Matus; Haaijer-Ruskamp, Flora M.; Butler, Chris C.; Stichele, Robert H. Vander; Verheij, Theo J. M.; Monnet, Dominique L.; Goossens, Paul Little Herman

    2007-01-01

    Background and objective: Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug- specific quality indicators for outpatient antibiotic use in E

  3. Efficacy of Group Art Therapy on Depressive Symptoms in Adult Heterogeneous Psychiatric Outpatients

    Science.gov (United States)

    Chandraiah, Shambhavi; Ainlay Anand, Susan; Avent, Lindsay Cherryl

    2012-01-01

    This study evaluated the potential benefit of weekly group art therapy in groups of adult psychiatric outpatients at a university medical center. Eighteen patients participated in 4 successive 8-week groups of 6 to 8 patients each that met weekly and were led by 2 therapists (a board-certified art therapist and a psychiatry resident). The…

  4. 42 CFR 413.122 - Payment for hospital outpatient radiology services and other diagnostic procedures.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for hospital outpatient radiology services... radiology services and other diagnostic procedures. (a) Basis and purpose. (1) This section implements section 1833(n) of the Act and establishes the method for determining Medicare payments for...

  5. Risk of criminal victimisation in outpatients with common mental health disorders

    NARCIS (Netherlands)

    Meijwaard, Sabine C.; Kikkert, Martijn; de Mooij, Liselotte D.; Lommerse, Nick M.; Peen, Jaap; Schoevers, Robert A.; Van, Rien; de Wildt, Wencke; Bockting, Claudi L. H.; Dekker, Jack J. M.

    2015-01-01

    Background Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of

  6. Motivation for Psychiatric Treatment in Outpatients with Severe Mental Illness : Different Perspectives

    NARCIS (Netherlands)

    E.C. Jochems (Eline)

    2016-01-01

    textabstractThe main aim of the current thesis was to empirically test and compare three current theoretical models of motivation for treatment in the context of outpatient psychiatric care for patients with severe mental illness (SMI). In a literature review (Chapter 2), we argued that Self-Determi

  7. Outpatient Marijuana Treatment for Adolescents: Economic Evaluation of a Multisite Field Experiment.

    Science.gov (United States)

    French, Michael T.; Roebuck, M. Christopher; Dennis, Michael L.; Godley, Susan H.; Liddle, Howard A.; Tims, Frank M.

    2003-01-01

    Conducted an economic evaluation of five outpatient adolescent treatment approaches (12 total site-by-conditions) to identify average economic costs to society. Results suggest that some types of substance-abuse intervention for adolescents can reduce social costs immediately after treatment. (SLD)

  8. Outpatient Art Therapy with Multiple Personality Disorder: A Survey of Current Practice.

    Science.gov (United States)

    Mills, Anne

    1995-01-01

    Reports findings of a 1993 questionnaire completed by 46 North American art therapists that focuses on the outpatient treatment of multiple personality disorder. Includes information on role in diagnosing, fees and third-party payment, and therapeutic activities. Treatment issues include pacing and containment, and managing the client's chronic…

  9. Assessment of Benzodiazepine dependence in alcohol and drug dependent outpatients: A research report

    NARCIS (Netherlands)

    Kan, C.C.; Breteler, M.H.M.; Ven, A.H.G.S. van der; Timmermans, M.A.Y.; Zitman, F.G.

    2001-01-01

    In this study on 99 outpatients who were being treated for alcohol and/or drug dependence and also using benzodiazepines (BZDs), prevalence rates of DSM-III-R and ICD-10 substance dependence diagnoses were ascertained and scalability, reliability and validity of the scales of the Benzodiazepine Depe

  10. The Accelerated Intake: A Method for Increasing Initial Attendance to Outpatient Cocaine Treatment.

    Science.gov (United States)

    Festinger, David S.; And Others

    1996-01-01

    The effectiveness of offering same day appointments at an outpatient cocaine treatment program to increase intake attendance was examined. Seventy-eight clients were given standard or accelerated intake appointments. Significantly more clients who were given accelerated appointments attended the program. An accelerated intake procedure appears to…

  11. Task analysis of IT-mediated medication management in outpatient care

    NARCIS (Netherlands)

    Stiphout, van F.; Zwart-van Rijkom, J.E.F.; Maggio, L.A.; Aarts, J.E.C.M.; Bates, D.W.; Gelder, van T.; Jansen, P.A.F.; Schraagen, J.M.C.; Egberts, A.C.G.; Braak, ter E.W.M.T.

    2015-01-01

    Aim Educating physicians in the procedural as well as cognitive skills of IT-mediated medication management could be one of the missing links for improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. M

  12. Predictors of incident major depression in diabetic outpatients with subthreshold depression

    NARCIS (Netherlands)

    Bot, Mariska; Pouwer, Francois; Ormel, Johan; Slaets, Joris P. J.; de Jonge, Peter

    2010-01-01

    P>Aims The objective of the study was to determine rates and risks of major depression in diabetes outpatients with subthreshold depression. Methods This study is based on data of a stepped care-based intervention study in which diabetic patients with subthreshold depression were randomly allocated

  13. Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support

    NARCIS (Netherlands)

    Campmans-Kuijpers, Marjo J.; Baan, Caroline A.; Lemmens, Lidwien C.; Rutten, Guy E.

