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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 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

  3. Should Anthroposophic Medicinal Products Be Regulated in Europe?

    Science.gov (United States)

    Michaux, Geneviève

    2017-03-01

    European Commission’s reports suggest that the European Union should address the status of anthroposophic products, i.e. products that are developed, manufactured and prescribed in accordance with the holistic approach on which anthroposophic medicine is based. Anthroposophic products cannot be placed as such on the European market because they cannot meet the marketing authorisation or even registration requirements set out by European or national pharmaceutical law. Yet, the 95-year European tradition and good safety profile of anthroposophic products justify giving them an easier access to market. Such access can result from specific rules on anthroposophic products, but can be more efficiently achieved by encouraging the Member States to better apply the existing rules on marketing authorisation procedures or on registration of homeopathic and traditional herbal medicinal products, or by including anthroposophic substances, manufacturing methods or uses in monographs.

  4. Pain management in the outpatient surgical setting

    African Journals Online (AJOL)

    QuickSilver

    2003-05-14

    May 14, 2003 ... Pain management in the outpatient surgical setting. Robert S. Wolf MD. American Sports Medicine Institute. Birmingham, AL USA emptive and post-operative setting. These medications inhibit prostaglandin synthesis, promote analgesia, and consequently decrease the post-operative demand for opioids.

  5. Psychosocial risk factors and personality disorders in outpatient cardiology setting

    Directory of Open Access Journals (Sweden)

    Mariana Suárez-Bagnasco

    2015-01-01

    Psychological risk factors and personality disorders comorbidities are more frequent than psychological risk factors only or personality disorders only in outpatient cardiology setting without cardiovascular diseases.

  6. Nuclear technology and anthroposophic theory

    International Nuclear Information System (INIS)

    Leben, S.

    1982-01-01

    The construction of nuclear power plants as a solution to the current energy, crisis is controversial. That was not so in the beginning of the 'peaceful' utilization of nuclear power; with thousands of millions to promote it given as subsidies by the governments it was developing fast, until citizens' initiatives asked ecologic and moral questions delaying the further extension of this energy production. Both positions can be substantiated. But can a first judgement, too, be given with any degree of safety. And what cognitive aids are provided by the anthroposophic theory. This is demonstrated in some aspects. From the contents: The energy crisis and its apparent way out; of the causes: modern scientific methods; New forces: some facts and phenomena; Destructive powers as viewed by ancient mysteries; Of desirable states of conscience and technical forms; spelling their distortion; Nuclear powers and morality; Untimeliness in historicity; 'What's the stance of anthroposophic theory with regard to nuclear technology'. (orig./HP) [de

  7. Transitional care management in the outpatient setting.

    Science.gov (United States)

    Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle

    2017-01-01

    Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.

  8. 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.

  9. 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

  10. Health costs in anthroposophic therapy users: a two-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2006-06-01

    Full Text Available Abstract Background Anthroposophic therapies (counselling, special medication, art, eurythmy movement, and rhythmical massage aim to stimulate long-term self-healing processes, which theoretically could lead to a reduction of healthcare use. In a prospective two-year cohort study, anthroposophic therapies were followed by a reduction of chronic disease symptoms and improvement of quality of life. The purpose of this analysis was to describe health costs in users of anthroposophic therapies. Methods 717 consecutive outpatients from 134 medical practices in Germany, starting anthroposophic therapies for chronic diseases, participated in a prospective cohort study. We analysed direct health costs (anthroposophic therapies, physician and dentist consultations, psychotherapy, medication, physiotherapy, ergotherapy, hospital treatment, rehabilitation and indirect costs (sick leave compensation in the pre-study year and the first two study years. Costs were calculated from resource utilisation, documented by patient self-reporting. Data were collected from January 1999 to April 2003. Results Total health costs in the first study year (bootstrap mean 3,297 Euro; 95% confidence interval 95%-CI 3,157 Euro to 3,923 Euro did not differ significantly from the pre-study year (3,186 Euro; 95%-CI 3,037 Euro to 3,711 Euro, whereas in the second year, costs (2,771 Euro; 95%-CI 2,647 Euro to 3,256 Euro were significantly reduced by 416 Euro (95%-CI 264 Euro to 960 Euro compared to the pre-study year. In each period hospitalisation and sick-leave together amounted to more than half of the total health costs. Anthroposophic therapies and medication amounted to 3%, 15%, and 8% of total health costs in the pre-study year, first year, and second study year, respectively. The cost reduction in the second year was largely accounted for by a decrease of inpatient hospitalisation, leading to a hospital cost reduction of 519 Euro (95%-CI 377 Euro to 904 Euro compared to the

  11. [Promotion of breast feeding in paediatric outpatient settings].

    Science.gov (United States)

    Böse-O'Reilly, S; Wermuth, I; Hellmann, J; Siebert, U; Lob-Corzilius, T

    2008-03-01

    With some data and examples it can be shown that the competence and the knowledge of paediatric doctor's assistants and paediatric nurses can and should be improved. The training courses to become a "prevention assistant" have been very positively accepted by doctor's assistants and paediatric nurses, and it seems an appropriate method to reach these aims. Prevention and especially promotion of breast feeding is possible in paediatric outpatient settings. The immediate contact between infants, parents, paediatric doctor's assistants, paediatric nurses, and doctors offers a unique opportunity to promote the health of children, mainly due to the high acceptance of regular check-ups. So why not introduce the promotion of breast feeding in paediatric outpatient settings with specially trained doctor's assistants and paediatric nurses?

  12. 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.

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

    DEFF Research Database (Denmark)

    Ottosen, B; Pedersen, B D

    2013-01-01

    qualitative interviews regarding their NPWT treatment. The French philosopher, Ricoeur's,theory of interpretation guided the data analysis, which included three levels: naive reading, structural analysis and critical interpretation and discussion. RESULTS: The patients experienced a high level of dependency......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......, and they experienced embarrassment about odour,anxiety and uneasiness in relation to complications, a need for relatives' support and other social relation issues. It was important to include relatives as a resource and make use of the opportunity they presented to assist patients during information sessions about...

  14. Analysis of Misdiagnosis of Bipolar Disorder in An Outpatient Setting.

    Science.gov (United States)

    Shen, Hui; Zhang, Li; Xu, Chuchen; Zhu, Jinling; Chen, Meijuan; Fang, Yiru

    2018-04-25

    Bipolar disorder is a mental illness with a high misdiagnosis rate and commonly misdiagnosed as other mental disorders including depression, schizophrenia, anxiety disorders, obsessive-compulsive disorders, and personality disorders, resulting in the mistreatment of clinical symptoms and increasing of recurrent episodes. To understand the reasons for misdiagnosis of bipolar disorder in an outpatient setting in order to help clinicians more clearly identify the disease and avoid diagnostic errors. Data from an outpatient clinic included two groups: those with a confirmed diagnosis of bipolar disorder (CD group) and those who were misdiagnosed (i.e. those who did in fact have bipolar disorder but received a different diagnoses and those without bipolar disorder who received a bipolar diagnosis [MD group]). Information between these two groups was compared. There were a total of 177 cases that met the inclusion criteria for this study. Among them, 136 cases (76.8%) were in the MD group and 41 cases (23.2%) were in the CD group. Patents with depression had the most cases of misdiagnosis (70.6%). The first episode of the patients in the MD group was more likely to be a depressive episode (χ 2 =5.206, p =0.023) and these patients had a greater number of depressive episodes during the course of the disease ( Z =-2.268, p =0.023); the time from the onset of the disease to the first treatment was comparatively short ( Z =-2.612, p =0.009) in the group with misdiagnosis; the time from the onset of disease to a confirmed diagnosis was longer ( Z =-3.685, p bipolar and other related disorders in the misdiagnosis group than in the confirmed diagnosis group (11.0% v. 4.9%) and there were more patients in the MD group diagnosed with depressive episodes who had a recent episode (78.7% v. 65.9%). The rate of misdiagnosis of patients with bipolar receiving outpatient treatment was quite high and they often received a misdiagnosis of depression. In the misdiagnosis group the first

  15. Validity of Two WPPSI Short Forms in Outpatient Clinic Settings.

    Science.gov (United States)

    Haynes, Jack P.; Atkinson, David

    1983-01-01

    Investigated the validity of subtest short forms for the Wechsler Preschool and Primary Scale of Intelligence in an outpatient population of 116 children. Data showed that the short forms underestimated actual level of intelligence and supported use of a short form only as a brief screening device. (LLL)

  16. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting

    DEFF Research Database (Denmark)

    Prip, Anne; Møller, Kirsten Alling; Nielsen, Dorte Lisbet

    2017-01-01

    and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. METHODS: The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs...... on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. CONCLUSIONS: The relationship and communication between patients...... and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. IMPLICATIONS FOR PRACTICE: Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More...

  17. Elective penicillin skin testing in a pediatric outpatient setting.

    Science.gov (United States)

    Jost, Barbara Capes; Wedner, H James; Bloomberg, Gordon R

    2006-12-01

    Adverse reactions associated with penicillin-type antibiotics are common in pediatric practice, leading to the subsequent unnecessary use of alternative antibiotics. IgE-mediated penicillin allergy represents only a fraction of these adverse reactions. To examine (1) the trend of penicillin skin test reactivity during a recent 10-year interval, (2) the relative distribution of specific reagents related to a positive skin test result, and (3) skin test reactivity as a function of reaction history. Penicillin testing using 3 reagents--benzylpenicilloyl polylysine, penicillin G, and sodium penicilloate (penicillin A)--was conducted in a prospective study of 359 consecutive patients referred to an outpatient pediatric allergy clinic between January 1, 1993, and May 31, 2003. We also retrospectively reviewed penicillin skin test results for 562 children previously tested between January 1, 1979, and December 31, 1992. Between 1993 and 2003, the prevalence of penicillin skin test sensitivity markedly declined. Of all the positive skin test results between 1979 and 2002, either penicillin G or sodium penicilloate or both identified 34%, with sodium penicilloate alone responsible for 8.5%. The rate of positive skin test reactions was not significantly different between patients with vs without a history of suggestive IgE-mediated reactions. A marked decline in penicillin skin test sensitivity in the pediatric age group is identified. The minor determinant reagents penicillin G and sodium penicilloate are both necessary for determining potential penicillin allergy. Relating history alone to potential penicillin sensitivity is unreliable in predicting the presence or absence of a positive skin test result.

  18. The opinion of Greek parents on the advantages and disadvantages of the outpatient pediatric oncology setting.

    Science.gov (United States)

    Matziou, Vasiliki; Servitzoglou, Marina; Vlahioti, Efrosini; Deli, Haralampia; Matziou, Theodora; Megapanou, Efstathia; Perdikaris, Pantelis

    2013-12-01

    The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward. The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010. According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000). According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. 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.

  20. Ketogenic Diet in Refractory Childhood Epilepsy : Starting With a Liquid Formulation in an Outpatient Setting

    NARCIS (Netherlands)

    Weijenberg, Amerins; van Rijn, Margreet; Callenbach, Petra M C; de Koning, Tom J; Brouwer, Oebele F

    2018-01-01

    Background: Ketogenic diet in children with epilepsy has a considerable impact on daily life and is usually adopted for at least 3 months. Our aim was to evaluate whether the introduction of an all-liquid ketogenic diet in an outpatient setting is feasible, and if an earlier assessment of its

  1. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting: A Systematic Review.

    Science.gov (United States)

    Prip, Anne; Møller, Kirsten Alling; Nielsen, Dorte Lisbet; Jarden, Mary; Olsen, Marie-Helene; Danielsen, Anne Kjaergaard

    2017-07-27

    Today, cancer care and treatment primarily take place in an outpatient setting where encounters between patients and healthcare professionals are often brief. The aim of this study was to summarize the literature of adult patients' experiences of and need for relationships and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs Institute Evidence Based Practice Database. Nine studies were included, qualitative (n = 5) and quantitative (n = 4). The studies identified that the relationship between patients and healthcare professionals was important for the patients' ability to cope with cancer and has an impact on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. The relationship and communication between patients and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More research is needed to investigate the type of interaction and intervention that would be the most effective in supporting adult patients' coping during chemotherapy in an outpatient clinic.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  2. Residents' perceived needs in communication skills training across in- and outpatient clinical settings.

    Science.gov (United States)

    Junod Perron, Noelle; Sommer, Johanna; Hudelson, Patricia; Demaurex, Florence; Luthy, Christophe; Louis-Simonet, Martine; Nendaz, Mathieu; De Grave, Willem; Dolmans, Diana; Van der Vleuten, Cees

    2009-05-01

    Residents' perceived needs in communication skills training are important to identify before designing context-specific training programmes, since learrners' perceived needs can influence the effectiveness of training. To explore residents' perceptions of their training needs and training experiences around communication skills, and whether these differ between residents training in inpatient and outpatient clinical settings. Four focus groups (FG) and a self-administered questionnaire were conducted with residents working in in- and outpatient medical service settings at a Swiss University Hospital. Focus groups explored residents' perceptions of their communication needs, their past training experiences and suggestions for future training programmes in communication skills. Transcripts were analysed in a thematic way using qualitative analytic approaches. All residents from both settings were asked to complete a questionnaire that queried their sociodemographics and amount of prior training in communication skills. In focus groups, outpatient residents felt that communication skills were especially useful in addressing chronic diseases and social issues. In contrast, inpatient residents emphasized the importance of good communication skills for dealing with family conflicts and end-of-life issues. Felt needs reflected residents' differing service priorities: outpatient residents saw the need for skills to structure the consultation and explore patients' perspectives in order to build therapeutic alliances, whereas inpatient residents wanted techniques to help them break bad news, provide information and increase their own well-being. The survey's overall response rate was 56%. Its data showed that outpatient residents received more training in communication skills and more of them than inpatient residents considered communication skills training to be useful (100% vs 74%). Outpatient residents' perceived needs in communication skills were more patient

  3. Individualized Integrative Cancer Care in Anthroposophic Medicine

    Science.gov (United States)

    Kienle, Gunver S.; Mussler, Milena; Fuchs, Dieter; Kiene, Helmut

    2016-01-01

    Background. Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective. To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods. This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results. The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient’s wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care–related specialists. Conclusion. Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care. PMID:27151589

  4. Fever: Views in Anthroposophic Medicine and Their Scientific Validity

    Directory of Open Access Journals (Sweden)

    David D. Martin

    2016-01-01

    Full Text Available Objective. To conduct a scoping review to characterize how fever is viewed in anthroposophic medicine (AM and discuss the scientific validity of these views. Methods. Systematic searches were run in Medline, Embase, CAMbase, and Google Scholar. Material from anthroposophic medical textbooks and articles was also used. Data was extracted and interpreted. Results. Most of the anthroposophic literature on this subject is in the German language. Anthroposophic physicians hold a beneficial view on fever, rarely suppress fever with antipyretics, and often use complementary means of alleviating discomfort. In AM, fever is considered to have the following potential benefits: promoting more complete recovery; preventing infection recurrences and atopic diseases; providing a unique opportunity for caregivers to provide loving care; facilitating individual development and resilience; protecting against cancer and boosting the anticancer effects of mistletoe products. These views are discussed with regard to the available scientific data. Conclusion. AM postulates that fever can be of short-term and long-term benefit in several ways; many of these opinions have become evidence-based (though still often not practiced while others still need empirical studies to be validated, refuted, or modified.

  5. Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center.

    Science.gov (United States)

    Rice, Danielle B; McIntyre, Amanda; Mirkowski, Magdalena; Janzen, Shannon; Viana, Ricardo; Britt, Eileen; Teasell, Robert

    2017-09-01

    Goal-setting can have a positive impact on stroke recovery during rehabilitation. Patient participation in goal formulation can ensure that personally relevant goals are set, and can result in greater satisfaction with the rehabilitation experience, along with improved recovery of stroke deficits. This, however, not yet been studied in a stroke outpatient rehabilitation setting. To assess patient satisfaction of meeting self-selected goals during outpatient rehabilitation following a stroke. Retrospective chart review. Stroke patients enrolled in a multidisciplinary outpatient rehabilitation program, who set at least 1 goal during rehabilitation. Patients recovering from a stroke received therapy through the outpatient rehabilitation program between January 2010 and December 2013. Upon admission and discharge from rehabilitation, patients rated their satisfaction with their ability to perform goals that they wanted to achieve. Researchers independently sorted and labeled recurrent themes of goals. Goals were further sorted into International Classification of Functioning, Disability and Health (ICF) categories. To compare the perception of patients' goal satisfaction, repeated-measures analysis of variance was conducted across the 3 ICF goal categorizations. Goal satisfaction scores. A total of 286 patients were included in the analysis. Patient goals concentrated on themes of improving hand function, mobility, and cognition. Goals were also sorted into ICF categories in which impairment-based and activity limitation-based goals were predominant. Compared to activity-based and participation-based goals, patients with impairment-based goals perceived greater satisfaction with meeting their goals at admission and discharge (P rehabilitation program (P stroke rehabilitation setting, patients set heterogeneous goals that were predominantly impairment based. Satisfaction in achieving goals significantly improved after receiving therapy. The type of goals that patients

  6. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review

    OpenAIRE

    Yushi Yang; Onur Asan

    2016-01-01

    Introduction: The implementation of health information technologies (HITs) has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may pot...

  7. A comparison of burnout among oncology nurses working in adult and pediatric inpatient and outpatient settings.

    Science.gov (United States)

    Davis, Shoni; Lind, Bonnie K; Sorensen, Celeste

    2013-07-01

    To investigate differences in burnout among oncology nurses by type of work setting, coping strategies, and job satisfaction. Descriptive. A metropolitan cancer center. A convenience sample of 74 oncology nurses. Participants completed a demographic data form, the Nursing Satisfaction and Retention Survey, and the Maslach Burnout Inventory. Burnout, coping strategies, job satisfaction, and oncology work setting (inpatient versus outpatient and adult versus pediatric). The participants most often used spirituality and coworker support to cope. Emotional exhaustion was lowest for youngest nurses and highest for outpatient RNs. Personal accomplishment was highest in adult settings. Job satisfaction correlated inversely with emotional exhaustion and the desire to leave oncology nursing. The findings support that the social context within the work environment may impact emotional exhaustion and depersonalization, and that demographics may be more significant in determining burnout than setting. The findings raise questions of whether demographics or setting plays a bigger role in burnout and supports organizational strategies that enhance coworker camaraderie, encourage nurses to discuss high-stress situations, and share ways to manage their emotions in oncology settings. Spirituality and coworker relationships were positive coping strategies among oncology nurses to prevent emotional exhaustion. Nurses who rely on supportive social networks as a coping mechanism have lower levels of depersonalization. Age was inversely related to emotional exhaustion.

  8. Assessment of patient satisfaction with pain management in small community inpatient and outpatient settings.

    Science.gov (United States)

    Corizzo, C C; Baker, M C; Henkelmann, G C

    2000-09-01

    To describe patient outcomes (e.g., pain intensity and relief, satisfaction, expectations) and analgesic practices of healthcare providers for inpatients and outpatients in community hospital settings. Descriptive, correlational, and random sampling. Three community-based institutions in southeast Louisiana. 114 inpatients and outpatients with cancer-related or acute postoperative pain. Inpatients (n = 68) mostly were women and younger than 60 years of age. Outpatients (n = 46) mostly were men and older than 60 years of age. Both groups were predominantly well-educated and Caucasian. Subjects completed a modified version of the American Pain Society's Patient Satisfaction Survey. Researchers completed a chart audit tool reviewing analgesic prescriptive and administrative practices. Weak to moderately strong correlations existed for the relationships between the satisfaction variables and the pain intensity, pain relief, and expectation variables for all subjects. Satisfaction with current pain intensity was correlated most strongly with pain intensity and relief scores. Higher pain intensity and relief were related to lower satisfaction with current pain intensity. Regardless of setting or pain type, subjects experienced significant amounts of pain during a 24-hour period. Patient expectations for experiencing high levels of pain were realized, but expectations for significant pain relief were not. Institutional pain management programs that approach pain from a multidimensional perspective need to be developed. Continued education for healthcare professionals and patients is a vital part of this process.

  9. Management of Newly Diagnosed Atrial Fibrillation in an Outpatient Clinic Setting

    DEFF Research Database (Denmark)

    Thrysoee, Lars; Strömberg, Anna; Brandes, Axel

    2018-01-01

    fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. CONCLUSIONS: This study indicates that patients were uncertain......AIMS: To gain in-depth knowledge of patients' experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality...... if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision making on medical therapy. DESIGN: This is a qualitative study of 14 patients newly diagnosed...

  10. The metabolic syndrome and related characteristics in major depression: inpatients and outpatients compared metabolic differences across treatment settings

    NARCIS (Netherlands)

    Luppino, F.S.; Bouvy, P.F.; Giltay, E.J.; Penninx, B.W.J.H.; Zitman, F. G.

    2014-01-01

    Objective: We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and

  11. The metabolic syndrome and related characteristics in major depression : inpatients and outpatients compared Metabolic differences across treatment settings

    NARCIS (Netherlands)

    Luppino, Floriana S.; Bouvy, Paul F.; Giltay, Erik J.; Penninx, Brenda W. J. H.; Zitman, Frans G.

    Objective: We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and

  12. Perfectionism Group Treatment for Eating Disorders in an Inpatient, Partial Hospitalization, and Outpatient Setting.

    Science.gov (United States)

    Levinson, Cheri A; Brosof, Leigh C; Vanzhula, Irina A; Bumberry, Laura; Zerwas, Stephanie; Bulik, Cynthia M

    2017-11-01

    Perfectionism is elevated in individuals with eating disorders and is posited to be a risk factor, maintaining factor, and treatment barrier. However, there has been little literature testing the feasibility and effectiveness of perfectionism interventions in individuals specifically with eating disorders in an open group format. In the current study, we tested the feasibility of (a) a short cognitive behavioural therapy for perfectionism intervention delivered in an inpatient, partial hospitalization, and outpatient for eating disorders setting (combined N = 28; inpatient n = 15; partial hospital n = 9; outpatient n = 4), as well as (b) a training for disseminating the treatment in these settings (N = 9). Overall, we found that it was feasible to implement a perfectionism group in each treatment setting, with both an open and closed group format. This research adds additional support for the implementation of perfectionism group treatment for eating disorders and provides information on the feasibility of implementing such interventions across multiple settings. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  13. Meal support using mobile technology in Anorexia Nervosa. Contextual differences between inpatient and outpatient settings.

    Science.gov (United States)

    Cardi, Valentina; Lounes, Naima; Kan, Carol; Treasure, Janet

    2013-01-01

    The aim of this study was to examine the impact of a "supported eating" intervention using mobile technology in patients with Anorexia Nervosa (AN). Twenty Inpatients and 18 Outpatients with AN underwent a test meal on two occasions, whilst listening to either a short video-clip ('vodcast'), or music delivered on an MP4 player. Self-report and behavioural measures were collected before and after each test meal. Differences were found between the inpatient and outpatient settings. Inpatients drank more of the test meal and had increased levels of vigilance to food after the test meal, in both conditions. When the support conditions (Vodcast vs. Music) were compared, inpatients seemed to benefit more from listening to music (reduced distress and more smoothie drunk), whereas outpatients benefitted more from using the vodcast (reduced distress, more smoothie drunk, and reduced vigilance to food). The context in which the intervention was delivered had an impact on self-report and behavioural measures collected during the test meal. This suggests that the form of meal support in AN needs to match the context. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. 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.

  15. 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

  16. A casemix study of patients seen by a dermatology trainee in rural and urban outpatient settings.

    Science.gov (United States)

    Tilakaratne, Dev; Warren, Lachlan; Menz, Jennifer

    2016-02-01

    For 8 years South Australian dermatologists have provided an outreach service to the Northern Territory (NT), including rural and remote areas. In 2012 and 2013, a trainee accompanied a dermatologist on these outreach visits. This is the first prospective study that documents the spectrum of dermatological diseases requiring outpatient specialist input in various settings in the NT, and also the first study to compare the clinical experience of one Australian dermatology trainee in urban and rural settings. Characteristics of patients managed primarily by the outreach dermatology registrar were recorded prospectively from February 2013 to July 2013. The data from the trainee's urban encounters were compared to that of the rural centres. The spectrum of conditions seen in these two settings was placed in the disease categories specified in the Australasian College of Dermatologists (ACD) curriculum. The Royal Adelaide Hospital outpatient experience provided greater exposure to skin neoplasms, lymphoproliferative and myeloproliferative disorders and non-infectious neutrophilic/eosinophilic disorders. The outreach sites provided greater exposure to infections, adnexal diseases and genodermatoses. Both urban and rural experiences provided a broad exposure to the disease categories outlined in the ACD curriculum. The spectrum of disease requiring specialist dermatology input varies between urban South Australia and rural NT. The inclusion of dermatology trainees in outreach visits broadens their clinical exposure. It is recommended that other dermatology service providers in Australia consider documenting clinical casemix comparisons to assess dermatology demand, outcomes and trainee exposure. © 2014 The Australasian College of Dermatologists.

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

    International Nuclear Information System (INIS)

    Fagerstedt, Sara; Kippler, Maria; Scheynius, Annika; Gutzeit, Cindy; Mie, Axel; Alm, Johan; Vahter, Marie

    2015-01-01

    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

  18. 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

  19. Barriers and challenges in integration of anthroposophic medicine in supportive breast cancer care.

    Science.gov (United States)

    Ben-Arye, Eran; Schiff, Elad; Levy, Moti; Raz, Orit Gressel; Barak, Yael; Bar-Sela, Gil

    2013-01-01

    In the last decade, more and more oncology centers are challenged with complementary medicine (CM) integration within supportive breast cancer care. Quality of life (QOL) improvement and attenuation of oncology treatment side effects are the core objectives of integrative CM programs in cancer care. Yet, limited research is available on the use of specific CM modalities in an integrative setting and on cancer patients' compliance with CM consultation. Studies are especially warranted to view the clinical application of researched CM modalities, such as anthroposophic medicine (AM), a unique CM modality oriented to cancer supportive care. Our objective was to characterize consultation patterns provided by physicians trained in CM following oncology health-care practitioners' referral of patients receiving chemotherapy. We aimed to identify characteristics of patients who consulted with AM and to explore patients' compliance to AM treatment. Of the 341 patients consulted with integrative physicians, 138 were diagnosed with breast cancer. Following integrative physician consultation, 56 patients were advised about AM treatment and 285 about other CM modalities. Logistic multivariate regression model found that, compared with patients receiving non-anthroposophic CM, the AM group had significantly greater rates of previous CM use [EXP(B) = 3.25, 95% C.I. 1.64-6.29, p = 0.001] and higher rates of cancer recurrence at baseline (p = 0.038). Most AM users (71.4%) used a single AM modality, such as mistletoe (viscum album) injections, oral AM supplements, or music therapy. Compliance with AM modalities following physician recommendation ranged from 44% to 71% of patients. We conclude that AM treatment provided within the integrative oncology setting is feasible based on compliance assessment. Other studies are warranted to explore the effectiveness of AM in improving patients' QOL during chemotherapy.

  20. Management of lower respiratory tract infection in outpatient settings: Focus on clarithromycin

    Directory of Open Access Journals (Sweden)

    Ashok Mahashur

    2018-01-01

    Full Text Available Lower respiratory tract infection (LRTI is a broad terminology which includes acute bronchitis, pneumonia, acute exacerbations of chronic obstructive pulmonary disease/chronic bronchitis (AECB, and acute exacerbation of bronchiectasis. Acute LRTIs (ALRTIs are one of the common clinical problems in community and hospital settings. Management of community-acquired pneumonia (CAP and AECB may pose challenges because of diagnostic difficulty in differentiating infections caused by typical and atypical microorganisms and rising rates of antimicrobial resistance. Beta-lactam antibiotics, macrolides, and fluoroquinolones are routinely prescribed medicines for the management of ALRTIs. Macrolides are time-tested and effective agents for the treatment of LRTIs. Clarithromycin, a macrolide, offers several benefits in the management of ALRTIs. In this article, we discuss the management approach of LRTIs with focus on clarithromycin in the management of mild-to-moderate LRTIs (CAP and AECB, i.e., in outpatient settings.

  1. Self-esteem in adolescents treated in an outpatient mental health setting.

    Science.gov (United States)

    Modrcin-Talbott, M A; Pullen, L; Ehrenberger, H; Zandstra, K; Muenchen, B

    1998-01-01

    Although self-esteem is an important concept, nursing has only begun to focus on the significance of self-esteem as a mechanism for achieving wellness among adolescents, and as a variable for targeted intervention. Nursing studies identifying self-esteem as the primary focus of their research in an adolescent population seeking treatment in mental health settings are scarce. The Roy Adaptation Model's Theory of a Person as an Adaptive System was used to guide this descriptive, correlational study. Research examined the self-report of self-esteem on age, gender, smoking, exercise, depression, anger, and parental alcohol use in a sample of adolescents ages 12-19 years who were being treated in an outpatient mental health setting.

  2. Antipsychotic Polypharmacy among Children and Young Adults in Office-Based or Hospital Outpatient Department Settings

    Directory of Open Access Journals (Sweden)

    Minji Sohn

    2017-11-01

    Full Text Available The purpose of the study was three-fold: (1 to estimate the national trends in antipsychotic (AP polypharmacy among 6- to 24-year-old patients in the U.S.; (2 to identify frequently used AP agents and mental disorder diagnoses related to AP polypharmacy; and (3 to assess the strength of association between AP polypharmacy and patient/provider characteristics. We used publicly available ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital outpatient department settings to conduct a cross-sectional study. First, national visit rates between 2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in AP polypharmacy were identified. Third, a multivariate logistic regression model was developed to assess the strength of association between AP polypharmacy and patient and provider characteristics. Between 2007 and 2011, approximately 2% of office-based or hospital outpatient department visits made by 6- to 24-year-old patients included one or more AP prescriptions. Of these visits, 5% were classified as AP polypharmacy. The most common combination of AP polypharmacy was to use two or more second-generation APs. Also, bipolar disorder and schizophrenia were the two most frequent primary mental disorder diagnoses among AP polypharmacy visits. The factors associated with AP polypharmacy were: older age (young adults, black, having one or more non-AP prescriptions, and having schizophrenia or ADHD.

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

    Science.gov (United States)

    Henrichs, Jens; Bogaerts, Stefan; Sijtsema, Jelle; Klerx-van Mierlo, Fanny

    2015-07-01

    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 victimological factors between IPV perpetrators (n = 61, 51.3%) and non-intimate violence (NIV) perpetrators (n = 58, 48.7%) were examined. All data, including information on demographics, criminal history, history of psychological, sexual, and physical victimization during childhood or adolescence, family history of psychopathology, history of psychopathology in childhood and adolescence, and mental disorders, were derived from archival electronic medical records. Mental disorders were measured using structured psychiatric interviews and final consensus diagnoses were established during weekly case consultations. Both IPV and NIV perpetrators displayed high rates of criminal history, psychopathology, and previous victimization, but the two groups did not differ in these factors with two exceptions. IPV perpetrators were significantly more likely to have higher rates of previous physical victimization and intermittent explosive disorder than NIV perpetrators. The current study suggests that a history of physical victimization and intermittent explosive disorder are specific characteristics of IPV perpetrators in a forensic psychiatric outpatient setting. Future research should focus on mechanisms explaining the association of childhood victimization and IPV and increase our understanding of the role of intermittent explosive disorder in IPV. © The Author(s) 2014.

  4. Infection prevention and control in outpatient settings in China-structure, resources, and basic practices.

    Science.gov (United States)

    Qiao, Fu; Huang, Wenzhi; Zong, Zhiyong; Yin, Weijia

    2018-01-25

    More than 7 billion visits are made by patients to ambulatory services every year in mainland China. Healthcare-associated infections are becoming a new source of illness for outpatients. Little is known about infection prevention, control structure, resources available, and basic practices in outpatient settings. In 2014, we conducted a multisite survey. Five provinces were invited to participate based on geographic dispersion. Self-assessment questionnaires regarding the structure, infrastructure, apparatus and materials, and basic activities of infection prevention and control were issued to 25 hospitals and 5 community health centers in each province. A weight was assigned to each question according to its importance. Overall, 146 of 150 facilities (97.3%) participated in this study. The average survey score was 77.6 (95% confidence interval 75.7-79.5) and varied significantly between the different gross domestic product areas (P infection prevention and control was practiced consistently, although there were lapses in some areas. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review

    Directory of Open Access Journals (Sweden)

    Yushi Yang

    2016-04-01

    Full Text Available Introduction: The implementation of health information technologies (HITs has changed the dynamics of doctor–patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.   Objectives: The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor–patient communication and patient-centred care.   Method: We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.   Results: Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor–patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1 a separate patient display, (2 a projector, (3 a portable tablet, (4 a touch-based screen and (5 a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.   Conclusion: The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  6. Designing Patient-facing Health Information Technologies for the Outpatient Settings: A Literature Review.

    Science.gov (United States)

    Yang, Yushi; Asan, Onur

    2016-04-06

      The implementation of health information technologies (HITs) has changed the dynamics of doctor-patient communication in outpatient settings. Designing patient-facing HITs provides patients with easy access to healthcare information during the visit and has the potential to enhance the patient-centred care.  The objectives of this study are to systematically review how the designs of patient-facing HITs have been suggested and evaluated, and how they may potentially affect the doctor-patient communication and patient-centred care.  We conducted an online database search to identify articles published before December 2014 relevant to the objectives of this study. A total of nine papers have been identified and reviewed in this study.  Designing patient-facing HITs is at an early stage. The current literature has been exploring the impact of HITs on doctor-patient communication dynamics. Based on the findings of these studies, there is an emergent need to design more patient-centred HITs. There are also some papers that focus on the usability evaluation of some preliminary prototypes of the patient-facing HITs. The design styles of patient-facing HITs included sharing the health information with the patients on: (1) a separate patient display, (2) a projector, (3) a portable tablet, (4) a touch-based screen and (5) a shared computer display that can be viewed by both doctors and patients. Each of them had the strengths and limitations to facilitate the patient-centred care, and it is worthwhile to make a comparison of them in order to identify future research directions.  The designs of patient-facing HITs in outpatient settings are promising in facilitating the doctor-patient communication and patient engagement. However, their effectiveness and usefulness need to be further evaluated and improved from a systems perspective.

  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. 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%.

  9. Caring touch--patients' experiences in an anthroposophic clinical context.

    Science.gov (United States)

    Ozolins, Lise-Lotte; Hörberg, Ulrica; Dahlberg, Karin

    2015-12-01

    This study describes the phenomenon of caring touch from the patients' perspective in an anthroposophic clinical context where caring touch is often used to promote health and alleviate suffering. The aim of the study was to explore and phenomenologically describe the phenomenon of caring touch from the patients' perspectives. The study has been carried out with a Reflective Lifeworld Research approach in order to understand and describe human existential phenomena. Ten female patients were interviewed in an anthroposophic clinic in Sweden. The findings show how caring touch has multifaceted meanings and makes the patients' feel present and anchored in a meaningful context. The patients' feel that they are seen, accepted and confirmed. Furthermore, touch creates a caring space where the patients become receptive for care and has the power to alleviate the patients' suffering, as well as to frighten and cause or worsen the suffering. In order to take advantage of the caring potential, the patient needs to be invited to a respectful and sensitive form of touch. An interpersonal flexible space is necessary where the touch can be effective, and where a dynamic interplay can develop. In conclusion, caring touch is an opportunity for carers to support well-being and health. The carers need to approach their patients in both a sensitive and reflective way. A caring science perspective can serve as a help to further understand touch as a unique caring act. © 2015 Nordic College of Caring Science.

  10. The effect of automated alerts on provider ordering behavior in an outpatient setting.

    Directory of Open Access Journals (Sweden)

    2005-09-01

    Full Text Available BACKGROUND: Computerized order entry systems have the potential to prevent medication errors and decrease adverse drug events with the use of clinical-decision support systems presenting alerts to providers. Despite the large volume of medications prescribed in the outpatient setting, few studies have assessed the impact of automated alerts on medication errors related to drug-laboratory interactions in an outpatient primary-care setting. METHODS AND FINDINGS: A primary-care clinic in an integrated safety net institution was the setting for the study. In collaboration with commercial information technology vendors, rules were developed to address a set of drug-laboratory interactions. All patients seen in the clinic during the study period were eligible for the intervention. As providers ordered medications on a computer, an alert was displayed if a relevant drug-laboratory interaction existed. Comparisons were made between baseline and postintervention time periods. Provider ordering behavior was monitored focusing on the number of medication orders not completed and the number of rule-associated laboratory test orders initiated after alert display. Adverse drug events were assessed by doing a random sample of chart reviews using the Naranjo scoring scale. The rule processed 16,291 times during the study period on all possible medication orders: 7,017 during the pre-intervention period and 9,274 during the postintervention period. During the postintervention period, an alert was displayed for 11.8% (1,093 out of 9,274 of the times the rule processed, with 5.6% for only "missing laboratory values," 6.0% for only "abnormal laboratory values," and 0.2% for both types of alerts. Focusing on 18 high-volume and high-risk medications revealed a significant increase in the percentage of time the provider stopped the ordering process and did not complete the medication order when an alert for an abnormal rule-associated laboratory result was displayed

  11. Screening for Body Dysmorphic Disorder in a Dermatology Outpatient Setting at a Tertiary Care Centre

    Science.gov (United States)

    Thanveer, Fibin; Khunger, Niti

    2016-01-01

    Context: A distressing pre-occupation with an imagined or slight defect in appearance with a marked negative effect on the patient's life is the core symptom of body dysmorphic disorder (BDD). Aim: To screen the patients attending a dermatology clinic at a tertiary care centre for BDD using the BDD-dermatology version (DV) questionnaire. Settings and Design: This cross-sectional study enrolled 245 consecutive patients from the dermatology outpatients clinic. Methods: The demographic details were collected and the DV of BDD screening questionnaire was administered. A 5-point Likert scale was used for objective scoring of the stated concern and patients who scored ≥3 were excluded from the study. Statistical Analysis Used: The results were statistically analysed. Differences between the groups were investigated by Chi-square analysis for categorical variables, and Fisher exact test wherever required. Results: A total of 177 patients completed the study, and of these, eight patients screened positive for BDD. The rate of BDD in patients presenting with cosmetic complaints was 7.5% and in those with general dermatology, complaints were 2.1%, with no significant difference between the two groups (P = 0.156). Facial flaws (62.5%) were the most common concern followed by body asymmetry (25%). Conclusion: The rates of BDD found in this study are comparable but at a lower rate than that reported in literature data. PMID:27761090

  12. Patient autonomy preferences among hypertensive outpatients in a primary care setting in Japan.

    Science.gov (United States)

    Nomura, Kyoko; Ohno, Maiko; Fujinuma, Yasuki; Ishikawa, Hirono

    2007-01-01

    To investigate autonomy preferences and the factors to promote active patient participation in a primary care setting in Japan. Ninety-two hypertensive outpatients who consecutively visited a Japanese hospital between January and May of 2005 in Tokyo, Japan. This cross-sectional study was conducted by using a self-administered questionnaire. The main outcome measures were patient preferences for autonomy (i.e., decision-making and information-seeking preferences), measured by the Autonomy Preference Index (API). The variables studied were patient sociodemographic characteristics, physician characteristics based on patient preference (i.e., ability to communicate, extent of clinical experience, qualifications, educational background, gender, and age), and the Multidimensional Health Locus of Control. On the API scale from 0 to 100, the patients had an intermediate desire for decision-making (median: 51) and a greater desire for information (median: 95). A multivariate regression model indicated that decision-making preference increased when patients were woman and decreased as physician age increased, and information-seeking preference was positively associated with good communication skills, more extensive clinical experience, physicians of middle age, and patient beliefs that they were responsible for their own health, and was negatively associated with a preference for man physicians. Physicians may need to understand that patient autonomy preferences pertain to physician age and gender, physician communication ability and extent of clinical experience, and patient beliefs about self-responsibility toward health, and could use the information to promote reliable patient-physician relationships.

  13. Ketogenic Diet in Refractory Childhood Epilepsy: Starting With a Liquid Formulation in an Outpatient Setting.

    Science.gov (United States)

    Weijenberg, Amerins; van Rijn, Margreet; Callenbach, Petra M C; de Koning, Tom J; Brouwer, Oebele F

    2018-01-01

    Ketogenic diet in children with epilepsy has a considerable impact on daily life and is usually adopted for at least 3 months. Our aim was to evaluate whether the introduction of an all-liquid ketogenic diet in an outpatient setting is feasible, and if an earlier assessment of its efficacy can be achieved. The authors conducted a prospective, observational study in a consecutive group of children with refractory epilepsy aged 2 to 14 years indicated for ketogenic diet. Ketogenic diet was started as an all-liquid formulation of the classical ketogenic diet, KetoCal 4:1 LQ, taken orally or by tube. After 6 weeks, the liquid diet was converted into solid meals. The primary outcome parameter was time-to-response (>50% seizure reduction). Secondary outcome parameters were time to achieve stable ketosis, the number of children showing a positive response, and the retention rate at 26 weeks. Sixteen children were included. Four of them responded well with respect to seizure frequency, the median time-to-response was 14 days (range 7-28 days). The mean time to achieve stable ketosis was 7 days. The retention rate at 26 weeks was 50%. Of the 8 children who started this protocol orally fed, 6 completed it without requiring a nasogastric tube. Introduction of ketogenic diet with a liquid formulation can be accomplished in orally fed children without major complications. It allowed for fast and stable ketosis.

  14. Screening for body dysmorphic disorder in a dermatology outpatient setting at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Fibin Thanveer

    2016-01-01

    Full Text Available Context: A distressing pre-occupation with an imagined or slight defect in appearance with a marked negative effect on the patient's life is the core symptom of body dysmorphic disorder (BDD. Aim: To screen the patients attending a dermatology clinic at a tertiary care centre for BDD using the BDD-dermatology version (DV questionnaire. Settings and Design: This cross-sectional study enrolled 245 consecutive patients from the dermatology outpatients clinic. Methods: The demographic details were collected and the DV of BDD screening questionnaire was administered. A 5-point Likert scale was used for objective scoring of the stated concern and patients who scored ≥3 were excluded from the study. Statistical Analysis Used: The results were statistically analysed. Differences between the groups were investigated by Chi-square analysis for categorical variables, and Fisher exact test wherever required. Results: A total of 177 patients completed the study, and of these, eight patients screened positive for BDD. The rate of BDD in patients presenting with cosmetic complaints was 7.5% and in those with general dermatology, complaints were 2.1%, with no significant difference between the two groups (P = 0.156. Facial flaws (62.5% were the most common concern followed by body asymmetry (25%. Conclusion: The rates of BDD found in this study are comparable but at a lower rate than that reported in literature data.

  15. A Systematic Review on Communication and Relations between Health Care Professionals and Patients with Cancer in Outpatient Settings Matter

    DEFF Research Database (Denmark)

    Prip, Anne

    2017-01-01

    Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development...... will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Research has shown there is a possible risk of overlooking cancer patients´ needs when the time allotted...