    2015-01-01

    OBJECTIVE: To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. RESEARCH DESIGN AND METHODS: This before-and-after study with a 1-year follow-up surveyed qualitymanagers on six domains of quality management. Q

  14. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, P.; Andersen, Klaus Kaae; Munch, E.;

    2009-01-01

    of dyspnoea using MRC dyspnoea scale increased from 7.2 to 47.2% (both p analysing the results with focus on the performance of the individual outpatient clinics we also observed an improvement in the quality. Conclusion: We conclude that it is possible to improve the quality of care for COPD...

  15. Word use of outpatients with a personality disorder and concurrent or previous major depressive disorder

    NARCIS (Netherlands)

    Molendijk, M.L.; Bamelis, L.; van Emmerik, A.A.P.; Arntz, A.; Haringsma, R.; Spinhoven, P.

    2010-01-01

    In a recent study, Rude, Gortner, and Pennebaker (2004) found word use to be related to depression and vulnerability to depression in the essays of college students. We sought to replicate and extend these findings in a clinical sample. Written essays of 304 psychiatric outpatients with a personalit

  16. Use of Outpatient Endometrial Biopsy in a Population with Intellectual Disability

    Science.gov (United States)

    Jaffe, Joshua S.

    2008-01-01

    Background: To demonstrate the feasibility of outpatient endometrial sampling to evaluate abnormal uterine bleeding in a population of women with intellectual disability. Method: Retrospective chart review was completed of all endometrial biopsies performed on women attending a dedicated gynaecology clinic for women with intellectual disability…

  17. Determinants of tinnitus’ impact in Quality of Life in an outpatient clinic protocol.

    NARCIS (Netherlands)

    Magali Roggerone, [No Value

    2010-01-01

    Summary Background: Tinnitus is a chronic condition that can cause substantial handicap for certain patients and affects their Quality of Life. Our study focuses on Quality of Life for the tinnitus patients who participated in the protocol of an outpatient clinic established at the ENT department of

  18. Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD

    DEFF Research Database (Denmark)

    Ringbaek, Thomas J.; Lavesen, Marie; Lange, Peter

    2016-01-01

    BACKGROUND: A minicomputer (tablet) with instructions and a training diary has the potential of facilitating adherence to pulmonary rehabilitation (PR). OBJECTIVE: To evaluate the effect of adding a tablet to a classic outpatient PR programme for COPD patients. METHODS: A total of 115 patients pa...

  19. Evaluation of a hand carried cardiac ultrasound device in an outpatient cardiology clinic

    NARCIS (Netherlands)

    E.C. Vourvouri (Eleni); D. Poldermans (Don); G.E. Parharidis; J.R.T.C. Roelandt (Jos); J.W. Deckers (Jaap)

    2005-01-01

    textabstractOBJECTIVE: To determine the diagnostic potential of a hand carried cardiac ultrasound (HCU) device (OptiGo, Philips Medical Systems) in a cardiology outpatient clinic and to compare the HCU diagnosis with the clinical diagnosis and diagnosis with a full featured standar

  20. Adolescent Substance-Use Frequency following Self-Help Group Attendance and Outpatient Substance Abuse Treatment

    Science.gov (United States)

    Gangi, Jennifer; Darling, Carol A.

    2012-01-01

    Despite the heterogeneity of posttreatment outcomes, the likelihood of relapse is often dependent on several factors, including participation in continuing care services such as self-help groups. However, few studies have examined the use of self-help groups among adolescent outpatients. Therefore, in this study, investigators examined self-help…

  1. Cost-effectiveness of an Intensive Smoking Cessation Intervention for COPD Outpatients

    NARCIS (Netherlands)

    Christenhusz, L.C.A.; Prenger, H.C.; Pieterse, M.E.; Seydel, E.R.; Palen, van der J.

    2012-01-01

    Introduction: To determine the cost-effectiveness of a high-intensity smoking cessation program (SmokeStop Therapy; SST) versus a medium-intensity treatment (Minimal Intervention Strategy for Lung patients [LMIS]) for chronic obstructive pulmonary disease outpatients. Methods: The cost-effectiven

  2. Update in outpatient general internal medicine: practice-changing evidence published in 2014.

    Science.gov (United States)

    Sundsted, Karna K; Wieland, Mark L; Szostek, Jason H; Post, Jason A; Mauck, Karen F

    2015-10-01

    The practice of outpatient general internal medicine requires a diverse and evolving knowledge base. General internists must identify practice-changing shifts in the literature and reflect on their impact. Accordingly, we conducted a review of practice-changing articles published in outpatient general internal medicine in 2014. To identify high-quality, clinically relevant publications, we reviewed all titles and abstracts published in the following primary data sources in 2014: New England Journal of Medicine, Journal of the American Medical Association (JAMA), Annals of Internal Medicine, JAMA Internal Medicine, and the Cochrane Database of Systematic Reviews. All 2014 primary data summaries from Journal Watch-General Internal Medicine and ACP JournalWise also were reviewed. The authors used a modified Delphi method to reach consensus on inclusion of 8 articles using the following criteria: clinical relevance to outpatient internal medicine, potential for practice change, and strength of evidence. Clusters of important articles around one clinical question were considered as a single-candidate series. The article merits were debated until consensus was reached on the final 8, spanning a variety of topics commonly encountered in outpatient general internal medicine.

  3. Telephone-Administered Cognitive Behavioral Therapy for Veterans Served by Community-Based Outpatient Clinics

    Science.gov (United States)

    Mohr, David C.; Carmody, Timothy; Erickson, Lauren; Jin, Ling; Leader, Julie

    2011-01-01

    Objective: Multiple trials have found telephone-administered cognitive behavioral therapy (T-CBT) to be effective for the treatment of depression. The aim of this study was to evaluate T-CBT for the treatment of depression among veterans served by community-based outpatient clinics (CBOCs) outside of major urban areas. Method: Eighty-five veterans…

  4. 76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Science.gov (United States)

    2011-11-30

    .... Background b. Packaging Issues (1) CMS Presentation of Findings Regarding Expanded Packaging at the February... CONTACT: Marjorie Baldo, (410) 786-4617, Hospital outpatient prospective payment issues. Char Thompson, (410) 786-2300, Ambulatory surgical center issues. Michele Franklin, (410) 786-4533, and Jana...

  5. 75 FR 71799 - Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates...

    Science.gov (United States)

    2010-11-24

    .... Packaging Issues ] (1) CMS Presentation of Findings Regarding Expanded Packaging at the February 2010 APC... Service-Specific Packaging Issues 4. Calculation of OPPS Scaled Payment Weights B. Conversion Factor... INFORMATION CONTACT: Gift Tee, (410) 786-9316, Hospital outpatient prospective payment issues. Paula...

  6. Rating Problem Behaviors in Outpatients with Mental Retardation: Use of the Aberrant Behavior Checklist.

    Science.gov (United States)

    Freund, Lisa S.; Reiss, Allan L.

    1991-01-01

    Parent and teacher ratings on the Aberrant Behavior Checklist with an outpatient sample of 110 children, adolescents, and young adults with mental retardation found that the 5-factor structure of both parent and teacher data corresponded very well with the 5 factors originally obtained from staff ratings of mentally retarded inpatients. (Author/DB)

  7. Early Detection and Outpatient Management of Alcoholism: A Curriculum for Medical Residents.

    Science.gov (United States)

    Barnes, Henrietta N.; And Others

    1984-01-01

    A course in the early detection and outpatient management of alcoholism for medical residents is discussed. Unlike other courses on alcoholism that have emphasized changes in physicians' attitudes, this course was designed to promote changes in residents' practice behavior and to foster the development of necessary clinical skills. (MLW)

  8. Outpatient Management of Hypertension By General Medicine and Traditional Track Residents.

    Science.gov (United States)

    Robie, Peter W.; Andrus, Peter L.

    1982-01-01

    A study to determine whether general internal medicine and traditional track medicine residents differed in their outpatient management of essential hypertension is discussed. General internal medicine residents seem to do better in the areas of assessment of drug side effects and patient education. (MLW)

  9. The Impact of Quality Service Provided by SRM Hospital on Outpatients

    Directory of Open Access Journals (Sweden)

    Kenneth Amoah-Binfoh

    2015-04-01

    Full Text Available Consumer’s perceptions about the health care services play an important role when choosing a hospital. The quality of service is crucial to both the outpatients and the service providers. The dimensions of the service quality are reliability, responsiveness, assurance, empathy, and tangibles. Customer’s expectations and experiences vary with services. When there is a shortfall between expectation of service level and perception of actual service delivery, it is called customer gap. The causes of customer gap include; not knowing what customers expect, not selecting the right service designs and standards, not delivering to service standards and not matching performance to promises. This paper focuses on the level of service quality rendered by SRM’s hospital, the patient-physicians’ relationship and to examine the pre and post service of outpatients in the SRM’s hospital. A structured questionnaires and interviews were constructed to provide answers to the research questions using a sample size of 50 [employees and outpatients]. It was found out that some outpatients were satisfied with the services rendered by the hospital with reservations for more improvement. It was also found out that, there were gaps between the outpatients’ expectation and perception about the service rendered by the hospital. It was recommended that a competent marketing executive should be employed since marketing is the voice of the healthcare industry.

  10. Outpatient Mental Health and the Dual-Diagnosis Patient: Utilization of Services and Community Adjustment.

    Science.gov (United States)

    Ford, Lucy; And Others

    1991-01-01

    Differences in service utilization and community adjustment between community mental health clients with and without substance abuse disorders were studied for 144 outpatients, 37 percent of whom had dual diagnoses (substance abuse and another disorder). The association of dual diagnosis with poor service use and adjustment is discussed. (SLD)

  11. Outpatient costing and classification: are we any closer toa national standard for ambulatory classification systems?

    Science.gov (United States)

    Cleary, M I; Murray, J M; Michael, R; Piper, K

    1998-10-19

    The Outpatient Costing and Classification Study was commissioned by the Department of Health and Family Services to evaluate the suitability of the Developmental Ambulatory Classification System (DACS). Data on the full range of ambulatory services (outpatient clinics, emergency departments and allied health services) were collected prospectively from a stratified sample of 28 public hospitals. Patient encounters captured in the study represent 1% of the total ambulatory encounters in Australia in one year. Costing per encounter included time spent with the patient, cost of procedures, indirect costs (salaries and consumables), overhead costs and diagnostic costs. The most significant variable explaining cost variation was hospital type, followed by outpatient clinic type. Visit type and presence or absence of a procedure--major splits for the proposed DACS--did not produce splits that were consistent across all hospital strata. The study found that DACS is not an appropriate classification for hospital ambulatory services. A clinic-based structure for outpatients and allied health departments is recommended for classifying and funding ambulatory services in Australia.