  16. Early initiation of night-time NIV in an outpatient setting: a randomized non-inferiority study in ALS patients.

    Science.gov (United States)

    Bertella, Enrica; Banfi, Paolo; Paneroni, Mara; Grilli, Silvia; Bianchi, Luca; Volpato, Eleonora; Vitacca, Michele

    2017-12-01

    In patients with amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is usually initiated in an in-hospital regime. We investigated if NIV initiated in an outpatient setting can be as effective in terms of patients' acceptance/adherence. We also evaluated factors predicting NIV acceptance and adherence and disease progression. Prospective randomized study. Outpatient versus inpatient rehabilitation. ALS patients. ALS patients were randomized to two groups for NIV initiation: outpatients versus inpatients. At baseline (T0), end of NIV trial program (T1) and after 3 months from T1 (T2), respiratory function tests, blood gas analysis, and sleep study were performed. At T1, we assessed: NIV acceptance (>4 h/night), and dyspnea symptoms (day/night) by Visual analogue scale (VAS), staff and patients' experience (how difficult NIV was to accept, how difficult ventilator was to manage, satisfaction); at T2: NIV adherence (>120 h/month) and patients' experience. Fifty patients participated. There were no differences in acceptance failure (P=0.733) or adherence failure (P=0.529). At T1, outpatients had longer hours of nocturnal ventilation (PNIV acceptance/adherence failure. There were no between-group differences in progression of respiratory impairment, symptoms and sleep quality. Early outpatient initiation of NIV in ALS is as effective as inpatient initiation.

  17. Transition of Care from the Emergency Department to the Outpatient Setting: A Mixed-Methods Analysis

    Directory of Open Access Journals (Sweden)

    Chad S. Kessler

    2018-02-01

    expectations and multiple barriers to effective communication. This study highlights the need to optimize technology for an effective transition of care from the ED to the outpatient setting.

  18. Patient safety culture in China: a case study in an outpatient setting in Beijing.

    Science.gov (United States)

    Liu, Chaojie; Liu, Weiwei; Wang, Yuanyuan; Zhang, Zhihong; Wang, Peng

    2014-07-01

    To investigate the patient safety culture in an outpatient setting in Beijing and explore the meaning and implications of the safety culture from the perspective of health workers and patients. A mixed methods approach involving a questionnaire survey and in-depth interviews was adopted. Among the 410 invited staff members, 318 completed the Hospital Survey of Patient Safety Culture (HSOPC). Patient safety culture was described using 12 subscale scores. Inter-subscale correlation analysis, ANOVA and stepwise multivariate regression analyses were performed to identify the determinants of the patient safety culture scores. Interviewees included 22 patients selected through opportunity sampling and 27 staff members selected through purposive sampling. The interview data were analysed thematically. The survey respondents perceived high levels of unsafe care but had personally reported few events. Lack of 'communication openness' was identified as a major safety culture problem, and a perception of 'penalty' was the greatest barrier to the encouragement of error reporting. Cohesive 'teamwork within units', while found to be an area of strength, conversely served as a protective and defensive mechanism for medical practice. Low levels of trust between providers and consumers and lack of management support constituted an obstacle to building a positive patient safety culture. This study in China demonstrates that a punitive approach to error is still widespread despite increasing awareness of unsafe care, and managers have been slow in acknowledging the importance of building a positive patient safety culture. Strong 'teamwork within units', a common area of strength, could fuel the concealment of errors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. The Cost-effectiveness of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Emergency and Outpatient Medical Settings.

    Science.gov (United States)

    Barbosa, Carolina; Cowell, Alexander; Bray, Jeremy; Aldridge, Arnie

    2015-06-01

    This study analyzed the cost-effectiveness of delivering alcohol screening, brief intervention, and referral to treatment (SBIRT) in emergency departments (ED) when compared to outpatient medical settings. A probabilistic decision analytic tree categorized patients into health states. Utility weights and social costs were assigned to each health state. Health outcome measures were the proportion of patients not drinking above threshold levels at follow-up, the proportion of patients transitioning from above threshold levels at baseline to abstinent or below threshold levels at follow-up, and the quality-adjusted life years (QALYs) gained. Expected costs under a provider perspective were the marginal costs of SBIRT, and under a societal perspective were the sum of SBIRT cost per patient and the change in social costs. Incremental cost-effectiveness ratios were computed. When considering provider costs only, compared to outpatient, SBIRT in ED cost $8.63 less, generated 0.005 more QALYs per patient, and resulted in 13.8% more patients drinking below threshold levels. Sensitivity analyses in which patients were assumed to receive a fixed number of treatment sessions that met clinical sites' guidelines made SBIRT more expensive in ED than outpatient; the ED remained more effective. In this sensitivity analysis, the ED was the most cost-effective setting if decision makers were willing to pay more than $1500 per QALY gained. Alcohol SBIRT generates costs savings and improves health in both ED and outpatient settings. EDs provide better effectiveness at a lower cost and greater social cost reductions than outpatient. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Assessment of satisfaction with pharmaceutical services in patients receiving antiretroviral therapy in outpatient HIV treatment setting.

    Science.gov (United States)

    Agu, Kenneth Anene; Oqua, Dorothy; Agada, Peter; Ohiaeri, Samuel I; Adesina, Afusat; Abdulkareem, Mohammed Habeeb; King, Rosalyn C; Wutoh, Anthony K

    2014-06-01

    The patient's perception and satisfaction are increasingly considered as a useful factor in the assessment of competency of health care providers and quality of care. However, these patient focused assessments are largely ignored when assessing health care outcomes. The study assessed the perception and satisfaction of patients receiving antiretroviral therapy (ART) with pharmaceutical services received in outpatient HIV treatment settings. Seventeen HIV treatment centres in Nigeria. This cross-sectional survey included 2,700 patients randomly selected from 26,319 HIV patients on ART, who received pharmaceutical services in the study setting. A study-specific Likert-type instrument was administered to the participants at point of exit from the pharmacy. Midpoint of the 5-point scale was computed and scores above it were regarded as positive while below as negative. Chi-square was used for inferential statistics. All reported p values were 2-sided at 95 % confidence interval (CI). Patient satisfaction with pharmaceutical services. Of 2,700 patients sampled, data from 1,617 (59.9 %) were valid for analysis; 62.3 % were aged 26-40 years and 65.4 % were females. The participants had received pharmaceutical services for a mean duration of 25.2 (95 % CI 24.3-26.1) months. Perception of participants regarding the appearance of pharmacy was positive while that regarding the pharmacists' efforts to solve patients' medication related problems was negative. The participants' rating of satisfaction with the waiting time to access pharmaceutical services was negative; the satisfaction decreases with increasing waiting time. However, the satisfaction with the overall quality of pharmaceutical services received was rated as positive; 90.0 % reported that they got the kind of pharmaceutical services they wanted; 98.2 % would come back to the pharmacy if they were to seek help again and would recommend services to others. The level of satisfaction was found to be associated with

  1. 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.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    Objective: Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potentia...

  3. Utility of electronic hand hygiene counting devices for measuring physicians' hand hygiene adherence applied to outpatient settings.

    Science.gov (United States)

    Arai, Akie; Tanabe, Masaki; Nakamura, Akiko; Yamasaki, Daisuke; Muraki, Yuichi; Kaneko, Toshihiro; Kadowaki, Ayako; Ito, Masaaki

    2016-12-01

    Our objectives were to evaluate the utility of electronic hand hygiene counting devices in outpatient settings and the impact of results feedback on physicians' hand hygiene behaviors. We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians' hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories. Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders. Physicians' adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians' hand hygiene compliance. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel.

    Science.gov (United States)

    Baugh, Christopher W; Clark, Carol L; Wilson, Jason W; Stiell, Ian G; Kocheril, Abraham G; Luck, Krista K; Myers, Troy D; Pollack, Charles V; Roumpf, Steven K; Tomassoni, Gery F; Williams, James M; Patel, Brian B; Wu, Fred; Pines, Jesse M

    2018-03-10

    Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States. Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways. They are widely used in Canada and other countries but less widely adopted in the United States. In this project, we convened an expert panel to create a practical framework for the process of creating, implementing, and maintaining an outpatient AF pathway for emergency physicians to assess and treat AF patients, safely reduce hospitalization rates, ensure appropriate stroke prophylaxis, and effectively transition patients to longitudinal outpatient treatment settings from the ED and/or observation unit. To support local pathway creation, the panel also reached agreement on a protocol development plan, a sample pathway, consensus recommendations for pathway components, sample pathway metrics, and a structured literature review framework using a modified Delphi technique by a technical expert panel of emergency medicine, cardiology, and other stakeholder groups. © 2018 by the Society for Academic Emergency Medicine.

  5. 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.

  6. 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

  7. Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting.

    Science.gov (United States)

    Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J

    2015-01-01

    To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.

  8. Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

    Science.gov (United States)

    Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

    2014-01-01

    To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and improve rehabilitation effects such as return

  9. Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation

    Science.gov (United States)

    Löbner, Margrit; Luppa, Melanie; Konnopka, Alexander; Meisel, Hans J.; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; Angermeyer, Matthias C.; König, Hans-Helmut; Riedel-Heller, Steffi G.

    2014-01-01

    Objective To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient) and setting-specific rehabilitation outcomes. Methods The longitudinal observational study referred to 534 consecutive disc surgery patients (18–55 years). Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%). The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale), pain intensity (numeric analog scale), health-related quality of life (Short Form 36 Health Survey), subjective prognosis of gainful employment (SPE-scale) as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. Results The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%). Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p<.001). Conclusion The results suggest a “pre-selection” of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures and

  10. Inpatient or outpatient rehabilitation after herniated disc surgery? - Setting-specific preferences, participation and outcome of rehabilitation.

    Directory of Open Access Journals (Sweden)

    Margrit Löbner

    Full Text Available OBJECTIVE: To examine rehabilitation preferences, participation and determinants for the choice of a certain rehabilitation setting (inpatient vs. outpatient and setting-specific rehabilitation outcomes. METHODS: The longitudinal observational study referred to 534 consecutive disc surgery patients (18-55 years. Face-to-face baseline interviews took place about 3.6 days after disc surgery during acute hospital stay. 486 patients also participated in a follow-up interview via telephone three months later (dropout-rate: 9%. The following instruments were used: depression and anxiety (Hospital Anxiety and Depression Scale, pain intensity (numeric analog scale, health-related quality of life (Short Form 36 Health Survey, subjective prognosis of gainful employment (SPE-scale as well as questions on rehabilitation attendance, return to work, and amount of sick leave days. RESULTS: The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%. Thereby two-thirds of these patients took part in an inpatient rehabilitation program (67.9%. Physical, psychological, vocational and health-related quality of life characteristics differed widely before as well as after rehabilitation depending on the setting. Inpatient rehabilitees were significantly older, reported more pain, worse physical quality of life, more anxiety and depression and a worse subjective prognosis of gainful employment before rehabilitation. Pre-rehabilitation differences remained significant after rehabilitation. More than half of the outpatient rehabilitees (56% compared to only one third of the inpatient rehabilitees (33% returned to work three months after disc surgery (p<.001. CONCLUSION: The results suggest a "pre-selection" of patients with better health status in outpatient rehabilitation. Gaining better knowledge about setting-specific selection processes may help optimizing rehabilitation allocation procedures

  11. Neonatal Abstinence Syndrome (NAS): Transitioning Methadone Treated Infants From An Inpatient to an Outpatient Setting

    Science.gov (United States)

    Backes, Carl H.; Backes, Carl R.; Gardner, Debra; Nankervis, Craig A.; Giannone, Peter J.; Cordero, Leandro

    2013-01-01

    Background Each year in the US approximately 50,000 neonates receive inpatient pharmacotherapy for the treatment of neonatal abstinence syndrome (NAS). Objective To compare the safety and efficacy of a traditional inpatient only approach with a combined inpatient and outpatient methadone treatment program. Design/Methods Retrospective review (2007-9). Infants were born to mothers maintained on methadone or buprenorphine in an antenatal substance abuse program. All infants received methadone for NAS treatment as inpatient. Methadone weaning for the traditional group (75 pts) was inpatient while the combined group (46 pts) was outpatient. Results Infants in the traditional and combined groups were similar in demographics, obstetrical risk factors, birth weight, GA and the incidence of prematurity (34 & 31%). Hospital stay was shorter in the combined than in the traditional group (13 vs 25d; p < 0.01). Although the duration of treatment was longer for infants in the combined group (37 vs 21d, p<0.01), the cumulative methadone dose was similar (3.6 vs 3.1mg/kg, p 0.42). Follow-up: Information was available for 80% of infants in the traditional and 100% of infants in the combined group. All infants in the combined group were seen ≤ 72 hours from hospital discharge. Breast feeding was more common among infants in the combined group (24 vs. 8% p<0.05). Following discharge there were no differences between the two groups in hospital readmissions for NAS. Prematurity (<37w GA) was the only predictor for hospital readmission for NAS in both groups (p 0.02, OR 5). Average hospital cost for each infant in the combined group was $13,817 less than in the traditional group. Conclusions A combined inpatient and outpatient methadone treatment in the management of NAS decreases hospital stay and substantially reduces cost. Additional studies are needed to evaluate the potential long term benefits of the combined approach on infants and their families. PMID:21852772

  12. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting

    Directory of Open Access Journals (Sweden)

    Ener Cagri Dinleyici

    2015-08-01

    Full Text Available OBJECTIVE: Two randomized controlled clinical trials have shown thatLactobacillus (L reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.METHODS: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours. The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.RESULTS: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 h, 60.4 ± 24.5 h [95% CI: 51.0-69.7 h] vs. 74.3 ± 15.3 h [95% CI: 68.7-79.9 h], p < 0.05. The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8% after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79,p < 0.01. From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.CONCLUSION:L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.

  13. Intestinal parasitic infections in children presenting with diarrhoea in outpatient and inpatient settings in an informal settlement of Nairobi, Kenya.

    Science.gov (United States)

    Mbae, Cecilia Kathure; Nokes, David James; Mulinge, Erastus; Nyambura, Joyce; Waruru, Anthony; Kariuki, Samuel

    2013-05-27

    The distribution of and factors associated with intestinal parasitic infections are poorly defined in high risk vulnerable populations such as urban slums in tropical sub-Saharan Africa. In a cross sectional study, children aged 5 years and below who presented with diarrhoea were recruited from selected outpatient clinics in Mukuru informal settlement, and from Mbagathi District hospital, Nairobi, over a period of two years (2010-2011). Stool samples were examined for the presence of parasites using direct, formal-ether concentration method and the Modified Ziehl Neelsen staining technique. Overall, 541/2112 (25.6%) were positive for at least one intestinal parasite, with the common parasites being; Entamoeba histolytica, 225 (36.7%),Cryptosporidium spp. 187, (30.5%), Giardia lamblia, 98 (16%).The prevalence of intestinal parasites infection was higher among children from outpatient clinics 432/1577(27.4%) than among those admitted in hospital 109/535 (20.1%) p informal settlements' environment. Routine examinations of stool samples and treatment could benefit both the HIV infected and uninfected children in outpatient and inpatient settings.

  14. 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.

  15. Task-technology fit of video telehealth for nurses in an outpatient clinic setting.

    Science.gov (United States)

    Cady, Rhonda G; Finkelstein, Stanley M

    2014-07-01

    Incorporating telehealth into outpatient care delivery supports management of consumer health between clinic visits. Task-technology fit is a framework for understanding how technology helps and/or hinders a person during work processes. Evaluating the task-technology fit of video telehealth for personnel working in a pediatric outpatient clinic and providing care between clinic visits ensures the information provided matches the information needed to support work processes. The workflow of advanced practice registered nurse (APRN) care coordination provided via telephone and video telehealth was described and measured using a mixed-methods workflow analysis protocol that incorporated cognitive ethnography and time-motion study. Qualitative and quantitative results were merged and analyzed within the task-technology fit framework to determine the workflow fit of video telehealth for APRN care coordination. Incorporating video telehealth into APRN care coordination workflow provided visual information unavailable during telephone interactions. Despite additional tasks and interactions needed to obtain the visual information, APRN workflow efficiency, as measured by time, was not significantly changed. Analyzed within the task-technology fit framework, the increased visual information afforded by video telehealth supported the assessment and diagnostic information needs of the APRN. Telehealth must provide the right information to the right clinician at the right time. Evaluating task-technology fit using a mixed-methods protocol ensured rigorous analysis of fit within work processes and identified workflows that benefit most from the technology.

  16. Treatment of anorexia nervosa with long-term risperidone in an outpatient setting: case study.

    Science.gov (United States)

    Kracke, Elsa J; Tosh, Aneesh K

    2014-01-01

    There are currently few studies focusing on the efficacy of long-term atypical antipsychotics to treat anorexia nervosa in the pediatric population. This case report follows the treatment of a 17 year-old female with anorexia nervosa over her four-year undergraduate career. After two years of multidisciplinary treatment, low-dose risperidone was initiated due to persistence of her disease. She expressed decreased rigidity around meal times, her weight improved and she had resumption of menses. She was compliant with treatment through graduation and maintained her weight gain. Atypical antipsychotics are a treatment option in the management of anorexia nervosa. Risperidone has not been studied as frequently as olanzapine for eating disorders. Risperidone was chosen for its more favorable side effect profile and decreased cost to the patient. Previous studies on anorexia nervosa treatment have occurred during inpatient treatment and have limited follow-up due to patients' refusal to initiate or maintain medication compliance. This case presents 17 months of outpatient data. The efficacy of risperidone therapy was evaluated with frequent weight checks, subjective decrease in rigidity, serial complete metabolic panels, and restoration of menses. In this case report, an adolescent female treated with low-dose risperidone had decreased rigid thinking, weight gain and resolution of secondary amenorrhea without medication side effects. Therefore, the atypical antipsychotic risperidone may be an effective long-term outpatient treatment option for patients with anorexia nervosa.

  17. Introduction of antineoplastic drug NSC631570 in an inpatient and outpatient setting: Comparative evaluation of biological effects

    Directory of Open Access Journals (Sweden)

    Mariia Rudyk

    2016-04-01

    Full Text Available The aim of this study is to evaluate the effect of moderate physical exercise and treatment time on the organism's response to NSC631570. The sensitivity of circulating phagocytes to the drug at different times of day was estimated in in vitro experiments. NSC631570 was administered intravenously to healthy volunteers (eleven men, 23 ± 2 years in a single therapeutic dose in an inpatient and an outpatient setting. Blood samples were obtained before the drug administration, 30 min after the drug injection and every fourth hour throughout the 24 hour period. Biochemical parameters were determined using the hematological analyzer. Flow cytometry was used to evaluate phagocyte metabolism. Treatment of circulating phagocytes with NSC631570 in vitro resulted in an increase in ROS production along with a decrease in their phagocytic activity, most expressed in the morning time. Drug injection to sedentary persons resulted in pro-inflammatory metabolic polarization of circulating phagocytes. Introduction of NSC631570 to active persons was accompanied by a significant increase in phagocyte endocytosis along with a decrease in the daily mean of ROS generation. Significant oscillation (but in the normal ranges of urea, creatinine, alanine aminotransferase and aspartate aminotransferase after NSC631570 introduction in the outpatient setting was shown during the day. Physical activity interferes with immunomodulatory action of NSC631570 and abrogates pro-inflammatory shift of circulating phagocytes. Biochemical parameters of blood from patients treated with NSC631570 in the outpatient setting must be interpreted cautiously considering the effect of physical activity on some metabolic biomarkers.

  18. Potential Drug-Drug Interactions among Patients prescriptions collected from Medicine Out-patient Setting.

    Science.gov (United States)

    Farooqui, Riffat; Hoor, Talea; Karim, Nasim; Muneer, Mehtab

    2018-01-01

    To identify and evaluate the frequency, severity, mechanism and common pairs of drug-drug interactions (DDIs) in prescriptions by consultants in medicine outpatient department. This cross sectional descriptive study was done by Pharmacology department of Bahria University Medical & Dental College (BUMDC) in medicine outpatient department (OPD) of a private hospital in Karachi from December 2015 to January 2016. A total of 220 prescriptions written by consultants were collected. Medications given with patient's diagnosis were recorded. Drugs were analyzed for interactions by utilizing Medscape drug interaction checker, drugs.com checker and stockley`s drug interactions index. Two hundred eleven prescriptions were selected while remaining were excluded from the study because of unavailability of the prescribed drugs in the drug interaction checkers. In 211 prescriptions, two common diagnoses were diabetes mellitus (28.43%) and hypertension (27.96%). A total of 978 medications were given. Mean number of medications per prescription was 4.6. A total of 369 drug-drug interactions were identified in 211 prescriptions (175%). They were serious 4.33%, significant 66.12% and minor 29.53%. Pharmacokinetic and pharmacodynamic interactions were 37.94% and 51.21% respectively while 10.84% had unknown mechanism. Number wise common pairs of DDIs were Omeprazole-Losartan (S), Gabapentine- Acetaminophen (M), Losartan-Diclofenac (S). The frequency of DDIs is found to be too high in prescriptions of consultants from medicine OPD of a private hospital in Karachi. Significant drug-drug interactions were more and mostly caused by Pharmacodynamic mechanism. Number wise evaluation showed three common pairs of drugs involved in interactions.

  19. Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.

    Science.gov (United States)

    Lucchetti, Giancarlo; Lucchetti, Alessandra Granero; Badan-Neto, Antonio M; Peres, Patricia T; Peres, Mario F P; Moreira-Almeida, Alexander; Gomes, Cláudio; Koenig, Harold G

    2011-03-01

    To evaluate the relationship between religiousness and mental health, hospitalization, pain, disability and quality of life in older adults from an outpatient rehabilitation setting in Sao Paulo, Brazil. Cross-sectional study. A total of 110 patients aged 60 years or older were interviewed during attendance at an outpatient rehabilitation service. Researchers administered a standardized questionnaire that assessed socio-demographic data, religiousness, self-reported quality of life, anxiety, physical activity limitation, depression, pain and cognition. Predictors were included in each model analysis, and a backward conditional method was used for variable selection using logistic regression (categorical outcomes) or linear regression (continuous outcomes). Thirty-one patients (28.2%) fulfilled criteria for significant depressive symptoms, 27 (24.5%) for anxiety, and 10 (9.6%) for cognitive impairment. Pain was present in 89 (80.7%) patients. Limited depressive symptoms (as assessed by the Geriatric Depression Scale), and greater self-reported quality of life were related to greater self-reported religiousness, as were scores on the Mini-Mental State Examination (less cognitive impairment), and lower ratings of pain. Religiousness is related to significantly less depressive symptoms, better quality of life, less cognitive impairment, and less perceived pain. Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings.

  20. Alcohol use and alcohol use disorder among male outpatients in a primary care setting in rural Puducherry

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    Akkilagunta Sujiv

    2015-01-01

    Full Text Available Context: Alcohol use contributes to considerable morbidity and mortality worldwide. Screening for alcohol use and alcohol use disorder (AUD at the primary care level can help in reducing this burden. While several community studies have been conducted to estimate the AUD, there apparently are no studies on opportunistic screening in a primary care setting in India. Aims: The aim was to estimate the prevalence of alcohol use and AUD in a primary care setting. Settings and Design: A hospital-based cross-sectional study was conducted among adult male outpatients in a primary care setting in Puducherry, South India. Subjects and Methods: Male outpatients aged 18 and above were interviewed for alcohol use. Current alcohol users were screened for AUD using World Health Organization - AUD identification test (AUDIT questionnaire, respectively. Statistical Analysis Used: Proportions were used to describe the study population and the main study findings. The Chi-square test was used to find out the association between sociodemographic factors and alcohol use. Results: Of 256 subjects studied, 39.8% were found to be current alcohol users and 10.9% had AUD (AUDIT score ≥8. The sociodemographic factors did not show any association with an alcohol use in the current setting. Conclusion: Based on the findings of the present study, four current alcohol users are to be screened to identify one patient with AUD. Screening at the primary health care level can help in identifying the risk group and thus help in reducing the morbidity and mortality due to alcohol use in the population.

  1. Does cognitive/physical screening in an outpatient setting predict institutionalization after hip fracture?

    Science.gov (United States)

    Hongisto, Markus T; Nuotio, Maria; Luukkaala, Tiina; Väistö, Olli; Pihlajamäki, Harri K

    2016-10-22

    Institutionalization after hip fracture is a socio-economical burden. We examined the predictive value of Instrumental Activities of Daily Living (IADL) and Mini Mental State Examination (MMSE) for institutionalization after hip fracture to identify patients at risk for institutionalization. Fragility hip fracture patients ≥65 years of age (n = 584) were comprehensively examined at a geriatric outpatient clinic 4 to 6 months after surgery and followed 1 year postoperatively. A telephone interview with a structured inquiry was performed at 1, 4, and 12 months after hip fracture. Age-adjusted univariate logistic regression analysis revealed that IADL and MMSE scores measured at the outpatient clinic were significantly associated with living arrangements 1 year after hip fracture. Multivariate logistic regression analysis established that institutionalization 1 year after hip fracture was significantly predicted by institutionalization at 4 months (odds ratio [OR] 16.26, 95 % confidence interval [CI] 7.37-35.86), IADL <5 (OR 12.96, 95 % CI 1.62-103.9), and MMSE <20 (OR 4.19, 95 % CI 1.82-9.66). A cut-off value of 5 was established for IADL with 100 % (95 % CI 96 %-100 %) sensitivity and 38 % (95 % CI 33 %-43 %) specificity and for MMSE, a cut-off value of 20 had 83 % (95 % CI 74 %-91 %) sensitivity and 65 % (95 % CI 60 %-70 %) specificity for institutionalization. During the time period from 4 to 12 months, 66 (11 %) patients changed living arrangements, and 36 (55 %) of these patients required more supportive accommodations. IADL and MMSE scores obtained 4 to 6 months after hospital discharge may be applicable for predicting institutionalization among fragility hip fracture patients ≥65 years of age at 1 year after hip fracture. An IADL score of ≥5 predicted the ability to remain in the community. Changes in living arrangements also often occur after 4 months.

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

    NARCIS (Netherlands)

    Harmsen, I.A.; Ruiter, R.A.C.; Paulussen, T.G.W.M.; Mollema, L.; Kok, G.; de Melker, H.E.R.

    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

  3. 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

    Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The ...... to strengthen patient involvement and securing benefit from PROs.......Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self......-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...

  4. [Recommendations for problem solving in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

    Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina; Heusser, Peter

    2014-01-01

    In the context of the first-time evaluation of the quality and problems of integrative postgraduate medical training (PGMT) at German and Swiss anthroposophic hospitals, all 240 trainees and all 214 trainers were asked to propose options for problem solutions. The study included a cross-sectional questionnaire survey with sections for further comments. The data were evaluated with qualitative content analysis (Mayring). 56 (51.8%) out of 108 responding trainees and 54 (54%) out of 100 responding trainers had given potential solutions. Both groups were analyzed together. On internal level, recommendations comprised re-orientation on a leadership basis, i.e. elevation of PGMT to a core element of hospital policy in anthroposophic medicine (AM), as well as better personnel policy; trainers with more professional and teaching competency in AM; structured and extended continual education program; coordination of PGMT with ward and hospital organization; and work load reduction for physicians through process optimization and resource planning. Externally, the recommendations embraced financial support; external training programs; networking of anthroposophic hospitals in PGMT; implementation of a common competence center for anthroposophic PGMT; conventional and anthroposophic PGMT curriculums; and improvement of science base and public discourse of AM. The proposed options for problem solving in PGMT at anthroposophic hospitals emerge from concrete problem perceptions of the trainers and trainees. They can serve as a basis for concrete improvements of PGMT in AM that could be implemented professionally and in an international context. The preconditions for this are given through the already existing establishment of AM at universities and through the good international connections of anthroposophic hospitals and anthroposophic physicians' associations.

  5. Improving doctor-patient communication in the outpatient setting using a facilitation tool: a preliminary study.

    Science.gov (United States)

    Neeman, Naama; Isaac, Thomas; Leveille, Suzanne; Dimonda, Clementina; Shin, Jacob Y; Aronson, Mark D; Freedman, Steven D

    2012-08-01

    Patients often do not fully understand medical information discussed during office visits. This can result in lack of adherence to recommended treatment plans and poorer health outcomes. We developed and implemented a program utilizing an encounter form, which provides structure to the medical interaction and facilitates bidirectional communication and informed decision-making. We conducted a prospective quality improvement intervention at a large tertiary-care academic medical center utilizing the encounter form and studied the effect on patient satisfaction, understanding and confidence in communicating with physicians. The intervention included 108 patients seen by seven physicians in five sub-specialties. Ninety-eight percent of patients were extremely satisfied (77%) or somewhat satisfied (21%) with the program. Ninety-six percent of patients reported being involved in decisions about their care and treatments as well as high levels of understanding of medical information that was discussed during visit. Sixty-nine percent of patients reported that they shared the encounter form with their families and friends. Patients' self-confidence in communicating with their doctors increased from a score of 8.1 to 8.7 post-intervention (P-value = 0.0018). When comparing pre- and post-intervention experiences, only 38% of patients felt that their problems and questions were adequately addressed by other physicians' pre-intervention, compared with 94% post-intervention. We introduced a program to enhance physician-patient communication and found that patients were highly satisfied, more informed and more actively involved in their care. This approach may be an easily generalizable approach to improving physician-patient communication at outpatient visits.

  6. Motivations for seeking minimally invasive cosmetic procedures in an academic outpatient setting.

    Science.gov (United States)

    Sobanko, Joseph F; Taglienti, Anthony J; Wilson, Anthony J; Sarwer, David B; Margolis, David J; Dai, Julia; Percec, Ivona

    2015-11-01

    The demand for minimally invasive cosmetic procedures has continued to rise, yet few studies have examined this patient population. This study sought to define the demographics, social characteristics, and motivations of patients seeking minimally invasive facial cosmetic procedures. A prospective, single-institution cohort study of 72 patients was conducted from 2011 through 2014 at an urban academic medical center. Patients were aged 25 through 70 years; presented for botulinum toxin or soft tissue filler injections; and completed demographic, informational, and psychometric questionnaires before treatment. Descriptive statistics were conducted using Stata statistical software. The average patient was 47.8 years old, was married, had children, was employed, possessed a college or advanced degree, and reported an above-average income. Most patients felt that the first signs of aging occurred around their eyes (74.6%), and a similar percentage expressed this area was the site most desired for rejuvenation. Almost one-third of patients experienced a "major life event" within the preceding year, nearly half had sought prior counseling from a mental health specialist, and 23.6% were being actively prescribed psychiatric medication at the time of treatment. Patients undergoing injectable aesthetic treatments in an urban outpatient academic center were mostly employed, highly educated, affluent women who believed that their procedure would positively impact their appearance. A significant minority experienced a major life event within the past year, which an astute clinician should address during the initial patient consultation. This study helps to better understand the psychosocial factors characterizing this patient population. 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  7. Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting

    Directory of Open Access Journals (Sweden)

    Ener Cagri Dinleyici

    2015-07-01

    Full Text Available Objective: Two randomized controlled clinical trials have shown that Lactobacillus (L reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea. Methods: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours. The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded. Results: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 h, 60.4 ± 24.5 h [95% CI: 51.0–69.7 h] vs. 74.3 ± 15.3 h [95% CI: 68.7–79.9 h], p < 0.05. The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8% after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34–0.79, p < 0.01. From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted. Conclusion: L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea. Resumo: Objetivo: Dois ensaios clínicos randomizados controlados demonstraram que o Lactobacillus (L reuteri DSM 17938 reduz a duração de diarreia em crianças hospitalizadas devido a diarreia infecciosa aguda. Este é o primeiro ensaio que avalia a eficácia do L. reuteri DSM 17938 em crianças com diarreia infecciosa aguda no

  8. Health-Related Quality of Life in Persons With Ostomies Managed in an Outpatient Care Setting.

    Science.gov (United States)

    Santos, Vera Lucia Conceição de Gouveia; Augusto, Fabiana da Silva; Gomboski, Gustavo

    2016-01-01

    We examined health-related quality of life (HRQOL) in persons with ostomies receiving outpatient care. We also analyzed relationships among HRQOL, demographic, and pertinent clinical factors. We used a descriptive, exploratory, cross-sectional study design to collect and analyze data. Data in this article are a secondary analysis of data collected from a primary study, developed by Santos and Gomboski, on the adaptation and validation of the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) to the Portuguese language in Brazil. A convenience sample of 215 adults living with an ostomy was evaluated. Slightly more than half (51.6%) were men, 67.5% underwent colostomy surgery, and 59.1% underwent cancer-related ostomy surgery. Subjects received care in specialized health care units in 3 cities in the Brazilian state of Rio Grande do Sul. After approval by the Research Ethics Committee and permission from health care units, data were collected using 2 instruments: the World Health Organization Quality of Life-Short Version (WHOQOL-Bref) (generic HRQOL instrument) and the COH-QOL-OQ (disease specific HRQOL instrument). Data were analyzed using χ test and logistic regression (via a stepwise forward method). Patients were classified into 3 groups according to the means and standard deviations of the scores: low, moderate, and high quality of life (QOL). Ostomy patients had total scores of 69.6 ± 20.2 and 6.1 ± 1.4 for the WHOQOL-Bref and COH-QOL-OQ instruments, respectively. Patients with shorter times since their ostomy creation had worse scores on both the specific QOL (P = .006) and generic QOL (P = .019) instruments. Patients who did not practice religion (P = .027; odds ratio [OR] = 3.39) and those without a partner/spouse (P = .007; OR = 4.90) had increased probability of having worse scores on the WHOQOL-Bref (generic instrument). Persons living with ostomies were found to have scores indicating moderate HRQOL on a disease-specific and generic

  9. Ambulatory screening of diabetic neuropathy and predictors of its severity in outpatient settings.

    Science.gov (United States)

    Qureshi, M S; Iqbal, M; Zahoor, S; Ali, J; Javed, M U

    2017-04-01

    Diabetic neuropathy is one of the most common causes of chronic neuropathic symptomatology and the most disabling and difficult-to-treat diabetic microangiopathic complication. The neuropathies associated with diabetes are typically classified into generalized, focal and multifocal varieties. There exists a scarcity of literature studying the correlation of different patient- and disease-related variables with severity of neuropathy. This study aims to delineate the prevalence of diabetic neuropathy in type 2 diabetes, describe its characteristics and find out predictors of its severity. Eight hundred consecutive diabetic patients presenting to outpatient department (OPD) of Khan Research Labs (KRL) General Hospital and Centre for Diabetes and Liver diseases, Islamabad, during March-June, 2015 were made to complete a self-administered questionnaire (Michigan Neuropathy Screening Instrument-MNSI) and underwent a thorough physical examination according to MNSI protocols. A score of >2 was considered to be diagnostic for DPN. Patient and disease variables were noted. MNSI score was used as an index of severity of diabetic peripheral neuropathy (DPN). Correlation of several patient- and disease-related variables with the severity of DPN was determined using multivariate regression. Out of a total 800 patients screened, 90 (11.25%) were found to have diabetic neuropathy. Of these 90, 45.5% were males, the median age was 54.47 ± 10.87 years and the median duration of diabetes was 11.12 ± 9.8 years. The most common symptom was found to be numbness (63.6%) followed by generalized body weakness (61.5%). The common findings on physical examination were dry skin/callus (38.7%) and deformities (14.7%). Duration of diabetes was found to be the strongest predictor for development and severity of diabetic neuropathy followed by glycemic controls (HbA1c values) and age. Duration of diabetes rather than diabetic controls predicts better the development and severity of

  10. Dose and Duration of Opioid Use in Patients with Cancer and Noncancer Pain at an Outpatient Hospital Setting in Malaysia.

    Science.gov (United States)

    Zin, Che S; Rahman, Norny A; Ismail, Che R; Choy, Leong W

    2017-07-01

    There are currently limited data available on the patterns of opioid prescribing in Malaysia. This study investigated the patterns of opioid prescribing and characterized the dosing and duration of opioid use in patients with noncancer and cancer pain. This retrospective, cross-sectional study was conducted at an outpatient hospital setting in Malaysia. All prescriptions for opioids (dihydrocodeine, fentanyl, morphine, and oxycodone) issued between January 2013 and December 2014 were examined. The number of prescriptions and patients, the distribution of mean daily dose, annual total days covered with opioids, and annual total opioid dose at the individual level were calculated and stratified by noncancer and cancer groups. A total of 1015 opioid prescriptions were prescribed for 347 patients from 2013 to 2014. Approximately 41.5% of patients (N = 144/347) and 58.5% (N = 203/347) were associated with noncancer and cancer diagnosis, respectively. Oxycodone (38.0%) was the highest prescribed primarily for the noncancer group. The majority of patients in both noncancer (74.3%) and cancer (60.4%) groups were receiving mean daily doses of 90 days per year) was associated with 21.8% of patients in the noncancer group and 17.5% in the cancer group. The finding from this study showed that 41.5% of opioid users at an outpatient hospital setting in Malaysia received opioids for noncancer pain and 21.8% of these users were using opioids for longer than 90 days. The average daily dose in the majority of patients in both groups of noncancer and cancer was modest. © 2016 World Institute of Pain.

  11. 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.

  12. Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting

    Directory of Open Access Journals (Sweden)

    Chelsea Phillips Renfro

    2018-01-01

    Full Text Available Managing patient health is a complex task, requiring the support of an interprofessional healthcare team. Collaboration between neighboring community pharmacies and primary care practices can be an alternate solution for team-based patient care. The purpose of this project was to design and implement a communication strategy for patients with diabetes and hypertension between a community pharmacy and physician practice. An interprofessional team for the practice settings was formed to develop a strategy for collaboration. After agreeing on the common goals and target patient population for the disease states, the team devised a way to communicate via electronic health record (EHR. The communication strategy allowed for more frequent follow-up with the patients which has the potential to result in better clinical outcomes. A communication strategy between a community pharmacy and a physician practice office can be achieved using EHR technology. The greatest outcome of this project was the formation of the collaborative team between the practice settings that continues to work together on additional patient-centered initiatives. Further research is warranted to allow for incorporation of patient perspectives in development of communication strategies.

  13. 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. Copyright 2000 Harcourt Publishers Ltd.

  14. Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings

    Directory of Open Access Journals (Sweden)

    Sun-Jin Jo

    2015-09-01

    Full Text Available Objectives: Although the prevalence of depressive disorders in South Korea’s general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities. Methods: Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated. Results: The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2, with major depressive disorder 5.4% (95% CI, 2.1 to 8.7, dysthymia 1.1% (95% CI, 0.0 to 2.6, and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5. Among the 26 patients with depressive disorder, 19 patients were newly diagnosed. Conclusions: As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

  15. Prevalence of Depressive Disorder of Outpatients Visiting Two Primary Care Settings.

    Science.gov (United States)

    Jo, Sun-Jin; Yim, Hyeon Woo; Jeong, Hyunsuk; Song, Hoo Rim; Ju, Sang Yhun; Kim, Jong Lyul; Jun, Tae-Youn

    2015-09-01

    Although the prevalence of depressive disorders in South Korea's general population is known, no reports on the prevalence of depression among patients who visit primary care facilities have been published. This preliminary study was conducted to identify the prevalence of depressive disorder in patients that visit two primary care facilities. Among 231 consecutive eligible patients who visited two primary care settings, 184 patients consented to a diagnostic interview for depression by psychiatrists following the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. There were no significant differences in sociodemographic characteristics such as gender, age, or level of education between the groups that consented and declined the diagnostic examination. The prevalence of depressive disorder and the proportion of newly diagnosed patients among depressive disorder patients were calculated. The prevalence of depressive disorder of patients in the two primary care facilities was 14.1% (95% confidence interval [CI], 9.1 to 19.2), with major depressive disorder 5.4% (95% CI, 2.1 to 8.7), dysthymia 1.1% (95% CI, 0.0 to 2.6), and depressive disorder, not otherwise specified 7.6% (95% CI, 3.7 to 11.5). Among the 26 patients with depressive disorder, 19 patients were newly diagnosed. As compared to the general population, a higher prevalence of depressive disorders was observed among patients at two primary care facilities. Further study is needed with larger samples to inform the development of a primary care setting-based depression screening, management, and referral system to increase the efficiency of limited health care resources.

  16. Food-Dependent, Exercise-Induced Anaphylaxis: Diagnosis and Management in the Outpatient Setting.

    Science.gov (United States)

    Feldweg, Anna M

    Food-dependent, exercise-induced anaphylaxis is a disorder in which anaphylaxis develops most predictably during exercise, when exercise takes place within a few hours of ingesting a specific food. IgE to that food should be demonstrable. It is the combination of the food and exercise that precipitates attacks, whereas the food and exercise are each tolerated independently. Recently, it was demonstrated that exercise is not essential for the development of symptoms, and that if enough of the culprit food is ingested, often with additional augmentation factors, such as alcohol or acetylsalicylic acid, symptoms can be induced at rest in the challenge setting. Thus, food-dependent, exercise-induced anaphylaxis appears to be more correctly characterized as a food allergy syndrome in which symptoms develop only in the presence of various augmentation factors, with exercise being the primary one. However, additional factors are not usually present when the patient exercises normally, so ongoing investigation is needed into the physiologic and cellular changes that occur during exercise to facilitate food-induced anaphylaxis. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  17. Establishing a general medical outpatient clinic for cancer survivors in a public city hospital setting.

    Science.gov (United States)

    Goytia, Elliott J; Lounsbury, David W; McCabe, Mary S; Weiss, Elisa; Newcomer, Meghan; Nelson, Deena J; Brennessel, Debra; Rapkin, Bruce D; Kemeny, M Margaret

    2009-11-01

    Many cancer centers and community hospitals are developing novel models of survivorship care. However, few are specifically focused on services for socio-economically disadvantaged cancer survivors. To describe a new model of survivorship care serving culturally diverse, urban adult cancer patients and to present findings from a feasibility evaluation. Adult cancer patients treated at a public city hospital cancer center. The clinic provides comprehensive medical and psychosocial services for patients within a public hospital cancer center where they receive their oncology care. Longitudinal data collected over a 3-year period were used to describe patient demographics, patient needs, and services delivered. Since inception, 410 cancer patients have been served. Demand for services has grown steadily. Hypertension was the most frequent comorbid condition treated. Pain, depression, cardiovascular disease, hyperlipidemia, and bowel dysfunction were the most common post-treatment problems experienced by the patients. Financial counseling was an important patient resource. This new clinical service has been well-integrated into its public urban hospital setting and constitutes an innovative model of health-care delivery for socio-economically challenged, culturally diverse adult cancer survivors.

  18. Pharmacists providing care in the outpatient setting through telemedicine models: a narrative review

    Directory of Open Access Journals (Sweden)

    Littauer SL

    2017-12-01

    Full Text Available Telemedicine refers to the delivery of clinical services using technology that allows two-way, real time, interactive communication between the patient and the clinician at a distant site. Commonly, telemedicine is used to improve access to general and specialty care for patients in rural areas. This review aims to provide an overview of existing telemedicine models involving the delivery of care by pharmacists via telemedicine (including telemonitoring and video, but excluding follow-up telephone calls and to highlight the main areas of chronic-disease management where these models have been applied. Studies within the areas of hypertension, diabetes, asthma, anticoagulation and depression were identified, but only two randomized controlled trials with adequate sample size demonstrating the positive impact of telemonitoring combined with pharmacist care in hypertension were identified. The evidence for the impact of pharmacist-based telemedicine models is sparse and weak, with the studies conducted presenting serious threats to internal and external validity. Therefore, no definitive conclusions about the impact of pharmacist-led telemedicine models can be made at this time. In the Unites States, the increasing shortage of primary care providers and specialists represents an opportunity for pharmacists to assume a more prominent role managing patients with chronic disease in the ambulatory care setting. However, lack of reimbursement may pose a barrier to the provision of care by pharmacists using telemedicine.