  12. Outpatient vs. home-based pulmonary rehabilitation in COPD: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Mendes de Oliveira Júlio C

    2010-12-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients, families and society. Pulmonary rehabilitation (PR is a multidisciplinary program that integrates components of exercise training, education, nutritional support, psychological support and self-care, resulting in an improvement in dyspnea, fatigue and quality of life. Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD, PR is generally underutilized and strategies for increasing access to PR are needed. Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation. In the present study, patients with mild, moderate and severe COPD submitted to either an outpatient or at-home PR program for 12 weeks were analyzed. Methods Patients who fulfilled the inclusion criteria were randomized into three distinct groups: an outpatient group who performed all activities at the clinic, a home-based group who performed the activities at home and a control group. PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks. Results There was a significant difference in the distance covered on the six-minute walk test (p Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD.

  13. The Treatment Engagement Rating scale (TER) for forensic outpatient treatment : Description, psychometric properties, and norms

    NARCIS (Netherlands)

    Drieschner, Klaus Heinrich; Boomsma, Anne

    2008-01-01

    The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various p

  14. A Survey on Dementia Training Needs among Staff at Community-Based Outpatient Clinics

    Science.gov (United States)

    Adler, Geri; Lawrence, Briana M.; Ounpraseuth, Songthip T.; Asghar-Ali, Ali Abbas

    2015-01-01

    Dementia is a major public health concern. Educating health-care providers about dementia warning signs, diagnosis, and management is paramount to fostering clinical competence and improving patient outcomes. The objective of this project was to describe and identify educational and training needs of staff at community-based outpatient clinics…

  15. Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry

    NARCIS (Netherlands)

    van den Brink, Rob H. S.; Troquete, Nadine A. C.; Beintema, Harry; Mulder, Tamara; van Os, Titus W. D. P.; Schoevers, Robert A.; Wiersma, Durk

    2015-01-01

    Background: In outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client's appreciation of his own problem behaviour is not systematically used for these purposes. The current study tes

  16. Traumatization in Deaf and Hard-of-Hearing Adult Psychiatric Outpatients

    Science.gov (United States)

    Øhre, Beate; Uthus, Mette Perly; von Tetzchner, Stephen; Falkum, Erik

    2015-01-01

    Deaf and hard-of-hearing persons are at risk for experiencing traumatic events and such experiences are associated with symptoms of mental disorder. We investigated the prevalence of traumatic events and subsequent traumatization in adults referred to specialized psychiatric outpatient units for deaf and hard-of-hearing patients. Sixty-two…

  17. Suicidal behaviour among alcohol-dependent Danes attending outpatient treatment

    DEFF Research Database (Denmark)

    Bjørk Petersen, Christina; Grønbæk, Morten; Bussey Rask, Marie;

    2009-01-01

    . Characteristics of, predictors for and outcome among suicidal patients were studied. Alcohol-dependent patients with a history of suicide attempts were found to constitute a highly selected group in alcohol abuse treatment as they often had a more severe course of alcohol dependence, were unemployed, younger......, were more often lowly educated, and had more physical and psychiatric problems. Traumatic childhood experience related to physical or sexual abuse was found as a major predictor for suicidal behaviour among alcohol-dependent patients. We found no significant difference in the effect of treatment...... that suicidal patients in treatment for alcohol abuse are treated effectively within the present treatment settings....

  18. Sets avoiding integral distances

    CERN Document Server

    Kurz, Sascha

    2012-01-01

    We study open point sets in Euclidean spaces $\\mathbb{R}^d$ without a pair of points an integral distance apart. By a result of Furstenberg, Katznelson, and Weiss such sets must be of Lebesgue upper density zero. We are interested in how large such sets can be in $d$-dimensional volume. We determine the lower and upper bounds for the volumes of the sets in terms of the number of their connected components and dimension, and also give some exact values. Our problem can be viewed as a kind of inverse to known problems on sets with pairwise rational or integral distances.

  19. Elements of set theory

    CERN Document Server

    Enderton, Herbert B

    1977-01-01

    This is an introductory undergraduate textbook in set theory. In mathematics these days, essentially everything is a set. Some knowledge of set theory is necessary part of the background everyone needs for further study of mathematics. It is also possible to study set theory for its own interest--it is a subject with intruiging results anout simple objects. This book starts with material that nobody can do without. There is no end to what can be learned of set theory, but here is a beginning.

  20. Generalization Rough Set Theory

    Institute of Scientific and Technical Information of China (English)

    XIAO Di; ZHANG Jun-feng; HU Shou-song

    2008-01-01

    In order to avoid the discretization in the classical rough set theory, a generlization rough set theory is proposed.At first, the degree of general importance of an attribute and attribute subsets are presented.Then, depending on the degree of general importance of attribute, the space distance can be measured with weighted method.At last, a generalization rough set theory based on the general near neighborhood relation is proposed.The proposed theory partitions the universe into the tolerant modules, and forms lower approximation and upper approximation of the set under general near neighborhood relationship, which avoids the discretization in Pawlak's rough set theory.