  19. Mental Health Service Use in Schools and Non-School-Based Outpatient Settings: Comparing Predictors of Service Use.

    Science.gov (United States)

    Langer, David A; Wood, Jeffrey J; Wood, Patricia A; Garland, Ann F; Landsverk, John; Hough, Richard L

    2015-09-01

    Researchers have consistently documented a gap between the large number of US youth meeting criteria for a mental health disorder with significant associated impairment, and the comparatively few youth receiving services. School-based mental health care may address the need-services gap by offering services more equitably to youth in need, irrespective of family economic resources, availability of transportation, and other factors that can impede access to community clinics. However, diagnoses alone do not fully capture the severity of an individual's mental health status and need for services. Studying service use only in relation to diagnoses may restrict our understanding of the degree to which service use is reflective of service need, and inhibit our ability to compare school and non-school-based outpatient settings on their responsiveness to service need. The present study evaluated predictors of mental health service use in school- and community-based settings for youth who had had an active case in one of two public sectors of care, comparing empirically-derived dimensional measurements of youth mental health service need and impairment ratings against non-need variables (e.g., ethnicity, income). Three dimensions of youth mental health service need were identified. Mental health service need and non-need variables each played a significant predictive role. Parent-rated impairment was the strongest need-based predictor of service use across settings. The impact of non-need variables varied by service setting, with parental income having a particularly noticeable effect on school-based services. Across time, preceding service use and impairment each significantly predicted future service use.

  20. 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

  1. 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

    2008-04-01

    Full Text Available 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.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.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 number of casual sex partners compared with the

  2. Management of dexamethasone-induced hyperglycemia in patients undergoing chemotherapy in an outpatient setting: a best practice implementation project.

    Science.gov (United States)

    Sinaga, Gery; de Koeijer, Elizabeth

    2018-04-01

    The objective of this project was to implement best practice in an outpatient clinical setting in order to increase both nursing staff and patients' knowledge and awareness on the importance of blood sugar management during chemotherapy and to show that through compliance with best practice, the incidence of dexamethasone-induced hyperglycemia during chemotherapy can be minimized. Steroid-induced hyperglycemia is a commonly neglected symptom in cancer treatment, contributing to poor patient prognosis and extended hospital stay. Evidence shows that controlled blood sugar during chemotherapy is associated with improved patient outcomes and better tolerance to cancer treatment. For the purpose of this paper steroid-induced hyperglycemia will be referred to as dexamethasone-induced hyperglycemia. This project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tools to promote compliance in the clinical setting. Thirty patients participated in the audit, which was executed by nursing staff in the Medical Oncology Outpatient Unit at the Cancer Ambulatory and Community Health Support Department at the Canberra Hospital. The baseline audit revealed large gaps between best practice and current practice. This underlined the need for more education for both nursing staff and patients. Other barriers such as the absence of assessment and documentation by the clinicians and the minimum number of potential referrals to the diabetes educator were addressed by encouraging patients to speak about their diabetes, and also in the development of a simplified referral process in order to have patients reviewed by the Diabetes Educator in a timely manner. There were significant improvements after more information sessions were held and more resources made available to both nursing staff and patients, but there were also minimal to zero compliance drop on parts of the follow-up audit. In an

  3. 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.

  4. Evaluation of outpatients with suspected pulmonary tuberculosis in a high HIV prevalence setting in Ethiopia: clinical, diagnostic and epidemiological characteristics.

    Science.gov (United States)

    Bruchfeld, Judith; Aderaye, Getachew; Palme, Ingela Berggren; Bjorvatn, Bjarne; Britton, Sven; Feleke, Yewenhareg; Källenius, Gunilla; Lindquist, Lars

    2002-01-01

    In a setting with a high prevalence of HIV we studied (i) the prevalence of pulmonary tuberculosis (PTB) and HIV; (ii) clinical and epidemiological characteristics of PTB; and (iii) the usefulness of standard procedures for diagnosing PTB. Of 509 consecutive outpatients evaluated on clinical suspicion of PTB in Addis Ababa, 33.0% were culture-verified as having PTB. PTB patients, non-TB patients and controls were HIV-1-positive in 57.1%, 38.5% and 8.3% of cases, respectively. Predictors for culture-verified PTB were age infection. Diagnosis of PTB based on clinical symptoms, sputum microscopy for acid-fast bacilli and chest radiography was sensitive (86.7%) but unspecific (64.1%). In HIV-positive patients both sensitivity and specificity were significantly lower (p infections are often misinterpreted as smear-negative PTB. HIV screening is therefore warranted not only in cases of verified TB but also as part of the diagnostic work-up in patients with respiratory symptoms suggestive of PTB. Also, increased awareness of, and improved diagnostic tools for, HIV-related pulmonary infections other than PTB are required, together with algorithms for patients with suspected PTB.

  5. Factors related to missing and rescheduling pharmaceutical care appointments by aged outpatients in a Brazilian public health setting

    Directory of Open Access Journals (Sweden)

    Thiago Vinícius Nadaleto Didone

    2015-12-01

    Full Text Available Objectives: To uncover reasons why patients missed pharmaceutical care (PC appointments, identify predictive factors to miss at least one appointment and to reschedule after a miss, and compare the rescheduling behavior of patients receiving different types of PC. Methods: All elderly patients who had at least one scheduled appointment in the PC service of a health setting of São Paulo city, Brazil, from January to December/2011 were included. Chi-square analysis compared categorical data between groups; multivariate logistic regression models predicted attendance and rescheduling behavior. Results: We identified 421 patients, being 221 (52.5% non-attenders. Forgetting the appointment was the most common patient-related reason (56.3%. Illiteracy was a risk factor to be a non-attender [OR(95%CI=2.27(1.17:4.40, p=0.015]. Patients having previous knowledge of the pharmacist presented more chance to rescheduled an appointment after the first miss compared to those who had not [OR(95%CI=3.57(1.90:6.71, p<0.001]. Further, non-attenders who had knowledge of the pharmacist and received Medication Review with Follow-up rescheduled more than the ones receiving other types of PC (p=0.035. Conclusion: Illiteracy predicted non-attendance in PC to aged outpatients and forgetfulness was the main reason for that. The previous acquaintance of the pharmacist and the provision of pharmaceotherapeutic follow-up explained the rescheduling behavior, which indicates the establishment of a patient-centered patient-pharmacist relationship plays a pivotal role in the continuity of the PC.

  6. Formal training in general movement assessment is required to effectively evaluate infants with perinatal asphyxia in outpatient settings

    DEFF Research Database (Denmark)

    Brown, Annemette K; Greisen, Gorm; Haugsted, Ulla

    2016-01-01

    recordings to assess GMA, in a busy Danish outpatient clinic. METHODS: The study comprised 30-term infants born with perinatal asphyxia, who were video recorded at three months. They were assessed by two certified GMA observers and re-assessed two weeks later. Interobserver and intra-observer agreements were...

  7. Guiding Principles for the use of Fluroquinolones in Out-patient Community Settings of India: Panel Consensus.

    Science.gov (United States)

    Vora, Agam; Krishnaprasad, K

    2017-08-01

    Respiratory tract infections have been an important cause of morbidity and mortality worldwide that is looming large especially in context of antibiotic resistance that is confronted both by a pulmonologist as well as a general practitioner. A reflection to this trend has been the rising phenomenon of MICs as shown the respiratory pathogens towards conventional antibiotics including macrolides or β lactam/β lactamase inhibitor combinations. Respiratory fluoroquinolones offer broad yet potent cover of respiratory pathogens leading to their obvious choice for empirical therapy for clinical persisters or high risk cases with prior history of antibiotics not-withstanding the clinical concerns in tropical countries. To further assess the clinical role of respiratory quinolones in outpatient settings of India especially in line with the known endemicity of chronic infections or tuberculosis. Cross-sectional, national survey questionnaire survey to explore the clinical perceptions, attitude and insights on the clinical use of respiratory fluoroquinolones was rolled out amongst pulmonologists and consultant physicians practicing respiratory medicine in India. Descriptive statistics was utilized to describe the numerical and categorical data. Nationwide representative sample of fourteen pulmonologists provided response and clinical insight on the current management strategies for community acquired pneumonia (CAP) with 'respiratory' fluoroquinolones. Each of the doctor in the panel agreed that the ideal antibiotic for the treatment in CAP or lower respiratory tract infection (LRTI) should be highly effective with lesser side effects and broader spectrum covering atypical bacteria. Doctors agreed that most the fixed dose combination (FDC) has gone into disrepute probably because of pharmacokinetic incompatibility that could have further fuelled the epidemic of antibiotic resistance. 9 (64%) doctors suggested that there is omnipresence if not overwhelming presence of

  8. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    Science.gov (United States)

    Heinz, Jürgen; Fiori, Wolfgang; Heusser, Peter

    2013-01-01

    Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. PMID:23431346

  9. Cost Analysis of Integrative Inpatient Treatment Based on DRG Data: The Example of Anthroposophic Medicine

    Directory of Open Access Journals (Sweden)

    Jürgen Heinz

    2013-01-01

    Full Text Available Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs. Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually.

  10. Ambulatory cardiology network in Greece: Clinical and therapeutic implications in the outpatient setting. The TEVE-SSF study.

    Science.gov (United States)

    Panagiotopoulos, Konstantinos E; Panagiotopoulou, Eleni E; Katsaros, Konstantinos; Noikokirakis, Georgios; Mpouziou, Maria; Stamelou, Angeliki; Toumanidis, Savvas

    2016-11-15

    Community based registries are particularly valuable tools to Preventive Cardiology as they summarize epidemiological data of ischemic heart disease risk factors, medications and lifestyle characteristics. We enrolled 1191 patients, from an outpatient community based cardiology network, dedicated to cover medically, office based professionals. We recorded demographic and lifestyle characteristics, risk factors for ischemic heart disease, all clinical entities diagnosed and therapies which were prescribed for hypertension and lipid disorders specifically. Our population consisted of 659 males (55%) and 532 females (45%), (mean age 46±14). A sedentary lifestyle was almost universal (92%), followed by smoking (44%) and overweight body composition (38%). Unhealthy lifestyle increased significantly during the third decade of life, while multimorbidity ascended during the fifth. Cardiovascular morbidity was present in 611 patients (51%), while 289 patients (24%) were found negative for cardiovascular disease and positive for a different system diagnosis. Lipid disorders (32%) and hypertension (31%) were the most frequent cardiovascular entities. β-Blockers and statins were the most frequently prescribed medications for hypertension and lipid disorders respectively. Cardiovascular morbidity was frequent in this ambulatory middle aged population, whereas multimorbidity (mainly from gastrointestinal and endocrine system) was a significant coexisting problem, even for a cardiology oriented outpatient population. Unhealthy lifestyle is of major importance because it was present in the majority of our patients early in their life and because it was statistically related to hyperlipidemia and hypertension. Preventive Cardiology must introduce special interventions to deescalate the presence of unhealthy lifestyle in young populations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Unplanned Readmission in Outpatient Hand Surgery: An Analysis of 23,613 Patients in the NSQIP Data Set.

    Science.gov (United States)

    Donato, Daniel P; Kwok, Alvin C; Bishop, Michael O; Presson, Angela P; Agarwal, Jayant P

    2017-01-01

    Objective: In an era of controlling cost and improving care, 30-day readmission rates have become an important quality measure. The purpose of this study was to identify the rates of 30-day unplanned readmission and the associated risk factors in patients undergoing outpatient hand surgery. Methods: The 2011-2014 National Surgical Quality Improvement Project data were queried for patients who met 368 hand-specific Current Procedural Terminology codes. Univariable and multivariable analyses were performed to identify patient- and surgery-specific risk factors associated with unplanned readmission within 30 days. Results: Of the 368 Current Procedural Terminology codes queried, 208 were represented in the data, for a total of 23,613 patients. The overall unplanned readmission rate was 0.88% (207/23,613). On both univariable and multivariable analyses, operative year (2012), increasing age, obesity, smoking status, chronic obstructive pulmonary disease, preoperative steroid use, preoperative anemia, increasing American Society of Anesthesiologists classification, increasing operative time, and a procedure performed by a surgeon other than a plastic or orthopedic surgeon were associated with increased readmission rates. Diabetes, hypertension, low albumin levels, elevated international normalized ratio, and dirty/infected wound classification were only significant in univariable analysis. Current Procedural Terminology codes associated with the highest readmission rates were related to amputations. The most common readmission diagnoses were wound complications, followed by uncontrolled postoperative pain. Conclusions: The incidence of unplanned readmission is low in patients undergoing outpatient hand surgery. Specific patient comorbidities are associated with increased unplanned readmission rates. This information may be useful in identifying patients at higher risk for unplanned readmission and in counseling of high-risk patients preparing for surgery.

  12. The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review.

    Science.gov (United States)

    Berglas, Nancy F; Battistelli, Molly F; Nicholson, Wanda K; Sobota, Mindy; Urman, Richard D; Roberts, Sarah C M

    2018-01-01

    Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes-for any procedure-is unclear. We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions. More and higher quality research is needed to determine if there is a public health problem to be addressed through facility

  13. Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons.

    Science.gov (United States)

    Frederick, John; Brown, Alexandria C; Cummings, Derek A; Gaydos, Charlotte A; Gibert, Cynthia L; Gorse, Geoffrey J; Los, Jenna G; Nyquist, Ann-Christine; Perl, Trish M; Price, Connie S; Radonovich, Lewis J; Reich, Nicholas G; Rodriguez-Barradas, Maria C; Bessesen, Mary T; Simberkoff, Michael S

    2018-04-01

    OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

  14. [Therapeutic effects of venlafaxine extended release for patients with depressive and anxiety disorders in the German outpatient setting - results of 2 observational studies including 8500 patients].

    Science.gov (United States)

    Anghelescu, I-G; Dierkes, W; Volz, H-P; Loeschmann, P-A; Schmitt, A B

    2009-11-01

    The therapeutic effects of venlafaxine extended release have been investigated by two prospective observational studies including 8506 patients in the outpatient setting of office based general practitioners and specialists. The efficacy has been documented by the Clinical Global Impression (CGI) scale and by the Hamilton depression (HAMD-21) scale. The tolerability has been assessed by the documentation of adverse events. About (2/3) of the patients were treated because of depression and about (1/3) mainly because of anxiety disorder. The patients of specialists did receive higher dosages and were more severely affected. The response rate on the CGI scale was 87.4 for the patients of general practitioners and 74.2 % for the patients of specialists. The results of the HAMD-21 scale, which has been used by specialists, showed a response rate of 71.8 and a remission rate of 56.3 %. These positive effects could be demonstrated even for the more severely and chronically affected patients. The incidence of adverse events was low in both studies and comparable to the tolerability profile of randomized studies. Importantly, the good tolerability profile was similar even for patients with concomitant cardiovascular disease. In conclusion, these results confirm the efficacy and good tolerability of venlafaxine extended release in the outpatient setting in Germany. Georg Thieme Verlag KG Stuttgart, New York.

  15. Evaluation of Preclinical Assays to Investigate an Anthroposophic Pharmaceutical Process Applied to Mistletoe (Viscum album L. Extracts

    Directory of Open Access Journals (Sweden)

    Stephan Baumgartner

    2014-01-01

    Full Text Available Extracts from European mistletoe (Viscum album L. developed in anthroposophic medicine are based on specific pharmaceutical procedures to enhance remedy efficacy. One such anthroposophic pharmaceutical process was evaluated regarding effects on cancer cell toxicity in vitro and on colchicine tumor formation in Lepidium sativum. Anthroposophically processed Viscum album extract (APVAE was produced by mixing winter and summer mistletoe extracts in the edge of a high-speed rotating disk and was compared with manually mixed Viscum album extract (VAE. The antiproliferative effect of VAE/APVAE was determined in five cell lines (NCI-H460, DU-145, HCC1143, MV3, and PA-TU-8902 by WST-1 assay in vitro; no difference was found between VAE and APVAE in any cell line tested (P>0.14. Incidence of colchicine tumor formation was assessed by measurement of the root/shoot-ratio of seedlings of Lepidium sativum treated with colchicine as well as VAE, APVAE, or water. Colchicine tumor formation decreased after application of VAE (−5.4% compared to water, P<0.001 and was even stronger by APVAE (−8.8% compared to water, P<0.001. The high-speed mistletoe extract mixing process investigated thus did not influence toxicity against cancer cells but seemed to sustain morphostasis and to enhance resistance against external noxious influences leading to phenomenological malformations.

  16. Use of the International Classification of Functioning, Disability and Health Generic-30 Set for the characterization of outpatients: Italian Society of Physical and Rehabilitative Medicine Residents Section Project.

    Science.gov (United States)

    Gimigliano, Francesca; De Sire, Alessandro; Gastaldo, Marco; Maghini, Irene; Paoletta, Marco; Pasquini, Andrea; Boldrini, Paolo; Selb, Melissa; Prodinger, Birgit

    2018-06-11

    The International Classification of Functioning, Disability and Health (ICF) Generic- 30 Set (previously referred to as Rehabilitation Set) is a minimal set of ICF categories for reporting and assessing functioning and disability in clinical populations with different health conditions along the continuum of care. Recently, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) developed an Italian modification of the simple and intuitive descriptions (SID) of these categories. This study was the first one to implement the use of the SID in practice. 1) To implement the use of the ICF in clinical practice and research among Italian Residents in PRM. 2) To verify if the SID made the application of ICF Generic 30 Set more user-friendly than the original descriptions. 3) To examine the prevalence of functioning problems of patients accessing Rehabilitation Services to serve as reference for the development of an ICF-based clinical data collection tool. Multicenter cross-sectional study. Italian Physical Medicine and Rehabilitation (PRM) outpatient rehabilitation services. Patients referring to Italian PRM outpatient rehabilitation services and Italian Residents in PRM. Each School of Specialization involved, randomly, received the ICF Generic-30 Set with the original descriptions or with the SID. Residents collected over a 4-month period (April-July 2016) patients data related to the ICF Generic-30 Set categories. Moreover, the residents self- assessed their difficulty in using the ICF Generic-30 Set with the original descriptions or with the SID, through a Numeric Rating Scale (NRS). Ninety-three residents collected functioning data of 864 patients (mean aged 57.7±19.3) with ICF Generic-30 Set: 304 with the original descriptions and 560 with SID. The difficulty in using the ICF Generic-30 Set with SID was rated as lower than using the original descriptions (NRS = 2.8±2.5 vs 3.5±3.1; p<0.001). The most common disease was the back pain (9.6%) and

  17. 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

    trials are needed to produce the best performance. Purpose: To examine if the fastest of three timed TUG trials producesbetter (faster) results than the recording of the second trial in elderly people when following an outpatient geriatric rehabilitation programme. Material and Methods: A total of 32...... 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...... elderly people (20 women), at a mean (SD) age of 83.4 (8.6) years were included. All subjects performed three timed TUG trials as fast as safely possible with their normal walking aid (if using). In addition, 30 of the 32 subjects performed the Chair Stand Test (CST) (number of sit to stands in 30 seconds...

  18. 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.

  19. Acute dental infections managed in an outpatient parenteral antibiotic program setting: prospective analysis and public health implications.

    Science.gov (United States)

    Connors, William J; Rabie, Heidi H; Figueiredo, Rafael L; Holton, Donna L; Parkins, Michael D

    2017-03-09

    The number of Acute Dental Infections (ADI) presenting for emergency department (ED) care are steadily increasing. Outpatient Parenteral Antibiotic Therapy (OPAT) programs are increasingly utilized as an alternative cost-effective approach to the management of serious infectious diseases but their role in the management of severe ADI is not established. This study aims to address this knowledge gap through evaluation of ADI referrals to a regional OPAT program in a large Canadian center. All adult ED and OPAT program ADI referrals from four acute care adult hospitals in Calgary, Alberta, were quantified using ICD diagnosis codes in a regional reporting system. Citywide OPAT program referrals were prospectively enrolled over a five-month period from February to June 2014. Participants completed a questionnaire and OPAT medical records were reviewed upon completion of care. Of 704 adults presenting to acute care facilities with dental infections during the study period 343 (49%) were referred to OPAT for ADI treatment and 110 were included in the study. Participant mean age was 44 years, 55% were women, and a majority of participants had dental insurance (65%), had seen a dentist in the past six months (65%) and reported prior dental infections (77%), 36% reporting the current ADI as a recurrence. Median length of parenteral antibiotic therapy was 3 days, average total course of antibiotics was 15-days, with a cumulative 1326 antibiotic days over the study period. There was no difference in total duration of antibiotics between broad and narrow spectrum regimes. Conservative cost estimate of OPAT care was $120,096, a cost savings of $597,434 (83%) compared with hospitalization. ADI represent a common preventable cause of recurrent morbidity. Although OPAT programs may offer short-term cost savings compared with hospitalization, risks associated with extended antibiotic exposures and delayed definitive dental management must also be gauged.

  20. Impact of quality management monitoring and intervention on central venous catheter dysfunction in the outpatient chemotherapy infusion setting.

    Science.gov (United States)

    Bansal, Anu; Binkert, Christoph A; Robinson, Malcolm K; Shulman, Lawrence N; Pellerin, Linda; Davison, Brian

    2008-08-01

    To assess the utility of maintaining and analyzing a quality-management database while investigating a subjectively perceived increase in the incidence of tunneled catheter and port dysfunction in a cohort of oncology outpatients. All 152 patients undergoing lytic therapy (2-4 mg alteplase) of a malfunctioning indwelling central venous catheter (CVC) from January through June 2004 at a single cancer center in the United States were included in a quality-management database. Patients were categorized by time to device failure and the initial method of catheter placement (surgery vs interventional radiology). Data were analyzed after 3 months, and areas of possible improvement were identified and acted upon. Three months of follow-up data were then collected and similarly analyzed. In a 6-month period, 152 patients treated for catheter malfunction received a total of 276 doses of lytic therapy. A 3-month interim analysis revealed a disproportionately high rate (34%) of early catheter malfunction (ECM; <30 days from placement). Postplacement radiographs demonstrated suboptimal catheter positioning in 67% of these patients, all of whom had surgical catheter placement. There was a 50% absolute decrease in the number of patients presenting with catheter malfunction in the period from April through June (P < .001). Evaluation of postplacement radiographs in these patients demonstrated a 50% decrease in the incidence of suboptimal positioning (P < .05). Suboptimal positioning was likely responsible for some, but not all, cases of ECM. Maintenance of a quality-management database is a relatively simple intervention that can have a clear and important impact on the quality and cost of patient care.

  1. Medical resource utilization for administration of trastuzumab in a New Zealand oncology outpatient setting: a time and motion study

    Directory of Open Access Journals (Sweden)

    North RT

    2015-07-01

    Full Text Available Richard T North,1 Vernon J Harvey,2 Levonne C Cox,2 Stuart N Ryan3 1Cancer and Haematology Service, Tauranga Hospital, Tauranga, 2Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, 3Medical Affairs, Roche Products (New Zealand Ltd, Auckland, New Zealand Background: In New Zealand, trastuzumab is standard therapy for human epidermal growth factor receptor-2 (HER2-positive early and metastatic breast cancer. Given the requirement for ongoing adjuvant or maintenance treatment and intravenous (IV delivery, such a regimen consumes considerable health care resources. The development of a subcutaneous (SC trastuzumab formulation with a short administration time offers the potential to reduce hospital expenditure. The aim of this study was to determine medical resource utilization associated with administration of trastuzumab SC injection via handheld syringe vs trastuzumab IV infusion in patients with HER2-positive breast cancer in New Zealand. Methods: This noninterventional, descriptive study was conducted at the outpatient oncology centers at Auckland City and Tauranga Hospitals. Trained observers recorded times associated with health care professional (HCP tasks and consumables use associated with preparation and administration of trastuzumab IV or SC in women with early or metastatic breast cancer. The cost for each formulation was calculated as the mean cost of HCP time (based on Pharmaceutical Management Agency hourly rates plus the mean cost of consumables used. Results: Use of trastuzumab SC vs IV reduced mean chair time by 36.95 minutes and total nurse time by 6.12 minutes; there was a 20.45-minute reduction in pharmacist time when the SC formulation was used. After adding consumable costs, the overall estimated saving with trastuzumab SC vs IV was $76.94 (New Zealand dollars per patient per cycle. Conclusions: Compared with trastuzumab IV infusion, administration of trastuzumab via SC injection reduced time spent in the

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

    Science.gov (United States)

    2011-01-01

    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 Introduction of

  3. [Problems in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

    Heusser, Peter; Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina

    2014-01-01

    Anthroposophic hospitals provide integrative medical care by complementing conventional (CON) with anthroposophic medicine (AM). They teach integrative medicine in postgraduate medical training (PGMT). In a first evaluation of PGMT quality in AM, we analyzed the problems of this training from the perspectives of trainers and trainees. We conducted an anonymous cross-sectional full survey of all trainee and trainer physicians at the 15 AM hospitals in Germany (DE) and Switzerland (CH) with questionnaires of the Swiss Institute of Technology (ETH) Zürich, complemented by a module for AM. We also conducted descriptive statistics for questions with answering scales as well as calculations of group differences (two-tailed Mann-Whitney U test) and a qualitative content analysis (Mayring) of free text answers related to the problem analysis. The response rate in DE embraced 89 out of 215 (41.39%) surveyed trainees and 78 out of 184 (42.39%) trainers; in CH, the response rate comprised 19 out of 25 (76%) trainees and 22 out of 30 (73.33%) trainers. Free text answers related to problem analysis in DE and CH were given by 16 out of 108 (14.8%) trainees and by 20 out of 100 (20%) trainers, overall. Perceived main problems include work overload; shortcomings in work organization; delimitation of competences; interprofessional cooperation; financial resources (trainers); wages (trainees DE); practical relevance of AM (trainees and trainers in DE); professional or didactic competence of trainers; lack of interest in AM (trainees); problems with learning and practicing AM; no curriculum for postgraduate medical training in AM; tensions between AM and CON. Explanations for the differences between DE and CH include larger departments and the DRG system in DE, but also better structural conditions for AM PGMT in CH. Main problems of PGMT in AM include not only non-specific and systemic aspects, but also AM-specific issues. In order to develop a basis for concrete problem solving

  4. 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.

  5. 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.

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

    OpenAIRE

    Gilbert, P; Ciccarone, D; Gansky, SA; Bangsberg, DR; Clanon, K; McPhee, SJ; Calderón, SH; Bogetz, A; Gerbert, B

    2008-01-01

    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...

  7. Prospective evaluation of IOTA logistic regression models LR1 and LR2 in comparison with subjective pattern recognition for diagnosis of ovarian cancer in an outpatient setting.

    Science.gov (United States)

    Nunes, N; Ambler, G; Foo, X; Widschwendter, M; Jurkovic, D

    2018-06-01

    .8-97.4%), specificity 96.3% (95% CI, 93.8-98.0%)), the specificities of the IOTA models were significantly lower (P IOTA models instead of pattern recognition (213/489 (43.6%) vs 142/489 (29.0%); P IOTA models maintained their high sensitivity when used in an outpatient setting. Specificity was relatively low, which indicates that a significant proportion of the women would have been offered unnecessary surgery for suspected ovarian cancer. These findings show that the IOTA models could be used as a first-stage test to diagnose ovarian cancer in an outpatient setting, but a different second-stage test is required to minimize the number of false-positive findings. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

  8. The impacts of a pharmacist-managed outpatient clinic and chemotherapy-directed electronic order sets for monitoring oral chemotherapy.

    Science.gov (United States)

    Battis, Brandon; Clifford, Linda; Huq, Mostaqul; Pejoro, Edrick; Mambourg, Scott

    2017-12-01

    Objectives Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve. Methods A collaborative agreement was reached among oncology pharmacists, a pharmacy resident, two oncologists, and a physician assistant to establish a pharmacist-managed oral chemotherapy monitoring clinic at the VA Sierra Nevada Healthcare System. Drug-specific electronic order sets for prescribing and lab monitoring were created for initiating new drug therapy and prescription renewal. The order sets were created to be provider-centric, minimizing clicks needed to order necessary medications and lab monitoring. A standard progress note template was developed for documenting interventions made by the clinic. Patients new to an oral chemotherapy regimen were first counseled by an oncology pharmacist. The patients were then enrolled into the oral chemotherapy monitoring clinic for subsequent follow up and pharmacist interventions. Further, patients lacking monitoring or missing provider appointments were captured through a Clinical Dashboard developed by the US Department of Veterans Affairs (VA) Regional Office (VISN21) using SQL Server Reporting Services. Between September 2014 and April 2015, a total of 68 patients on different oral chemotherapy agents were enrolled into the clinic. Results Out of the 68 patients enrolled into the oral chemotherapy

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

    Science.gov (United States)

    Büssing, Arndt; Cysarz, Dirk; Edelhäuser, Friedrich; Bornhöft, Gudrun; Matthiessen, Peter F; Ostermann, Thomas

    2008-12-04

    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. 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. 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. 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.

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

    Science.gov (United States)

    Büssing, Arndt; Cysarz, Dirk; Edelhäuser, Friedrich; Bornhöft, Gudrun; Matthiessen, Peter F; Ostermann, Thomas

    2008-01-01

    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. PMID:19055811

  12. 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.

  13. A pilot study of the efficacy of a computerized executive functioning remediation training with game elements for children with ADHD in an outpatient setting: outcome on parent and teacher-rated executive functioning and ADHD behavior

    NARCIS (Netherlands)

    van der Oord, S.; Ponsioen, A.J.G.B.; Geurts, H.M.; ten Brink, E.L.; Prins, P.J.M.

    2014-01-01

    Objective: This pilot study tested the short- and long-term efficacy (9 weeks follow-up) of an executive functioning (EF) remediation training with game elements for children with ADHD in an outpatient clinical setting, using a randomized controlled wait-list design. Furthermore, in a subsample,

  14. Factors That Influence Vaccination Decision-Making by Parents Who Visit an Anthroposophical Child Welfare Center: A Focus Group Study

    Directory of Open Access Journals (Sweden)

    Irene A. Harmsen

    2012-01-01

    Full Text Available 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 ( 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.

  15. Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting?

    Science.gov (United States)

    Mallett, Ross; Bakker, Edward; Burton, Maria

    2014-12-01

    The aim of the present study was to establish if physiotherapy self-referral (SR) is viable, cost effective and beneficial to musculoskeletal outpatients in a primary care setting. In an urban National Health Service (NHS) primary care physiotherapy service, waiting times, attendance rates and treatment ratios (thus, episode-of-care costs) were deemed unsustainable. The introduction of 'Any Qualified Provider' is imminent and will drive NHS physiotherapy services to compete directly with private counterparts. Current literature, healthcare policy and the Chartered Society of Physiotherapy strongly advocate SR to promote value for money and improve the patient experience. A repeated measure prospective cohort study introduced an SR pathway parallel to existing general practice (GP) referrals and compared costs, attendance and data relating to the patient experience across groups. SR referral groups were found to have a higher proportion of female patients presenting with acute conditions. Cost minimization analysis indicated an average 32.3% reduction in episode-of-care cost with an SR-initiated intervention. An estimated cost minimization of between £84,387.80 and £124,472.06 was calculated if SR were to be expanded service-wide. SR referral reduced waiting times and improved patient satisfaction relating to waiting times and communication compared with traditional pathways. The results of the present study showed that the introduction of the described SR pathway was feasible, cost-effective and offered comparable care. Certain aspects of the SR patient experience compared more favourably than those studied in traditional GP referral routes. They also added to an existing body of evidence supporting SR with a variety of administrative processes in various socioeconomic settings. Copyright © 2014 John Wiley & Sons, Ltd.

  16. Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting.

    Science.gov (United States)

    Christiansen, Sandra; Jürgens, Tim P; Klinger, Regine

    2015-09-01

    To test the long-term clinical effectiveness (follow-up at 3, 6 and 12 months) of an outpatient combined group and individual cognitive-behavioral treatment (CBT) for headache patients following standard medical care. A decrease in headache intensity, frequency, headache-specific impairment, depression, and change of pain-related cognitions was expected. The efficacy of CBT for primary headaches has been confirmed in research, yet the translation into clinical practice has remained untested thus far. In this single-group outcome study, 87 headache patients diagnosed with migraine and/or tension-type headache received (1) headache-specific medication for 10 weeks and (2) a subsequent CBT treatment made up of 13 individual and 12 group sessions consisting of psychoeducation, progressive muscle relaxation, coping strategies for pain and stress, and goal setting skills. Booster group sessions after 3 and 6 months were implemented to stimulate individual goal attainment, and follow-up measures were recorded up to 12 months. A significant decrease was found for all primary and secondary outcome criteria, ie, average headache intensity (prae M: 6.0, standard deviation [SD]: 1.5 vs follow-up [FU] 1 year M: 5.1, SD: 1.9), headache frequency (prae M: 16.0, SD: 9.5 vs FU 1 year M: 13.4, SD: 9.9), and catastrophizing (prae M: 3.4, SD: 1.0 vs FU 1 year M: 2.6, SD: 1.1). Coping strategies were increased (prae M: 3.4, SD: .9 vs FU 1 year M: 4.0, SD: 1.0). CBT treatment is a useful component within a routine clinical setting and can improve standard medical care thereby helping patients in managing their headache pain. © 2015 American Headache Society.

  17. Outpatient invasive radiologic procedures - Diagnostic and therapeutic

    International Nuclear Information System (INIS)

    Dublin, A.

    1987-01-01

    This book is a ''how-to'' book for radiologists who are planning to, or considering whether to establish outpatient practice in response to DRGs. It provides practical, expert advice on both the administrative and clinical sides of outpatient radiology. It focuses on the essentials of clinical practice in the outpatient setting - and how it differs from inpatient practice

  18. Efficacy and Safety of Oritavancin Relative to Vancomycin for Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI) in the Outpatient Setting: Results From the SOLO Clinical Trials.

    Science.gov (United States)

    Lodise, Thomas P; Redell, Mark; Armstrong, Shannon O; Sulham, Katherine A; Corey, G Ralph

    2017-01-01

    The objective of this analysis was to evaluate the efficacy and safety of oritavancin compared with vancomycin for patients with acute bacterial skin and skin structure infections (ABSSSIs) who received treatment in the outpatient setting in the Phase 3 SOLO clinical trials. SOLO I and SOLO II were 2 identically designed comparative, multicenter, double-blind, randomized studies to evaluate the efficacy and safety of a single 1200-mg dose of intravenous (IV) oritavancin versus 7-10 days of twice-daily IV vancomycin for the treatment of ABSSSI. Protocols were amended to allow enrolled patients to complete their entire course of antimicrobial therapy in an outpatient setting. The primary efficacy outcome was a composite endpoint (cessation of spread or reduction in size of the baseline lesion, absence of fever, and no rescue antibiotic at early clinical evaluation [ECE]) (48 to 72 hours). Key secondary endpoints included investigator-assessed clinical cure 7 to 14 days after end of treatment (posttherapy evaluation [PTE]) and 20% or greater reduction in lesion area at ECE. Safety was assessed until day 60. Seven hundred ninety-two patients (oritavancin, 392; vancomycin, 400) received entire course of treatment in the outpatient setting. Efficacy response rates at ECE and PTE were similar (primary composite endpoint at ECE: 80.4% vs 77.5% for oritavancin and vancomycin, respectively) as was incidence of adverse events. Five patients (1.3%) who received oritavancin and 9 (2.3%) vancomycin patients were subsequently admitted to a hospital. Oritavancin provides a single-dose alternative to multidose vancomycin for treatment of ABSSSI in the outpatient setting. © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

  19. Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)

    Science.gov (United States)

    Kalra, Ankur; Pokharel, Yashashwi; Hira, Ravi S; Risch, Samantha; Vicera, Veronique; Li, Qiong; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Glusenkamp, Nathan; Turakhia, Mintu P; Virani, Salim S

    2015-01-01

    Background India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India’s first national outpatient CVD quality-improvement program. Methods and Results In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin–angiotensin–aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation. Conclusions This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data

  20. Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP).

    Science.gov (United States)

    Kalra, Ankur; Pokharel, Yashashwi; Hira, Ravi S; Risch, Samantha; Vicera, Veronique; Li, Qiong; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Glusenkamp, Nathan; Turakhia, Mintu P; Virani, Salim S

    2015-05-20

    India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology's PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India's first national outpatient CVD quality-improvement program. In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin-angiotensin-aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation. This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data collection and demonstrates that such an initiative is

  1. Tablet splitting: is it worthwhile? Analysis of drug content and weight uniformity for half tablets of 16 commonly used medications in the outpatient setting.

    Science.gov (United States)

    Helmy, Sally A

    2015-01-01

    Tablet splitting is a well-established medical practice in clinical settings for multiple reasons, including cost savings and ease of swallowing. However, it does not necessarily result in weight-uniform half tablets. To (a) investigate the effect of tablet characteristics on weight and content uniformity of half tablets, resulting from splitting 16 commonly used medications in the outpatient setting and (b) provide recommendations for safe tablet-splitting prescribing practices. Ten random tablets from each of the selected medications were weighed and split by 5 volunteers (2 men and 3 women aged 25-44 years) using a knife. The selected medications were mirtazapine 30 mg, bromazepam 3 mg, oxcarbazepin 150 mg, sertraline 50 mg, carvedilol 25 mg, bisoprolol fumarate 10 mg, losartan 50 mg, digoxin 0.25 mg, amiodarone HCl 200 mg, metformin HCl 1,000 mg, glimepiride 4 mg, montelukast 10 mg, ibuprofen 600 mg, celecoxib 200 mg, meloxicam 15 mg, and sildenafil citrate 50 mg. The resulting half tablets were evaluated for weight and drug content uniformity in accordance with proxy United States Pharmacopeia (USP) specification (95%-105% for digoxin and 90%-110% for the other 15 drugs). Weight and drug content uniformity were assessed by comparing weight or drug content of the half tablets with one-half of the mean weight or drug content for all whole tablets in the sample. The percentages by which the weight and drug content of each whole tablet or half tablet differed from sample mean values were calculated. Other relevant physical characteristics of the 16 products were measured. A total of 52 of 320 half tablets (16.2%) and 48 of 320 half tablets (15.0%) fell outside of the proxy USP specification for weight and drug content, respectively. Bromazepam, carvedilol, bisoprolol, losartan, digoxin, and meloxicam half tablets failed the weight and content uniformity test; however, the half tablets for the rest of the medications passed the test. Mean percent weight loss after

  2. Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain

  3. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals

    OpenAIRE

    Heusser, Peter; Eberhard, Sabine; Berger, Bettina; Weinzirl, Johannes; Orlow, Pascale

    2014-01-01

    Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland...

  4. The Outpatient Physical Examination.

    Science.gov (United States)

    Artandi, Maja K; Stewart, Rosalyn W

    2018-05-01

    The physical examination in the outpatient setting is a valuable tool. Even in settings where there is lack of evidence, such as the annual physical examination of an asymptomatic adult, the physical examination is beneficial for the physician-patient relationship. When a patient has specific symptoms, the physical examination-in addition to a thorough history-can help narrow down, or in many cases establish, a diagnosis. In a time where imaging and laboratory tests are easily available, but are expensive and can be invasive, a skilled physical examination remains an important component of patient evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals.

    Science.gov (United States)

    Heusser, Peter; Eberhard, Sabine; Berger, Bettina; Weinzirl, Johannes; Orlow, Pascale

    2014-06-16

    Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach's alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann-Whitney U-test for independent variables to calculate group differences. The level of significance was set at p 0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. The lower quality of PGMT in German hospitals can be attributed to

  6. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals

    Science.gov (United States)

    2014-01-01

    Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT. Methods An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p 0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features. Conclusion The lower quality of PGMT in

  7. 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.

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

    International Nuclear Information System (INIS)

    Ledermann, H.P.; Mengiardi, B.; Schmid, A.; Froehlich, J.M.

    2010-01-01

    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 -1 1.73 m -2 ) in 10 (1.3%) and moderate RI (eGFR 30-59 ml min -1 1.73 m -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.)

  9. THE CONTROL OF INTERNATIONAL NORMALISED RATIO IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH WARFARIN IN OUTPATIENT AND HOSPITAL SETTINGS: DATA FROM RECVASA REGISTRIES

    Directory of Open Access Journals (Sweden)

    M. M. Loukianov

    2018-01-01

    Full Text Available Am. To study in the RECVASA registers the availability of data about the international normalized ratio (INR indicator and achievement of its target values in outpatient and hospital practice in patients with atrial fibrillation (AF receiving anticoagulant therapy with warfarin.Material and methods. Data about the INR control and the frequency of achievement of its target values at the outpatient and hospital stages were analyzed in RECVASA (Ryazan and RECVASA FP – Yaroslavl outpatient registries, as well as in the hospital registers RECVASA FP (Moscow, Kursk, Tula in 817 patients (46.9% of men, age 68.5±9.6 years with AF and the prescribed anticoagulant therapy with warfarin.Results. INR was determined in 689 (84.3% of 817 patients. The values of INR were monitored during therapy with warfarin in RECVASA (Ryazan and RECVASA FP –Yaroslavl outpatient registries in 73.7% and 77.7% of patients, respectively, and in RECVASA FP hospital registers: 95.8% (Moscow; 81.3% (Tula and 93.5% (Kursk. The target level of INR (2.0-3.0 was achieved in a minority of patients with AF during treatment with warfarin: inRyazan – in 26.3% of cases;Yaroslavl – 38.3%;Kursk – 34.8%;Moscow – 39.5%; Tule – 26.3%. Control of INR in hospital registries during warfarin therapy in patients with AF significantly more often (p<0.05 was performed at the hospital stage, compared with prehospital (in Kursk –2.3 times more often in Moscow – 2.6 times, in Tula – in 1,8 times. The target level of INR in the hospital was achieved significantly more often (p<0.05 than before hospitalization (Moscow andKursk, but no significant differences were found in the RECVASA FP –Tula register (p=0.08. The INR was monitored by 94.9% of the patients; however, the target values of this indicator were achieved only in 33% of cases in the sample study in the RECVASA FP –Moscow registry according to a survey of 39 patients with AF who continued to receive warfarin after 2.6±0

  10. Outpatient management of schizophrenia.

    Science.gov (United States)

    Martin, R L

    1991-03-01

    As effective antipsychotic pharmacotherapy has become available, patients with schizophrenia are increasingly managed in an outpatient setting by primary care physicians. Pharmacotherapy is generally effective in treating "positive," or psychotic, symptoms and lessening the risks of relapse, but ineffective in improving "negative," or deficit, symptoms. Aggressive attempts to totally control positive symptoms and to ameliorate negative symptoms tend to increase side effects and may be detrimental to the patient. Intensive psychotherapeutic and rehabilitative approaches are generally unproductive. Attempting to obtain a cure is unrealistic. A moderate approach is recommended, taking into consideration the limitations of existing treatments, achieving control of extreme symptoms and minimizing social and occupational limitations.