  1. Noncomputable Spectral Sets

    CERN Document Server

    Teutsch, J

    2007-01-01

    It is possible to enumerate all computer programs. In particular, for every partial computable function, there is a shortest program which computes that function. f-MIN is the set of indices for shortest programs. In 1972, Meyer showed that f-MIN is Turing equivalent to 0'', the halting set with halting set oracle. This paper generalizes the notion of shortest programs, and we use various measures from computability theory to describe the complexity of the resulting "spectral sets." We show that under certain Godel numberings, the spectral sets are exactly the canonical sets 0', 0'', 0''', ... up to Turing equivalence. This is probably not true in general, however we show that spectral sets always contain some useful information. We show that immunity, or "thinness" is a useful characteristic for distinguishing between spectral sets. In the final chapter, we construct a set which neither contains nor is disjoint from any infinite arithmetic set, yet it is 0-majorized and contains a natural spectral set. Thus ...

  2. Outpatient red blood cell transfusion payments among patients on chronic dialysis

    Directory of Open Access Journals (Sweden)

    Gitlin Matthew

    2012-11-01

    Full Text Available Abstract Background Payments for red blood cell (RBC transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. Methods Using Truven Health MarketScan® data (1/1/02-10/31/10 in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days, blood acquisition/administration (within 2 days, and associated complications (within 3 days for acute events; up to 45 days for chronic events. Results A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD] age was 60.9 (15.0 years, and mean Charlson comorbidity index was 4.3 (2.5. During a mean (SD follow-up of 495 (474 days, patients had a mean of 2.2 (3.8 outpatient RBC transfusion episodes. Mean/median (SD total payment per RBC transfusion episode was $854/$427 ($2,060 with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD $213 ($168 for delayed hemolytic transfusion reaction to $19,466 ($15,424 for congestive heart failure. Conclusions Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

  3. Notifications of hospital events to outpatient clinicians using health information exchange: a post-implementation survey

    Directory of Open Access Journals (Sweden)

    Richard Altman

    2013-09-01

    Full Text Available Background The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients’ encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients’ emergency department (ED visits and inpatient admissions and discharges using health information exchange can inform outpatient clinicians of patients’ hospital-based events.Objective Assess outpatient clinicians’ impressions of a new, secure messaging-based, patient event notification system.Methods Twenty outpatient clinicians receiving notifications of hospital-based events were recruited and 14 agreed to participate. Using a semi-structured interview, clinicians were asked about their use of notifications and the impact on their practices.Results Nine of 14 interviewed clinicians (64% thought that without notifications, they would have heard about fewer than 10% of ED visits before the patient’s next visit. Nine clinicians (64% thought that without notifications, they would have heard about fewer than 25% of inpatient admissions and discharges before the patient’s next visit. Six clinicians (43% reported that they call the inpatient team more often because of notifications. Eight users (57% thought that notifications improved patient safety by increasing their awareness of the patients’ clinical events and their medication changes. Key themes identified were the importance of workflow integration and a desire for more clinical information in notifications.Conclusions The notification system is perceived by clinicians to be of value. These findings should instigate further message-oriented use of health information exchange and point to refinements that can lead to even greater benefits.

  4. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    Science.gov (United States)

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  5. Temperature effects on outpatient visits of respiratory diseases, asthma, and chronic airway obstruction in Taiwan

    Science.gov (United States)

    Wang, Yu-Chun; Lin, Yu-Kai

    2015-07-01

    This study evaluated the risk of outpatient visits for respiratory diseases, asthma, and chronic airway obstruction not elsewhere classified (CAO) associated with ambient temperatures and extreme temperature events from 2000 to 2008 in Taiwan. Based on geographical and socioeconomics characteristics, this study divided the whole island into seven areas. A distributed lag non-linear model was used to estimate the area-disease-specific cumulative relative risk (RR), and random-effect meta-analysis was used to estimate the pooled RR of outpatient visits, from lag 0 to lag 7 days, associated with daily temperature, and added effects of prolonged extreme heat and cold for population of all ages, the elderly and younger than 65 years. Pooled analyses showed that younger population had higher outpatient visits for exposing to low temperature of 18 °C, with cumulative 8-day RRs of 1.36 (95 % confidence interval (CI) 1.31-1.42) for respiratory diseases, 1.10 (95 % CI 1.03-1.18) for asthma, and 1.12 (95 % CI 1.02-1.22) for CAO. The elderly was more vulnerable to high temperature of 30 °C with the cumulative 8-day RR of 1.08 (95 % CI 1.03-1.13) for CAO. Elevated outpatient visits for all respiratory diseases and asthma were associated with extreme heat lasting for 6 to 8 days. On the contrary, the extreme cold lasting more than 8 days had significant negative association with outpatient visits of all respiratory diseases. In summary, elderly patients of respiratory diseases and CAO are vulnerable to high temperature. Cold temperature is associated with all types of respiratory diseases for younger patients.