  11. 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.)

  12. Transdermal fentanyl for pain caused by radiotherapy in head and neck cancer patients treated in an outpatient setting. A multicenter trial in Taiwan

    International Nuclear Information System (INIS)

    Chang, J.T.C.; Lin Chienyu; Wang Hungming; Lin Jinching; Lee Moonsing; Chen Yujen

    2010-01-01

    This study evaluated the efficacy and safety of transdermal fentanyl in the outpatient treatment of head and neck cancer patients with pain caused by radiotherapy. Patients with a visual analogue scale score ≥4 were invited to participate in the study. The following variables were collected: visual analogue scale, the Brief Pain Inventory, concomitant pain medications and adverse effects. A total of 163 head and neck cancer patients were enrolled (148 males and 15 females; median age, 53 years; age range, 21-72 years). Seventy-two (44%) patients had a visual analogue scale score >6 at enrollment, despite the use of non-steroidal anti-inflammatory drugs or weak opioids. Ninety-four (57.7%) patients received concurrent chemotherapy. A total of 88 patients completed the study, whereas 55 underwent a drop-out by side effects. The most frequently reported adverse events were vomiting (23.9%) and nausea (16.6%). Treatment with transdermal fentanyl resulted in a significant decrease in visual analogue scale and Brief Pain Inventory scores that persisted during treatment. In the overall efficacy evaluation, the pain-alleviating effect, the easiness of application and the overall impression of transdermal fentanyl were rated as good by 54.5%, 65.9% and 59.1% of the completers, respectively. Effects of transdermal fentanyl were rated as good by 64.8% of the investigators. Our data provide evidence that transdermal fentanyl is effective and relatively easy to use for outpatient treatment of pain control in head and neck cancer patients following radiotherapy in selected patients. Reduction of side effects and effective pain management need to be paramount in the management of head and neck cancer patients undergoing radiotherapy. (author)

  13. Reducing the Risk of Cardiovascular Diseases in Non-selected Outpatients With Schizophrenia: A 30-Month Program Conducted in a Real-life Setting.

    Science.gov (United States)

    Hjorth, Peter; Juel, Anette; Hansen, Mette Vinther; Madsen, Nikolaj Juul; Viuff, Anne Grethe; Munk-Jørgensen, Povl

    2017-12-01

    The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors. Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic. On average, the participating women reduced their waist circumference by 11.4cm (P=0.037), whereas the participating men increased their waist circumference by 3.3cm (P=0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P=0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1l/day (P=0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P=0.086). The time women spent on light physical activity increased from 134 to 469min/week (P=0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers. Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 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

    International Nuclear Information System (INIS)

    Mueller, Frank Hugo Heinz

    2014-01-01

    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 measures and

  15. 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

  16. Towards non-reductionistic medical anthropology, medical education and practitioner-patient-interaction: the example of Anthroposophic Medicine.

    Science.gov (United States)

    Heusser, Peter; Scheffer, Christian; Neumann, Melanie; Tauschel, Diethart; Edelhäuser, Friedrich

    2012-12-01

    To develop the hypothesis that reductionism in medical anthropology, professional education and health care influences empathy development, communication and patient satisfaction. We identified relevant literature and reviewed the material in a structured essay. We reflected our hypothesis by applying it to Anthroposophic Medicine (AM), an example of holistic theory and practice. Reductionism in medical anthropology such as in conventional medicine seems to lead to a less empathetic and less communicative health care culture than holism such as in CAM disciplines. However, reductionism can be transformed into a systemic, multi-perspective holistic view, when the emergent properties of the physical, living, psychic, spiritual and social levels of human existence and the causal relations between them are more carefully accounted for in epistemology, medical anthropology and professional education. This is shown by the example of AM and its possible benefits for communication with and satisfaction of patients. A non-reductionistic understanding of the human being may improve communication with patients and enhance patient benefit and satisfaction. Interdisciplinary qualitative and quantitative studies are warranted to test this hypothesis and to understand the complex relations between epistemology, medical anthropology, education, health care delivery and benefit for patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. A cross-sectional study of the knowledge, attitude, and practice of patients aged 50 years or above towards herpes zoster in an out-patient setting.

    Science.gov (United States)

    Lam, A Cy; Chan, M Y; Chou, H Y; Ho, S Y; Li, H L; Lo, C Y; Shek, K F; To, S Y; Yam, K K; Yeung, I

    2017-08-01

    There has been limited research on the knowledge of and attitudes about herpes zoster in the Hong Kong population. This study aimed to investigate the knowledge, attitude, and practice of patients aged 50 years or above towards herpes zoster and its vaccination. This was a cross-sectional study in the format of a structured questionnaire interview carried out in Sai Ying Pun Jockey Club General Outpatient Clinic in Hong Kong. Knowledge of herpes zoster and its vaccination was assessed, and patient attitudes to and concerns about the disease were evaluated. Factors that affected a decision about vaccination against herpes zoster were investigated. A total of 408 Hong Kong citizens aged 50 years or above were interviewed. Multiple regression analysis revealed that number of correct responses regarding knowledge about herpes zoster was positively correlated with educational attainment (B=0.313, P=0.026) and history of herpes zoster (B=0.408, P=0.038), and negatively correlated with age (B= -0.042, Pherpes zoster. Misconceptions about herpes zoster were notable in this study. More health education is needed to improve the understanding and heighten awareness of herpes zoster among the general public. Although the majority of participants indicated that herpes zoster would have a significant impact on their health, a relatively smaller proportion was actually worried about getting the disease. Further studies on this topic should be encouraged to gauge the awareness and knowledge of herpes zoster among broader age-groups.

  18. [A case report-advanced pancreas cancer with liver and lung metastases well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting].

    Science.gov (United States)

    Hasuike, Yasunori; Tanigawa, Takahiko; Yamada, Masaharu; Minami, Yukiko; Ezumi, Koji; Kashiwazaki, Masaki; Fujimoto, Takayoshi

    2008-11-01

    We report a case of advanced pancreatic cancer with liver and lung metastases that was well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting. The patient was a 74-year-old woman. Chief complaints were back pain and anorexia. She was diagnosed with pancreas cancer with liver and lung metastases at the time of first visit. We started systemic chemotherapy with gemcitabine 1 g/body and 5-FU 1 g/body alternately every other week on an outpatient basis. At 1.5 months (M) after initiation of chemotherapy, we started radiation therapy to the main tumor at a total dose of 40 Gy. After radiation, chemotherapy was resumed. As a result, the size of the main tumor decreased but metastatic liver tumors got larger. Then we changed to combination therapy with systemic chemotherapy (gemcitabine and 5-FU) and hepatic arterial infusion (5-FU weekly). Liver metastases almost disappeared after 7.5 M. Despite all these treatments, however, the number of metastatic lung tumors increased. The patient was hospitalized for 15 M and died after 17 M. We focused on and succeeded in the prolongation of lifetime and maintenance of QOL by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion therapy.

  19. Clinical and economic impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in England and Wales.

    Science.gov (United States)

    Guest, Julian F; Candy, David C A; Clegg, John P; Edwards, Di; Helter, Marianne T; Dale, Anne K; Fell, John; Cosgrove, Michael; Debelle, Geoffrey

    2007-09-01

    To estimate the clinical and economic impact of using macrogol 3350 plus electrolytes (macrogol 3350; Movicol; Movicol Paediatric Plain) in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction. A chart review was undertaken to extract clinical outcomes and resource use from the case notes of a cohort of children aged 2-11 years with faecal impaction who initially received either macrogol 3350 (in an outpatient setting) or enemas and suppositories or manual evacuation for initial disimpaction. Five centres across England and Wales participated in the study. These data were used to inform a decision model which depicted the management of children during the disimpaction phase and for a period of 12 weeks following initial disimpaction. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the incremental costs and consequences of using macrogol 3350 in an outpatient setting, compared to the other treatments, to be estimated. 112 patients treated with macrogol 3350, 101 who received enemas and suppositories and 11 who underwent a manual evacuation were eligible for analysis. Ninety-seven per cent of children treated with macrogol 3350 were successfully disimpacted within 5 days, compared to 73% of those who received enemas and suppositories and 89% of those who underwent a manual evacuation (p suppositories and manual evacuation respectively; p suppositories or underwent a manual evacuation, respectively. Hence, using macrogol 3350 instead of enemas and suppositories and manual evacuation to disimpact the whole annual cohort of faecally impacted children aged 2-11 years in England could potentially reduce annual NHS expenditure on this condition by 59% (5 million pounds sterling) and reduce the annual number of paediatric hospital admissions for this condition by 92% (4330). Within the limitations of our model, macrogol 3350 affords the NHS

  20. 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

    with a CHADS2 ≥ 2 was 42.1, 63.0, and 32.4%, respectively. Initiation of OAC therapy was only modestly influenced by CHADS2 and HAS-BLED scores, regardless of the healthcare setting. The rate of TE was 4.30 [95% confidence interval (CI) 4.21-4.40] per 100 person-years for inpatients, 2.28 (95% CI 2...

  1. 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

  2. Vaginal hysterectomy, an outpatient procedure.

    Science.gov (United States)

    Engh, Marie Ellström; Hauso, Wenche

    2012-11-01

    To report our experience of treating women undergoing vaginal hysterectomy in an outpatient setting and to identify risk factors for hospital admission and women dissatisfied with care. Prospective observational report. department of obstetrics and gynecology, university hospital in Norway. 150 women who underwent vaginal hysterectomy at the outpatient clinic from February 2009 to April 2010. Perioperative data were collected prospectively and case notes were searched for complications. On the first postoperative day all women were contacted by telephone by a nurse. A visual analogue scale (VAS) was used to monitor pain and nausea during the stay at the outpatient clinic and the day after surgery. VAS was also used to specify the women's degree of satisfaction with care the day after surgery. The number of women who could be discharged from the outpatient unit and had a satisfaction score of ≥7 the day after surgery. Of the 150 women, 84% could be discharged after a mean observation period of 276 min (SD ± 80 min). The mean satisfaction score was 9.0, SD ± 1.4, and 92.6% of the women reported ≥7 points in the satisfaction score. No women with serious complications were sent home. Using a multivariable logistic regression model only pain at discharge was found as significant (p= 0.009) for admittance to hospital. Vaginal hysterectomy is a feasible outpatient procedure and the majority of women were satisfied with the care they received. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  3. A pilot study of the efficacy of a computerized executive functioning remediation training with game elements for children with ADHD in an outpatient setting: outcome on parent- and teacher-rated executive functioning and ADHD behavior.

    Science.gov (United States)

    van der Oord, S; Ponsioen, A J G B; Geurts, H M; Ten Brink, E L; Prins, P J M

    2014-11-01

    This pilot study tested the short- and long-term efficacy (9 weeks follow-up) of an executive functioning (EF) remediation training with game elements for children with ADHD in an outpatient clinical setting, using a randomized controlled wait-list design. Furthermore, in a subsample, that is, those treated with methylphenidate, additive effects of the EF training were assessed. A total of 40 children (aged 8-12 years) were randomized to the EF training or wait-list. The training consisted of a 25-session training of inhibition, cognitive flexibility, and working memory. Treatment outcome was assessed by parent- and teacher-rated EF, ADHD, oppositional deviant disorder, and conduct disorder symptoms. Children in the EF training showed significantly more improvement than those in the wait-list condition on parent-rated EF and ADHD behavior in the total sample and in the subsample treated with methylphenidate. Effects were maintained at follow-up. This pilot study shows promising evidence for the efficacy of an EF training with game elements. © 2012 SAGE Publications.

  4. 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...

  5. 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...

  6. [Vitreoretinal outpatient surgery: clinical and financial considerations].

    Science.gov (United States)

    Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

    2008-11-01

    Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

  7. Satisfaction with the outpatient encounter - A comparison of patients' and physicians' views

    NARCIS (Netherlands)

    Zandbelt, Linda C.; Smets, Ellen M. A.; Oort, Frans J.; Godfried, Mieke H.; de Haes, Hanneke C. J. M.

    2004-01-01

    OBJECTIVE: To compare patients' and physicians' visit-specific satisfaction in an internal medicine outpatient setting, and to explain their respective views. DESIGN: Patients' and physicians' background characteristics were assessed prior to outpatient encounters. Immediately after the encounter,

  8. Billing for outpatient transplant pharmacy services.

    Science.gov (United States)

    Maldonado, Angela Q; Seiger, Todd C; Urann, Christina L; McCleary, Jo Ann; Goroski, Angela L; Ojogho, Okechukwu N

    2012-01-15

    The economic impact of out-patient pharmacy services in a transplant program was evaluated. Full-time kidney transplant pharmacy services were implemented at Providence Sacred Heart Medical Center (PSHMC) in the fall of 2008, with two pharmacists combining hours to provide one full-time-equivalent position. At PSHMC, posttransplantation patients are seen three times per week. The number of patient visits with pharmacists for 2010 was compared with the total number of patient visits. The face-to-face time spent with the patient was translated to a level of billing that was associated with a set reimbursement schedule. For each patient encounter in which a pharmacist was involved, the incremental difference between the nursing and pharmacy levels of billing was examined, as were the levels most often billed by pharmacists. The difference in billing levels between pharmacists and nurses for the same patient encounter was also evaluated. Overall, pharmacist visits accounted for 208 (22%) of the 994 out-patient kidney transplant visits in 2010, with pharmacists billing at a higher level of acuity compared with nursing for the same patient encounter 48% of the time. This translated to an approximate increase of $100 per patient visit. For the one-year study period, pharmacists utilizing facility- fee billing increased out-patient reimbursement by approximately $10,000. By utilizing outpatient facility-fee billing for pharmacy services, the transplant program at PSHMC increased reimbursement in the outpatient setting.

  9. Outpatient waiting time in Jos University Teaching Hospital ...

    African Journals Online (AJOL)

    Problem Long waiting time for services has been identified as a reason people avoid presenting to for care in African countries. Design Examination of causes for long outpatient waiting time and the effect of measures to reduce waiting time. Setting Outpatient department of the Jos University Teaching Hospital.

  10. Outpatient total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Vehmeijer, Stephan B.W.; Husted, Henrik; Kehlet, Henrik

    2017-01-01

    , but efforts to control undesirable pathophysiological responses will be a prerequisite to improve the success rate of an outpatient setting. Also, care must be taken to avoid extra activities or investments solely to enable discharge on the day of surgery. Further cost analyses will have to be performed...

  11. Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial [SATT]): a randomised, open-label, equivalence trial.

    Science.gov (United States)

    Mir, Fatima; Nisar, Imran; Tikmani, Shiyam S; Baloch, Benazir; Shakoor, Sadia; Jehan, Fyezah; Ahmed, Imran; Cousens, Simon; Zaidi, Anita K M

    2017-02-01

    Parenteral antibiotic therapy for young infants (aged 0-59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection. We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0-59 days) who either presented at a primary health-care clinic or were identified by a community health worker with signs of clinical severe infection. We included infants who were not critically ill and whose family refused admission. We randomly assigned infants to either intramuscular procaine benzylpenicillin and gentamicin once a day for 7 days (reference); oral amoxicillin twice daily and intramuscular gentamicin once a day for 7 days; or intramuscular procaine benzylpenicillin and gentamicin once a day for 2 days followed by oral amoxicillin twice daily for 5 days. The primary outcome was treatment failure within 7 days of enrolment and the primary analysis was per protocol. We judged experimental treatments as efficacious as the reference if the upper bound of the 95% CI for the difference in treatment failure was less than 5·0. This trial is registered at ClinicalTrials.gov, number NCT01027429. Between Jan 1, 2010, and Dec 26, 2013, 2780 infants were deemed eligible for the trial, of whom 2453 (88%) were enrolled. Because of inadequate clinical follow-up or treatment adherence, 2251 infants were included in the per-protocol analysis. 820 infants (747 per protocol) were assigned the reference treatment of procaine benzylpenicillin and gentamicin, 816 (751 per protocol) were allocated amoxicillin and gentamicin, and

  12. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM

    Directory of Open Access Journals (Sweden)

    Goorden M

    2017-07-01

    Full Text Available Maartje Goorden,1 Christina M van der Feltz-Cornelis,2,3 Kirsten M van Steenbergen-Weijenburg,4 Eva K Horn,5 Aartjan TF Beekman,6,7 Leona Hakkaart-van Roijen1 1Institute of Health Policy and Management (iBMG/Institute for Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, 2Tranzo Department, Tilburg University, 3Clinical Centre of Excellence for Body, Mind and Health, GGzBreburg, Tilburg, 4Trimbos Instituut, Utrecht, 5Viersprong Institute for Studies on Personality Disorders, Halsteren, 6Department of Psychiatry, 7EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands Purpose: Major depressive disorder (MDD is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.Patients and methods: In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.Results: The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680 compared to €4,582 (95% CI: 2,782 to 6,740 in the CAU group. The average quality-adjusted life years (QALYs gained were 0.07 higher

  13. Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

    Science.gov (United States)

    Marsh, Fiona; Kremer, Christian; Duffy, Sean

    2004-03-01

    To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

  14. 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. Copyright 2014, SLACK Incorporated.

  15. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...

  16. Blood lipid profiles and factors associated with dyslipidemia assessed by a point-of-care testing device in an outpatient setting: A large-scale cross-sectional study in Southern China.

    Science.gov (United States)

    Zhang, Pei-dong; He, Lin-yun; Guo, Yang; Liu, Peng; Li, Gong-xin; Wang, Li-zi; Liu, Ying-feng

    2015-06-01

    To promote the concept of POCT and to investigate dyslipidemia in Guangzhou, China, we performed a study examining blood lipids assessed by POCT and reported factors associated with dyslipidemia. This multicenter, cross-sectional study enrolled outpatients from 9 Guangzhou hospitals from May through September 2013. After informed consent was obtained, the following information was collected: age; gender; the presence of diabetes mellitus, obesity, and hypertension as well as current use of cigarettes or alcohol. Patients were asked to fast for 8h before the blood examination performed on a POCT device, the CardioChek PA. Of 4012 patients enrolled (1544 males, 2468 females; mean age 60.35±9.41 years), 1993 (49.7%) patients had dyslipidemia, but only 101 (5.1%) took statins. The multivariate tests of associations between demographic variables, comorbidities, and the risk of having dyslipidemia found that the significant predictors of dyslipidemia were male gender, age ≥60 years, being a current smoker or alcohol drinker, and hypertension. Most dyslipidemia patients in Guangzhou remain untreated. POCT in China is feasible, and its widespread use might improve dyslipidemia awareness, treatment and control. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  17. Monitoring Outpatient Care

    Science.gov (United States)

    2003-01-01

    Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

  18. 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.

  19. 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.

  20. A 4-year non-randomized comparative phase-IV study of early rheumatoid arthritis: integrative anthroposophic medicine for patients with preference against DMARDs versus conventional therapy including DMARDs for patients without preference

    Directory of Open Access Journals (Sweden)

    Hamre HJ

    2018-03-01

    Full Text Available Harald J Hamre,1 Van N Pham,2 Christian Kern,3 Rolf Rau,4 Jörn Klasen,3 Ute Schendel,5 Lars Gerlach,6 Attyla Drabik,2 Ludger Simon6,† 1Institute for Applied Epistemology and Medical Methodology at the Witten/Herdecke University, Freiburg, Germany; 2Institute of Statistics in Medicine, Universitätsklinikum Düsseldorf, Düsseldorf, Germany; 3Department of Integrative Medicine, Asklepios Westklinikum, Hamburg, Germany; 4Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Ratingen, Germany; 5Department of Rheumatology, m&i-Fachklinik Bad Pyrmont, Bad Pyrmont, Germany; 6Department of Internal Medicine and Gastroenterology, Filderklinik, Filderstadt, Germany †Dr Ludger Simon passed away on June 10, 2016 Background: While disease-modifying antirheumatic drugs (DMARDs are a mainstay of therapy for rheumatoid arthritis (RA, some patients with early RA refuse DMARDs. In anthroposophic medicine (AM, a treatment strategy for early RA without DMARDs has been developed. Preliminary data suggest that RA symptoms and inflammatory markers can be reduced under AM, without DMARDs. Patients and methods: Two hundred and fifty-one self-selected patients aged 16–70 years, starting treatment for RA of <3 years duration, without prior DMARD therapy, participated in a prospective, non-randomized, comparative Phase IV study. C-patients were treated in clinics offering conventional therapy including DMARDs, while A-patients had chosen treatment in anthroposophic clinics, without DMARDs. Both groups received corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs. Primary outcomes were intensity of RA symptoms measured by self-rating on visual analog scales, C-reactive protein, radiological progression, study withdrawals, serious adverse events (SAE, and adverse drug reactions in months 0–48. Results: The groups were similar in most baseline characteristics, while A-patients had longer disease duration (mean 15.1 vs 10.8 months, p<0

  1. The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities.

    Science.gov (United States)

    Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G

    2015-01-01

    There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.

  2. Implementation and evaluation of an algorithm-based order set for the outpatient treatment of urinary tract infections in the spinal cord injury population in a VA Medical Center.

    Science.gov (United States)

    Patros, Clayton; Sabol, Mirella; Paniagua, Angela; Lans, Daniel

    2018-03-01

    Treatment of urinary tract infections (UTI) in the spinal cord injury (SCI) population is often difficult due to the lack of symptoms, increased resistance, and increased morbidity and mortality associated with UTIs. To develop an algorithm-based order set for the treatment of UTIs for patients with SCI based on SCI-specific antibiogram data in order to assess and improve current antimicrobial prescribing practices at the Clement J. Zablocki Veterans Affairs Medical Center (ZVAMC). This study is a retrospective, pre- and post-implementation analysis of an order set based on SCI antibiogram data. Descriptive statistics were used to compare baseline data and characteristics and chi squared tests were used to evaluate the primary outcome and all secondary outcomes. To achieve a power of 80% with an effect size of 0.3, the goal was to assess 45 antimicrobial treatment courses in the pre-implementation group and 45 antimicrobial treatment courses in the post-implementation group. The percentage of appropriate antimicrobial treatment courses increased from 47.9% in the pre-intervention group (n = 73) to 71.8% in the post-intervention group (n = 39), which was statistically significant (P = 0.015). Patients with SCI treated for UTIs within the ZVAMC had a significantly higher percentage of appropriate treatment courses following the implementation of a unit-specific antibiogram, electronic order set, and educational in-service for providers. An order set and unit-specific antibiogram with related education may be beneficial in improving antimicrobial therapy from a stewardship perspective.

  3. 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...

  4. Adding psychologist's intervention to physicians' advice to problem drinkers in the outpatient clinic

    NARCIS (Netherlands)

    Emmen, M. J.; Schippers, G. M.; Wollersheim, H.; Bleijenberg, G.

    2005-01-01

    AIMS: To test the effectiveness of a brief psychological intervention for problem drinking among outpatients in a hospital setting. METHODS: Over a period of 3 years physicians screened patients who visited an outpatient clinic for general internal medicine for problem drinking. Of the 4728 patients

  5. A comparison of inpatient versus outpatient resistance patterns of pediatric urinary tract infection.

    Science.gov (United States)

    Saperston, Kara N; Shapiro, Daniel J; Hersh, Adam L; Copp, Hillary L

    2014-05-01

    Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level. We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chi-square analysis. We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. The Profile and Urological Service Needs of Outpatients Attending a ...

    African Journals Online (AJOL)

    This study strives to and meets this important objective. Objective: To establish the epidemiology of outpatient urology patients and their service needs as seen in a tertiary centre in the Western region of Kenya. Design: Hospital based observational, descriptive, prospective, cross sectional study. Setting: The Urology ...

  7. Outpatient Treatment of the Sexually Motivated Murderer and Potential Murderer.

    Science.gov (United States)

    Schlesinger, Louis B.; Revitch, Eugene

    1990-01-01

    Introduces the psychopathology and psychodynamics of sex murderer (and potential sex murderer) with emphasis on treatment in outpatient setting. Reviews system of classification of murder based on motivational dynamics of the act itself. Presents three cases that demonstrate a treatment failure, successful treatment of a catathymic sex murderer,…

  8. 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.

  9. 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...

  10. Smoking Cessation Counseling Beliefs and Behaviors of Outpatient Oncology Providers

    Science.gov (United States)

    Danhauer, Suzanne C.; Tooze, Janet A.; Blackstock, A. William; Spangler, John; Thomas, Leslie; Sutfin, Erin L.

    2012-01-01

    Purpose. Many cancer patients continue to smoke after diagnosis, increasing their risk for treatment complications, reduced treatment efficacy, secondary cancers, and reduced survival. Outpatient oncology providers may not be using the “teachable moment” of cancer diagnosis to provide smoking cessation assistance. Providers and Methods. Physicians and midlevel providers (n = 74) who provide outpatient oncology services completed an online survey regarding smoking cessation counseling behaviors, beliefs, and perceived barriers. Outpatient medical records for 120 breast, lung, head and neck, colon, prostate, and acute leukemia cancer patients were reviewed to assess current smoking cessation assessment and intervention documentation practices. Results. Providers reported commonly assessing smoking in new patients (82.4% frequently or always), but rates declined at subsequent visits for both current smokers and recent quitters. Rates of advising patients to quit smoking were also high (86.5% frequently or always), but oncology setting. PMID:22334454

  11. Cost associated with stroke: outpatient rehabilitative services and medication.

    Science.gov (United States)

    Godwin, Kyler M; Wasserman, Joan; Ostwald, Sharon K

    2011-10-01

    This study aimed to capture direct costs of outpatient rehabilitative stroke care and medications for a 1-year period after discharge from inpatient rehabilitation. Outpatient rehabilitative services and medication costs for 1 year, during the time period of 2001 to 2005, were calculated for 54 first-time stroke survivors. Costs for services were based on Medicare reimbursement rates. Medicaid reimbursement rates and average wholesale price were used to estimate medication costs. Of the 54 stroke survivors, 40 (74.1%) were categorized as independent, 12 (22.2%) had modified dependence, and 2 (3.7%) were dependent at the time of discharge from inpatient rehabilitation. Average cost for outpatient stroke rehabilitation services and medications the first year post inpatient rehabilitation discharge was $17,081. The corresponding average yearly cost of medication was $5,392, while the average cost of yearly rehabilitation service utilization was $11,689. Cost attributed to medication remained relatively constant throughout the groups. Outpatient rehabilitation service utilization constituted a large portion of cost within each group: 69.7% (dependent), 72.5% (modified dependence), and 66.7% (independent). Stroke survivors continue to incur significant costs associated with their stroke for the first 12 months following discharge from an inpatient rehabilitation setting. Changing public policies affect the cost and availability of care. This study provides a snapshot of outpatient medication and therapy costs prior to the enactment of major changes in federal legislation and serves as a baseline for future studies.

  12. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Elderly outpatient profile and predictors of falls.

    Science.gov (United States)

    Gomes, Grace Angélica de Oliveira; Cintra, Fernanda Aparecida; Batista, Fernanda Sotelo; Neri, Anita Liberalesso; Guariento, Maria Elena; Sousa, Maria da Luz Rosario de; D'Elboux, Maria José

    2013-01-01

    CONTEXT AND OBJECTIVES Falls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects. DESIGN AND SETTING Cross-sectional descriptive study forming part of the project "Quality of Life of Frail Elderly People", carried out in Campinas, Brazil. METHODS The subjects were 145 elderly individuals (76.3 ± 7.8 years old), of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out. RESULTS Cluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found. CONCLUSIONS The results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living.

  14. Animal-assisted therapy at an outpatient pain management clinic.

    Science.gov (United States)

    Marcus, Dawn A; Bernstein, Cheryl D; Constantin, Janet M; Kunkel, Frank A; Breuer, Paula; Hanlon, Raymond B

    2012-01-01

    The objective of this study was to evaluate the effects of brief therapy dog visits to an outpatient pain management facility compared with time spent in a waiting room. The design of this study is open-label. Setting.  This study was conducted in a university tertiary care adult chronic pain outpatient clinic. The subjects of this study include outpatients, adults accompanying outpatients to their appointments, and clinic staff. Intervention.  Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area. Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time. Two hundred ninety-five therapy dog visits (235 with patients, 34 family/friends, and 26 staff) and 96 waiting room surveys (83 from patients, 6 family/friends, and 7 staff) were completed over a 2-month study period. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit but not the waiting room control, with clinically meaningful pain relief (decrease ≥2 points) in 23% after the therapy dog visit and 4% in the waiting room control. Significant improvements were likewise seen after therapy dog visits for family/friends and staff. Therapy dog visits in an outpatient setting can provide significant reduction in pain and emotional distress for chronic pain patients. Therapy dog visits can also significantly improve emotional distress and feelings of well-being in family and friends accompanying patients to appointments and clinic staff. Wiley Periodicals, Inc.

  15. Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência Analysis of the applicability of different pain questionnaires in three hospital settings: outpatient clinic, ward and emergency unit

    Directory of Open Access Journals (Sweden)

    José Eduardo Martinez

    2011-08-01

    Full Text Available OBJETIVO: Avaliar a aplicabilidade dos instrumentos de avaliação de dor em três ambientes hospitalares. METODOLOGIA: Foram estudados 60 pacientes com dor musculoesquelética atendidos no Conjunto Hospitalar de Sorocaba: enfermaria da Ortopedia, ambulatório de Reumatologia e Unidade Regional de Emergência (Pronto-socorro. QUESTIONÁRIOS: Inventário breve de dor (BPI; questionário McGill de Dor (MPQ; escala visual analógica para dor (EVA. RESULTADOS: Na urgência, houve um predomínio do gênero masculino com média de idade de 35 anos. No ambulatório, foram entrevistados 18 homens com idade média de 42 anos e duas mulheres com idade média de 55 anos. Na enfermaria, predominavam os homens com idade média de 30,7 anos. No pronto-socorro e na enfermaria, a duração foi menor para a EVA e maior para o MPQ. A duração para a EVA foi menor e não diferiu com relação aos locais. Na enfermaria e no pronto-socorro, a preferência dos pacientes recaiu pelo BPI sendo que, na enfermaria, a EVA foi segunda opção. No ambulatório, a preferência dos pacientes recaiu sobre o BPI (80% seguido do MPQ e os entrevistadores se dividiram igualmente entre esses mesmos questionários. No pronto-socorro, a preferência dos entrevistadores foi pelo BPI (40%, os restantes foram divididos igualmente. Houve uma prevalência maior de concordância do que de discordância das preferências entre pacientes e entrevistadores. CONCLUSÃO: Os instrumentos multidimensionais para avaliação da dor têm limitações em sua aplicabilidade no cotidiano da assistência hospitalar à saúdeOBJECTIVE: To assess the applicability of pain assessment instruments in three hospital settings. METHODOLOGY: This study comprised 60 patients with musculoskeletal pain cared for at the Conjunto Hospitalar de Sorocaba: orthopedic ward, Rheumatology outpatient clinic, and orthopedic emergency unit. QUESTIONNAIRES: Brief Pain Inventory (BPI; McGill Pain Questionnaire (MPQ; Visual

  16. Movement to outpatient hysterectomy for benign indications in the United States, 2008-2014.

    Directory of Open Access Journals (Sweden)

    Gaby Moawad

    Full Text Available The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS, alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH, as well as whether these trends exacerbate disparities.Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH, vaginal hysterectomy (VH, laparoscopic hysterectomy (LH, and robotic-assisted hysterectomy (RH. Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR using the most recent year of data (2014 to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration.From 2008-2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001. Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%. We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001. Surgical approach (51.8% and physician outpatient MIS experience (19.9% had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16-1.31, as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05.From 2008-2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged

  17. Frailty measurements and dysphagia in the outpatient setting.

    Science.gov (United States)

    Hathaway, Bridget; Vaezi, Alec; Egloff, Ann Marie; Smith, Libby; Wasserman-Wincko, Tamara; Johnson, Jonas T

    2014-09-01

    Deconditioning and frailty may contribute to dysphagia and aspiration. Early identification of patients at risk of aspiration is important. Aspiration prevention would lead to reduced morbidity and health care costs. We therefore wondered whether objective measurements of frailty could help identify patients at risk for dysphagia and aspiration. Consecutive patients (n = 183) were enrolled. Patient characteristics and objective measures of frailty were recorded prospectively. Variables tested included age, body mass index, grip strength, and 5 meter walk pace. Statistical analysis tested for association between these parameters and dysphagia or aspiration, diagnosed by instrumental swallowing examination. Of variables tested for association with grip strength, only age category (P = .003) and ambulatory status (P dysphagia or aspiration, ambulatory status was significantly associated with dysphagia and aspiration in multivariable model building. Nonambulatory status is a predictor of aspiration and should be included in risk assessments for dysphagia. The relationship between frailty and dysphagia deserves further investigation. Frailty assessments may help identify those at risk for complications of dysphagia. © The Author(s) 2014.

  18. Predictors of Prolonged TB Treatment in a Dutch Outpatient Setting.

    Directory of Open Access Journals (Sweden)

    Natasha Van't Boveneind-Vrubleuskaya

    Full Text Available Standard treatment duration for drug-susceptible tuberculosis (TB treatment is 6 months. Treatment duration is often extended-and for various different reasons. The aim of this study was to determine the prevalence and to assess risk factors associated with extended TB treatment.A cross-sectional study was conducted. Data including demographic, clinical, radiological and microbiological information from the Netherlands TB Register (NTR of 90 patients with smear and culture positive pulmonary TB of the region Haaglanden, The Netherlands, was eligible for analysis.Treatment was extended to ≥ 200 days by 46 (51% patients. Extended TB treatment was associated with a higher frequency of symptoms, presumed to be due to adverse drug reactions (ADR; OR 2.39 95% CI: 1.01-5.69, drug-induced liver injury (DILI (OR: 13.51; 95% CI: 1.66-109.82 and longer than 2 month smear and culture conversion rate (OR: 11.00; 95% CI: 1.24-97.96 and OR: 8.56; 95% CI: 1.53-47.96. In the multivariable logistic analysis, development of DILI emerged as the single statistically strong risk factor necessitating extension of TB treatment.This finding will need further confirmation in a prospective study, exploring the possible mutual role of pharmacokinetic and pharmacogenetic determinants of DILI among TB patients.

  19. Management of plantar fasciitis in the outpatient setting

    Science.gov (United States)

    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-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. PMID:27075037

  20. Promote Breastfeeding in the Outpatient Setting: It's Easy!

    Science.gov (United States)

    Sriraman, Natasha K

    2017-12-01

    The numerous benefits for both mother and baby of breastfeeding are evidence-based and well-defined. Breastmilk is the physiologic norm for infant nutrition, offering multiple health benefits and protections for mothers and babies. Although major medical and health organizations, which represent the health of women and children, such as the American Academy of Pediatrics (AAP), American College of Obstetrics and Gynecology (ACOG), American Academy of Family Practice (AAFP), Centers for Disease Control (CDC), UNICEF, the World Health Organization (WHO) and the National Public Health Service (NPHS), all recommend exclusive breastfeeding, few women meet the recommended goals for duration and exclusivity, despite high initiation rates. This article will discuss the barriers women face when breastfeeding. Strategies will be discussed on how physicians and health care providers can assist and advocate for their mothers while helping to improve the health of women and children. Physicians/pediatricians can support women and design interventions that can help patients' mothers overcome these challenges. Copyright © 2016 Mosby, Inc. All rights reserved.

  1. Payment methods for outpatient care facilities

    Science.gov (United States)

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-01-01

    Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised

  2. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    Science.gov (United States)

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  3. Comparison of student learning in the out-patient clinic and ward round.

    Science.gov (United States)

    Davis, M H; Dent, J A

    1994-05-01

    In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

  4. Intensive outpatient treatment of elephantiasis.

    Science.gov (United States)

    Pereira De Godoy, J M; Amador Franco Brigidio, P; Buzato, E; Fátima Guerreiro De Godoy, M

    2012-10-01

    The aim of this paper was to report on a novel approach to the intensive outpatient treatment of elephantiasis of an underprivileged population. Prospective, random study, the diagnosis of lymphedema was clinical and the inclusion of patients was by order of arrival in the treatment center where all were invited to participate in the study. Intensive outpatient therapy was performed for 6 to 8 hours daily over a period of four weeks. Eleven legs with grade III elephantiasis of 8 patients were evaluated in a random prospective study. Three patients were men and five were women with ages ranging between 28 and 66 years old. Treatment included mechanical lymph drainage using the RAGodoy® apparatus for a period of 6 to 8 hours daily and the Godoy & Godoy cervical stimulation technique for 20 minutes per day, both associated to the use of a home-made medical compression stocking using a low-stretch cotton-polyester material. Additionally, manual lymph drainage using the Godoy & Godoy technique was performed for one hour. Perimetry was used to compare measurements made before and after treatment, of the three points of the limb with the largest circumferences. The paired t-test was utilized for statistical analysis with an alpha error greater than 5% (P-value elephantiasis.

  5. Dysfluent Handwriting in Schizophrenic Outpatients.

    Science.gov (United States)

    Gawda, Barbara

    2016-04-01

    Taking into account findings in the literature, the author aimed to test whether specific graphical characteristics of handwriting can distinguish patients diagnosed with schizophrenic disorders from healthy controls. Handwriting samples (one sample from each person) from 60 outpatients (29 women, 31 men; age M = 28.5, SD = 5.4) with paranoid schizophrenia were analyzed by three documents examiners and were compared to samples from 60 controls (30 men, 30 women, age M = 28.0, SD = 3.0) without psychiatric disorders. Document examiners assessed 32 graphical features potentially related to schizophrenia. The comparisons between groups revealed that only 7 out of 32 handwriting properties were significantly different in the handwriting of schizophrenic outpatients from controls: the calligraphic forms of letters, loops in ovals, lacking of dots, tremor, sinusoidal baseline, and irregularities size of lower zone. These findings are discussed in terms of motor disturbances in schizophrenia and in relation to the previous research on handwriting of other mental disorders. Similarities between the graphical patterns of handwriting of schizophrenic patients and those of other mental disorders and/or other mental states have been demonstrated. © The Author(s) 2016.

  6. Fatigue Experiences Among OCD Outpatients.

    Science.gov (United States)

    Pasquini, Massimo; Piacentino, Daria; Berardelli, Isabella; Roselli, Valentina; Maraone, Annalisa; Tarsitani, Lorenzo; Biondi, Massimo

    2015-12-01

    Patients with OCD are impaired in multiple domains of functioning and quality of life. While associated psychopathology complaints and neuropsychological deficits were reported, the subjective experience of general fatigue and mental fatigue was scarcely investigated. In this single-center case-control study we compared 50 non-depressed OCD outpatients consecutively recruited and 50 panic disorder (PD) outpatients, to determine whether they experienced fatigue differently. Assessment consisted of structured clinical interview for DSM-IV criteria by using the SCID-I and the SCID-II. Symptom severity was assessed using the Yale-Brown Obsessive-Compulsive Scale, the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, the Clinical Global Impressions Scale, severity and the Global Assessment of Functioning Scale. Fatigue was assessed by using the Multidimensional Fatigue Inventory (MFI). Regarding MFI physical fatigue, an OR of 0.196 (95 % CI 0.080-0.478) was found, suggesting that its presence is associated with lower odds of OCD compared to PD. The same can be said for MFI mental fatigue, as an OR of 0.138 (95 % CI 0.049-0.326) was found, suggesting that its presence is associated with lower odds of OCD. Notably, OCD patients with OCDP co-morbidity reported higher scores of mental fatigue. In this study fatigue, including mental fatigue, seems not to be a prominent experience among adult non-depressed OCD patients.

  7. 42 CFR 419.21 - Hospital outpatient services subject to the outpatient prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... outpatient prospective payment system. 419.21 Section 419.21 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM... Excluded From the Hospital Outpatient Prospective Payment System § 419.21 Hospital outpatient services...

  8. Payment methods for outpatient care facilities.

    Science.gov (United States)

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-03-03

    Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Randomised trials, non-randomised trials, controlled before

  9. Temporal trends in outpatient management of incident pulmonary embolism and associated mortality.

    Science.gov (United States)

    Klil-Drori, Adi J; Coulombe, Janie; Suissa, Samy; Hirsch, Andrew; Tagalakis, Vicky

    2018-01-01

    In clinical trial settings, outpatient management of pulmonary embolism (PE) is feasible and safe, but less is known on its use in routine care. We determined trends in outpatient management of PE and associated mortality in a large non-select patient population. All residents of Quebec, Canada with a first-ever work-up for suspected PE in the emergency department (ED) over 10years were included. Patients could transition to outpatient management and from unconfirmed to confirmed PE in a time-varying fashion. Comparing the years 2005-9 with 2000-4, we assessed the odds ratio (OR) for outpatient management, and relative risk (RR) for all-cause mortality, readmissions for PE, and major bleeding in 30days. We adjusted the RR for a mortality risk score. Of 15,217 patients included, 7583 were outpatients (7.5% confirmed PE) and 7634 were inpatients (60.6% confirmed PE). In all, 10.9% of patients with confirmed PE were outpatients, but outpatient management of confirmed PE was more likely in the latter study period (OR 1.73, 95%CI 1.44-2.09). Among outpatients with confirmed PE, mortality (RR 0.84, 95%CI 0.15-4.61) and readmission (RR 1.25, 95%CI 0.45-3.48) rates were stable, and only 3 major bleeding events were noted. Inpatients with confirmed PE had stable mortality rates (RR 0.95, 95%CI 0.72-1.24). Outpatient PE management increased over 10years while remaining fairly uncommon. Nevertheless, stable mortality and readmission rates indicate this practice is safe in routine care, and add to the growing evidence in support of outpatient PE management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Aspiration Curettage and its Outpatient Usage

    African Journals Online (AJOL)

    Aspiration Curettage and its Outpatient Usage. D. A. G. BARFORD, M, NOTELOVITZ. SUMMARY ... its use on a number of outpatients without anaesthesia is discussed. S. Afr. Med. l., 48, 22 (1974). In order to ... plastic aspiration chamber and suction is applied centrally at the base of the chamber, a cylindrical filter within the.

  11. Outpatient treatment for acute uncomplicated diverticulitis

    NARCIS (Netherlands)

    Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.

    2013-01-01

    Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment

  12. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis

    Science.gov (United States)

    Miccio, Robin Streit; Parikh, Bijal

    2017-01-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment–related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals. PMID:28845677

  13. [Importance of an outpatient record in obstetric anesthesia].

    Science.gov (United States)

    Lanza, V; Mercadante, S; Pignataro, A; Guglielmo, L; Villari, P; Di Fiore, G; Sapio, M; De Michele, P; Vegna, G

    1991-01-01

    A computerised record was used to collect data following an anesthesiological check-up of pregnant women at approximately 30 weeks of pregnancy. The record was input onto a portable PC in the anesthesia outpatient clinic, memorized on disk (3.5") and then transferred onto a PC network (one PC for each operating theatre) for "real time" consultation of each patient's data. All pregnant women attending the antenatal clinico were also given a folder illustrating epidural anesthetic techniques. Seven hundred and nine outpatient visits have been performed over the past two years with a 62% utilisation ratio. The collection of data using a computerised system allows a rapid and efficacious system of communication to be set up among the membranes of the anesthesiological team, thus encouraging the use of epidural techniques during labour. The distribution of the folder also facilitated the task of the anesthetist who found that pregnant women visiting the anesthesia clinic were already familiar with the epidural technique.