  6. Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals

    OpenAIRE

    Thompson, E. A.; Mathie, R. T.; Baitson, E.S.; Barron, S J; Berkovitz, S.R.; Brands, M.; Fisher, P.; Kirby, T.M.; Leckridge, R.W.; Mercer, S.W.; Nielsen, H J; Ratsey, D.H.K.; Reilly, D.; Roniger, H.; Whitmarsh, T.E.

    2008-01-01

    We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS).\\ud \\ud Aims (1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and...

  7. Antimicrobial Non-Susceptibility of Escherichia coli from Outpatients and Patients Visiting Emergency Rooms in Taiwan.

    Directory of Open Access Journals (Sweden)

    Jann-Tay Wang

    Full Text Available Longitudinal nationwide surveillance data on antimicrobial non-susceptibility and prevalence of extended-spectrum β-lactamases (ESBLs as well as AmpC β-lactamases producers among Escherichia coli from different sources in the community settings are limited. Such data may impact treatment practice. The present study investigated E. coli from outpatients and patients visiting emergency rooms collected by the Taiwan Surveillance of Antimicrobial Resistance (TSAR program. A total of 3481 E. coli isolates were studied, including 2153 (61.9% from urine and 1125 (32.3% from blood samples. These isolates were collected biennially between 2002 and 2012 from a total of 28 hospitals located in different geographic regions of Taiwan. Minimum inhibitory concentrations (MIC were determined using methods recommended by the Clinical Laboratory Standards Institute (CLSI. The prevalence and factors associated with the presence of ESBL and AmpC β-lactamase-producers were determined. Significant increases in non-susceptibility to most β-lactams and ciprofloxacin occurred during the study period. By 2012, non-susceptibility to cefotaxime and ciprofloxacin reached 21.1% and 26.9%, respectively. The prevalence of ESBL- and AmpC- producers also increased from 4.0% and 5.3%, respectively, in 2002-2004, to 10.7% for both in 2010-2012 (P < 0.001. The predominant ESBL and AmpC β-lactamase genes were CTX-M and CMY-types, respectively. Non-susceptibility of urine isolates to nitrofurantoin remained at around 8% and to fosfomycin was low (0.7% but to cefazolin (based on the 2014 CLSI urine criteria increased from 11.5% in 2002-2004 to 23.9% in 2010-2012 (P <0.001. Non-susceptibility of isolates from different specimen types was generally similar, but isolates from elderly patients were significantly more resistant to most antimicrobial agents and associated with the presence of ESBL- and AmpC- β-lactamases. An additional concern is that decreased ciprofloxacin

  8. Conducting Family Nursing in Heart Failure outpatient clinics: Nurses experiences

    DEFF Research Database (Denmark)

    Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte

    2014-01-01

    Aim: This study aimed to explore what was documented during structured Family Nursing (FN) conversations with patients diagnosed with Heart Failure and their families, and to gain knowledge about the nurses’ experiences conducting FN. Background: Patients with HF face many challenges, and so do...... throughout the FN intervention and a Focus group interview with 6 nurses who were conducting the conversations. Content analyses of all text material dealt with both manifest and latent content, and were analyzed through a deductive and inductive process. Results: Enabling bonding emerged as the overall...... theme for the FN conversations, and was made possible through two subthemes; “strengthening family bonds” and “creating an enabling context for FN”. Conducting the FN conversations was challenging due to the use of new communication skills. Optimal setting, experience, retraining and professional...

  9. Evaluation Management of Drugs and Relations with Quality of Outpatient Pharmacy Services in One of Hospital Pontianak City

    Directory of Open Access Journals (Sweden)

    Enggy Erwansani

    2016-04-01

    Full Text Available Nowadays government policy which embodies the National Social Security System (SJSN where the presence of this system that every Indonesian people entitled to social security to be able to meet the basic needs of living. This study aims to describe the pharmaceutical drug outpatient management Hospital X Pontianak City and analyze the relationship management with the quality of pharmaceutical care medicine outpatient Hospital X Pontianak. This medication management including planning, organizing, directing, and monitoring. This study uses a quantitative approach which is an observational analytic research using cross sectional study with a sample of outpatient pharmacy customer research in Hospital X Pontianak. Collecting data using questionnaires from 100 customers outpatient with consecutive sampling method. The results using Pearson Correlation analysis showed the drug management relationship with the quality of outpatient pharmacy services which means the value of aspects planning (r=0.626; p<0,001, organizing (r=0.409; p<0,001, directing (r=0.359; p<0,001, and controlling (r=0.426; p<0,001 with R2 multiple 66.80%. The description of pharmaceutical drug management in outpatient Hospital X produce an average value 96.90% so as to be in very good category, there by proving the existence of a strong relationship between the four functions of management of the quality of pharmaceutical care medicine outpatient Hospital X.

  10. Quality of life changes following inpatient and outpatient treatment in obsessive-compulsive disorder: a study with 12 months follow-up

    Directory of Open Access Journals (Sweden)

    Hertenstein Elisabeth

    2013-02-01

    Full Text Available Abstract Background Quality of life (QoL is increasingly recognized as a critical outcome parameter in mental health studies. The aim of this study was to investigate different domains of the QoL in persons with obsessive-compulsive disorder (OCD before and after a multimodal, disorder-specific in- and outpatient treatment. Methods Data of 73 persons with OCD treated in an inpatient setting followed by outpatient treatment were analyzed. The World Health Organization Quality of Life abbreviated (a multidimensional measure of the QoL and the Beck Depression Inventory were administered prior to (baseline and 12 months after the inpatient treatment (follow-up. Results At baseline, participants reported a significantly diminished psychological, social, physical, and global QoL compared to the German general population. Environmental QoL was not impaired in the present sample. The QoL was significantly improved at follow-up, except for social QoL, but remained below norm values. The QoL improvement was predicted by improvements of depressive symptoms. Conclusions The results indicate that persons with OCD suffer from a very low QoL. The QoL was significantly improved after 12 months of intensive state-of-the-art treatment. However, the QoL indices remained considerably lower than population norm values, indicating the need for additional research into novel treatment options for persons with OCD.

  11. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India

    Directory of Open Access Journals (Sweden)

    Nagarajan Sripriya

    2008-01-01

    Full Text Available Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth, which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

  12. Patient Safety Culture in Nephrology Nurse Practice Settings: Initial Findings.

    Science.gov (United States)

    Ulrich, Beth; Kear, Tamara

    2014-01-01

    Patient safety culture has been studied in many practice settings, but there is a dearth of information on the culture of safety in nephrology nurse practice settings. This research study employed the use of an online survey to assess patient safety cultures in nephrology nurse practice settings. The survey was created using items from two Agency for Healthcare Research and Quality (AHRQ) survey assessment tools--the Hospital Survey on Patient Safety Culture and the Medical Office Survey on Patient Safety Culture. Select items from these tools were combined to address the safety of care delivered in hospital and outpatient nephrology nurse practice settings. Almost 1,000 nephrology nurses responded to the survey. Analysis of results and comparison with AHRQ comparative data found high ratings for teamwork, but indicted a continued needfor additional education and attention related to hand hygiene, medication administration safety, communication, and prioritization in nephrology practice settings. Nurses in all nephrology nurse practice settings need to routinely assess and positively contribute to the culture of patient safety in their practice settings, and lead and engage in efforts to ensure that patients are safe.

  13. Clinical consequences of switching from olanzapine to risperidone and vice versa in outpatients with schizophrenia: 36-month results from the worldwide schizophrenia outpatients health outcomes (W-SOHO study

    Directory of Open Access Journals (Sweden)

    Hong Jihyung

    2012-12-01

    Full Text Available Abstract Background With many atypical antipsychotics now available in the market, it has become a common clinical practice to switch between atypical agents as a means of achieving the best clinical outcomes. This study aimed to examine the impact of switching from olanzapine to risperidone and vice versa on clinical status and tolerability outcomes in outpatients with schizophrenia in a naturalistic setting. Methods W-SOHO was a 3-year observational study that involved over 17,000 outpatients with schizophrenia from 37 countries worldwide. The present post hoc study focused on the subgroup of patients who started taking olanzapine at baseline and subsequently made the first switch to risperidone (n=162 and vice versa (n=136. Clinical status was assessed at the visit when the first switch was made (i.e. before switching and after switching. Logistic regression models examined the impact of medication switch on tolerability outcomes, and linear regression models assessed the association between medication switch and change in the Clinical Global Impression-Schizophrenia (CGI-SCH overall score or change in weight. In addition, Kaplan-Meier survival curves and Cox-proportional hazards models were used to analyze the time to medication switch as well as time to relapse (symptom worsening as assessed by the CGI-SCH scale or hospitalization. Results 48% and 39% of patients switching to olanzapine and risperidone, respectively, remained on the medication without further switches (p=0.019. Patients switching to olanzapine were significantly less likely to experience relapse (hazard ratio: 3.43, 95% CI: 1.43, 8.26, extrapyramidal symptoms (odds ratio [OR]: 4.02, 95% CI: 1.49, 10.89 and amenorrhea/galactorrhea (OR: 8.99, 95% CI: 2.30, 35.13. No significant difference in weight change was, however, found between the two groups. While the CGI-SCH overall score improved in both groups after switching, there was a significantly greater change in those who

  14. Metabolic syndrome and associated factors among outpatients of Jimma University Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Abda E

    2016-03-01

    Full Text Available Edris Abda,1 Leja Hamza,2 Fasil Tessema,3 Waqtola Cheneke4 1Department of Medicine, College of Medicine and Health Sciences, Madda Walabu University, Bale Robe, 2Department of Internal Medicine, 3Department of Epidemiology, 4Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia Background: Developing countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult (≥20 years patients. Methods: A cross-sectional hospital-based study was conducted in July 2014 among adult (≥20 years patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program’s Adult Treatment Panel III criteria. Results: A total of 225 participants were included in the study, of whom 106 (47.1% were males and 119 (52.9% were females. A total of 59 (26% adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%, as compared with males, 17 (16%, (P<0.01. The most frequent metabolic syndrome parameters were hypertension (45%, hyperglycemia (39%, decreased high-density lipoprotein (HDL (31%, central obesity (26%, and elevated triglycerides (18%. Elevated blood pressure is more common in females (44.5% than in males (34.9%. Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P

  15. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    Science.gov (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  16. Descriptive set theory

    CERN Document Server

    Moschovakis, YN

    1987-01-01

    Now available in paperback, this monograph is a self-contained exposition of the main results and methods of descriptive set theory. It develops all the necessary background material from logic and recursion theory, and treats both classical descriptive set theory and the effective theory developed by logicians.