  14. Massage Therapy in Outpatient Cancer Care: A Metropolitan Area Analysis.

    Science.gov (United States)

    Cowen, Virginia S; Miccio, Robin Streit; Parikh, Bijal

    2017-10-01

    Massage offers cancer patients general quality of life benefits as well as alleviation of cancer-related symptoms/cancer-treatment-related symptoms including pain, anxiety, and fatigue. Little is known about whether massage is accessible to cancer patients who receive treatment in the outpatient setting and how massage is incorporated into the overall cancer treatment plan. Outpatient cancer centers (n = 78) in a single metropolitan area were included this mixed-methods project that included a systematic analysis of website information and a telephone survey. Massage was offered at only 40 centers (51.3% of total). A range of massage modalities were represented, with energy-based therapies (Reiki and Therapeutic Touch) most frequently provided. Although massage therapists are licensed health care providers in the states included in this analysis, massage was also provided by nurses, physical therapists, and other health care professionals.

  15. Observational study of outpatients with schizophrenia in the Middle ...

    African Journals Online (AJOL)

    Observational study of outpatients with schizophrenia in the Middle East and Africa — 3- and 6-month efficacy and safety results. The Intercontinental Schizophrenia Outpatient Health Outcomes Study.

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

    Science.gov (United States)

    Wang, Kuo-Ying; Chau, Tang-Tat

    2013-01-01

    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.

  17. 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.

  18. 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...

  19. The quality of outpatient antimicrobial prescribing

    DEFF Research Database (Denmark)

    Malo, Sara; Bjerrum, Lars; Feja, Cristina

    2013-01-01

    The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing....

  20. Breadth versus volume: Neurology outpatient clinic cases in medical education.

    Science.gov (United States)

    Albert, Dara V; Blood, Angela D; Park, Yoon Soo; Brorson, James R; Lukas, Rimas V

    2016-06-01

    This study examined how volume in certain patient case types and breadth across patient case types in the outpatient clinic setting are related to Neurology Clerkship student performance. Case logs from the outpatient clinic experience of 486 students from The University of Chicago Pritzker School of Medicine, USA, participating in the 4week Neurology Clerkship from July 2008 to June 2013 were reviewed. A total of 12,381 patient encounters were logged and then classified into 13 diagnostic categories. How volume of cases within categories and the breadth of cases across categories relate to the National Board of Medical Examiners Clinical Subject Examination for Neurology and a Neurology Clerkship Objective Structured Clinical Examination was analyzed. Volume of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.290, pNeurology (r=.231, p=.017), however was not significantly correlated with any component of the Objective Structured Clinical Examination. Volume of cases correlated with higher performance on measures of specialty knowledge and clinical skill. Fewer relationships emerged correlating breadth of cases and performance on the same measures. This study provides guidance to educators who must decide how much emphasis to place on volume versus breadth of cases in outpatient clinic learning experiences. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Outpatient management of pediatric acute mastoiditis.

    Science.gov (United States)

    Alkhateeb, Ahmed; Morin, Francis; Aziz, Haya; Manogaran, Mayuri; Guertin, William; Duval, Melanie

    2017-11-01

    Evaluate the Montreal Children's Hospital experience with outpatient management of uncomplicated acute mastoiditis with parenteral antibiotic therapy alone and determine if it is a safe alternative to inpatient management. A retrospective review of pediatric patients diagnosed with acute mastoiditis at a tertiary care pediatric hospital between 2013 and 2015 was performed. Patients with syndromes, immunodeficiency, cholesteatoma, chronic otitis media, cochlear implant in the affected ear, or incidental mastoid opacity were excluded. 56 children age 6 months to 15 years old were treated for acute mastoiditis, including 29 hospitalizations and 27 outpatients. Patients managed as outpatient with daily intravenous ceftriaxone had a 93% cure rate. Eighteen hospitalized and one outpatient had complications of acute mastoiditis. Children with complications were more likely to be febrile (p = 0.045). Two patients failed outpatient therapy and were admitted; one for myringotomy and piperacillin-tazobactam treatment and one required a mastoidectomy. 4/27 children treated as outpatient underwent myringotomy and tube insertion, 2 underwent myringotomy and tube along with admission and 21 did not require tube insertion. The average total duration of intravenous antibiotic therapy was respectively 4.9 and 18.9 days in the outpatient and hospitalized group. The average duration of admission was 5.9 days. Outpatient medical therapy of uncomplicated pediatric mastoiditis is safe, successful, and efficient. Benefits include efficient use of surgical beds, cost savings and patient and family convenience. Careful patient selection and close monitoring are keys for successful outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. 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).

  3. The importance of time cost in pricing outpatient care.

    Science.gov (United States)

    Heshmat, S

    1988-01-01

    The purpose of this article is to discuss the component of the full price charged to patients using outpatient care. The full price of a visit to a physician is equal to out-of-pocket payment (money price), and time costs. In particular, the article discusses the concept of time price (marginal value of time for a patient), and presents a specific example to illustrate the concept of time price elasticity. The concepts and information presented in this article can help marketing managers in setting pricing strategy that would explicitly consider time price.

  4. The outpatient psychotherapy of the borderline patient.

    Science.gov (United States)

    Chessick, R D

    1993-01-01

    This paper discussed common problems in the outpatient psychotherapy of borderline patients, especially their rage, seductiveness, and abrupt negative shifts. The definition of "borderline" is not settled. Even DSM-III-R mixes it up with other personality disorders. There are no pathognomonic symptoms, no specific personality constellations, and no compelling evidence for a definitive stage in infant development when this disorder is fixed; all stages are involved, from faulty foundational to oedipal periods. It is a descriptive diagnosis and typical presentations of such patients are reviewed. In the psychotherapeutic approach, limits must be set first, but these must be flexible and reasonable. Medications are used rarely and with care. We attempt to form an alliance by (a) getting the patient to join us in a study of himself or herself, especially a study of when rage and maladaptive behavior emerges, and (b) providing a consistent and reasonable ambience. The ultimate aim is uncovering and interpreting when the patient is ready for it, more and more approximating psychoanalytic treatment as the patient's pathology permits. The special phenomena of the self-object (Kohut), transitional object (Modell), and disruptive extreme erotic or raging (Kernberg) transferences were reviewed, as well as the pitfalls of therapist anxiety and impatience in dealing with them. While archaic transferences predominate, we serve as an auxiliary microscopic ego and appeal to the rational adult part of the patient's ego in a phenomenological investigation. We interpret early only if we cannot get the patient to examine what has led to the explosions and when distortions or projection without insight continues to predominate. The dangers of early transference interpretations are discussed. Therapy is long, tedious, and requires the willingness to patiently catalyze the patient's resumed development and endure the periodic disruptions. Countertransference problems and what to do about

  5. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

    OpenAIRE

    Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-01-01

    Objectives To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD). Design Cross-sectional survey. Setting Outpatient clinics at a tertiary psychiatric hospital in Singapore. Participants 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD. Methods Data were collect...

  6. The impact of outpatient clinical teaching on students' academic performance in obstetrics and gynecology.

    Science.gov (United States)

    Hassan, Bahaeldin A; Elfaki, Omer A; Khan, Muhammed A

    2017-01-01

    Clinical teaching at outpatient settings is an essential part of undergraduate medical students' training. The increasing number of students in many medical schools and short hospital stays makes inpatient teaching alone insufficient to provide students with the required clinical skills. To make up this shortfall, outpatient clinical teaching has been implemented by our Department of Obstetrics and Gynecology, King Khalid University, KSA, throughout the academic year 2015-2016. The aim of this study was to evaluate the impact of clinical teaching at outpatient settings on the academic performance of our students. In this comparative retrospective study, the effects of outpatient clinical teaching of obstetrics and gynecology on the academic performance of student was assessed through an objective structured clinical examination (OSCE). During their course on obstetrics and gynecology, 58 students had their clinical teaching both at inpatient and outpatient settings and constituted "study group". The remaining 52 students had clinical teaching only at inpatient settings and were considered "control group". Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Students in both groups sat for OSCE at the end of week 8 of the gynecology course. Four stations were used for assessment: obstetric history, gynecological history, obstetric physical examination of pregnant women, and gynecological procedure station. Twenty marks were allocated for each station giving a total score of 80. The OSCE scores for study group were compared with those of the control group using Student's t -test; p performance in OSCE. There is evidence of remarkable improvement in the mastery of clinical skills as manifested in the students' scores in physical examination and procedures stations. These results will encourage us to have clinical teaching in other disciplines at outpatient settings.

  7. Integration of Massage Therapy in Outpatient Cancer Care

    Science.gov (United States)

    Cowen, Virginia S.; Tafuto, Barbara

    2018-01-01

    Background Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. Purpose The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. Setting This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Design Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. Main Outcome Measure The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. Results The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all—not even provision of information about massage to patients through the center website. Conclusions The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care. PMID:29593842

  8. Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features.

    Science.gov (United States)

    Rush, A John; Zimmerman, Mark; Wisniewski, Stephen R; Fava, Maurizio; Hollon, Steven D; Warden, Diane; Biggs, Melanie M; Shores-Wilson, Kathy; Shelton, Richard C; Luther, James F; Thomas, Brandi; Trivedi, Madhukar H

    2005-07-01

    This study evaluated the clinical and sociodemographic features associated with various degrees of concurrent comorbidity in adult outpatients with nonpsychotic major depressive disorder (MDD). Outpatients enrolled in the STAR*D trial completed the Psychiatric Diagnostic Screening Questionnaire (PDSQ). An a priori 90% specificity threshold was set for PDSQ responses to ascertain the presence of 11 different concurrent DSM-IV Axis I disorders. Of 1376 outpatients, 38.2% had no concurrent comorbidities, while 25.6% suffered one, 16.1% suffered two, and 20.2% suffered three or more comorbid conditions. Altogether, 29.3% met threshold for social anxiety disorder, 20.8% for generalized anxiety disorder, 18.8% for posttraumatic stress disorder, 12.4% for bulimia, 11.9% for alcohol abuse/dependence, 13.4% for obsessive-compulsive disorder, 11.1% for panic disorder, 9.4% for agoraphobia, 7.3% for drug abuse/dependence, 3.7% for hypochondriasis, and 2.2% for somatoform disorder. Those with more concurrent Axis I conditions had earlier ages at first onset of MDD, longer histories of MDD, greater depressive symptom severity, more general medical comorbidity (even though they were younger than those with fewer comorbid conditions), poorer physical and mental function, health perceptions, and life satisfaction; and were more likely to be seen in primary care settings. Participants had to meet entry criteria for STAR*D. Ascertainment of comorbid conditions was not based on a structured interview. Concurrent Axis I conditions (most often anxiety disorders) are very common with MDD. Greater numbers of concurrent comorbid conditions were associated with increased severity, morbidity, and chronicity of their MDD.

  9. Managing outpatient consultations: from referral to discharge.

    Science.gov (United States)

    Mitchell, Rachael; Jacob, Hannah; Morrissey, Benita; Macaulay, Chloe; Gomez, Kumudini; Fertleman, Caroline

    2017-08-01

    Although a great deal of paediatric consultations are not urgent, doctors in training spend so much time providing service for acute conditions that they spend little time focusing on outpatient work before they become a consultant. Engaging clinicians in the managerial aspects of providing clinical care is a key to improving outcomes, and this article addresses these aspects of the outpatient consultation from referral to discharge. We aim to provide doctors in training with a tool to use during their training and their first few years as a consultant, to think about how outpatient work is organised and how it can be improved to maximise patient experience. The non-urgent consultation varies across the world; this article is aimed to be relevant to an international audience. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients.

    Science.gov (United States)

    Curley, Michelle; Liebers, Jill; Maynard, Roy

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy.

  11. 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…

  12. Patient experience with outpatient encounters at public hospitals in Shanghai: Examining different aspects of physician services and implications of overcrowding.

    Science.gov (United States)

    Bao, Yuhua; Fan, Guanrong; Zou, Dongdong; Wang, Tong; Xue, Di

    2017-01-01

    Over 90% of outpatient care in China was delivered at public hospitals, making outpatient experience in this setting an important aspect of quality of care. To assess outpatient experience with different aspects of physician services at China's public hospitals and its association with overcrowding of the hospital outpatient departments. Retrospective analysis of a large survey of outpatient experience in Shanghai, China. We tested the hypotheses that patient experience was poorer with physician-patient communication, education, and shared decision-making and where and when there was greater overcrowding of the hospital outpatient departments. Ordered logistic models were estimated separately for general and specialty hospitals. 7,147 outpatients at 40 public hospitals in Shanghai, China, in 2014. Patient experience with physician services were self-reported based on 12 questions as part of a validated instrument. Indicators of overcrowding included time of visit (morning vs. afternoon, Monday vs. rest of the week) and hospital outpatient volume in the first half of 2014. Overall, patients reported very favorable experience with physician services. Two out of the 12 questions pertaining to both communication and shared decision-making consistently received lower ratings. Hospitals whose outpatient volumes were in the top two quartiles received lower patient ratings, but the relationship achieved statistical significance among specialty hospitals only. Inadequate physician-patient communication and shared decision-making and hospital overcrowding compromise outpatient experience with physician services at Chinese public hospitals. Effective diversion of patients with chronic and less complex conditions to community health centers will be critical to alleviate the extreme workloads at hospitals with high patient volumes and, in turn, improve patient experience.

  13. Gender Differences in Outpatient Utilization : A Pooled Analysis of Data from the Korea Health Panel

    NARCIS (Netherlands)

    Noh, Jin-Won; Kim, Kyoung-Beom; Park, Hyunchun; Kwon, Young Dae

    2017-01-01

    Background: This study aims to set itself apart from prior research by elucidating gender differences in outpatient service utilization among adults aged 20 years or older, using nationally representative survey data. Methods: Data from the Korea Health Panel (KHP) collected between 2010 and 2011

  14. 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

  15. Structure and quality of outpatient care for people living with an HIV infection

    NARCIS (Netherlands)

    Engelhard, Esther A. N.; Smit, Colette; Nieuwkerk, Pythia T.; Reiss, Peter; Kroon, Frank P.; Brinkman, Kees; Geerlings, Suzanne E.

    2016-01-01

    Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this

  16. 42 CFR 410.28 - Hospital or CAH diagnostic services furnished to outpatients: Conditions.

    Science.gov (United States)

    2010-10-01

    ... or under arrangements made by a participating hospital or participating CAH, except in the case of an...). (d) Rules on emergency services furnished to outpatients by nonparticipating hospitals are set forth... supervision” means the definition specified in § 410.32(b)(3)(ii). (f) The rules for clinical diagnostic...

  17. Does receiving a copy of correspondence improve patients' satisfaction with their out-patient consultation?

    NARCIS (Netherlands)

    Saunders, N. C.; Georgalas, C.; Blaney, S. P. A.; Dixon, H.; Topham, J. H.

    2003-01-01

    It is standard practice to write to a patient's general practitioner (GP) following an out-patients consultation. This study set out to assess whether sending a copy of this letter to the patient improves their satisfaction with the consultation. Two hundred patients were randomly assigned to

  18. 75 FR 7218 - Payment for Inpatient and Outpatient Health Care Professional Services at Non-Departmental...

    Science.gov (United States)

    2010-02-18

    ... Medicare's dialysis facility pricing methods to set the maximum allowable charge (based on Medicare's... method of determining pricing, which is known as method 2. When VA authorizes dialysis treatment and... Outpatient PPS, and End Stage Renal Disease composite rate payment method. In the absence of an amount...

  19. 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

  20. An Analysis of the Last Clinical Encounter before Outpatient Mortality among Children with HIV Infection and Exposure in Lilongwe, Malawi.

    Directory of Open Access Journals (Sweden)

    Chris A Rees

    Full Text Available Human immunodeficiency virus (HIV contributes to nearly 20% of all deaths in children under five years of age in Malawi. Expanded coverage of antiretroviral therapy has allowed children to access treatment on an outpatient basis. Little is known about characteristics of the final outpatient encounter prior to mortality in the outpatient setting.This retrospective cohort study assessed clinical factors associated with mortality among HIV-exposed infants and HIV-infected children less than 18 years of age at the Baylor College of Medicine Abbott Fund Children's Center of Excellence in Lilongwe, Malawi. We compared clinical indicators documented from the final outpatient encounter for patients who died in the outpatient setting versus those who were alive after their penultimate clinical encounter.Of the 8,546 patients who were attended to over a 10-year period at the Baylor Center of Excellence, 851 had died (10%. Of children who died, 392 (46% were directly admitted to the hospital after their last clinical encounter and died as inpatients. Of the remaining 459 who died as outpatients after their last visit, 53.5% had a World Health Organization (WHO stage IV condition at their last visit, and 25% had a WHO stage III condition. Multivariate regression analysis demonstrated that poor nutritional status, female gender, shorter time as a patient, more clinical encounters in the prior month, if last visit was an unscheduled sick visit, and if the patient had lost weight since their prior visit independently predicted increased mortality in the outpatient setting after the final clinical encounter.Clinical indicators may assist in identifying children with HIV who have increased risk of mortality in the outpatient setting. Recognizing these indicators may aid in identifying HIV-infected children who require a higher level of care or closer follow-up.

  1. Tobacco Smoking in Adolescent Psychiatric Outpatients

    Science.gov (United States)

    Ditchburn, K. Marie; Sellman, J. Douglas

    2013-01-01

    Three main aims of this study were to ascertain the prevalence rate of smoking among adolescent psychiatric outpatients; estimate smokers' degree of nicotine dependence; and investigate the relationship between smoking and common mental health disorders. Face-to-face interviews were conducted on 93 patients ages 13-18 presenting to an adolescent…

  2. Ethnic diversity outpatient clinic in paediatrics

    NARCIS (Netherlands)

    Dahhan, Nordin; Meijssen, Dominique; Chegary, Malika; Bosman, Diederik; Wolf, Bart

    2012-01-01

    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)

  3. Mobile information and communication in the hospital outpatient service.

    Science.gov (United States)

    Jen, Wen-Yuan; Chao, Chia-Chen; Hung, Ming-Chien; Li, Yu-Chuan; Chi, Y P

    2007-08-01

    Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

  4. Integration of Massage Therapy in Outpatient Cancer Care.

    Science.gov (United States)

    Cowen, Virginia S; Tafuto, Barbara

    2018-03-01

    Massage therapy can be helpful in alleviating cancer-related symptoms and cancer treatment-related symptoms. While surveys have noted that cancer patients seek out massage as a nonpharmacologic approach during cancer treatment, little is known about the integration of massage in outpatient cancer care. The purpose of this study was to examine the extent to which massage is being integrated into outpatient cancer care at NCI-designated Cancer Centers. This study used descriptive methods to analyze the integration of massage in NCI-designated Cancer Centers providing clinical services to patients (n = 62). Data were collected from 91.1% of the centers (n = 59) using content analysis and a telephone survey. A dataset was developed and coded for analysis. The integration of massage was assessed by an algorithm that was developed from a set of five variables: 1) acceptance of treatment as therapeutic, 2) institution offers treatment to patients, 3) clinical practice guidelines in place, 4) use of evidence-based resources to inform treatment, and 5) shared knowledge about treatment among health care team. All centers were scored against all five variables using a six-point scale, with all variables rated equally. The integration of massage ranged from not at all (0) to very high (5) with all five levels of integration evident. Only 11 centers (17.7% of total) rated a very high level of integration; nearly one-third of the centers (n = 22) were found to have no integration of massage at all-not even provision of information about massage to patients through the center website. The findings of this analysis suggest that research on massage is not being leveraged to integrate massage into outpatient cancer care.

  5. Routine screening for depression and quality of life in outpatients with congestive heart failure.

    Science.gov (United States)

    Holzapfel, Nicole; Zugck, Christian; Müller-Tasch, Thomas; Löwe, Bernd; Wild, Beate; Schellberg, Dieter; Nelles, Manfred; Remppis, Andrew; Katus, Hugo; Herzog, Wolfgang; Jünger, Jana

    2007-01-01

    The influence of depression and perceived quality of life (QoL) on symptom perception and prognosis in congestive heart failure is well known. The authors therefore introduced routine questionnaire screening for these parameters in patients attending their outpatient heart failure clinic (N=320). The authors found QoL to be significantly reduced, and almost every third patient screened positive for a depressive disorder. These patients got a clearly-defined treatment offer. The present study demonstrates that screening for depression and QoL is feasible without being too complex or time-consuming and easily implementable in an interdisciplinary outpatient setting.

  6. 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...

  7. Volume, structure and funding of specialized outpatient care at the outpatient Advisory Department of Mariinskaya hospital

    Directory of Open Access Journals (Sweden)

    E. M. Kutyrev

    2015-01-01

    Full Text Available With the development of technologies, and discovery of new methods of diagnostics and treatment of diseases, a shift of the disease towards chronic disease is observed. Growth in prosperity will increase average life expectancy and mean age of population. Year after year, the elderly sector grows, with several chronic diseases per person. This is especially true for St. Petersburg, where 25 % of the populations of over working age. Thus, the demand for specialized medical care, particularly outpatient, will increase. Given that outpatient care is more profitable than hospital care, particular attention should be paid to its organization and expansion (increase in area, number of personnel, logistics, and so on. The article attempts to analyze changes in the volume of specialized outpatient medical care delivered at the outpatient Advisory Department of St. Petersburg state establishment of healthcare Mariinsky hospital in the period from 2008 through 2013.

  8. An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding.

    Science.gov (United States)

    Diwakar, L; Roberts, T E; Cooper, N A M; Middleton, L; Jowett, S; Daniels, J; Smith, P; Clark, T J

    2016-03-01

    To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia. Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results. Thirty-one secondary care UK NHS hospitals between April 2008 and July 2011. Five hundred and seven women with abnormal uterine bleeding and hysteroscopically diagnosed endometrial polyps. Outpatient uterine polypectomy versus standard inpatient treatment. Clinicians were free to choose the technique for polypectomy within the allocated setting. Patient-reported effectiveness of the procedure determined by the women's self-assessment of bleeding at 6 months, and QALY gains at 6 and 12 months. Inpatient treatment was slightly more effective but more expensive than outpatient treatment, resulting in relatively high incremental cost-effectiveness ratios. Intention-to-treat analysis of the base case at 6 months revealed that it cost an additional £9421 per successfully treated patient in the inpatient group and £ 1,099,167 per additional QALY gained, when compared with outpatient treatment. At 12 months, these costs were £22,293 per additional effectively treated patient and £445,867 per additional QALY gained, respectively. Outpatient treatment of uterine polyps associated with abnormal uterine bleeding appears to be more cost-effective than inpatient treatment at willingness-to-pay thresholds acceptable to the NHS. HTA-funded OPT trial concluded that outpatient uterine polypectomy is cost-effective compared with inpatient polypectomy. © 2015 Royal College of Obstetricians and Gynaecologists.

  9. Outpatient alcohol withdrawal management for Aboriginal and Torres Strait Islander peoples.

    Science.gov (United States)

    Brett, Jonathan; Lawrence, Leanne; Ivers, Rowena; Conigrave, Kate

    2014-08-01

    There is concern from within Aboriginal and Torres Strait Islander communities about the lack of access to alcohol withdrawal management ('detox') services. Outpatient detox is described within national Australian guidelines as a safe option for selected drinkers. However, uncertainly exists as to how suited Aboriginal and Torres Strait Islander peoples are to this approach. 
 Consultations were conducted with stakeholders of four health services providing outpatient detox for Aboriginal and Torres Strait Islander peoples in NSW. Thematic analysis was performed to determine elements perceived as important for success. Key themes that emerged were individual engagement, flexibility, assessment of suitability, Aboriginal staff and community engagement, practical support, counselling, staff education and support, coping with relapse and contingency planning. 
 There is a need to improve access to alcohol detox services for Aboriginal and Torres Strait Islander peoples. The outpatient setting seems to be a feasible and safe environment to provide this kind of service for selected drinkers.

  10. What characterizes the communication between patients with cancer and nurses in an outpatient clinic

    DEFF Research Database (Denmark)

    Prip, Anne

    predominantly are treated in outpatient clinics today, little is known about what constitutes communication when the encounters between patients and nurses are brief and takes place in outpatient settings. The aim of the study was to explore communication between nurses and patients with cancer undergoing...... chemotherapy in an outpatient clinic. Methods The study is based on ethnographic fieldwork that explored through multiple observations and adhoc interviews, the communicative practice between nurses and patients with cancer. A thematic analysis guided by Interpretive Description was carried out to identify...... characteristics and variations in the nurse-patient communication. Results We identified three themes: Communication on the run, reflects the nurses’ multitasking approach to communication; Treatment-centered communication illustrates how topics and issues related to the patient’s treatment guided conversations...

  11. Quality of life of lung cancer patients receiving outpatient chemotherapy

    OpenAIRE

    MATSUDA, AYAKO; KOBAYASHI, MIKA; SAKAKIBARA, YUMI; TAMAOKA, MEIYO; FURUIYE, MASASHI; INASE, NAOHIKO; MATSUSHIMA, EISUKE

    2011-01-01

    An increasing number of cancer patients receive outpatient chemotherapy as an alternative to inpatient chemotherapy. The aim of this study was to investigate whether quality of life (QOL) during outpatient chemotherapy was better than QOL prior to hospital discharge, and to explore possible related factors prior to hospital discharge that affected the QOL of lung cancer patients who received outpatient chemotherapy. Lung cancer inpatients who were scheduled for outpatient chemotherapy were as...

  12. Determinants of completion of advance directives: a cross-sectional comparison of 649 outpatients from private practices versus 2158 outpatients from a university clinic.

    Science.gov (United States)

    Pfirstinger, Jochen; Bleyer, Bernhard; Blum, Christian; Rechenmacher, Michael; Wiese, Christoph H; Gruber, Hans

    2017-12-21

    To compare outpatients from private practices and outpatients from a university clinic regarding the determinants of completion of advance directives (AD) in order to generalise results of studies from one setting to the other. Five determinants of completion of AD were studied: familiarity with AD, source of information about AD, prior experiences with own life-threatening diseases or family members in need of care and motives in favour and against completion of AD. Observational cross-sectional study. Private practices and a university clinic in Germany in 2012. 649 outpatients from private practices and 2158 outpatients from 10 departments of a university clinic. Completion of AD, familiarity with AD, sources of information about AD (consultation), prior experiences (with own life-threatening disease and family members in need of care), motives in favour of or against completion of AD, sociodemographic data. Determinants of completion of AD did not differ between outpatients from private practices versus university clinic outpatients. Prior experience with severe disease led to a significantly higher rate of completion of AD (33%/36% with vs 24%/24% without prior experience). Participants with completion of AD had more often received legal than medical consultation before completion, but participants without completion of AD are rather aiming for medical consultation. The motives in favour of or against completion of AD indicated inconsistent patterns. Determinants of completion of AD are comparable in outpatients from private practices and outpatients from a university clinic. Generalisations from university clinic samples towards a broader context thus seem to be legitimate. Only one-third of patients with prior experience with own life-threatening diseases or family members in need of care had completed an AD as expression of their autonomous volition. The participants' motives for or against completion of AD indicate that ADs are considered a kind of

  13. Managing and Communicating Operational Workflow: Designing and Implementing an Electronic Outpatient Whiteboard.

    Science.gov (United States)

    Steitz, Bryan D; Weinberg, Stuart T; Danciu, Ioana; Unertl, Kim M

    2016-01-01

    Healthcare team members in emergency department contexts have used electronic whiteboard solutions to help manage operational workflow for many years. Ambulatory clinic settings have highly complex operational workflow, but are still limited in electronic assistance to communicate and coordinate work activities. To describe and discuss the design, implementation, use, and ongoing evolution of a coordination and collaboration tool supporting ambulatory clinic operational workflow at Vanderbilt University Medical Center (VUMC). The outpatient whiteboard tool was initially designed to support healthcare work related to an electronic chemotherapy order-entry application. After a highly successful initial implementation in an oncology context, a high demand emerged across the organization for the outpatient whiteboard implementation. Over the past 10 years, developers have followed an iterative user-centered design process to evolve the tool. The electronic outpatient whiteboard system supports 194 separate whiteboards and is accessed by over 2800 distinct users on a typical day. Clinics can configure their whiteboards to support unique workflow elements. Since initial release, features such as immunization clinical decision support have been integrated into the system, based on requests from end users. The success of the electronic outpatient whiteboard demonstrates the usefulness of an operational workflow tool within the ambulatory clinic setting. Operational workflow tools can play a significant role in supporting coordination, collaboration, and teamwork in ambulatory healthcare settings.

  14. 77 FR 5317 - Medicaid Program; Covered Outpatient Drugs

    Science.gov (United States)

    2012-02-02

    ... for Medicare & Medicaid Services 42 CFR Part 447 Medicaid Program; Covered Outpatient Drugs; Proposed... Part 447 [CMS-2345-P] RIN 0938-AQ41 Medicaid Program; Covered Outpatient Drugs AGENCY: Centers for... requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the...

  15. Utilisation of outpatient services at Red Cross War Memorial ...

    African Journals Online (AJOL)

    The demand for outpatient services continues to grow at Red Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department (OPD). In addition, we reviewed the RCCH Annual Reports for the period 1961 - 1988. Annual outpatient ...

  16. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - Facility

    Data.gov (United States)

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

  17. 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 included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic...... and mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had...

  18. Primary epiploic appendagitis and successful outpatient management

    Science.gov (United States)

    Schnedl, Wolfgang J.; Krause, Robert; Wallner-Liebmann, Sandra J.; Tafeit, Erwin; Mangge, Harald; Tillich, Manfred

    2012-01-01

    Summary Background Primary epiploic appendagitis (PEA) is a rare cause of abdominal acute or subacute complaints. Diagnosis of PEA is made with ultrasonography (US) or when computed tomography (CT) reveals a characteristic lesion. Case Report We report on two patients with PEA. In one patient PEA was first seen with US and confirmed with contrast enhanced CT, and in the second patient CT without contrast enhancement demonstrated PEA. In both patients an outpatient recovery with conservative non-surgical treatment is described. Conclusions Medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions. A correct diagnosis of PEA with imaging procedures enables conservative and successful outpatient management avoiding unnecessary surgical intervention and additional costs. PMID:22648258

  19. 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.......) or placebo (D0) before surgery. The primary outcome was pain intensity 8 h after surgery rated on a numeric rating scale of 0 to 10. Secondary outcomes were pain intensity, analgesic consumption and side effects during the first 3 days after surgery. Results Data from 73 patients were available for analysis...

  20. 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.

  1. Platelet activation in outpatients undergoing esophagogastroduodenoscopy

    International Nuclear Information System (INIS)

    Sagripanti, A.; Polloni, A.; Materazzi, F.; Ferdeghini, M.; Pinori, E.; Bianchi, R.

    1989-01-01

    To evaluate the influence of emotional stress on platelet function mesured by radioimmunoassay in plasma two platelet factor 4, in a series of outpatients undergoing esophagogastroduodenoscopy for upper digestive complaints has been measured. The plasma levels of β-thromboglobulin and platelet factor 4, determined just before the instrumental examination, were significantly more elevated as compared to basal values, checked a week later. These results provide evidence of enhanced in vivo platelet release reaction during emotional stress

  2. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients

    OpenAIRE

    Curley, Michelle; Liebers, Jill; Maynard, Roy

    2017-01-01

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac tran...

  3. Myelography conducted on an outpatient basis

    Energy Technology Data Exchange (ETDEWEB)

    Kausch, W

    1981-03-01

    The introduction of the non-ionogenic product metrizamide made lumbosacral myelography a low-risk, invasive diagnostic procedure. Examination carried out on an outpatient basis does not involve greater risks or side effects than examination on a inpatient basis. However, it is essential that - apart from informing the patient properly - the patient shows discipline and remains available for the examining physician during a period of 36 hours.

  4. Increasing the Number of Outpatients Receiving Spiritual Assessment: A Pain and Palliative Care Service Quality Improvement Project.

    Science.gov (United States)

    Gomez-Castillo, Blanca J; Hirsch, Rosemarie; Groninger, Hunter; Baker, Karen; Cheng, M Jennifer; Phillips, Jayne; Pollack, John; Berger, Ann M

    2015-11-01

    Spirituality is a patient need that requires special attention from the Pain and Palliative Care Service team. This quality improvement project aimed to provide spiritual assessment for all new outpatients with serious life-altering illnesses. Percentage of new outpatients receiving spiritual assessment (Faith, Importance/Influence, Community, Address/Action in care, psychosocial evaluation, chaplain consults) at baseline and postinterventions. Interventions included encouraging clinicians to incorporate adequate spiritual assessment into patient care and implementing chaplain covisits for all initial outpatient visits. The quality improvement interventions increased spiritual assessment (baseline vs. postinterventions): chaplain covisits (25.5% vs. 50%), Faith, Importance/Influence, Community, Address/Action in care completion (49% vs. 72%), and psychosocial evaluation (89% vs. 94%). Improved spiritual assessment in an outpatient palliative care clinic setting can occur with a multidisciplinary approach. This project also identifies data collection and documentation processes that can be targeted for improvement. Published by Elsevier Inc.

  5. Brachial artery approach for outpatient arteriography

    International Nuclear Information System (INIS)

    You, Jai Kyung; Park, Sung Il; Lee, Do Yun; Won, Jae Hwan

    1999-01-01

    To evaluate the diagnostic usefulness of brachial approach arteriography for outpatients, with particular regard to safety and image quality. The angiographic findings and follow-up medical records of 131 brachial approach arteriographies in 121 outpatients were retrospectively analysed. 5 F pigtail catheters were used in 125 cases and 5-F OCU-A catheters were used in three cases of renal arteriography, and three of upper extremity arteriography without catheter. Except for three cases of brachial artery puncture failure, all procedures were performed successfully. One hundred and fifteen of 119 lower extremity arteriographies were visualized down to the level of the tibioperoneal artery. The non-visualized cases were three in which there was multiple obstruction at the distal common iliac artery and one with insufficient contrast amount due to renal failure In four cases there were complications : two involved arterial thrombosis, one was an intramuscular hematoma, and one an A-V fistula. For outpatients, brachial approach arteriography can replace the femoral approach. Its image quality is excellent, there are time-cost benefits, and the rate of complications is relatively low

  6. Ambulatory phlebectomy at radiologic outpatient clinic

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-03-15

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

  7. Ambulatory phlebectomy at radiologic outpatient clinic

    International Nuclear Information System (INIS)

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

    2007-01-01

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

  8. Racial disparities in the use of outpatient mastectomy.

    Science.gov (United States)

    Salasky, Vanessa; Yang, Rachel L; Datta, Jashodeep; Graves, Holly L; Cintolo, Jessica A; Meise, Chelsey; Karakousis, Giorgos C; Czerniecki, Brian J; Kelz, Rachel R

    2014-01-01

    Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007-2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders. We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80-0.93; OR, 0.55; 95% CI, 0.41-0.72; and OR, 0.70; 95% CI, 0.64-0.76, respectively) compared with white patients. Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Outpatient management of pulmonary embolism in cancer: data on a prospective cohort of 138 consecutive patients.

    Science.gov (United States)

    Font, Carme; Carmona-Bayonas, Alberto; Fernández-Martinez, Aranzazu; Beato, Carmen; Vargas, Andrés; Gascon, Pere; Otero, Remedios

    2014-03-01

    The purpose of this prospective cohort study was to assess the feasibility of outpatient treatment in patients with cancer and objectively confirmed pulmonary embolism (PE), and to compare the performance of the different prognostic scales available in this setting. Patients were selected for outpatient management according to a set of exclusion criteria. Outcomes at 30 and 90 days of follow-up included thromboembolic recurrences, major bleeding, and all-cause death. The performance of 4 prognostic scales (Pulmonary Embolism Severity Index, Geneva Prognostic Score, POMPE-C, and Registro Informatizado de Enfermedad Tromboembólica [RIETE registry]) was evaluated. Of 138 patients, 62 (45%) were managed as outpatients. Incidental PE constituted 47% of the sample. Most patients treated at home had an incidentally detected PE (89%). The rate of recurrence and major bleeding events was similar in both groups. Mortality rates were higher for patients admitted to the hospital compared with outpatients at 30 days (18% vs 3%; P=.06) and 90 days (34% vs 10%; P=.001) of follow-up. None of the patients selected for home treatment required further admission because of PE complications. None of the prognostic models developed for symptomatic PE was significantly associated with 30-day mortality. Improved survival outcomes were observed in incidentally detected PEs compared with acute symptomatic events (overall mortality rates, 3.2% vs 18.4%; P=.006). A large proportion of patients with cancer and PE may be safely treated as outpatients, especially those with incidental PE. Cancer-specific prognostic scales including incidental PE should be developed for the optimal management of PE in this setting.

  10. Emergency in the clinic: a simulation curriculum to improve outpatient safety.

    Science.gov (United States)

    Espey, Eve; Baty, Gillian; Rask, John; Chungtuyco, Michelle; Pereda, Brenda; Leeman, Lawrence

    2017-12-01

    Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes. The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy. This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum. Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (Pimprovement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency situations (Pimproved both self-efficacy and objectively rated performance scores in management of outpatient medical

  11. Outpatient percutaneous renal biopsy in adult patients

    International Nuclear Information System (INIS)

    Al-Hweish, Abdulla K.; Abdul-Rehman, I. Saeed

    2007-01-01

    To study the safety and efficacy of performing percutanaeous renal biopsy in the outpatient department compared to the traditional inpatient policy, we studied 44 consecutive patients with proteinuria and other urinary sediment abnormalities, at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, during the period from September 2004 to August 2006. The patients were divided into two groups: group I, in whom kidney biopsy was performed and followed by 1-day hospital admission; and group II, in whom renal biopsy was performed in the outpatient department and followed by 6 hours observation period and then by regular outpatient visits. All biopsies were performed with the use of real-time ultrasound and automated biopsy needle. Patients with a history of bleeding diathesis or abnormal coagulation profile and those receiving warfarin, heparin, aspirin or nonsteroidal anti-inflammatory drugs were excluded from the study. Only minor biopsy-related complications such as gross hematuria, perinephric hematoma that resolved without the need for blood transfusion or surgical intervention occurred in three (13.6%) patients in group I and in two (9.1%) patients in group II. The complications were apparent within 6 hours in all but one patient (97.7%). Overall, hematuria was identified in 52% of patients at <-72 hours, 85% at <-4 hours and 97.7% at <- 6 hours. The 24-hour hematocrit levels were not significantly different between the study groups. One (4.5%) patient from group II had a small perinephric hematoma, which was detected by ultrasound examination at 24 hours but not at 6 hours post biopsy period; it resolved spontaneously without intervention. We conclude that in selected patients, same day discharge after 6 hours of renal biopsy may be given safety without increased risk of complications. (author)

  12. Multisource feedback analysis of pediatric outpatient teaching.

    Science.gov (United States)

    Tiao, Mao-Meng; Huang, Li-Tung; Huang, Ying-Hsien; Tang, Kuo-Shu; Chen, Chih-Jen

    2013-11-01

    This study aims to evaluate the outpatient communication skills of medical students via multisource feedback, which may be useful to map future directions in improving physician-patient communication. Family respondents of patients, a nurse, a clinical teacher, and a research assistant evaluated video-recorded medical students' interactions with outpatients by using multisource feedback questionnaires; students also assessed their own skills. The questionnaire was answered based on the video-recorded interactions between outpatients and the medical students. A total of 60 family respondents of the 60 patients completed the questionnaires, 58 (96.7%) of them agreed with the video recording. Two reasons for reluctance were "personal privacy" issues and "simply disagree" with the video recording. The average satisfaction score of the 58 students was 85.1 points, indicating students' performance was in the category between satisfied and very satisfied. The family respondents were most satisfied with the "teacher"s attitude," followed by "teaching quality". In contrast, the family respondents were least satisfied with "being open to questions". Among the 6 assessment domains of communication skills, the students scored highest on "explaining" and lowest on "giving recommendations". In the detailed assessment by family respondents, the students scored lowest on "asking about life/school burden". In the multisource analysis, the nurses' mean score was much higher and the students' mean self-assessment score was lower than the average scores on all domains. The willingness and satisfaction of family respondents were high in this study. Students scored the lowest on giving recommendations to patients. Multisource feedback with video recording is useful in providing more accurate evaluation of students' communication competence and in identifying the areas of communication that require enhancement.

  13. Outpatient care utilization in urban Kerala, India.

    Science.gov (United States)

    Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

    2006-07-01

    Kerala is characterized by a high density of public and private health infrastructure. While less inequality in access has been reported in this Indian state, few studies have looked at problems found within cities. Escalation of costs of private services and reduced public investments could generate some inequalities in access for the poor. To assess factors associated with utilization and source of outpatient care in urban Kerala, and to discuss policy implications with regards to access to care. A multilevel analysis of individual and urban characteristics associated with utilization and source of outpatient care was conducted using data from a 1995-96 survey by the National Sample Survey Organisation on health care in urban Kerala. There is a high level of utilization (83.6%) of allopathic medical services. Controlling for illness severity and age, utilization thereof was lower for the very poor (OR 0.13 [0.03; 0.49]), inhabitants of medium towns (OR 0.20 [0.05; 0.70]), and inhabitants of cities with a lower proportion of permanent material (pucca) houses (0.21 [0.06; 0.72]). Among all users, 77% resorted to a private source of care. Utilization of a private provider was less likely for the very poor (OR 0.13 [0.03; 0.51]) and individuals from casual worker households (OR 0.54 [0.30; 0.97]), while it was more likely for inhabitants of cities from both low public bed density districts (OR 4.08 [1.05; 15.95]) and high private bed density districts (OR 5.83 [2.34; 14.53]). Problems of quality and accessibility of the public sector were invoked to justify utilization of private clinics. A marked heterogeneity in utilization of outpatient care was found between cities of various sizes and characteristics. This study confirms high utilization of private outpatient care in Kerala and suggests problems of access for the poorest. Even in a context of high public availability and considering the health transition factor, relying on the development of the private sector

  14. Attribute correlates of hospital outpatient satisfaction.

    Science.gov (United States)

    Krueckeberg, H F; Hubbert, A

    1995-01-01

    Customer satisfaction (patient satisfaction) with hospital outpatient or ambulatory services is an important factor in influencing patient patronage and loyalty. Based on an empirical study, this article examines the attributes of the ambulatory care experience which were significantly associated with the level of satisfaction resulting from the most recent hospital ambulatory visit. This study focuses on identifying attributes of ambulatory services. This article brings to the health care marketing literature information on ambulatory satisfaction comparable to that which has been contributed to the literature regarding satisfaction with physician and hospital experiences.

  15. Compulsory outpatient treatment can prevent involuntary commitment

    DEFF Research Database (Denmark)

    Hansen, Lene Nørregård; Svensson, Eva Maria Birgitta; Brandt-Christensen, Anne Mette

    2014-01-01

    Compulsory outpatient treatment (co-pt) has been possible in Denmark since 2010. The aim is to secure necessary treatment, reduce involuntary commitment and improve quality of life for patients with a severe psychiatric illness. Co-pt has been brought into use in 33 cases. This case report...... describes a patient with paranoid schizophrenia who several times developed severe psychotic symptoms shortly after discharge due to lack of compliance with treatment. Within one year of co-pt the patient was not admitted to hospital and improved in overall functioning. After terminating co-pt the patient...

  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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Prevalence and course of pseudothrombocytopenia in outpatients.

    Science.gov (United States)

    Froom, Paul; Barak, Mira

    2011-01-01

    The prevalence and course of pseudothrombocytopenia in outpatients is uncertain. In a cohort study of 687,955 members of a health maintenance organization, we extracted 36,780 consecutive automated complete blood count test results and determined the point prevalence of pseudothrombocytopenia during a one-month period. We also calculated a retrospective cumulative prevalence over the past 5 years. There were 1105 (2.7%) patients with platelet counts of 100-149×10(9)/L and 304 (0.8%) with counts values, or the reference limit value should be lowered to 100×10(9)/L.

  18. How did market competition affect outpatient utilization under the diagnosis-related group-based payment system?

    Science.gov (United States)

    Kim, Seung Ju; Park, Eun-Cheol; Kim, Sun Jung; Han, Kyu-Tae; Jang, Sung-In

    2017-06-01

    Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. Population-based retrospective observational study. We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. Patient with a total artificial heart maintained on outpatient dialysis while listed for combined organ transplant, a single center experience.

    Science.gov (United States)

    Hanna, Ramy M; Hasnain, Huma; Kamgar, Mohammad; Hanna, Mina; Minasian, Raffi; Wilson, James

    2017-10-01

    Advanced mechanical circulatory support is increasingly being used with more sophisticated devices that can deliver pulsatile rather than continuous flow. These devices are more portable as well, allowing patients to await cardiac transplantation in an outpatient setting. It is known that patients with renal failure are at increased risk for developing worsening acute kidney injury during implantation of a ventricular assist device (VAD) or more advanced modalities like a total artificial heart (TAH). Dealing with patients who have an implanted TAH who develop renal failure has been a challenge with the majority of such patients having to await a combined cardiac and renal transplant prior to transition to outpatient care. Protocols do exist for VAD implanted patients to be transitioned to outpatient dialysis care, but there are no reported cases of TAH patients with end stage renal disease (ESRD) being successfully transitioned to outpatient dialysis care. In this report, we identify a patient with a TAH and ESRD transitioned successfully to outpatient hemodialysis and maintained for more than 2 years, though he did not survive to transplant. It is hoped that this report will raise awareness of this possibility, and assist in the development of protocols for similar patients to be successfully transitioned to outpatient dialysis care. © 2017 International Society for Hemodialysis.

  20. The effect of employee assistance plan benefits on the use of outpatient behavioral health care.

    Science.gov (United States)

    Hodgkin, Dominic; Merrick, Elizabeth L; Hiatt, Deirdre; Horgan, Constance M; McGuire, Thomas G

    2010-12-01

    Nearly half of all US workers have access to an employee assistance plan (EAP). At the same time, most large US employers also purchase health benefits for their employees, and these benefits packages typically include behavioral health services. There is some potential overlap in services covered by the EAP and the health plan, and some employers choose to purchase the two jointly as an 'integrated product'. It is not clear whether EAP services substitute for outpatient behavioral health care services covered by the health plan. To evaluate how the number of EAP visits covered affects the use of regular outpatient behavioral health care (number of visits, and total spending), in an integrated product setting. Analysis of claims, eligibility and benefits data for 26,464 users of behavioral health care for the year 2005. For both EAP and regular behavioral health care, the individuals were enrolled with Managed Health Network (MHN), a large national specialty insurance plan. Multivariate regression analyses were performed to investigate the determinants of the number of regular outpatient visits, and spending for regular outpatient care. To address skewness in the dependent variables, the estimation used generalized linear models with a log link. A limited instrumental variable analysis was used to test for endogeneity of the number of EAP visits covered. Nearly half the enrollees in this sample were in employer plans that allowed 4-5 EAP visits per treatment episode, and 31% were allowed 3 EAP visits per year. Having an EAP visit allowance of 4-5 sessions per episode predicts fewer regular outpatient visits, compared with having an allowance of 3 sessions per year. More generous EAP allowances also reduce payments for outpatient care, with one exception. Greater availability of EAP benefits appears to reduce utilization of regular outpatient care, supporting the idea that the two types of care are to some extent perceived as substitutes. One limitation of this

  1. A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding.

    Science.gov (United States)

    Clark, T Justin; Middleton, Lee J; Cooper, Natalie Am; Diwakar, Lavanya; Denny, Elaine; Smith, Paul; Gennard, Laura; Stobert, Lynda; Roberts, Tracy E; Cheed, Versha; Bingham, Tracey; Jowett, Sue; Brettell, Elizabeth; Connor, Mary; Jones, Sian E; Daniels, Jane P

    2015-07-01

    Uterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited. To test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined. A multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study. Outpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals. Women with AUB - defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding - and hysteroscopically diagnosed uterine polyps. We randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia. The primary outcome was successful treatment at 6 months, determined by the woman's assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained. At 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed

  2. A comparison of work-related physical activity levels between inpatient and outpatient physical therapists: an observational cohort trial.

    Science.gov (United States)

    Brewer, Wayne; Ogbazi, Raluchukwu; Ohl, Devan; Daniels, Jeffry; Ortiz, Alexis

    2016-06-16

    Physical therapists (PTs) work in a variety of healthcare settings with varied levels of physical activity demands placed on them. The purpose of this study is to compare the physical activity (PA) levels between PTs in inpatient versus outpatient environments for one work week using a cross-sectional design. Sixty-one PTs (30 inpatient, 31 outpatient) wore a tri-axial accelerometer and inclinometer for one work-week. The number steps-per-day, PA intensities, energy expenditures and postural positions adopted during the work day were recorded. Significantly longer amounts of time spent sitting was found for inpatient PTs regardless of the significantly higher number of steps-per-day. Outpatient PTs had a higher number of breaks from sedentary activity with those breaks being longer than the inpatient PTs. The percentage of time spent performing moderate-vigorous PA approached significance implying more time was spent performing these types of activities for outpatient PTs. The energy expenditures between the two groups of PTs were not different. This study compared the differences in physical activity levels between physical therapists who worked at inpatient versus outpatient environment as little is known about their activity levels. Inpatient physical therapists took more steps per day than outpatient physical therapists but the outpatient physical therapists were less sedentary and took more frequent and longer breaks from sedentary activities. The energy expenditures were similar between both types of therapists and this may be reflective of the gender and bodyweight differences between the groups that equalizes the energy expenditures. The findings of this study suggests that there are differences in the physical activity demands between inpatient and outpatient physical therapists. The results of this study may serve dual purposes: (1) employers may be able to more accurately describe the expected physical activity demands to future employees; (2

  3. 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. © The Author(s) 2015.

  4. Complications with Outpatient Angiography and Interventional Procedures

    International Nuclear Information System (INIS)

    Young, Noel; Chi, Ka-Kit; Ajaka, Joe; McKay, Lesa; O'Neill, Diane; Wong, Kai Ping

    2002-01-01

    Purpose: To prospectively identify the complications, and rates of complication, in outpatient angiography and interventional procedures. Methods: There were 1050 consecutive patients, 646 men and 404 women, aged 17-89 years, with a total of 1239 procedures studied in a 2-year period, 1997 to 1999. Results: There were 560 cases of aorto-femoral angiography,resulting in 124 complications (22%), with pain or hematoma in 110.There were 206 cases of neck and cerebral angiography, resulting in 51 complications (25%), with pain and hematoma in 34, transient ischemic attack in 2 and cerebrovascular accident in 1. There were 197 interfentional procedures, with 177 being balloon dilatations, resulting in 68 complications (35%), with 2 having hematomas and 1 having hematoma/abscess requiring active treatment. There were 276 cases having various 'other' procedures (e.g., renal angiography),resulting in 65 complications (24%), with pain and hematoma in 61. No procedure-related death occurred. Eighteen cases (1.5%) had significant complications, with contrast allergy in eight. Conclusion: Outpatient angiography and intervention are relatively safe, with low significant complication rates

  5. Elderly outpatient profile and predictors of falls

    Directory of Open Access Journals (Sweden)

    Grace Angélica de Oliveira Gomes

    Full Text Available CONTEXT AND OBJECTIVESFalls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects.DESIGN AND SETTINGCross-sectional descriptive study forming part of the project “Quality of Life of Frail Elderly People”, carried out in Campinas, Brazil.METHODSThe subjects were 145 elderly individuals (76.3 ± 7.8 years old, of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out.RESULTSCluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found.CONCLUSIONSThe results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living.

  6. Violence prevention education program for psychiatric outpatient departments.

    Science.gov (United States)

    Feinstein, Robert E

    2014-10-01

    Approximately 40 % of psychiatrists and up to 64 % of psychiatric residents have been physically assaulted. Ranges of 72-96 % of psychiatric residents in various studies have been verbally threatened. As violence risk occurs in outpatient settings, our department developed a quality and safety curriculum designed to prepare psychiatric residents and staff to optimally respond to aggressive outpatients and violence threats or events. In 2011 and 2012, we offered an 8-part violence prevention performance improvement curriculum/program including (1) situational awareness/creating a safe environment; (2) violence de-escalation training; (3) violence risk assessment training, use of risk assessment tools, and medical record documentation; (4) violence safety discharge planning; (5) legal issues and violence; (6) "shots fired on campus" video/discussion; (7) "2011 violence threat simulation" video/discussion; and (8) violence threat simulation exercise. This program was offered to approximately 60 psychiatric residents/staff in each year. We obtained qualitative comments about the entire program and data from 2 years of post-event surveys on the usefulness of the "violence threat simulation exercise." The large majority of comments about program elements 1 to 7 were positive. In 2011 and 2012, respectively, 76 and 86 % of participants responded to a post-event survey of the violence threat simulation exercise; 90 and 88 % of participants, respectively, reported the simulation to be very helpful/somewhat helpful; and 86 and 82 % of participants, respectively, reported feeling much better/better prepared to deal with a violent event. Although some participants experienced anxiety, sleep disturbances, increase in work safety concerns, and/or traumatic memories, the majority reported no post-simulation symptoms (72 and 80 %, respectively). Although we are unable to demonstrate that this program effectively prevents violence, the overall positive response from participants

  7. Margin alert: time to revisit your outpatient strategy.

    Science.gov (United States)

    Abramson, Steven M; Tyler, David

    2006-04-01

    An increasingly competitive market for outpatient services has made it necessary for acute care hospitals to reevaluate their outpatient, and inpatient, strategies. Many acute care hospitals are in a strong market position to command premium payment for their inpatient services. Under current market conditions, hospitals are in danger of pricing themselves out of the outpatient market. Hospitals can benefit from the increased focus of consumers and payers on quality and the rise of pay for performance by investing in service excellence.

  8. Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

    Science.gov (United States)

    Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M; Koss, Kari; Perera, Kanchana U; Rowan, Anderson; VanSickle, Marcus R; Novak, Laura A; Trieu, Theresa H

    2018-04-23

    Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines ( N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines ( N = 40) was matched to a non-treatment-seeking sample of Marines ( N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls ( p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

  9. Frailty profile for geriatric patients in outpatient clinic of RSUP H. Adam Malik Medan

    Science.gov (United States)

    Permatasari, T. D.; Sihombing, B.; Arianto, P.

    2018-03-01

    Frailty is a circumstance of increased vulnerability to bad resolution of homeostasis after a stressor occasion, which increases the risk of adverse outcomes. Early detection of frailty in elderly patients is a must but is rarely in the Geriatric Outpatient settings. We conducted a study to see the frailty profile for geriatric patients in the outpatient clinic of RSUP H. Adam Malik Medan. A cross-sectional research with a descriptive method was in the Geriatric Outpatient Clinic of Adam Malik Hospital from July-September 2016. The population of this study was patients from the Geriatric Outpatient Clinic, and sampling was by using consecutive methods. Samples were by questionnaires assessing (FRAIL Scale).This study was140 patients. Based on age, the age group of 81-90 years was dominantly frail (53.8%). Most of the subjects worked as government employees (109 subjects), and most of them were robust (42.2%). Based on income, both groups were dominated by robust (38.3% and 41.3%, respectively). Based on BMI, most were robust with underweight 33.5%, normoweight 37.8%, and obese 44.7%. Among the 140 patients, frailty was in the 27.1% of the subjects and the contributing factors were Age, Gender, and Obesity.

  10. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Unanticipated Admission Following Outpatient Rotator Cuff Repair: An Analysis of 18,061 Cases.

    Science.gov (United States)

    Gil, Joseph A; Durand, Wesley M; Johnson, Joey P; Goodman, Avi D; Owens, Brett D; Daniels, Alan H

    2018-05-01

    The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after outpatient arthroscopic rotator cuff repair. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program data sets from years 2012 to 2015. Patients were included in the study based on the presence of a primary Current Procedural Terminology code for rotator cuff repair (23410, 23412, 23420, and 29827). Only outpatient, nonemergent, and elective procedures performed on patients with American Society of Anesthesiologists classification of 4 or less were considered. The primary outcome variable was admission after outpatient surgery (defined as length of initial hospital stay >0). This study examined risk factors for unanticipated admission following rotator cuff repair, finding that age of 65 years or older, female sex, hypertension, body mass index of 35 kg/m 2 or greater, American Society of Anesthesiologists classification of 2 or greater, and open surgical technique were significant predictors of admission, whereas monitored anesthesia care and regional anesthesia were associated with decreased odds of admission. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient rotator cuff repair. [Orthopedics. 2018; 41(3):164-168.]. Copyright 2018, SLACK Incorporated.

  12. The potential of telehealth for 'business as usual' in outpatient clinics.

    Science.gov (United States)

    Day, Karen; Kerr, Patricia

    2012-04-01

    A six-month pilot study was conducted to ascertain the value of using high-definition videoconferencing equipment in an outpatients' setting. The videoconferencing equipment, which included digital biometric equipment, was installed in the outpatient clinics of a remote health service in New Zealand. Use of the equipment was evaluated using action research techniques. Clinicians were interviewed about their assessment of the equipment's usefulness. Patients and their carers completed questionnaires about their clinic experience. During the pilot trial, 109 patients were seen in 25 clinics of six different specialities. Questionnaire results showed that patients and their companions had a good user experience, similar to a face-to-face appointment. Clinicians found that the large screen, sense of proximity, video clarity and definition, and lack of sound/picture lag worked well for certain types of outpatients' clinics, e.g. methadone maintenance clinics. The need for process changes made it difficult to turn telehealth into business as usual in an environment built for face-to-face appointments. We conclude that videoconference equipment has potential to become integral to outpatients' clinics.

  13. 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

  14. Process Improvement in Outpatient Installation RSUD dr. Soediran Mangun Sumarso Using Lean Hospital Approach

    Science.gov (United States)

    Sayyida, Ghany; Fahma, Fakhrina; Iftadi, Irwan

    2018-03-01

    RSUD dr. Soediran Mangun Sumarso is a public hospital in Wonogiri district which has an outpatient installation service. However, the waiting time of some services in outpatient installations exceeds the standard time set by the health minister of the Republic of Indonesia. It is known from the data waiting time in the outpatient installation. The purpose of this study is to provide improvements using lean hospital approach. Proposed improvement is done by eliminating waste that occurs in outpatient installation service. The methodology used in this study consists of four stages. The first stage is describing the service system using a cross-functional flowchart. The second stage is identifying waste using value stream mapping, observation and interview. The third stage is to determine critical waste by borda method and pareto diagram. The last stage is to provide recommendation improvement using fishbone diagram and FMEA. The result of this research is proposed improvements. The proposed improvements are adding special register counters, implementing an online reservation system, doctors schedule synchronization, adding doctors in polyclinics, fixing queue numbers, applying visual management concepts, making connecting glass in pharmacies and adding multifunction shelves in polyclinics.

  15. The prevalence of underweight is increased in chronic pancreatitis outpatients and associates with reduced life quality.

    Science.gov (United States)

    Olesen, Søren S; Frandsen, Louise Kuhlman; Poulsen, Jakob Lykke; Vestergaard, Peter; Rasmussen, Henrik Højgaard; Drewes, Asbjørn M

    Underweight is a well-known complication of chronic pancreatitis (CP), but little is known about its prevalence in the outpatient setting. We investigated the prevalence of underweight in outpatients with CP and its association with quality of life (QOL) and various risk factors. This was a cross-sectional study of 166 outpatients with CP that was conducted at a tertiary referral center. The primary outcome was the prevalence of underweight (body mass index [BMI] pancreatic insufficiency (EPI), pain severity, pain pattern (constant versus intermittent), opioid use, and smoking and drinking habits were analyzed for their association with BMI. Patients with CP had a decreased mean BMI compared with controls (22.9 ± 4.2 kg/m 2 versus 26.8 ± 5.2 kg/m 2 ; P associated with underweight, including physical functioning (P = 0.024). Alcoholic etiology (P = 0.002), EPI (P = 0.004), and constant pain (P = 0.026) were independently associated with low BMI. One quarter of outpatients with CP are underweight and report reduced life quality compared with their normal-weight counterparts. EPI, alcoholic etiology, and pain-related symptoms are independent risk factors. Our findings emphasize the need for a multidisciplinary approach in the handling of patients with CP that focuses on alcohol cessation and the appropriate treatment of pain and EPI. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Orthognathic surgery in the office setting.

    Science.gov (United States)

    Farrell, Brian B; Tucker, Myron R

    2014-11-01

    The delivery of care by oral and maxillofacial surgeons is becoming more challenging because of escalating health care costs and limited reimbursement from insurance providers. The changing health care landscape forces surgical practices to be flexible and adaptive to change in order to remain viable. The delivery of surgical services continues to evolve as care traditionally performed in a hospital environment is now routinely achieved in an outpatient setting. Outpatient facilities can aid in controlling the perioperative costs associated with orthognathic surgery. Safe and efficient orthognathic surgery completed in the office can aid in controlling the escalation of health care costs. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

    Science.gov (United States)

    Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

    2017-09-01

    Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

  18. Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma.

    Science.gov (United States)

    Evans, Sarah S; Gandhi, Arpita S; Clemmons, Amber B; DeRemer, David L

    2017-08-01

    Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin's lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study's primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH. A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution's financial department. Descriptive statistics were utilized for analysis. A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance. EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.

  19. Counting SET-free sets

    OpenAIRE

    Harman, Nate

    2016-01-01

    We consider the following counting problem related to the card game SET: How many $k$-element SET-free sets are there in an $n$-dimensional SET deck? Through a series of algebraic reformulations and reinterpretations, we show the answer to this question satisfies two polynomiality conditions.

  20. Supervisory Turnover in Outpatient Substance Abuse Treatment

    Science.gov (United States)

    Knight, Danica K.; Broome, Kirk M.; Edwards, Jennifer R.; Flynn, Patrick M.

    2009-01-01

    Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the USA. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover. PMID:19949883

  1. 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.

  2. 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.

  3. Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research

    Directory of Open Access Journals (Sweden)

    Hanson Janice L

    2012-11-01

    content. Conclusions Perspectives of these four stakeholder groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

  4. 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.

  5. 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.

  6. Quality of outpatient clinical notes: a stakeholder definition derived through qualitative research.

    Science.gov (United States)

    Hanson, Janice L; Stephens, Mark B; Pangaro, Louis N; Gimbel, Ronald W

    2012-11-19

    groups provide a comprehensive description of quality in outpatient clinical documentation. The resulting description of characteristics and content necessary for quality notes provides a research-based foundation for assessing the quality of clinical documentation in outpatient health care settings.

  7. 38 CFR 17.163 - Posthospital outpatient dental treatment.

    Science.gov (United States)

    2010-07-01

    ... dental treatment. 17.163 Section 17.163 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.163 Posthospital outpatient dental treatment. The Chief, Dental Service may authorize outpatient dental care which is reasonably necessary to complete treatment of a...

  8. Continuity of care of outpatients with schizophrenia in Pretoria ...

    African Journals Online (AJOL)

    Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their ...

  9. 42 CFR 410.59 - Outpatient occupational therapy services: Conditions.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient occupational therapy services... Other Health Services § 410.59 Outpatient occupational therapy services: Conditions. (a) Basic rule... occupational therapy services only if they are furnished by an individual meeting the qualifications in part...

  10. 76 FR 49458 - TRICARE; Hospital Outpatient Radiology Discretionary Appeal Adjustments

    Science.gov (United States)

    2011-08-10

    ... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE; Hospital Outpatient Radiology Discretionary...: This notice is to advise hospitals of an opportunity for net adjusted payments for radiology services... hospital outpatient services, DoD has determined that, for radiology services specified in the regulation...

  11. 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…

  12. Feasibility and safety of outpatient breast cancer surgery

    DEFF Research Database (Denmark)

    Duriaud, Helle Molter; Kroman, Niels; Kehlet, Henrik

    2018-01-01

    INTRODUCTION: Improvement in perioperative care programmes has facilitated post-operative recovery and use of short-term or outpatient procedures. The aim of this study was to assess the feasibility and safety of an outpatient breast cancer programme in patients referred to a large breast cancer...

  13. 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

  14. Drug prescribing patterns for outpatients in three hospitals in north ...

    African Journals Online (AJOL)

    Background: Information about drug utilization at the out patient departments of the Hospitals in Ethiopia is scanty although a large segment of the patients are being served at the outpatient departments. Objective: To evaluate and compare patterns of drug prescribing practiced in the outpatient departments of three ...

  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...

  16. Prevalence and determinants for malnutrition in geriatric outpatients

    NARCIS (Netherlands)

    van Bokhorst-de van der Schueren, M.A.E.; Lonterman-Monasch, S.; de Vries, O.J.; Danner, S.A.; Kramer, M.H.H.; Muller, M.

    2013-01-01

    Background & aims: Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. Methods: From 2005 to

  17. 42 CFR 410.60 - Outpatient physical therapy services: Conditions.

    Science.gov (United States)

    2010-10-01

    ... services furnished under § 410.62; (iii) Outpatient physical therapy and speech-language pathology services... physical therapy and speech-language pathology services furnished by a nurse practitioner, clinical nurse... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient physical therapy services: Conditions...

  18. Detecting delirium in elderly outpatients with cognitive impairment

    NARCIS (Netherlands)

    Stroomer-van Wijk, Anne J. M.; Jonker, Barbara W.; Kok, Rob M.; van der Mast, Roos C.; Luijendijk, Hendrika J.

    Background: Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients. Methods: We performed a case-control

  19. Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional single-centre study

    OpenAIRE

    Ganasegeran, Kurubaran; Renganathan, Pukunan; Manaf, Rizal Abdul; Al-Dubai, Sami Abdo Radman

    2014-01-01

    Objective To determine the prevalence and factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia. Design Descriptive, cross-sectional single-centre study with universal sampling of all patients with type 2 diabetes. Setting Endocrinology clinic of medical outpatient department in a Malaysian public hospital. Participants All 169 patients with type 2 diabetes (men, n=99; women, n=70) aged between 18 and 90 years who acquired follow-up treatment from the en...

  20. Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project.

    Science.gov (United States)

    Gabbe, Belinda J; Watterson, Dina M; Singer, Yvonne; Darton, Anne

    2015-05-01

    Most studies about burn injury focus on admitted cases. To compare outpatient and inpatient presentations at burn centers in Australia to inform the establishment of a repository for outpatient burn injury. Data for sequential outpatient presentations were collected at seven burn centers in Australia between December 2010 and May 2011 and compared with inpatient admissions from these centers recorded by the Burns Registry of Australia and New Zealand for the corresponding period. There were 788 outpatient and 360 inpatient presentations. Pediatric outpatients included more children burns (39% vs 24%). Adult outpatients included fewer males (58% vs 73%) and intentional injuries (3.3% vs 10%), and more scald (46% vs 30%) and contact burns (24% vs 13%). All pediatric, and 98% of adult, outpatient presentations involved a %TBSAburns presenting to burn centers differed to inpatient admission data, particularly with respect to etiology and burn severity, highlighting the importance of the need for outpatient data to enhance burn injury surveillance and inform prevention. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  1. [Differences between adolescents with pathological Internet use in inpatient and outpatient treatment].

    Science.gov (United States)

    Wartberg, Lutz; Moll, Bettina; Baldus, Christiane; Thomsen, Monika; Thomasius, Rainer

    2017-07-01

    In epidemiological studies high prevalence estimates for pathological Internet use in adolescence were reported. There are only few studies published, reporting data of adolescents seeking treatment concerning their pathological Internet use. Currently, a comparison of patients in inpatient versus outpatient treatment is not available. We investigated 74 adolescents reporting pathological Internet use with standardized questionnaires concerning problematic Internet use, psychopathological symptoms and life satisfaction. Overall, 35 adolescents were treated in an outpatient and another 39 adolescents in an inpatient setting. A substantial portion in both groups showed comorbid mental health problems. There were no differences in the degree of problematic Internet use between the two groups. However, compared to adolescents in an outpatient setting, adolescents in inpatient treatment reported longer average Internet usage times, a lower life satisfaction as well as more anxiety/depressiveness and self-esteem problems. In a multivariate logistic regression analysis Internet usage time and life satisfaction were identified as statistically significant factors for the affiliation to one of the two treatment groups. The results of the present study could be useful as a further description of this group of patients and more general to develop interventions for adolescents reporting pathological Internet use.

  2. Benzodiazepine use in medical out-patient clinics: a study from a developing country

    International Nuclear Information System (INIS)

    Patel, M.J.; Ahmer, S.; Khan, F.; Qureshi, A.W.A.; Shehzad, M.F.

    2013-01-01

    Objective: To estimate the prevalence of Benzodiazepine use in the outpatient setting of general medicine clinics at a single tertiary care centre. Methods: The prospective prevalence study was conducted in the outpatient setting of Internal Medicine Clinics at Aga Khan University Hospital, Karachi, from November to December 2009. All subjects were interviewed after informed consent and variables were recorded on a specially-designed proforma. Apart from basic demographics and comorbid conditions, duration, frequency and route of benzodiazepine use, as well as the reason and who initiated it was noted. Chi-square test and t test was applied to see the association of socio demographic or clinical factors with the use of benzodiazepine. Results: Of the 355 patients, 129 (36.33%) reported using the drug. The majority (n=86; 24.2%) were taking it on a daily basis. The highest numbers of patients using the drug were suffering from cardiovascular problems, 32 (25%) followed by 22 (17%) from endocrinology. Diazepam equivalent dose was around 7.04+-4, with a inter-quartile range of 3-96 weeks. Alprazolam (9%) was the most frequently prescribed Benzodiazepine. Conclusion: Benzodiazepine use is alarmingly high in the outpatient clinics of General Internal Medicine Department. There is no implementation of law to prevent its hazardous sale. In this regard all concerned should work collectively for awareness and irrational drug sale and use. (author)

  3. Feasibility of a real-time hand hygiene notification machine learning system in outpatient clinics.

    Science.gov (United States)

    Geilleit, R; Hen, Z Q; Chong, C Y; Loh, A P; Pang, N L; Peterson, G M; Ng, K C; Huis, A; de Korne, D F

    2018-04-09

    Various technologies have been developed to improve hand hygiene (HH) compliance in inpatient settings; however, little is known about the feasibility of machine learning technology for this purpose in outpatient clinics. To assess the effectiveness, user experiences, and costs of implementing a real-time HH notification machine learning system in outpatient clinics. In our mixed methods study, a multi-disciplinary team co-created an infrared guided sensor system to automatically notify clinicians to perform HH just before first patient contact. Notification technology effects were measured by comparing HH compliance at baseline (without notifications) with real-time auditory notifications that continued till HH was performed (intervention I) or notifications lasting 15 s (intervention II). User experiences were collected during daily briefings and semi-structured interviews. Costs of implementation of the system were calculated and compared to the current observational auditing programme. Average baseline HH performance before first patient contact was 53.8%. With real-time auditory notifications that continued till HH was performed, overall HH performance increased to 100% (P machine learning system were estimated to be 46% lower than the observational auditing programme. Machine learning technology that enables real-time HH notification provides a promising cost-effective approach to both improving and monitoring HH, and deserves further development in outpatient settings. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  4. Automatic sets and Delone sets

    International Nuclear Information System (INIS)

    Barbe, A; Haeseler, F von

    2004-01-01

    Automatic sets D part of Z m are characterized by having a finite number of decimations. They are equivalently generated by fixed points of certain substitution systems, or by certain finite automata. As examples, two-dimensional versions of the Thue-Morse, Baum-Sweet, Rudin-Shapiro and paperfolding sequences are presented. We give a necessary and sufficient condition for an automatic set D part of Z m to be a Delone set in R m . The result is then extended to automatic sets that are defined as fixed points of certain substitutions. The morphology of automatic sets is discussed by means of examples

  5. Mental disorders and general well-being in cardiology outpatients--6-year survival

    DEFF Research Database (Denmark)

    Birket-Smith, Morten; Hansen, Baiba H; Hanash, Jamal A

    2009-01-01

    disorder with the Primary Care Evaluation of Mental Disorders; Structured Clinical Interview for DSM-III-R, Non-Patient Edition, psychosis screening; the Clock Drawing Test; and the WHO-5 Well-Being Index. The cardiologists were asked in each patient to rate the severity of somatic disease and mental......OBJECTIVE: Long-term survival in a sample of cardiology outpatients with and without mental disorders and other psychosocial risk factors. METHODS: In a cardiology outpatient setting, 103 consecutive patients were asked to participate in the study. Of these, 86 were included and screened for mental...... problems on visual analogue scales (VAS-somatic and VAS-mental). Cardiac diagnosis, noncardiac comorbidity, history of mental disorder, and the number of daily social contacts were noted. Survival was followed for 6 years. RESULTS: At baseline, 33 (38.4%) patients had mental disorder, 6 dementia, 11 major...

  6. 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.

  7. Crianças em situação de violência de um ambulatório do Rio de Janeiro: conhecendo seu perfil Niños en situación de violencia de un ambulatorio en Rio de Janeiro: conociendo su perfil Children under violence situation followed-up in the outpatient setting at Rio de Janeiro: knowing their profile

    Directory of Open Access Journals (Sweden)

    Lucia Martins de Magalhães Pierantoni

    2009-12-01

    relatives as an aggressor and protectors in the circle of violence. A quantitative descriptive study was developed in the outpatient setting at Rio de Janeiro during 2006-2007. Data from 44 children charts showed that there was a strong relation among poverty, low background and gender to the social matrix of the violence. Boys were the main victims (64% of violence. Physical aggression (33% was more reported. Paradoxically, mothers were the main relatives who caused the aggression (39.1%, and assumed the social role as children protector (57.1%. It concluded that children, aggressor/protector need to be assisted, followed-up and supported by healthcare facility. Consequently, the double social role aggressor/protector implies family center care approach in order to break the circle of violence.

  8. Acute health care utilization and outcomes for outpatient-treated urinary tract infections in children.

    Science.gov (United States)

    Copp, Hillary L; Hanley, Janet; Saigal, Christopher S; Saperston, Kara

    2016-08-01

    The majority of urinary tract infections (UTIs) in children are treated in the ambulatory setting. The goal of this study is to describe the course of outpatient UTI management, including health services utilization, antibiotic switching (change from empirically prescribed antibiotic to another antibiotic), and antibiotic side effects. Using a large claims database, Truven Health MarketScan Research Database, we analyzed all children younger than 18 years old who had an antibiotic prescribed for an outpatient UTI from 2002 to 2010. We evaluated health services utilization and antibiotic switching in the 21-day period after UTI diagnosis. We compared side effects with rates in patients receiving narrow versus broad-spectrum antibiotic treatment. Chi-square analysis was used for descriptive statistics. We identified 242,819 outpatient, antibiotic-treated, UTI episodes. During the 21-day period after presentation, 26% required more than one visit for UTI management and children did not have imaging within 21 days of UTI: renal bladder ultrasound in 6%, VCUG in 2.6%, and DMSA in 0.05%. Broad-spectrum antibiotics were empirically prescribed to 34% of patients. Antibiotic switching occurred in only 8% of UTI episodes, indicating that empiric prescription covered the offending uropathogen the majority of the time. Antibiotic side effects occurred in 8% of UTI episodes. The most common side effects were gastrointestinal (∼3% of UTI episodes). All other side effects occurred in UTI episodes. Although there were statistically significant differences in side effects between broad- and narrow-spectrum antibiotics, these differences were not clinically relevant. Most outpatient UTIs in children do not require more than one healthcare visit, hospital admission, or change in empiric antibiotic therapy. This study supports the fact that pediatric UTIs can be effectively treated in the ambulatory setting. Copyright © 2016. Published by Elsevier Ltd.

  9. Missed Diagnosis of Cardiovascular Disease in Outpatient General Medicine: Insights from Malpractice Claims Data.

    Science.gov (United States)

    Quinn, Gene R; Ranum, Darrell; Song, Ellen; Linets, Margarita; Keohane, Carol; Riah, Heather; Greenberg, Penny

    2017-10-01

    Diagnostic errors are an underrecognized source of patient harm, and cardiovascular disease can be challenging to diagnose in the ambulatory setting. Although malpractice data can inform diagnostic error reduction efforts, no studies have examined outpatient cardiovascular malpractice cases in depth. A study was conducted to examine the characteristics of outpatient cardiovascular malpractice cases brought against general medicine practitioners. Some 3,407 closed malpractice claims were analyzed in outpatient general medicine from CRICO Strategies' Comparative Benchmarking System database-the largest detailed database of paid and unpaid malpractice in the world-and multivariate models were created to determine the factors that predicted case outcomes. Among the 153 patients in cardiovascular malpractice cases for whom patient comorbidities were coded, the majority (63%) had at least one traditional cardiac risk factor, such as diabetes, tobacco use, or previous cardiovascular disease. Cardiovascular malpractice cases were more likely to involve an allegation of error in diagnosis (75% vs. 47%, p <0.0001), have high clinical severity (86% vs. 49%, p <0.0001) and result in death (75% vs. 27%, p <0.0001), as compared to noncardiovascular cases. Initial diagnoses of nonspecific chest pain and mimics of cardiovascular pain (for example, esophageal disease) were common and independently increased the likelihood of a claim resulting in a payment (p <0.01). Cardiovascular malpractice cases against outpatient general medicine physicians mostly occur in patients with conventional risk factors for coronary artery disease and are often diagnosed with common mimics of cardiovascular pain. These findings suggest that these patients may be high-yield targets for preventing diagnostic errors in the ambulatory setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. [Long-term effectiveness of psychodynamic outpatient treatment of addiction].

    Science.gov (United States)

    Steffen, D V; Werle, L; Steffen, R; Steffen, M; Steffen, S

    2012-07-01

    The aim of this study is to make an evaluation of the effectiveness of long-term outpatient treatment for addiction on the basis of abstinence, cognitive functions, and changes in personality structure. This is a prospective cohort study of 259 patients with registration of the German core data set "addiction", a 12-month follow-up and neuropsychological testing (personality inventory, intelligence and cognitive functions). One year after the end of the long-term treatment we see an abstinence rate (DGSS4) of 57.5 %. The most substantial factors in abstinence are the participation in a self-help-group (β = 0.734, p addiction seem to show its high effectiveness in terms of abstinence and processing of drug structures. The cognitive functions could increase. This could be determinate of a condition for the conservation and restoration of working capacity. Further studies should differentiate the effect of insight into the dependency structure from the abstinence as an specific or unspecific effect. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Eating disorders: a hidden phenomenon in outpatient mental health?

    Science.gov (United States)

    Fursland, Anthea; Watson, Hunna J

    2014-05-01

    Eating disorders are common but underdiagnosed illnesses. Help-seeking for co-occurring issues, such as anxiety and depression, are common. To identify the prevalence of eating problems, using the SCOFF, and eating disorders when screening positive on the SCOFF (i.e., ≥2), among patients seeking help for anxiety and depression at a community-based mental health service. Patients (N = 260) consecutively referred and assessed for anxiety and depression treatment were administered the SCOFF screening questionnaire and a semi-structured standardized diagnostic interview during routine intake. 18.5% (48/260) scored ≥2 on the SCOFF, indicating eating problems. Of these, 41% (19/48) met criteria for an eating disorder. Thus, overall, 7.3% (19/260) of the sample met criteria for a DSM-IV eating disorder. Those scoring ≥2 on the SCOFF were more likely to: be female (p = 0.001), younger (p = 0.003), and have a history of self-harm (p eating disorders are a hidden phenomenon in general outpatient mental health. By using a standardized diagnostic interview to establish diagnosis rather than self- or staff-report, the study builds on limited previous findings. The naturalistic study setting shows that screening for eating disorders can be easily built into routine intake practice, and successfully identifies treatment need. Copyright © 2013 Wiley Periodicals, Inc.

  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

  13. Psychiatric disorders in outpatients with borderline intellectual functioning: comparison with both outpatients from regular mental health care and outpatients with mild intellectual disabilities.

    Science.gov (United States)

    Wieland, Jannelien; Kapitein-de Haan, Sara; Zitman, Frans G

    2014-04-01

    In the Netherlands, patients with borderline intellectual functioning are eligible for specialized mental health care. This offers the unique possibility to examine the mix of psychiatric disorders in patients who, in other countries, are treated in regular outpatient mental health care clinics. Our study sought to examine the rates of all main Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Axis I psychiatric diagnoses in outpatients with borderline intellectual functioning of 2 specialized regional psychiatric outpatient departments and to compare these with rates of the same disorders in outpatients from regular mental health care (RMHC) and outpatients with mild intellectual disabilities (IDs). Our study was a cross-sectional, anonymized medical chart review. All participants were patients from the Dutch regional mental health care provider Rivierduinen. Diagnoses of patients with borderline intellectual functioning (borderline intellectual functioning group; n = 235) were compared with diagnoses of patients from RMHC (RMHC group; n = 1026) and patients with mild ID (mild ID group; n = 152). Compared with the RMHC group, psychotic and major depressive disorders were less common in the borderline intellectual functioning group, while posttraumatic stress disorder and V codes were more common. Compared with the mild ID group, psychotic disorders were significantly less common. Mental health problems in people with borderline intellectual functioning may not be well addressed in general psychiatry, or by standard psychiatry for patients with ID. Specific attention to this group in clinical practice and research may be warranted lest they fall between 2 stools.

  14. Outpatient radiographic exposure in the first five years of life

    International Nuclear Information System (INIS)

    Fosarelli, P.D.; DeAngelis, C.

    1987-01-01

    Young children receive a variety of diagnostic radiographs over time. In some cases the exposure to radiation may be unwarranted because the films may yield confusing results, or may also need to be repeated because of poor technical quality. Even when the results are clearly negative, the subsequent treatment may proceed as if the film had been positive because of the child's clinical condition. The cumulative effect of such low-dose radiation on infants and children over time is unknown. The number and types of outpatient radiographs received by a cohort of poor children from a hospital-based continuity clinic during their first 5 years of life were reviewed. Also noted were the reason for obtaining the film, whether it was positive for that reason or another, whether the child had a chronic condition that prompted the use of radiograph, and the child's sex, race, and age when the film was obtained. Of the 218 children, 132 (60.6%) received 349 sets of films in their first 5 years. There was no difference in the number of films by race or sex. Chest and posttrauma bone or joint films accounted for 315 sets of films or 90.3% of the total. Overall, 25.8% of the 267 chest films were positive; this varied by age. Only 15% of the chest films were positive in the first year compared with 29 to 49% in the second through fifth years (p less than 0.001). Cough was the respiratory symptom most reliably associated with a positive chest film, both for the cohort (p less than 0.0001) and for children in the first year of life (p less than 0.01)

  15. 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.

  16. Outcome of Pediatric Gastroenterology Outpatients With Fever and Central Line.

    Science.gov (United States)

    Alexander, Thomas; Blatt, Julie; Skinner, Asheley Cockrell; Jhaveri, Ravi; Jobson, Meghan; Freeman, Katherine

    2016-11-01

    Although management algorithms for fever and central venous catheters (CVCs) have been implemented for pediatric oncology (PO) patients, management of pediatric outpatients with noncancer diagnoses and CVCs lacks clear protocols. The aim of the study was to assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and CVC. Using a microbiology database and emergency department records, we created a database of pediatric gastroenterology (PGI) and PO outpatients with fever and a CVC who presented to our emergency department or clinics from January 2010 through December 2012. We excluded patients who had severe neutropenia (absolute neutrophil count, gastroenterology outpatients with fever and a CVC have a high prevalence of bloodstream infection. Algorithms for management need to be subspecialty specific. Pediatric gastroenterology patients presenting to emergency departments or clinics with fever and CVC require admission for monitoring and management.

  17. Cardiovascular risk factors in outpatients with bipolar disorder

    NARCIS (Netherlands)

    Klumpers, U.M.H.; Boom, K.; Janssen, F.M.G.; Tulen, J.H.M.; Loonen, Anton J. M.

    2004-01-01

    Background: The mortality due to cardiovascular diseases in bipolar patients is much higher than in the general population. It is unclear whether lithium treatment contributes to this cardiovascular morbidity. Methods: The cardiovascular risk factors in outpatients with bipolar disorder on

  18. A South African outpatient drug treatment centre | Karassellos ...

    African Journals Online (AJOL)

    The Cape Town Drug Counselling Centre is an outpatient drug treatment ... Management of clients, which includes psychotherapy with an emphasis on ... medical intervention, is described, and proposed areas for further research are outlined.

  19. A survey of hospital outpatient services for chronic diseases in ...

    African Journals Online (AJOL)

    A survey of hospital outpatient services for chronic diseases in Gauteng. ... aspects of the organisation of services, and indirect indicators of patient care. Design. A postal survey of services for asthma, epilepsy, diabetes and hypertension at ...

  20. Satisfaction with outpatient health services at Jimma Hospital

    African Journals Online (AJOL)

    Objective: To assess consumer satisfaction of outpatient health care services. Methods: A cross-sectional ... tend to influence utilization of services as well as compliance with ... P-value < 0.05 was considered significant. During the study ...

  1. 9. Staff competencies at health facilities implementing an outpatient ...

    African Journals Online (AJOL)

    Esem

    2006-09-26

    Sep 26, 2006 ... an Outpatient Therapeutic Programme for Severely ... ¹Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia. ²National Food and ...... professional practices of a three-day course on.

  2. Scientific Letter: Gestalt psychotherapy in the outpatient treatment of ...

    African Journals Online (AJOL)

    Scientific Letter: Gestalt psychotherapy in the outpatient treatment of borderline personality disorder: a case report. ... African Journal of Psychiatry. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives.

  3. 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...

  4. Clinical Features of Refractory Ascites in Outpatients

    Directory of Open Access Journals (Sweden)

    Wanda Regina Caly

    Full Text Available OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month. RESULTS: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R and 11 non-refractory ascites (NR]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034. The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively. Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262. CONCLUSION: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.