  17. China Sets Resources Strategy

    Institute of Scientific and Technical Information of China (English)

    LiMin

    2003-01-01

    All mineral mining in China now has a set road to follow, and straying off its path will attract severe penalties. The country's first-round programs for provincial mineral resources exploitation took effect in mid-January, setting output goals and designating mining regions.

  18. Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low.

    Science.gov (United States)

    Mehrotra, Ateev; Lave, Judith R

    2012-09-01

    Retail clinics have rapidly become a fixture of the US health care delivery landscape. We studied visits to retail clinics and found that they increased fourfold from 2007 to 2009, with an estimated 5.97 million retail clinic visits in 2009 alone. Compared with retail clinic patients in 2000-06, patients in 2007-09 were more likely to be age sixty-five or older (14.7 percent versus 7.5 percent). Preventive care-in particular, the influenza vaccine-was a larger component of care for patients at retail clinics in 2007-09, compared to patients in 2000-06 (47.5 percent versus 21.8 percent). Across all retail clinic visits, 44.4 percent in 2007-09 were on the weekend or during weekday hours when physician offices are typically closed. The rapid growth of retail clinics makes it clear that they are meeting a patient need. Convenience and after-hours accessibility are possible drivers of this growth. However, retail clinics make up a small share of overall visits in the outpatient setting, which include 117 million visits to emergency departments and 577 million visits to physician offices annually.

  19. Use and Analysis of Field Shelter Hospital Outpatient and Emergency Module in Non-war Operation%非战争军事行动野战方舱医院门急诊模块使用与分析

    Institute of Scientific and Technical Information of China (English)

    赵海鹰; 左广友; 王军; 张磊

    2012-01-01

    Objective To explore the layout of outpatient and emergency department and staff configuration of field shelter hospital. Methods The outpatient and emergency department was separated, and green channel for emergency department was established, The registered triage area for outpatient department was set up, and the specialists from the medical team did the normal treatment, the number of which was adjusted according to the casualty flow. Centre dressing room and special clinic tent were established. Results The layout of outpatient and emergency department and staff configuration studied were taken to the earthquake relief mission in 2008 Mianzhu and 2010 Yushu, and there were no lacks of treatment quality in the pre-control, triage, treatment, technical operations and rescue work. Conclusion The layout of outpatient and emergency department and staff configuration studied adapts to outpatient and emergency department management for field shelter hospital in non-war operation, and greutly improves the treatment force for field shelter hospital.[Chinese Medical Equipment Journal,2012,33(5):82-63]%目的:探讨方舱医院门急诊布局及人员配置.方法:门急诊分开,建主急诊绿色通道;设立门诊挂号分诊区,由医疗组各专科医生出正常门诊,随伤员流动情况调整出诊医生人数;成立中心换药室及特诊帐篷.结果:某部野战方舱医院在2008年赴四川绵竹,2010年赴青海玉树抗震救灾执行任务中,采取此门急诊布局及人员配置,对患者的预控、分诊、治疗、技术操作和抢救等做到了救活质量零缺陷.结论:此种门急诊布局及人员配置,适应非战争军事行动方舱医院的门急诊管理,极大地提高了方舱医院的救活能力.

  20. Prevalence and type of drug-drug interactions involving antiretrovirals in patients attending a specialist outpatient clinic in Kampala, Uganda

    Directory of Open Access Journals (Sweden)

    K Seden

    2012-11-01

    Full Text Available Scale-up of HIV services in countries such as Uganda has resulted in a rapid increase in facilities offering antiretrovirals (ARVs and an increase in healthcare workers trained to deliver care. Consequently, evaluating medication safety is increasingly important in these settings. Data from developed countries suggest that drug-drug interactions (DDIs involving ARVs are common, occurring at rates of 14–58%. Few data are available from low resource settings, however a study of 996 Kenyan patients found that 33.5% were at risk of clinically significant DDIs. We evaluated the prevalence and type of ARV DDIs and the patients most at risk in an African outpatient setting. A random sample of patients taking current ARVs and accessing care at the Infectious Diseases Institute, Makerere University, Kampala was selected from the clinic database. The most recent prescription for each patient was screened for DDIs using www.hiv-druginteractions.org. Clinical significance of DDIs was assessed by two of us using a previously developed technique evaluating: likelihood of interaction, therapeutic index of affected drug and severity of potential adverse effect. From 1000 consecutive patients 99.6% were taking≥1 co-medication alongside their ARV regimen (mean 1.89. 24.5% had≥1 potential DDI, with a total of 335 DDIs observed. Of these, 255 DDIs were considered clinically significant, affecting 18.8% of patients. Only 0.3% of DDIs involved a contraindicated combination. There was a higher rate of potential DDIs observed in patients taking TB treatment (p=0.0047, who were WHO stage 3 or 4 (p=0.001, or patients taking ≥2 co-medications alongside ARVs (p<0.0001 (Fishers exact test. Patient age, gender, CD4 count and weight did not affect risk for DDIs. Co-medications commonly associated with potential DDIs were antibiotics (6.2% of 1000 patients, anthelminthics (4.6% and antifungals (3.5%. Potential DDIs involving ARVs occur at similar rates in resource