  5. Oral anticancer agent medication adherence by outpatients.

    Science.gov (United States)

    Kimura, Michio; Usami, Eiseki; Iwai, Mina; Nakao, Toshiya; Yoshimura, Tomoaki; Mori, Hiromi; Sugiyama, Tadashi; Teramachi, Hitomi

    2014-11-01

    In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21-85 years) and 73 years (range, 30-90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3-3,585 days) and 219 days (24-3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4-5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

  6. 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.

  7. Evaluation of mortality rate and predictors of outcome in dogs receiving outpatient treatment for parvoviral enteritis.

    Science.gov (United States)

    Sarpong, Kathryn J; Lukowski, Jennifer M; Knapp, Cassandra G

    2017-11-01

    OBJECTIVE To determine mortality rates and prognostic factors for dogs with parvoviral enteritis receiving outpatient treatment. DESIGN Retrospective case series and case-control study. ANIMALS 130 client-owned dogs with a diagnosis of parvoviral enteritis between August 1, 2012, and January 31, 2015, that were treated with outpatient care. PROCEDURES Medical records were reviewed and data extracted regarding dog age, body weight, breed, and vaccination history; treatments administered; and short-term (≥ 3 day) outcome (determined via telephone call with owner). Treatments were administered according to clinician preference. Mortality rates were calculated overall and for various signalment and treatment groupings and compared. RESULTS 97 (75%) dogs survived and 33 (25%) dogs failed to survive for ≥ 3 days after initial diagnosis of parvoviral enteritis. Compared with distributions in the general hospital population, Chihuahuas, German Shepherd Dogs, pit bull-type dogs, and males were overrepresented. No significant difference was identified between survivors and nonsurvivors regarding age, body weight, or sex. Dogs prescribed a caloric supplement fed every 2 to 4 hours had a mortality rate of 19% (16/85). Most of these dogs had also received fluids administered SC, an antiemetic, and antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE Clinicians should note the 25% mortality rate of the dogs with parvoviral enteritis that received outpatient care in this study setting when discussing treatment options with owners of affected dogs who are financially unable to pursue hospitalization.

  8. Prevalence of Alcohol Use and Associated Factors in Urban Hospital Outpatients in South Africa

    Directory of Open Access Journals (Sweden)

    Hendry Van der Heever

    2011-06-01

    Full Text Available The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6% consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT. Two in five patients (40.5% were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.

  9. Impact of relational coordination on staff and patient outcomes in outpatient surgical clinics.

    Science.gov (United States)

    Gittell, Jody Hoffer; Logan, Caroline; Cronenwett, Jack; Foster, Tina C; Freeman, Richard; Godfrey, Marjorie; Vidal, Dale Collins

    2018-01-05

    Pressures are increasing for clinicians to provide high-quality, efficient care, leading to increased concerns about staff burnout. This study asks whether staff well-being can be achieved in ways that are also beneficial for the patient's experience of care. It explores whether relational coordination can contribute to both staff well-being and patient satisfaction in outpatient surgical clinics where time constraints paired with high needs for information transfer increase both the need for and the challenge of achieving timely and accurate communication. We studied relational coordination among surgeons, nurses, residents, administrators, technicians, and secretaries in 11 outpatient surgical clinics. Data were combined from a staff and a patient survey to conduct a cross-sectional study. Data were analyzed using ordinary least squares and random effects regression models. Relational coordination among all workgroups was significantly associated with staff outcomes, including job satisfaction, work engagement, and burnout. Relational coordination was also significantly associated with patients' satisfaction with staff and their overall visit, though the association between relational coordination and patients' satisfaction with their providers did not reach statistical significance. Even when patient-staff interactions are relatively brief, as in outpatient settings, high levels of relational coordination among interdependent workgroups contribute to positive outcomes for both staff and patients, and low levels tend to have the opposite effect. Clinical leaders can increase the expectation of positive outcomes for both staff and their patients by implementing interventions to strengthen relational coordination.

  10. 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.

  11. Patient involvement in rheumatology outpatient service design and delivery: a case study.

    Science.gov (United States)

    de Souza, Savia; Galloway, James; Simpson, Carol; Chura, Radka; Dobson, Joanne; Gullick, Nicola J; Steer, Sophia; Lempp, Heidi

    2017-06-01

    Patient involvement is increasingly recognized as important within the UK National Health Service to ensure that services delivered are relevant to users' needs. Organizations are encouraged to work with service users to achieve excellence in care. Patient education can improve health outcomes and reduce health-care costs. Mobile technologies could play a vital role in this. Patient-centred development of innovative strategies to improve the experience of rheumatology outpatients. The Group Rheumatology Initiative Involving Patients (GRIIP) project was set up in 2013 as a joint venture between patients, clinicians, academics and management at a London hospital. The project saw (i) the formation of an independent patient group which provided suggestions for service improvement - outcomes included clearer signs in the outpatient waiting area, extended phlebotomy opening hours and better access to podiatry; (ii) a rolling patient educational evening programme initiated in 2014 with topics chosen by patient experts - feedback has been positive and attendance continues to grow; and (iii) a mobile application (app) co-designed with patients launched in 2015 which provides relevant information for outpatient clinic attendees and data capture for clinicians - downloads have steadily increased as users adopt this new technology. Patients can effectively contribute to service improvement provided they are supported, respected as equals, and the organization is willing to undergo a cultural change. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  12. Outpatient diagnostic of bladder tumours in flexible cystoscopes

    DEFF Research Database (Denmark)

    Hermann, Gregers G; Mogensen, Karin; Toft, Birgitte Grønkær

    2012-01-01

    The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD).......The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD)....

  13. Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease

    Science.gov (United States)

    Ezenwa, Miriam O.; Molokie, Robert E.; Wang, Zaijie Jim; Yao, Yingwei; Suarez, Marie L.; Angulo, Veronica; Wilkie, Diana J.

    2014-01-01

    Context Patient demographic and clinical factors have known associations with acute health care utilization (AHCU) among patients with sickle cell disease (SCD), but it is unknown if pain measured predominantly in an outpatient setting is a predictor of future AHCU in patients with SCD. Objectives To determine whether multidimensional pain scores obtained predominantly in an outpatient setting predicted subsequent one-year AHCU by 137 adults with SCD and whether the pain measured at a second visit also predicted AHCU. Methods Pain data included the Composite Pain Index (CPI), a single score representative of a multidimensional pain experience (number of pain sites, intensity, quality, and pattern). Based on the distribution of AHCU events, we divided patients into three groups: (1) zero events (Zero), (2) 1–3 events (Low), or (3) 4–23 events (High). Results The initial CPI scores differed significantly by the three groups (F(2,134)=7.38, P=0.001). Post hoc comparisons showed that the Zero group had lower CPI scores than both the Low group (Pgroup (Page, and CPI scores (at both measurement times) were statistically significant predictors of utilization events. Pain intensity scores at both measurement times were significant predictors of utilization, but other pain scores (number of pain sites, quality, and pattern) were not. Conclusion Findings support use of outpatient CPI scores or pain intensity and age to identify at-risk young adults with SCD who are likely to benefit from improved outpatient pain management plans. PMID:24636960

  14. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery.

    Science.gov (United States)

    Stenberg, Karin; Lauer, Jeremy A; Gkountouras, Georgios; Fitzpatrick, Christopher; Stanciole, Anderson

    2018-01-01

    Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.

  15. Outpatient Vascular Intervention: A Two-Year Experience

    International Nuclear Information System (INIS)

    Macdonald, Sumaira; Thomas, Steven M.; Cleveland, Trevor J.; Gaines, Peter A.

    2002-01-01

    Purpose: To retrospectively analyze the outcome of a range of interventional vascular procedures performed on outpatients. Methods: Suitability for outpatient procedures was assessed according to agreed protocols. An episode was defined as any procedure/s through a single access site at one attendance. Retrospective case-note review was performed. Results: There were 693 outpatient episodes between April 1998 and May 2000 (290 interventional, and 403 diagnostic procedures),comprising 25% (693/2769) of the total workload. Follow-up is available in 214; 38 of these were transfers from outlying hospitals and were excluded from analysis. One hundred and seventy-six were true outpatients. There were 98 iliac and 46 femoropopliteal interventions,2 aortic stents, 1 renal and 5 upper-limb angioplasties (PTAs), 5 embolizations, 8 Hickman lines, 1 line stripping, 3 atherectomies, 1 dialysis-graft PTA and 6 bypass-graft PTAs. Sixty-eight closure devices were used. Twelve patients were converted to inpatients (6.8%,12/176). The readmission rate was 3.4% (6/176). The reattendance rate was 1.1% (2/176), both subsequently attending for outpatient duplex ultrasound examination to exclude pseudoaneurysm. The major complication rate was 3.4% and the delayed major complication rate was 1.7%. Conclusion: Outpatient vascular intervention is safe with appropriate protocols and with careful patient selection. Local vascular services benefit from the release of inpatient beds

  16. Structured outpatient treatment of alcohol vs. drug dependencies.

    Science.gov (United States)

    Washton, A M

    1990-01-01

    This chapter describes the rationale, indications, design, and use of a structured outpatient treatment approach as an effective alternative to residential treatment for alcohol and drug dependencies. An increasing demand for outpatient treatment services is being created by a combination of clinical and economic factors, including the influx of employed drug abusers who do not need or desire residential care and mounting financial pressures to contain health care costs. To be effective as a primary treatment modality, outpatient programs must be highly structured and intensive and able to deal with the full spectrum of alcohol and drug addictions. Perpetuating the historical separation between alcoholism and drug abuse treatment programs is unnecessary and counterproductive, although certain modifications in treatment approaches are needed to accommodate the distinctive characteristics of particular classes of drugs and the people who use them. The "outpatient rehab," a treatment model that approximates the intensity of inpatient treatment on an outpatient basis, may help to maximize the clinical efficacy and cost-effectiveness of outpatient treatment as a viable alternative to residential care. Initial treatment results with this model are encouraging.

  17. 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

  18. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The national average for the OAS CAHPS Survey categories. The OAS CAHPS survey collects information about patients’ experiences of care in hospital outpatient...

  19. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of the state averages for the OAS CAHPS Survey responses. The OAS CAHPS survey collects information about patients’ experiences of care in hospital outpatient...

  20. The use of spirometry in a primary care setting

    OpenAIRE

    Blain, Elizabeth A; 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...

  1. 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

  2. Transition Hand-Off from Inpatient to Outpatient Treatment of Acute Pyelonephritis in an Elderly Male.

    Science.gov (United States)

    Orlando, Patricia L; Shane-McWhorter, Laura

    2017-04-01

    Pyelonephritis is the progression of a urinary tract infection (UTI) to the kidney. In younger patients the infection may not be as severe and may even be treated with oral antibiotics. However, in elderly males pyelonephritis can be more complex and may require hospitalization and treatment with intravenous antibiotics. In the United States UTIs are responsible for frequent visits to emergency departments by elderly individuals. Current literature suggests that pyelonephritis in elderly males is a serious infection that may result in significant morbidity and mortality. Pharmacists are in a unique position to oversee the transition of antibiotic treatment from the inpatient to outpatienT SETTING.

  3. Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

    Science.gov (United States)

    Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

    2018-01-01

    Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

  4. Follow-up of patients with rheumatic heart diseases in the outpatient setting

    Directory of Open Access Journals (Sweden)

    B S Belov

    2009-01-01

    Full Text Available The major tasks of a follow-up of patients with rheumatic cardiac defects (RCD are formulated on the basis of the recommendations of international and national scientific associations. At the same time, a clinicianXs experience and judgments play an important role in supervising patients with chronic rheumatic heart disease and RCD.

  5. Drug Utilization Patterns and Costs of Erythropoiesis-Stimulating Agents in an Outpatient Setting in Greece.

    Science.gov (United States)

    Papachristos, Apostolos; Kani, Chara; Litsa, Panagiota; Valsami, Georgia; Souliotis, Kyriakos; Saridi, Maria; Markantonis, Sophia

    2016-05-01

    Anemia in the elderly is often related to a higher prevalence of chronic diseases such as chronic kidney failure, arthritis, and malignancy. Erythropoiesis-stimulating agents (ESAs) have been used for years to effectively treat anemia and when used appropriately can substantially improve the health status and quality of life of older adults. Following the 2008 recession in Greece, the government introduced ESA price control restrictions, but no prescribing restrictions, in an effort to reduce drug expenditure. ESA prescribing patterns and treatment costs were analyzed to determine inappropriate or appropriate use of these agents and related health care resources in Greece. A retrospective register-based drug utilization study was carried out using data from prescriptions dispensed at the public pharmacy of the largest social insurance fund (IKA-ETAM), for patients receiving ESAs over a six-month period. For each patient, demographic data, ESA dosage regimen, treatment indication and cost, prescriber specialty, and prescription origin were recorded. A total of 14,387 prescriptions from 6,074 patients (median age 74 years) were reviewed. A substantial number of patients (13.5%) were treated for off-label indications, for which the average cost per patient per indication was higher. ESA dosage/frequency of administration varied but was in accordance with recommendations. The percentage of patients who received innovator and biosimilar erythropoietin (EPO) was 88% and 12%, respectively. For the optimization of ESA utilization and the reduction of treatment costs, strict ESA prescription monitoring, development of registries, and criteria for off-label indications and biosimilar use in naive patients under the umbrella of risk-sharing agreements should be proposed.

  6. 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

    .79; 95% CI, 0.67-0.94), lived alone (HR, 0.75; 95% CI, 0.64-0.88), were unemployed (HR, 0.70; 95% CI, 0.54-0.90), had milder COPD with an HR of 0.67 (95% CI, 0.53-0.84) for Global Initiative for Chronic Obstructive Lung Disease (GOLD) A and 0.61 (95% CI, 0.47-0.80) for GOLD B compared with GOLD D, had...... Medical Research Council (MRC) dyspnea scale score disadvantaged patients have more difficulties achieving...

  7. A comparison of pain assessment by physicians, parents and children in an outpatient setting.

    Science.gov (United States)

    Brudvik, Christina; Moutte, Svein-Denis; Baste, Valborg; Morken, Tone

    2017-03-01

    Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief. This cross-sectional study involved 243 children aged 3-15 years treated at Bergen Accident and Emergency Department (ED) in 2011. The child patient's pain intensity was measured using age-adapted scales while parents and physicians did independent numeric rating scale (NRS) assessments. Physicians assessed the child's mean pain to be NRS=3.2 (SD 2.0), parents: NRS=4.8 (SD 2.2) and children: NRS=5.5 (SD 2.4). The overall child-parent agreement was moderate (Cohen's weighted κ=0.55), but low between child-physician (κ=0.12) and parent-physician (κ=0.17). Physicians significantly underestimated pain in all paediatric patients ≥3 years old and in all categories of medical conditions. However, the difference in pain assessment between child and physician was significantly lower for fractures (NRS=1.2; 95% CI 0.5 to 2.0) compared to wounds (NRS=3.4; CI 2.2 to 4.5; p=0.001), infections (NRS=3.1; CI 2.2 to 4.0; p=0.002) and soft tissue injuries (NRS=2.4; CI 1.9 to 2.9; p=0.007). The physicians' pain assessment improved with increasing levels of pain, but only 42.1% of children with severe pain (NRS≥7) received pain relief. Paediatric pain was significantly underestimated by ED physicians. In the absence of a self-report from the child, parents' evaluation should be listened to. Despite improved pain assessments in children with fractures and when pain was perceived to be severe, it is worrying that barely half of the children with severe pain received analgesics in the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. "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

    of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients' compliance; (5) use antibiotic...... combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab...

  9. Anesthetic Management of a Child With Unspecified Mitochondrial Disease in an Outpatient Dental Setting.

    Science.gov (United States)

    Gordon, Taylor R; Montandon, Richard J

    2017-01-01

    Mitochondrial disease (MD) represents a category of metabolic disorders with a wide range of symptoms across a variety of organ systems. It occurs with an incidence of greater than 1:5000 and can be difficult to specifically diagnose because of the variety of clinical presentations and multiple genomic origins. Although phenotypically variable, MD symptoms often include hypotonia, cardiac defects, dysautonomia, and metabolic dysfunction. Mitochondrial disease presents a unique challenge in terms of anesthetic management, as many anesthetic drugs suppress mitochondrial function. Additional considerations may need to be made in order to evaluate the patient's metabolic compensation prior to surgery. This article presents an in-depth discussion of a case involving a nearly 10-year-old boy with a history of an unspecified form of MD, who presented for endodontic treatment of tooth No. 30 under deep sedation. The article also provides a thorough review of the current literature surrounding the anesthetic management of patients with MD.

  10. Holter monitoring of central and peripheral temperature: possible uses and feasibility study in outpatient settings.

    Science.gov (United States)

    Varela, Manuel; Cuesta, David; Madrid, Juan Antonio; Churruca, Juan; Miro, Pau; Ruiz, Raul; Martinez, Carlos

    2009-08-01

    Conventional clinical thermometry has important limitations. A continuous monitoring of temperature may offer significant advantages, including the use of chronobiological and complexity analysis of temperature profile and eventually the identification of a "pre-febrile" pattern. We present a clinical model designed to measure, store and/or transmit in real time a central and a peripheral temperature reading. The results of its use in a healthy, free-living population is reported. Thirty subjects (15 women, 15 men, 20-70 years old), were monitored for 24 h while following their normal life. Temperatures were recorded every minute at the external auditory channel (EAC) and on the skin, at the intersection of the 5th intercostal space and the anterior axillary line. A Cosinor analysis and Approximate Entropy (ApEn) (m = 2, r = 0.15*SD, N = 180) were calculated for both temperatures. Median temperature was 35.55 degrees C [interquartile range (IR) 0.77 degrees C] in the external auditory channel (EAC) and 34.62 degrees C (IR 1.61) in the specified skin location. Median gradient between AEC and skin was 0.93 (IR 1.57). A circadian rhythm was present both in EAC and skin temperature, with a mean amplitude of 0.44 degrees C and an acrophase at 21:02 for the EAC and 0.70 degrees C and 00:42 for the skin. During the night there was a sizable increase in peripheral temperature, with a decrease in gradient and a loss of complexity in the temperature profile, most significantly in the peripheral temperature. Continuous monitoring of central and peripheral temperature may be a helpful tool in both ambulatory and admitted patients and may offer new approaches in clinical thermometry.

  11. e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics.

    Science.gov (United States)

    Novoa, Nuria M; Gómez, Maria Teresa; Rodríguez, María; Jiménez López, Marcelo F; Aranda, Jose L; Bollo de Miguel, Elena; Diez, Florentino; Hernández Hernández, Jesús; Varela, Gonzalo

    2016-11-01

    The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Economic assessment of the general thoracic surgery outpatient service.

    Science.gov (United States)

    Jones, David R; Vaughters, Ann B R; Smith, Philip W; Daniel, Thomas M; Shen, K Robert; Heinzmann, Janet L

    2006-09-01

    One aspect of the definition of institutional value for any program is based on the return on investment (ROI) for that program. Program requests for future resource allocations depend, in part, on that information. The purpose of this project was to determine the ROI for initial outpatient visits only for our General Thoracic Surgery (GTS) program. The number of GTS outpatient visits, studies, and requested consultations ordered by GTS surgeons only was determined after review of the hospital database and office records for the calendar year 2003. Only charges associated with the initial outpatient visits (no inpatient or physician charges) were included. Charges were based on hospital finance department data. The ROI for GTS outpatient services was calculated using total hospital costs and hospital collections. There were 689 initial outpatient GTS visits. The majority were for lung cancer (48%), benign lung diseases (21%), and esophageal diseases (14%). Total outpatient charges were 1.25M dollars and by disease process were lung cancer (644,000 dollars), benign lung disease (90,000 dollars), esophageal disease (159,000 dollars), and other (357,000 dollars). The most significant hospital charges were the following: radiology (850,000 dollars), laboratory studies (82,000 dollars), gastrointestinal medicine studies (59,000 dollars), and cardiology (42,000 dollars). Total operational costs for the GTS clinic were 415,000 dollars and hospital collections were 513,000 dollars, yielding an ROI of 98,000 dollars or an operating margin of 19%. An operating margin of 19% for GTS outpatient services is better than most Fortune 500 companies. Acquisition of this type of information by GTS surgeons may be helpful for future program development and institutional resource allocation.

  13. Enhancing outpatient clinics management software by reducing patients’ waiting time

    Directory of Open Access Journals (Sweden)

    Iman Almomani

    2016-11-01

    Full Text Available Summary: The Kingdom of Saudi Arabia (KSA gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients—which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient’s satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients’ distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients’ waiting time will consequently affect patients’ satisfaction and improve

  14. Substance Abuse Intensive Outpatient Programs: Assessing the Evidence

    Science.gov (United States)

    McCarty, Dennis; Braude, Lisa; Dougherty, Richard H.; Daniels, Allen S.; Ghose, Sushmita Shoma; Delphin-Rittmon, Miriam E.

    2014-01-01

    Objective Substance abuse intensive outpatient programs (IOPs) are direct services for people with substance use disorders or co-occurring mental and substance use disorders who do not require medical detoxification or 24-hour supervision. IOPs are alternatives to inpatient and residential treatment. They are designed to establish psychosocial supports and facilitate relapse management and coping strategies. This article assesses their evidence base. Methods Authors searched major databases: PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. They identified 12 individual studies and one review published between 1995 and 2012. They chose from three levels of research evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. Results Based on the quality of trials, diversity of settings, and consistency of outcomes, the level of evidence for IOP research was considered high. Multiple randomized trials and naturalistic analyses compared IOPs with inpatient or residential care; these types of services had comparable outcomes. All studies reported substantial reductions in alcohol and drug use between baseline and follow-up. However, substantial variability in the operationalization of IOPs and outcome measures was apparent. Conclusions IOPs are an important part of the continuum of care for alcohol and drug use disorders. They are as effective as inpatient treatment for most individuals seeking care. Public and commercial health plans should consider IOP treatment as a covered health benefit. Standardization of the elements included in IOPs may improve their quality and effectiveness. PMID:24445620

  15. Quality of life among dually diagnosed and non-substance-using male schizophrenia outpatients

    Directory of Open Access Journals (Sweden)

    Hatice Imer Aras

    2013-06-01

    Full Text Available Objective. To assess the quality of life (QoL in an outpatient setting among male patients dually diagnosed with schizophrenia and substance use disorder (SUD, and non-substance-using male schizophrenia patients. Methods. The study was conducted in an outpatient setting with 52 male schizophrenia patients and 49 male schizophrenia patients with SUD comorbidity, who were admitted to Bakirköy Research and Training Hospital between 1 May 2010 and 30 September 2010. The patients had been in remission for a minimum of 6 months. The subjects were re-evaluated for the persistence of the diagnosis by using the Structural Clinical Interview for DSM-IV Axis I disorders (SCID I socio-demographic data form, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF and positive and negative syndrome scale (PANSS were administered to detect the factors affecting diagnostic stability and clinical course. Results. Schizophrenia patients with no SUD comorbidity had a significantly earlier age of disease onset than the comorbid group. SUD comorbidity in schizophrenia patients leads to increased rates of unemployment and homicidality. WHOQOL-Bref psychological health scores were significantly lower among patients in the comorbidity group. No statistically significant difference was identified between the groups with regard to the PANSS scores. Conclusions. It is necessary to focus on the treatment challenges for schizophrenia patients with SUD comorbidity, such as the provision of treatment in criminal justice settings, in which a high proportion of such patients are found.

  16. Viruses Associated With Acute Respiratory Infections and Influenza-like Illness Among Outpatients From the Influenza Incidence Surveillance Project, 2010–2011

    Science.gov (United States)

    Fowlkes, Ashley; Giorgi, Andrea; Erdman, Dean; Temte, Jon; Goodin, Kate; Di Lonardo, Steve; Sun, Yumei; Martin, Karen; Feist, Michelle; Linz, Rachel; Boulton, Rachelle; Bancroft, Elizabeth; McHugh, Lisa; Lojo, Jose; Filbert, Kimberly; Finelli, Lyn

    2017-01-01

    Background The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. Methods From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. Results The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2–17 years, whereas other viruses had varied patterns among age groups. Conclusions The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children. PMID:24338352

  17. Viruses associated with acute respiratory infections and influenza-like illness among outpatients from the Influenza Incidence Surveillance Project, 2010-2011.

    Science.gov (United States)

    Fowlkes, Ashley; Giorgi, Andrea; Erdman, Dean; Temte, Jon; Goodin, Kate; Di Lonardo, Steve; Sun, Yumei; Martin, Karen; Feist, Michelle; Linz, Rachel; Boulton, Rachelle; Bancroft, Elizabeth; McHugh, Lisa; Lojo, Jose; Filbert, Kimberly; Finelli, Lyn

    2014-06-01

    The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥ 2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2-17 years, whereas other viruses had varied patterns among age groups. The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children.

  18. 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.

  19. 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

  20. Outpatient treatment costs and their potential impact on cancer care

    International Nuclear Information System (INIS)

    Isshiki, Takahiro

    2014-01-01

    Cancer creates a tremendous financial burden. Cancer-related costs are categorized into direct, indirect, and psychosocial costs. Although there have been many reports on medical care costs, which are direct, those on other costs are extremely scarce. We estimated travel time and costs required for cancer patients to receive outpatient treatment. We studied 521 cancer patients receiving anti-cancer treatment between February 2009 and December 2012 at the Outpatient Chemotherapy Center of Teikyo University Chiba Medical Center. Address data were extracted from Data Warehouse electronic medical records, and travel distance and time required for outpatient treatment were calculated via MapInfo and ACT Distance Calculator Package. Transportation costs were estimated on the basis of ¥274 (=$3.00) per kilometer. The study design was approved by an ethics review board of Teikyo University (12-851). Average round-trip travel distance, time, and cost for all patients were 26.7 km, 72.5 min, and ¥7,303 ($79.99), respectively. Cancer patients incurred a travel cost of ¥4000–¥9000 ($40.00 to $100.00) for each outpatient treatment. With population aging, seniors living alone and senior households are increasing, and outpatient visits are becoming a common burden

  1. 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.

  2. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

    Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

    2018-02-01

    To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Characteristics of the first 1000 headaches in an outpatient headache clinic registry.

    Science.gov (United States)

    Guerrero, Ángel L; Rojo, Esther; Herrero, Sonia; Neri, María J; Bautista, Lourdes; Peñas, María L; Cortijo, Elisa; Mulero, Patricia; Fernández, Rosa

    2011-02-01

    To analyze the incidence and characteristics of the first 1000 headaches in an outpatient clinic. Headache is a common cause of medical consultation, both in primary care and in specialist neurology outpatient clinics. The International Classification of Headache Disorders, 2nd Edition (ICHD-II), enables headaches to be classified in a precise and reproducible manner. In January 2008, an outpatient headache clinic was set up in Hospital Clínico Universitario, a tertiary hospital in Valladolid, Spain. Headaches were classified prospectively in accordance with ICHD-II criteria. In each case we recorded age and sex, duration of headache, ancillary tests required, and previous symptomatic or prophylactic therapies. In January 2010, the registry included 1000 headaches in 682 patients. The women/men ratio was 2.46/1 and the mean age of the patients was 43.19 ± 17.1 years (range: 14-94 years). Patients were referred from primary care (53.4%), general neurology clinics (36.6%), and other specialist clinics (9%). The headaches were grouped (ICHD-II classification) as follows: group 1 (Migraine), 51.4%; group 2 (Tension-type headache), 16%; group 3 (Trigeminal autonomic cephalalgias), 2.6%; group 4 (Other primary headaches) and group 13 (Cranial neuralgias), 3.4%. The diagnostic criteria of chronic migraine were satisfied in 8.5% of migraines. Regarding secondary headaches, 1.1% of all cases were included in group 5 (Headaches attributed to trauma) and 8.3% in group 8 (Headaches attributed to a substance or its withdrawal). Only 3.4% of headaches were classified in group 14 (Unspecified or not elsewhere classified), and 5.2% were included in the groups listed in the ICHD-II research appendix. This registry outlines the characteristics of patients seen in an outpatient headache clinic in a tertiary hospital; our results are similar to those previously reported for this type of outpatient clinic. Migraine was the most common diagnosis. Most headaches can be classified using

  4. 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.

  5. Service quality of hospital outpatient departments: patients' perspective.

    Science.gov (United States)

    Zarei, Ehsan

    2015-01-01

    Assessment of patient perceptions of health service quality as an important element in quality assessments has attracted much attention in recent years. The purpose of this paper is to assess the service quality of hospital outpatient departments affiliated to Shahid Beheshti University of Medical Sciences from the patients' perspective. This cross-sectional study was conducted in 2014 in Tehran, Iran. The study samples included 500 patients who were selected by multi-stage random sampling from four hospitals. The data collection instrument was a questionnaire consisting of 50 items, and the validity and reliability of the questionnaire were confirmed. For data analysis, exploratory and confirmatory factor analysis, Friedman test, and descriptive statistics were used through LISREL 8.54 and SPSS 18 applications. Eight significant factors were extracted for outpatient service quality, which explained about 67 per cent of the total variance. Physician consultation, information provided to the patient, and the physical environment of the clinic were the three determining factors of the quality of outpatient services. The highest and lowest perceptions were related to physician consultation and perceived waiting time dimension, respectively. The mean score of patients' perception of outpatient service quality was 3.89 (±0.60). About 59.5 per cent of patients assessed the quality of outpatient services as good, 38.2 per cent as moderate, and 2.3 per cent as poor. Practical implications - The instrument developed for this study is valid and reliable, and it can help hospital managers to identify the areas needing improvement and correction. According to the findings of this study, the majority of patients had a positive experience with outpatient departments of teaching hospitals, and the services provided in these centres were of adequate quality, based on patient assessments.

  6. Empirical analysis of scaling and fractal characteristics of outpatients

    International Nuclear Information System (INIS)

    Zhang, Li-Jiang; Liu, Zi-Xian; Guo, Jin-Li

    2014-01-01

    The paper uses power-law frequency distribution, power spectrum analysis, detrended fluctuation analysis, and surrogate data testing to evaluate outpatient registration data of two hospitals in China and to investigate the human dynamics of systems that use the “first come, first served” protocols. The research results reveal that outpatient behavior follow scaling laws. The results also suggest that the time series of inter-arrival time exhibit 1/f noise and have positive long-range correlation. Our research may contribute to operational optimization and resource allocation in hospital based on FCFS admission protocols.

  7. Empirical analysis of scaling and fractal characteristics of outpatients

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Li-Jiang, E-mail: zljjiang@gmail.com [College of Management and Economics, Tianjin University, Tianjin 300072 (China); Management Institute, Xinxiang Medical University, Xinxiang 453003, Henan (China); Liu, Zi-Xian, E-mail: liuzixian@tju.edu.cn [College of Management and Economics, Tianjin University, Tianjin 300072 (China); Guo, Jin-Li, E-mail: phd5816@163.com [Business School, University of Shanghai for Science and Technology, Shanghai 200093 (China)

    2014-01-31

    The paper uses power-law frequency distribution, power spectrum analysis, detrended fluctuation analysis, and surrogate data testing to evaluate outpatient registration data of two hospitals in China and to investigate the human dynamics of systems that use the “first come, first served” protocols. The research results reveal that outpatient behavior follow scaling laws. The results also suggest that the time series of inter-arrival time exhibit 1/f noise and have positive long-range correlation. Our research may contribute to operational optimization and resource allocation in hospital based on FCFS admission protocols.

  8. Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data.

    Science.gov (United States)

    Engler, J; Güthlin, C; Dahlhaus, A; Kojima, E; Müller-Nordhorn, J; Weißbach, L; Holmberg, C

    2017-11-01

    The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards. © 2017 John Wiley & Sons Ltd.

  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. Assisted outpatient treatment in New York: regional differences in New York's assisted outpatient treatment program.

    Science.gov (United States)

    Robbins, Pamela Clark; Keator, Karli J; Steadman, Henry J; Swanson, Jeffrey W; Wilder, Christine M; Swartz, Marvin S

    2010-10-01

    This study sought to describe the implementation of "Kendra's Law" in New York State and examine regional differences in the application of the program. Between February 2007 and April 2008, interviews were conducted with 50 key informants across New York State. Key informants included assisted outpatient treatment (AOT) county coordinators, county directors of community services, judges, attorneys from the Mental Hygiene Legal Service (MHLS), psychiatrists, treatment providers, peer advocates, family members, and other referred individuals. Additional analyses were conducted using AOT program administrative and evaluation databases and client history data. From program inception in 1999 through 2007, a total of 8,752 initial AOT orders and 5,684 renewals were granted. Notable regional differences were found in the use of two distinct models of AOT: AOT First and Enhanced Voluntary Services First. Regional differences were also found in how the AOT program was implemented and administered. Other variations stemmed from the court proceedings themselves, the continuity and interest of the presiding judge, and the attitudes of the MHLS attorneys. Many regional adaptations of the AOT program were found. Many were the result of lack of guidance in implementing Kendra's Law. Policy makers may want to consider whether the law should change to allow for these differences or whether additional support from a central source is warranted to ensure more uniformity in the implementation of AOT and thus the fairness of its application across the state.

  11. Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

    Science.gov (United States)

    Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

    2016-03-01

    Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

  12. A national comparison of burnout and work-life balance among internal medicine hospitalists and outpatient general internists.

    Science.gov (United States)

    Roberts, Daniel L; Shanafelt, Tait D; Dyrbye, Liselotte N; West, Colin P

    2014-03-01

    General internists suffer higher rates of burnout and lower satisfaction with work-life balance than most specialties, but the impact of inpatient vs outpatient practice location is unclear. Physicians in the American Medical Association Physician Masterfile were previously surveyed about burnout, depression, suicidal ideation, quality of life, fatigue, work-life balance, career plans, and health behaviors. We extracted and compared data for these variables for the 130 internal medicine hospitalists and 448 outpatient general internists who participated. Analyses were adjusted for age, sex, hours worked, and practice setting. There were 52.3% of the hospitalists and 54.5% of the outpatient internists affected by burnout (P = 0.86). High scores on the emotional exhaustion subscale (43.8% vs 48.1%, P = 0.71) and on the depersonalization subscale (42.3% vs 32.7%, P = 0.17) were common but similar in frequency in the 2 groups. Hospitalists were more likely to score low on the personal accomplishment subscale (20.3% vs 9.6%, P = 0.04). There were no differences in symptoms of depression (40.3% for hospitalists vs 40.0% for outpatient internists, P = 0.73) or recent suicidality (9.2% vs 5.8%, P = 0.15). Rates of reported recent work-home conflict were similar (48.4% vs 41.3%, P = 0.64), but hospitalists were more likely to agree that their work schedule leaves enough time for their personal life and family (50.0% vs 42.0%, P = 0.007). Burnout was common among both hospitalists and outpatient general internists, although hospitalists were more satisfied with work-life balance. A better understanding of the causes of distress and identification of solutions for all internists is needed. © 2014 Society of Hospital Medicine.

  13. [The low consumption of outpatient medical care in the department of Ardennes (France) (author's transl)].

    Science.gov (United States)

    Lebrun, T; Sailly, J C

    1982-01-01

    The purpose of the research explained in this article was to build up a methodology which allows to set up a map of low consumption of outpatient medical care and to find out to which extent the low recorded demand is attributable tho the medical aids supply. French National Health Service files were the basic data for this research which was led into the department of Ardennes. First and foremost the investigation was to identify on a district level with low consumer families after having eliminated demands' factors. Thus one could set up maps of low consumption in comparison with maps of low prescription. The investigation showed that low consumer families live generally in the cantons of low medical care consumption concerned mainly with low medical aids suppliers.

  14. Household costs of seeking outpatient care in Egyptian children with ...

    African Journals Online (AJOL)

    Introduction: Addressing difficulties of seeking and getting health care would lower the burden of diarrhea among ill children from developing countries as Egypt. The purpose of the study is to evaluate the economic burden of diarrhea associated with outpatient visits of children in Egypt by identifying the different types of ...

  15. A prospective analysis of gastroenterology out-patient consultations ...

    African Journals Online (AJOL)

    Introduction: The pattern and relative occurrence of gastrointestinal and liver disorders in Nigeria is unclear. The aim of this study was to assess the pattern of gastroenterology referral and consultations as seen in the outpatient department of the Lagos University Teaching Hospital, Lagos, Nigeria. Methods: This was a ...

  16. [Innovating to support the development of outpatient surgery].

    Science.gov (United States)

    Dubois, Ronan

    Le Confluent private hospital in Nantes has opened a unit devoted to outpatient surgery. Its architecture, organisation, facilities and services have all been designed to treat patients in as short a timeframe as possible. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. 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…

  18. 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…

  19. Determinants of Patient Waiting Time in the General Outpatient ...

    African Journals Online (AJOL)

    The Institute of Medicine (IOM) recommends that, at least 90% of patients should be seen within 30 min of their scheduled appointment time.[5] This is, however, not the case in most developing countries, as several studies have shown that patients spend 2‑4 h in the outpatient departments before seeing the doctor.[6‑8] A ...

  20. 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)

  1. 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.

  2. Patient satisfaction in Malaysia's busiest outpatient medical care.

    Science.gov (United States)

    Ganasegeran, Kurubaran; Perianayagam, Wilson; Manaf, Rizal Abdul; Jadoo, Saad Ahmed Ali; Al-Dubai, Sami Abdo Radman

    2015-01-01

    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.

  3. 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

  4. Outpatient rehabilitation as an intervention to improve employees' physical capacity.

    Science.gov (United States)

    Ojala, Birgitta; Nygård, Clas-Håkan; Nikkari, Seppo T

    2016-01-01

    The aging of the workforce poses new challenges for maintaining work ability. Because of limited information on the effectiveness of vocational rehabilitation performed in traditional inpatient programs, extended interest in outpatient rehabilitation has risen in the past few years. We examined the effects of a new outpatient rehabilitation program where every participant defined their own goals to improve work ability by the aid of a goal-oriented multi-professional team. This report will focus on the employees' physical capacity during a nine-month program. A total of 605 municipal employees from different production areas of the City of Tampere took part in the outpatient rehabilitation program, implemented by the occupational health unit. Groups of 12 employees participated in eight one-day sessions at intervals of two to three weeks; the final follow-up was 9 months from the beginning. Submaximal aerobic capacity was tested by a calibrated cycle ergometer with a commercial program (Aino Fitware pro, Helsinki, Finland). Musculoskeletal tests assessed muscle strength, balance and mobility. During the 9-month follow-up of the rehabilitation program, the employees' physical capacity was improved. The follow-up test scores from a total of 329 employees were significantly higher in the submaximal aerobic capacity test (p health situation to take part in physical capacity tests; however they took part in the intervention. The new outpatient rehabilitation program organized by the occupational health unit had a positive influence on employees' physical capacity during a nine-month follow up.

  5. Thoracoscopic Surgery for Pneumothorax Following Outpatient Drainage Therapy.

    Science.gov (United States)

    Sano, Atsushi; Yotsumoto, Takuma

    2017-10-20

    We investigated the outcomes of surgery for pneumothorax following outpatient drainage therapy. We reviewed the records of 34 patients who underwent operations following outpatient drainage therapy with the Thoracic Vent at our hospital between December 2012 and September 2016. Indications for outpatient drainage therapy were pneumothorax without circulatory or respiratory failure and pleural effusion. Indications for surgical treatment were persistent air leakage and patient preference for surgery to prevent or reduce the incidence of recurrent pneumothorax. Intraoperatively, 9 of 34 cases showed loose adhesions around the Thoracic Vent, all of which were dissected bluntly. The preoperative drainage duration ranged from 5 to 13 days in patients with adhesions and from 3 to 19 days in those without adhesions, indicating no significant difference. The duration of preoperative drainage did not affect the incidence of adhesions. The operative duration ranged from 30 to 96 minutes in patients with adhesions and from 31 to 139 minutes in those without adhesions, also indicating no significant difference. Outpatient drainage therapy with the Thoracic Vent was useful for spontaneous pneumothorax patients who underwent surgery, and drainage for less than 3 weeks did not affect intraoperative or postoperative outcomes.

  6. Efficacy of promethazine suppositories dispensed to outpatient surgical patients.

    Science.gov (United States)

    Wright, C. D.; Jilka, J.; Gentry, W. B.

    1998-01-01

    Postoperative nausea and vomiting frequently complicate outpatient anesthesia and surgery. The duration of treatment for this complication must occasionally extend beyond discharge from the hospital. In this study, we evaluated the commonly used anti-emetic promethazine for its efficacy in the post-discharge period. Adult outpatient surgical patients who had excessive postoperative nausea and vomiting in the recovery room, or who were at risk for postoperative nausea and vomiting following discharge were given two promethazine suppositories (25 mg) for home use. All patients were contacted by our recovery room nurses on the first business day after their surgery and questioned as to their use of the suppositories and, if used, their efficacy. We found that 55 percent of patients given promethazine suppositories for home use had nausea and vomiting in the post-discharge period. Of the patients given promethazine, 89 percent used the suppositories. All of these patients reported improvement in their symptoms following use of the suppositories. None reported adverse effects from the promethazine suppositories. In conclusion, we found promethazine suppositories to be an inexpensive and efficacious treatment for nausea and vomiting in adult outpatient surgical patients following discharge from the hospital. Side-effects were minimal, and our patients voiced no complaints about this mode of therapy. We recommend this therapy for treatment of nausea and vomiting after hospital discharge following adult outpatient surgery. PMID:10527366

  7. Substance abuse in outpatients attending rural and urban health ...

    African Journals Online (AJOL)

    Substance abuse in outpatients attending rural and urban health centres in Kenya. ... Objectives: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya. Design: A ... Socio-cultural factors might be responsible for the differences noted.

  8. 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…

  9. the profile and urological service needs of outpatients attending a ...

    African Journals Online (AJOL)

    A peek into the outpatient services would, therefore, give an insight into the common medical problems in a given discipline. (1). This study has similar demographic features to one done on inpatients in the same institution two years earlier and confirms the generally accepted knowledge that urology is a specialty dealing.

  10. Managing an outpatient parenteral antibiotic therapy team: challenges and solutions.

    Science.gov (United States)

    Halilovic, Jenana; Christensen, Cinda L; Nguyen, Hien H

    2014-01-01

    Outpatient parenteral antimicrobial therapy (OPAT) programs should strive to deliver safe, cost effective, and high quality care. One of the keys to developing and sustaining a high quality OPAT program is to understand the common challenges or barriers to OPAT delivery. We review the most common challenges to starting and managing an OPAT program and give practical advice on addressing these issues.

  11. [Observation on analgesia effect of electroacupuncture during gynecologic outpatient operation].

    Science.gov (United States)

    Wang, Xiao-Hui; Wu, Xue-Lei; Jin, Ping-Lin; Wang, Lu-Dong; Zhao, Zhi-En; Qin, Xue-Yu; Zhang, Zhi-Yan; Hu, Xue-Zhu; Cai, Zhen-Lin

    2012-10-01

    To verify the feasibility of electroacupuncture analgesia applied to gynecologic outpatient operation. Two hundred patients were randomly divided into an electroacupuncture analgesia group and an intravenous anesthesia group, 100 cases in each group. Operation types included artificial abortion, diagnostic curettage and remove of intrauterine divice. The electroacupuncture analgesia group was treated with electroacupuncture at bilateral Hegu (LI 4) and Neiguan (PC 6), and the routine gynecologic outpatient operation was performed under patients' waking state. The intravenous anesthesia group was treated with routine gynecologic outpatient operation after intravenous injection of fentanyl and propofol. The excellent rate and the effective rate of analgesia were 88.0% (88/100) and 100.0% (100/100) in the electroacupuncture analgesia group, and 94.0% (94/100) and 100.0% (100/100) in the intravenous anesthesia group, with no statistically significant differences between the two groups (all P > 0.05). There was no adverse reaction in the electroacupuncture anesthesia group, but 11 cases of adverse reactions in the intravenous anesthesia group. Electroacupuncture analgesia can effectively alleviate the pain during gynecologic outpatient operation and it is simple and safe without adverse reactions.

  12. Pediatric Urinary Tract Infection as a Cause of Outpatient Clinic ...

    African Journals Online (AJOL)

    2018-03-01

    Mar 1, 2018 ... predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department ... with pediatric UTI (1,4,5). Effective management of patients suffering ..... patients. J of. Resear in Medical and Dental Sci 2014; 2(1). 17.

  13. 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…

  14. Nasotracheal Intubation in Children for Outpatient Dental Surgery: Is ...

    African Journals Online (AJOL)

    2018-02-23

    Feb 23, 2018 ... in Children for Outpatient Dental Surgery: Is Fiberoptic Bronchoscopy. Useful?. Niger J Clin Pract 2018;21:183-8. This is an open access article distributed under the terms of the Creative Commons. Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the ...

  15. 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

  16. 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.

  17. Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.

    Science.gov (United States)

    Khawcharoenporn, Thana; Tice, Alan

    2010-10-01

    Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded. Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin. Risk factors for treatment failure were evaluated using multivariate logistic regression analysis. Of 544 patients with cellulitis, 405 met the inclusion criteria. The overall treatment success rate of trimethoprim-sulfamethoxazole was significantly higher than the rate of cephalexin (91% vs 74%; P<.001), whereas clindamycin success rates were higher than those of cephalexin in patients who had subsequently culture-confirmed MRSA infections (P=.01), had moderately severe cellulitis (P=.03), and were obese (P=.04). Methicillin-resistant S. aureus was recovered in 72 of 117 positive culture specimens (62%). Compliance and adverse drug reaction rates were not significantly different among patients who received these 3 antibiotics. Factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA (adjusted odds ratio 4.22; 95% confidence interval, 2.25-7.92; P<.001) and severity of cellulitis (adjusted odds ratio 3.74; 95% confidence interval, 2.06-6.79; P<.001). Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services.

    Science.gov (United States)

    Alappattu, Meryl; Neville, Cynthia; Beneciuk, Jason; Bishop, Mark

    2016-01-01

    The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Retrospective cross-sectional analysis. A convenience sample of patients that positively responded to a UI screening question was included in this study. Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e., urinary dysfunction, fecal dysfunction, pelvic pain, spine, neurological disorders, or extremity disorders); UI type (i.e., mixed, urge, stress, or insensible); UI symptom severity; and quality of life (QoL) impact. Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. The mean age of the sample (n = 599) was 49.8 years (SD = 18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7% and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on QoL compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorder group. These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings.

  19. [Turnover of Non-medical Staff in Outpatient Oncology Practices: Is Building Social Capital a Solution?].

    Science.gov (United States)

    Gloede, T D; Ernstmann, N; Baumann, W; Groß, S E; Ansmann, L; Nitzsche, A; Neumann, M; Wirtz, M; Schmitz, S; Schulz-Nieswandt, F; Pfaff, H

    2015-11-01

    While a lot is known about potential and actual turnover of non-medical hospital staff, only few data exist for the outpatient setting. In addition, little is known about actual instruments which leaders can use to influence staff turnover in physician practices. In the literature, the social capital of an organisation, which means the amount of trust, common values and reciprocal behaviour in the organisation, has been discussed as a possible field of action. In the present study, staff turnover as perceived by outpatient haematologists and oncologists is presented and analysed as to whether social capital is associated with that staff turnover. In conclusion, measures to increase the social capital of a practice are presented. The present study is based on data gathered in a questionnaire-based survey with members of the Professional Organisation of -Office-Based Haematologists and Oncologists (N=551). The social capital of the practice was captured from the haematologists and oncologists using an existing and validated scale. To analyse the impact of the practice's social capital on staff turnover, as perceived by the physicians, bivariate correlations and linear regression analyses were calculated. In total, 152 haematologists and oncologists participated in the study which represents a response rate of 28%. In the regression analyses, social capital appears as a significant and strong predictor of staff turnover (beta=-0.34; pturnover although the underlying study design does not allow for drawing causal conclusions regarding this relationship. To create social capital in their practice, outpatient physicians may apply measures that facilitate social interaction among staff, foster trust and facilitate cooperation. Such measures may already be applied when hiring and training new staff, but also continuously when leading employees and when organising work tasks, e.g., by establishing regular team meetings. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Directory of Open Access Journals (Sweden)

    Sarah M. Westberg

    2010-06-01

    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. Type: Original Research

  1. 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.

  2. 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.

  3. Impact of Diabetes E-Consults on Outpatient Clinic Workflow.

    Science.gov (United States)

    Zoll, Brian; Parikh, Pratik J; Gallimore, Jennie; Harrell, Stephen; Burke, Brian

    2015-08-01

    An e-consult is an electronic communication system between clinicians, usually a primary care physician (PCP) and a medical or surgical specialist, regarding general or patient-specific, low complexity questions that would not need an in-person consultation. The objectives of this study were to understand and quantify the impact of the e-consult initiative on outpatient clinic workflow and outcomes. We collected data from 5 different Veterans Affairs (VA) outpatient clinics and interviewed several physicians and staff members. We then developed a simulation model for a primary care team at an outpatient clinic. A detailed experimental study was conducted to determine the effects of factors, such as e-consult demand, view-alert notification arrivals, walk-in patient arrivals, and PCP unavailability, on e-consult cycle time. Statistical tests indicated that 4 factors related to outpatient clinic workflow were significant, and levels within each of the 4 significant factors resulted in statistically different e-consult cycle times. The arrival rate of electronic notifications, along with patient walk-ins, had a considerable effect on cycle time. Splitting the workload of an unavailable PCP among the other PCPs, instead of the current practice of allocating it to a single PCP, increases the system's ability to handle a much larger e-consult demand. The full potential of e-consults can only be realized if the workflow at the outpatient clinics is designed or modified to support this initiative. This study furthers our understanding of how e-consult systems can be analyzed and alternative workflows tested using statistical and simulation modeling to improve care delivery and outcomes. © The Author(s) 2014.

  4. Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Hogan, D; Lan, L T T; Diep, D T N; Gallegos, D; Collins, P F

    2017-02-01

    Nutritional screening and assessment is not currently part of routine clinical practice in Vietnam. Therefore, the present study aimed to investigate the utility of the commonly used methods for identifying malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). A cross-sectional pilot study and a larger retrospective study were carried out in outpatients with COPD who were attending a respiratory clinic in Ho Chi Minh City, Vietnam. Routine clinical data were collected [body mass index (BMI), forced expiratory volume in 1 s (FEV 1 )]. Nutritional screening and assessment were performed using the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA) as the gold standard to diagnose malnutrition. In total, 393 outpatients had documented BMI and 29 were prospectively assessed using SGA: males, n = 25; females, n = 4; mean (SD) age 69.7 (9.6) years; mean (SD) BMI 21.0 (3.4) kg m -2 ; mean (SD) FEV 1 percentage predicted 57.0% (19.7%). Malnutrition risk was identified in 20.7% (n = 6) of patients using the MST (38% sensitivity; 94% specificity). However, 45% (n = 13) were diagnosed as malnourished using the SGA (31% mild/moderate; 14% severe). All malnourished patients not identified by the MST had evidence of muscle wasting. BMI had a strong negative correlation with muscle wasting as assessed using the SGA (r = -0.857, n = 28; P Vietnamese outpatients with COPD. A BMI threshold of <21 kg m -2 appears to represent a useful and pragmatic cut-off point for identifying outpatients requiring comprehensive nutritional assessment and support. © 2016 The British Dietetic Association Ltd.

  5. Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study.

    Science.gov (United States)

    Del Baño-Aledo, M Elena; Medina-Mirapeix, Francesc; Escolar-Reina, Pilar; Montilla-Herrador, Joaquina; Collins, Sean M

    2014-03-01

    To identify elements of the physiotherapist-patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings. A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach. Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain). Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. Patients based their evaluations of quality of care on their assessment of physiotherapists' willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist-patient interaction emerged under all these themes, except for friendly and respectful communication. This study identified which elements of the physiotherapist-patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients' experiences of the physiotherapist-patient interaction in rehabilitation services to provide empirical and quantitative evidence. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  6. [Cooperation, Job Satisfaction and Burn Out - Sustainability in Outpatient Mental Health Care among Medical Specialists in Germany].

    Science.gov (United States)

    Baumgardt, Johanna; Moock, Jörn; Rössler, Wulf; Kawohl, Wolfram

    2017-04-01

    Objective Cooperation, job satisfaction, and burn out risk are indicators of sustainability in mental health services. Thus they were assessed among registered medical specialists in outpatient mental health care in Germany. Method A postal survey consisting of three questionnaires about cooperation, job satisfaction, and burnout was carried out among all registered medical specialists in outpatient mental health care in Germany (n = 4,430). Results 14.1 % (n = 626) of the specialists responded to the survey. Quality and quantity of cooperation regarding mental health care services were rated diverse, job satisfaction was assessed medium to high, and burnout risk was low to medium. Higher job satisfaction correlated with good quality of cooperation, fewer years of practice, fewer patients' chronically ill, more patients who as well seek psychotherapy, and less time spent on cooperation. Low burn out risk correlated with good quality of cooperation, higher age, single practice setting and a higher amount of patients who as well seek psychotherapy. Conclusion Quality and quantity of cooperation in outpatient mental health care - especially regarding community mental health care institutions - should be fostered. Aspects to be considered to reinforce job satisfaction and minimize burn out risk are age, years of practice, quality and quantity of cooperation, practice setting, and the mixture of patients. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Financial impact of surgical training on hospital economics: an income analysis of 1184 out-patient clinic consultations.

    Science.gov (United States)

    Fitzgerald, J E F; Ravindra, P; Lepore, M; Armstrong, A; Bhangu, A; Maxwell-Armstrong, C A

    2013-01-01

    In many countries healthcare commissioning bodies (state or insurance-based) reimburse hospitals for their activity. The costs associated with post-graduate clinical training as part of this are poorly understood. This study quantified the financial revenue generated by surgical trainees in the out-patient clinic setting. A retrospective analysis of surgical out-patient ambulatory care appointments under 6 full-time equivalent Consultants (Attendings) in one hospital over 2 months. Clinic attendance lists were generated from the Patient Access System. Appointments were categorised as: 'new', 'review' or 'procedure' as per the Department of Health Payment by Results (PbR) Outpatient Tariff (Outpatient Treatment Function Code 104; Outpatient Procedure Code OPRSI1). During the study period 78 clinics offered 1184 appointments; 133 of these were not attended (11.2%). Of those attended 1029 had sufficient detail for analysis (98%). 261 (25.4%) patients were seen by a trainee. Applying PbR reimbursement criteria to these gave a projected annual income of £GBP 218,712 (€EU 266,527; $USD 353,657) generated by 6 surgical trainees (Residents). This is equivalent to approximately £GBP 36,452 (€EU 44,415; $USD 58,943) per trainee annually compared to £GBP 48,732 (€EU 59,378; $USD 78,800) per Consultant. This projected yearly income off-set 95% of the trainee's basic salary. Surgical trainees generated a quarter of the out-patient clinic activity related income in this study, with each trainee producing three-quarters of that generated by a Consultant. This offers considerable commercial value to hospitals. Although this must offset productivity differences and overall running costs, training bodies should ensure hospitals offer an appropriate return. In a competitive market hospitals could be invited to compete for trainees, with preference given to those providing excellence in training. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights

  8. Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review

    NARCIS (Netherlands)

    van der Meer, Suzan; Zwerink, Marlies; van Brussel, M.; van der Valk, P.D.; Wajon, E.M.; van der Palen, Jacobus Adrianus Maria

    2012-01-01

    Advantages of outpatient exercise training are reduced waiting lists, better compliance, reduced time investment by the patient with reduced travel expenses, and less dependence on other people to participate. Therefore, this systematic review studies the effects of outpatient exercise training

  9. Patient-provider interaction during medication encounters : A study in outpatient pharmacies in the Netherlands

    NARCIS (Netherlands)

    Koster, Ellen S.; van Meeteren, Marijke M.; Van Dijk, M; van de Bemt, Bart J F; Ensing, Hendrikus T.; Bouvy, Marcel L.; Blom, Lyda; van Dijk, Liset

    2015-01-01

    Objective: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  10. Patient–provider interaction during medication encounters: a study in outpatient pharmacies in the Netherlands.

    NARCIS (Netherlands)

    Koster, E.S.; Meeteren, M.M. van; Dijk, M. van; Bemt, B.J.F. van de; Ensing, H.T.; Bouvy, M.; Blom, L.; Dijk, L. van

    2015-01-01

    Objective: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. Methods: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  11. Patient-provider interaction during medication encounters: A study in outpatient pharmacies in the Netherlands

    NARCIS (Netherlands)

    Koster, E.S.; Meeteren, M.M. van; Dijk, M.; Bemt, B.J.F van den; Ensing, H.T.; Bouvy, M.L.; Blom, L.; Dijk, L. van

    2015-01-01

    OBJECTIVE: To describe communication between pharmacy staff and patients at the counter in outpatient pharmacies. Both content and communication style were investigated. METHODS: Pharmaceutical encounters in three outpatient pharmacies in the Netherlands were video-recorded. Videos were analyzed

  12. 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

  13. The Impact of Different Diagnostic Criteria on the Prevalence of Sarcopenia in Healthy Elderly Participants and Geriatric Outpatients.

    Science.gov (United States)

    Reijnierse, Esmee M; Trappenburg, Marijke C; Leter, Morena J; Blauw, Gerard Jan; Sipilä, Sarianna; Sillanpää, Elina; Narici, Marco V; Hogrel, Jean-Yves; Butler-Browne, Gillian; McPhee, Jamie S; Gapeyeva, Helena; Pääsuke, Mati; de van der Schueren, Marian A E; Meskers, Carel G M; Maier, Andrea B

    2015-01-01

    A consensus on the diagnostic criteria for sarcopenia, a common syndrome in the elderly, has not been reached yet. Prevalence rates vary between studies due to the use of different criteria encompassing different measures, correction factors and cutoff points. This study compared prevalence rates of sarcopenia using nine sets of diagnostic criteria applied in two different elderly populations. The study population encompassed 308 healthy elderly participants (152 males, 156 females; mean age 74 years) and 123 geriatric outpatients (54 males, 69 females; mean age 81 years). Diagnostic criteria included relative muscle mass, absolute muscle mass, muscle strength and physical performance. Prevalence rates of sarcopenia varied between 0 and 15% in healthy elderly participants and between 2 and 34% in geriatric outpatients. This study clearly demonstrates the dependency of sarcopenia prevalence rates on the applied diagnostic criteria. © 2015 S. Karger AG, Basel.

  14. 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.

  15. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics

    Directory of Open Access Journals (Sweden)

    Diane M. Parente

    2017-03-01

    Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.

  16. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment.

    Science.gov (United States)

    Tims, Frank M; Dennis, Michael L; Hamilton, Nancy; J Buchan, Betty; Diamond, Guy; Funk, Rod; Brantley, Laura B

    2002-12-01

    Risk factors among adolescent substance abusers have been shown to correlate with substance use severity. Characteristics related to severity, such as demographic and family factors, peer influences, psychiatric co-morbidity and HIV risk behaviors, are examined for a sample of adolescent cannabis users entering treatment. These data are from a clinical trial study utilizing blocked random assignment of clients to one of five treatment conditions. The study targeted adolescents entering outpatient treatment for primarily cannabis abuse or dependence. Treatment and research facilities in four metropolitan areas of the US were used to recruit study participants. Treatment was delivered in outpatient drug-free settings. Participants were 600 clients, ages 12-18, admitted to outpatient substance abuse treatment programs for cannabis problems, 96% with DSM-IV diagnoses of substance abuse or dependence, with the remaining 4% having at least one symptom of dependence plus significant problems indicating need for treatment. The Global Appraisal of Individual Needs (GAIN) was used to collect the information presented in this paper. The GAIN incorporates DSM-IV criteria for substance use disorders, conduct disorder and attention deficit hyperactivity disorder, as well as dimensional (scale) measures for physical and mental health. All participants reported at least one symptom of substance use disorders, and 46% met the DSM-IV criteria for substance dependence, while 50% met criteria for a diagnosis of abuse. Only 20% of the participants perceived any need for help with problems associated with their drug or alcohol use. Clients participating in the study typically presented multiple problems at treatment entry, most often including conduct disorder, attention deficit hyperactivity disorder (ADHD), internal (mental) distress, and physical health distress. The co-occurrence of conduct disorder and ADHD was found in 30% of the sample. Clients meeting criteria for substance

  17. 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.

  18. Methods for estimating and comparing VA outpatient drug benefits with the private sector.

    Science.gov (United States)

    Render, Marta L; Nowak, John; Hammond, Emmett K; Roselle, Gary

    2003-06-01

    To estimate and compare Veterans Health Administration (VA) expenditures for outpatient pharmaceuticals for veterans at six VA facilities with hypothetical private sector costs. Using the VA Pharmacy Benefits Management Strategic Health Care Group (PBM) database, we extracted data for all dispensed outpatient prescriptions from the six study sites over federal fiscal year 1999. After extensive data validation, we converted prescriptions to the same units and merged relevant VA pricing information by National Drug Code to Redbook listed average wholesale price and the Medicaid maximal allowable charge, where available. We added total VA drug expenditures to personnel cost from the pharmacy portion of that medical center's cost distribution report. Hypothetical private sector payments were $200.8 million compared with an aggregate VA budget of $118.8 million. Using National Drug Code numbers, 97% of all items dispensed from the six facilities were matched to private sector price data. Nonmatched pharmaceuticals were largely generic over-the-counter pain relievers and commodities like alcohol swabs. The most commonly prescribed medications reflect the diseases and complaints of an older male population: pain, cardiovascular problems, diabetes, and depression or other psychiatric disorders. Use of the VA PBM database permits researchers to merge expenditure and prescription data to patient diagnoses and sentinel events. A critical element in its use is creating similar units among the systems. Such data sets permit a deeper view of the variability in drug expenditures, an important sector of health care whose inflation has been disproportionate to that of the economy and even health care.

  19. 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.

  20. [Use of lung ultrasound as a prognostic tool in outpatients with heart failure].

    Science.gov (United States)

    Tojo Villanueva, María Del Carmen; Fernández López, María; Canora Lebrato, Jesús; Satué Bartolomé, José Ángel; San Martín Prado, Alberto; Zapatero Gaviria, Antonio

    2016-07-01

    To assess the prognostic value of lung ultrasound for patients with chronic heart failure. Prospective observational cohort study, in which a lung ultrasound was performed on 54 patients at a heart failure outpatient consultation. Ultrasonography was classified as positive or negative for ultrasound interstitial syndrome depending on the number of B lines observed. Patients were followed up for six months; considering emergency visits, readmissions and deaths due to heart failure as markers of poor prognosis. 53.7% (29) of the patients had ultrasound interstitial syndrome. Among them, 48.3% (14) were readmitted, compared to 16% (4) of those without the syndrome (P=.012). Considering any of the events previously described as end points (readmissions, emergencies and deaths), we found that in the group of patients with ultrasound interstitial syndrome, 55.2% (16) had at least one of these complications, compared to 20% (5) of participants without the syndrome (P=.008). Lung ultrasound in the outpatient setting is useful in predicting which patients are at increased risk of heart failure decompensation in the mid-term. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  1. The Hidden Burden of Outpatient Repeat PSA Testing in a Prospective Cohort

    LENUS (Irish Health Repository)

    Browne, E

    2017-05-01

    PSA testing is widespread throughout Europe for diagnostic purposes and follow up. We performed a prospective outpatient cohort study of 250 men (2013-2015) in two hospital sites. Included were those men being followed up by urology with PSA blood testing. First appointments and those men in whom non-PSA tests were ordered by urology were excluded. The median age was 67.2yrs (46-88). Eighty-one point two percent of samples had a combination of 21 different serology tests at an added cost of >€18,000. Abnormal serology resulted in 53 referrals. Twenty-six-six percentof correspondence referenced abnormal serology other than PSA. Follow up of non-PSA test results poses a challenge in an outpatient setting with failure to appropriately follow-up on abnormal results, increased costs, and medico-legal implications. There is currently no Irish legislature in place to safeguard hospital physicians. This study quantifies the levels of expenditure, resources and risk associated with ambulant PSA testing.

  2. Comparison of Volume Status in Asymptomatic Haemodialysis and Peritoneal Dialysis Outpatients

    Directory of Open Access Journals (Sweden)

    Eugenia Papakrivopoulou

    2012-03-01

    Full Text Available Background: The majority of haemodialysis (HD patients gain weight between dialysis sessions and thereby become volume overloaded, whereas peritoneal dialysis (PD is a more continuous technique. Cardiovascular mortality and hypertension is increased with both treatment modalities. We therefore wished to compare volume status in PD and HD to determine whether PD patients are chronically volume overloaded, as a risk factor for cardiovascular mortality. Study Design, Setting and Participants:We retrospectively audited 72 healthy HD patients and 115 healthy PD patients attending a university hospital dialysis centre for routine outpatient treatment, who had multi-frequency bioimpedance measurements of extracellular water to total body water (ECW/TBW. Results: The groups were well matched for age, sex, weight and ethnicity, PD patients had greater urine output [1,075 (485–1,613 vs. 42.5 (0–1,020 ml/day, p Conclusions: Overhydration is common in healthy stable PD outpatients, and ECW volumes in PD patients are not dissimilar to those of pre-dialysis HD patients. The role of chronic volume overload as a risk factor for cardiovascular disease needs further investigation.

  3. Factors that influence the QOL of cancer patients who have undergone radiotherapy as outpatients

    International Nuclear Information System (INIS)

    Senuma, Maiko; Shinoda, Shizuyo; Kitada, Yoko; Takei, Akemi; Kanda, Kiyoko; Seyama, Ruka; Igarashi, Reiko

    2011-01-01

    The purpose of this study was to elucidate the factors that influence the QOL of cancer patients who have undergone radiotherapy in the outpatient setting. The patient's quality of life (QOL) was investigated by using the QOL evaluation standard functional assessment of cancer therapy-general (FACT-G) in 73 cancer patients (mean age 64.2±12.2 yrs standard deviation (SD)) who had undergone radiotherapy as outpatients. The mean QOL score was 74.8±17.1 pointy, and a significant difference was seen in about 25 items as a result of examining the factors that influenced the patient's QOL. In addition, a stepwise multiple regression analysis revealed that the factors which influenced the QOL were the operation due to the original disease, social support (excluding the family), tiredness, relapse and the metastasis, performance status (PS), uneasiness of presence in descending order of influence. The results revealed the strong influence of psychological, mental and social factors on the QOL score. From the patient of view of nursing support for cancer patients, screening for these factors may allow earlier detection of any decrease in the QOL, or identify when the QOL has already decreased. Furthermore, support should be initiated at as early a stage as possible. (author)

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

    Science.gov (United States)

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

    2010-12-01

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

  5. 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.

    2015-01-01

    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 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, 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 the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact 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. PMID:24080753

  6. Using Lean Thinking at an otorhinolaryngology outpatient clinic to improve quality of care.

    Science.gov (United States)

    van Leijen-Zeelenberg, Janneke E; Brunings, Jan Wouter; Houkes, Inge; van Raak, Arno J A; Ruwaard, Dirk; Vrijhoef, Hubertus J M; Kremer, Bernd

    2016-04-01

    Although Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture. Prospective before-and-after design. The 18-month prospective before-and-after design used mixed methods for data collection and analysis. A survey was conducted to measure satisfaction among patients and providers. Semistructured interviews were conducted to evaluate the effect of Lean Thinking on waste and organizational culture. During the project, 69 issues were posted on the Lean board. Improvements were made on 36 inefficiency issues, not all concerning a specific type of waste. Employees reported considerable improvement in transportation, motion, and waiting. Patient satisfaction was high both at baseline and follow-up and did not change significantly. The effects on provider satisfaction were slight; satisfaction with autonomy and participation decreased significantly, but satisfaction with communication increased significantly. The implementation of Lean Thinking at an otorhinolaryngology outpatient clinic reduced waste and increased provider satisfaction with communication. Although patient satisfaction did not change significantly, it cannot be concluded that the intervention had no effect on perceived quality of care. Other approaches to measure patients' perceptions should be considered. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Variables influencing presenting symptoms of patients with eating disorders at psychiatric outpatient clinics.

    Science.gov (United States)

    Tseng, Mei-Chih Meg; Chen, Kuan-Yu; Chang, Chin-Hao; Liao, Shih-Cheng; Chen, Hsi-Chung

    2016-04-30

    Eating disorders (EDs) have been underdiagnosed in many clinical settings. This study investigates the influence of clinical characteristics on presenting symptoms of patients with EDs. Psychiatric outpatients, aged 18-45, were enrolled sequentially and received a two-phase survey for EDs in August 2010-January 2013. Their primary reasons for seeking psychiatric help were obtained at their first encounter with outpatient psychiatrists. Patients' clinical and demographic characteristics were compared according to presenting symptoms with or without eating/weight problems. Of 2140 patients, 348 (16.3%) were diagnosed with an ED (22.6% of women and 6.3% of men). The three most common reasons for seeking psychiatric help were eating/weight problems (46.0%), emotional problems (41.3%), and sleep disturbances (19.3%). The multivariate analyses suggest that when patients with EDs presented symptoms that were less related to eating/weight problems, they were significantly more likely to be those having diagnoses other than anorexia nervosa or bulimia nervosa and less severe degree of binge-eating. Further, patients with EDs who demonstrated more impulsive behaviors and poorer functioning were less likely to report their eating problems when visiting psychiatric clinics. Thus, ED should be assessed routinely in patients with complex psychopathology to facilitate comprehensive treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Comparing Self-Concept Among Youth Currently Receiving Inpatient Versus Outpatient Mental Health Services.

    Science.gov (United States)

    Choi, Chris; Ferro, Mark A

    2018-01-01

    This study compared levels of self-concept among youth who were currently receiving inpatient versus outpatient mental health services. Forty-seven youth were recruited from the Child & Youth Mental Health Program at McMaster Children's Hospital. Self-concept was measured using the Self-Perception Profile for Children and Adolescents. The mean age was 14.5 years and most participants were female (70.2%). ANOVAs comparing self-concept with population norms showed large significant effects (d = 0.77 to 1.93) indicating compromised self-concept among youth receiving mental health services. Regression analyses controlling for patient age, sex, family income, and diagnoses of major depressive disorder, generalized social phobia, and generalized anxiety showed that the inpatient setting was a significant predictor of lower global self-worth (β=-.26; p=.035). Compared to outpatients, inpatients generally reported lower self-concept, but differences were significant only for global self-worth. Future research replicating this finding and assessing its clinical significance is encouraged.

  9. [Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study].

    Science.gov (United States)

    Osuna-Pozo, Carmen María; Serra-Rexach, José Antonio; Viña, José; Gómez-Cabrera, María del Carmen; Salvá, Antoni; Ruiz, Domingo; Masanes, Ferrán; Lopez-Soto, Alfonso; Formiga, Francesc; Cuesta, Federico; Cruz-Jentoft, Alfonso

    2014-01-01

    There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  10. 42 CFR 440.20 - Outpatient hospital services and rural health clinic services.

    Science.gov (United States)

    2010-10-01

    ... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... services that are not generally furnished by most hospitals in the State. (b) Rural health clinic services... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural health...

  11. 42 CFR 447.321 - Outpatient hospital and clinic services: Application of upper payment limits.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital and clinic services... SERVICES Payment Methods for Other Institutional and Noninstitutional Services Outpatient Hospital and Clinic Services § 447.321 Outpatient hospital and clinic services: Application of upper payment limits...

  12. 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...-Management Training and Diabetes Outcome Measurements § 410.141 Outpatient diabetes self-management training... Part B covers outpatient diabetes self-management training for a beneficiary who has been diagnosed...

  13. 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 in...

  14. 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...

  15. Quality of outpatient paediatric chest radiography - a pilot study

    International Nuclear Information System (INIS)

    Engelmann, D.; Duetting, T.; Wunsch, R.; Troeger, J.

    2001-01-01

    A quality control of outpatient paediatric chest X-rays was conducted in a sample of patients of one paediatric practice. During a period of eight months the technical image quality was analysed considering both diagnostic aspects and radiation protection. The quality of the 139 examined chest X-rays was inadequate concerning the collimation and focussing of the X-rays and the positioning of the patients. Exposure was estimated as average, sharpness was rated as good. In total 14% of the X-rays were not suitable for medical diagnosis. Image quality of the X-rays of infants (children younger than 6 years) was significantly lower compared to the total sample. Radiation protection standards were not fulfilled. As a conclusion from our results, improvements in outpatient paediatric radiography are urgently necessary. Quality control committees should pay particular attention in radiographs of infants. (orig.) [de

  16. Adverse cardiac events in out-patients initiating clozapine treatment

    DEFF Research Database (Denmark)

    Rohde, C; Polcwiartek, C; Kragholm, K

    2018-01-01

    OBJECTIVE: Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation. METHOD: Through nationwide health registers, we identified all out-patients initi......OBJECTIVE: Using national Danish registers, we estimated rates of clozapine-associated cardiac adverse events. Rates of undiagnosed myocarditis were estimated by exploring causes of death after clozapine initiation. METHOD: Through nationwide health registers, we identified all out...... the maximum rate of clozapine-associated fatal myocarditis to 0.28%. CONCLUSION: Cardiac adverse effects in Danish out-patients initiating clozapine treatment are extremely rare and these rates appear to be comparable to those observed for other antipsychotic drugs....

  17. Unmet needs for comprehensive services in outpatient addiction treatment.

    Science.gov (United States)

    Pringle, Janice L; Emptage, Nicholas P; Hubbard, Robert L

    2006-04-01

    Many addiction treatment patients suffer from health and psychosocial problems in addition to substance misuse at the time of their treatment entry. Outpatient treatment programs have attempted to address these problems by providing or facilitating access to comprehensive health and social services. Nevertheless, previous research have suggested high levels of unmet needs for these services in the addiction treatment population. Using data from a large study on community-based outpatient addiction treatment, this article provides additional information on levels of unmet service needs and the relationship between need and receipt of services during treatment. Our results suggest extremely high levels of unmet needs for a wide variety of health and psychosocial services. Specifically, the data suggest that unmet service needs may be far more prevalent than previous estimates and that addiction treatment populations in rural areas may be particularly disadvantaged.

  18. 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.

  19. Burst suppression in sleep in a routine outpatient EEG

    Directory of Open Access Journals (Sweden)

    Ammar Kheder

    2014-01-01

    Full Text Available Burst suppression (BS is an electroencephalogram (EEG pattern that is characterized by brief bursts of spikes, sharp waves, or slow waves of relatively high amplitude alternating with periods of relatively flat EEG or isoelectric periods. The pattern is usually associated with coma, severe encephalopathy of various etiologies, or general anesthesia. We describe an unusual case of anoxic brain injury in which a BS pattern was seen during behaviorally defined sleep during a routine outpatient EEG study.

  20. Burst suppression in sleep in a routine outpatient EEG ?

    OpenAIRE

    Kheder, Ammar; Bianchi, Matt T.; Westover, M. Brandon

    2014-01-01

    Burst suppression (BS) is an electroencephalogram (EEG) pattern that is characterized by brief bursts of spikes, sharp waves, or slow waves of relatively high amplitude alternating with periods of relatively flat EEG or isoelectric periods. The pattern is usually associated with coma, severe encephalopathy of various etiologies, or general anesthesia. We describe an unusual case of anoxic brain injury in which a BS pattern was seen during behaviorally defined sleep during a routine outpatient...

  1. Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

    OpenAIRE

    Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

    2016-01-01

    Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were ex...

  2. Managing an outpatient parenteral antibiotic therapy team: challenges and solutions

    OpenAIRE

    Nguyen, Hien; Halilovic,Jenana; Christensen,Cinda

    2014-01-01

    Jenana Halilovic,1 Cinda L Christensen,2 Hien H Nguyen31University of the Pacific Thomas J Long School of Pharmacy, Stockton, CA, USA; 2Department of Pharmaceutical Services, University of California, Davis Health System, Sacramento, CA, USA; 3Division of Infectious Diseases, Section of Hospital Medicine, University of California, Davis Health System, Sacramento, CA, USAAbstract: Outpatient parenteral antimicrobial therapy (OPAT) programs should strive to deliver safe, cost effective, and hig...

  3. Detecting delirium in elderly outpatients with cognitive impairment.

    Science.gov (United States)

    Stroomer-van Wijk, Anne J M; Jonker, Barbara W; Kok, Rob M; van der Mast, Roos C; Luijendijk, Hendrika J

    2016-08-01

    Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients. We performed a case-control study among outpatients that were referred to a psychiatric institution between January 1st and July 1st 2010 for cognitive evaluation. We compared 44 cases with DSM-IV delirium (24 with and 20 without dementia) to 44 controls with dementia only. All participants were aged 70 years or older. We extracted from the medical files (1) referral characteristics including demographics, medical history, medication use, and referral reasons, (2) delirium symptoms, scored with the Delirium Rating Scale-Revised-98, and (3) underlying disorders categorized as: drugs/intoxication, infection, metabolic/endocrine disturbances, cardiovascular disorders, central nervous system disorders, and other health problems. At referral, delirium patients had significantly higher numbers of chronic diseases and medications, and more often a history of delirium and a recent hospital admission than controls. Most study participants, including those with delirium, were referred for evaluation of (suspected) dementia. The symptoms that occurred more frequently in cases were: sleep disturbances, perceptual abnormalities, delusions, affect lability, agitation, attention deficits, acute onset, and fluctuations. Drug related (68%), infectious (61%), and metabolic-endocrine (50%) disturbances were often involved. Detection of delirium and distinction from dementia in older outpatients was feasible but required detailed caregiver information about the presence, onset, and course of symptoms. Most underlying disorders could be managed at home.

  4. Stress Levels of Nurses in Oncology Outpatient Units.

    Science.gov (United States)

    Ko, Woonhwa; Kiser-Larson, Norma

    2016-04-01

    Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.

  5. Impact of animal-assisted therapy for outpatients with fibromyalgia.

    Science.gov (United States)

    Marcus, Dawn A; Bernstein, Cheryl D; Constantin, Janet M; Kunkel, Frank A; Breuer, Paula; Hanlon, Raymond B

    2013-01-01

    Animal-assisted therapy using dogs trained to be calm and provide comfort to strangers has been used as a complementary therapy for a range of medical conditions. This study was designed to evaluate the effects of brief therapy dog visits for fibromyalgia patients attending a tertiary outpatient pain management facility compared with time spent in a waiting room. Open label with waiting room control. Tertiary care, university-based, outpatient pain management clinic. A convenience sample of fibromyalgia patients was obtained through advertisements posted in the clinic. Participants were able to spend clinic waiting time with a certified therapy dog instead of waiting in the outpatient waiting area. When the therapy dog was not available, individuals remained in the waiting area. OUTCOME MEASURES.: Self-reported pain, fatigue, and emotional distress were recorded using 11-point numeric rating scales before and after the therapy dog visit or waiting room time. Data were evaluated from 106 therapy dog visits and 49 waiting room controls, with no significant between-group demographic differences in participants. Average intervention duration was 12 minutes for the therapy dog visit and 17 minutes for the waiting room control. Significant improvements were reported for pain, mood, and other measures of distress among patients after the therapy dog visit, but not the waiting room control. Clinically meaningful pain relief (≥2 points pain severity reduction) occurred in 34% after the therapy dog visit and 4% in the waiting room control. Outcome was not affected by the presence of comorbid anxiety or depression. Brief therapy dog visits may provide a valuable complementary therapy for fibromyalgia outpatients. Wiley Periodicals, Inc.

  6. [General conditions concerning the implementation of an outpatient education programme--characteristics and distinctions from an inpatient training programme].

    Science.gov (United States)

    Brandes, I; Wunderlich, B; Niehues, C

    2011-04-01

    The aim of the EVA study was to develop an outpatient education programme for women with endometriosis with a view to permanent transfer into routine care. Implementation of the programme generated several problems and obstacles that are not, or not to this extent, present in the inpatient setting of a rehabilitation clinic. The patient education programme was developed in line with an existing inpatient programme, taking into account the criteria for evaluating such training programmes. Several adjustments to process, structure and content level had to be made to achieve the conditions of the outpatient setting. Since May 2008, 17 training courses took place in various outpatient and acute inpatient settings, and a total of 156 women with diagnosed endometriosis participated. The problems and obstacles that emerged affected similarly the process, structure and content of the training programme. On the structural level, especially problems with availability of rooms, technical equipment and trainers occurred, leading to significant time pressures. The main problem on the procedural level was the recruitment of participants, since--in contrast to the inpatient setting and to disease management programmes--no assignment by physicians or insurers takes place. Furthermore, gainful activity of the participants and the resulting shift of the training beyond the usual working and opening hours are important barriers for implementation. The unavailability of trainers in these settings requires creative solutions. Regarding the contents of the training it has to be taken into consideration that--unlike the inpatient setting--no aftercare intervention and no individual psychological consultation are possible. The training programme has to be designed in such a way that all problems that have occurred could be dealt with appropriately. In summary, the permanent implementation of an outpatient training programme is possible but is more time-consuming than inpatient trainings

  7. Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders.

    Science.gov (United States)

    Ta, K; Westermeyer, J; Neider, J

    1996-09-01

    The study assessed the prevalence and duration of axis III physical disorders and the resulting level of disability among Southeast Asian refugee outpatients with axis I psychiatric disorders. A total of 266 consecutive patients who were evaluated in a psychiatric outpatient clinic were assessed for the presence of axis III conditions through questions about physical symptoms, a medical history and review of records, physical examination, and laboratory screening. The sample included 158 Hmong, 58 Laotian, 43 Vietnamese, and seven Cambodian patients. Fifty-five percent of the patients had one or more axis III disorders, most of which were chronic and were not associated with extreme disability. Neurological conditions were most common, and the sequelae of war-related trauma were prominent. No associations were found between the presence of axis III conditions and age, gender, marital status, or ethnic group. In 48 cases, the axis III condition may have caused or exacerbated the axis I condition. Routine medical history and a physical examination, including a neurological examination, are recommended for all psychiatric patients, including outpatients.

  8. Association of polypharmacy with fall risk among geriatric outpatients.

    Science.gov (United States)

    Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

    2011-10-01

    To investigate the association of fall risk with comorbidities and medications in geriatric outpatients in a cross-sectional design.   A total of 262 outpatients (84 men and 178 women, mean age 76.2±6.8years) were evaluated. Physical examination, clinical histories and medication profile were obtained from each patient. History of falls in the past year, 22-item fall risk index, 13-point simple screening test for fall, and time interval of one-leg standing test were examined as markers of fall risk. On univariate analysis, older age, female sex, hypertension, osteoporosis, history of stroke, number of comorbidities, use of antihypertensives, aspirin, bisphosphonates, hypnotics and number of prescribed drugs were significantly associated with either of four indices. On multiple regression analysis, the number of drugs was associated with all of the four indices, independent of other factors associated in the univariate analysis. The association of number of drugs with fall risk indices was stepwise. In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk. Prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. © 2011 Japan Geriatrics Society.

  9. Polypharmacy as a risk for fall occurrence in geriatric outpatients.

    Science.gov (United States)

    Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

    2012-07-01

    To investigate the predictors of falls, such as comorbidity and medication, in geriatric outpatients in a longitudinal observational study. A total of 172 outpatients (45 men and 126 women, mean age 76.9 ± 7.0 years) were evaluated. Physical examination, clinical history and medication profile were obtained from each patient at baseline. These patients were followed for up to 2 years and falls were self-reported to their physicians. The factors associated with falls were analyzed statistically. A total of 32 patients experienced falls within 2 years. On univariate analysis, older age, osteoporosis, number of comorbid conditions and number of drugs were significantly associated with falls within 2 years. On multiple logistic regression analysis, the number of drugs was associated with falls, independent of age, sex, number of comorbid conditions and other factors that were significantly associated in univariate analysis. A receiver-operator curve evaluating the optimal cut-off value for the number of drugs showed that taking five or more drugs was a significant risk. In geriatric outpatients, polypharmacy is associated with falls. Intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidity and falls. © 2011 Japan Geriatrics Society.

  10. Comparing definitions of outpatient surgery: Implications for quality measurement.

    Science.gov (United States)

    Mull, Hillary J; Rivard, Peter E; Legler, Aaron; Pizer, Steven D; Hawn, Mary T; Itani, Kamal M F; Rosen, Amy K

    2017-08-01

    Adverse event (AE) rates in outpatient surgery are inconsistently reported, partly because of the lack of a standard definition of outpatient surgery. We compared the types and rates of surgical procedures defined by two national healthcare agencies: Health Care Cost Institute (HCCI) and the Healthcare Cost and Utilization Project (HCUP) and considered implications for quality measurement. We used HCCI and HCUP definitions to identify FY2012-14 VA outpatient surgeries. There were six times as many HCCI surgeries as HCUP (6,575,830 versus 1,086,640). Ninety-nine percent of HCUP-defined surgeries were also identified by HCCI. More HCUP surgeries had higher average Medicare Relative Value Units then HCCI surgeries [5.3 (SD = 4.4) versus 1.6 (SD = 2.3) RVUs]. Rates and types of procedures vary widely between definitions. Quality measurement using HCCI versus HCUP may produce significantly lower AE rates because many of the surgeries included reflect low complexity and potentially low risk of AEs. Published by Elsevier Inc.

  11. 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.

  12. [Domiciliary rehabilitation: an innovative form of outpatient medical rehabilitation].

    Science.gov (United States)

    Schmidt-Ohlemann, M; Schweizer, C

    2009-02-01

    Domiciliary rehabilitation is an innovative form of outpatient medical rehabilitation. All components of service provision are delivered in the rehabilitant's home by a multidisciplinary team headed by a physician. The key context factors in the rehab process can be taken into account firsthand. The target group of domiciliary rehabilitation consists of multimorbid patients with severe functional limitations and complex assistance needs, whose rehabilitation options would be poor without this outreach service. Here, as suggested by the WHO concept of functional health, the interaction between health condition and environmental factors is kept in view much better than in other forms of rehabilitation. The positive effects and the efficiency of the rehabilitation measures provided can be assessed very well at a high descriptive level. This fact had been a precondition for legal establishment of domiciliary rehabilitation as a regular service. Domiciliary rehabilitation not only complies with key demands in the health and social policy fields, such as priority of outpatient over inpatient treatment or rehabilitation to precede and accompany long term care, it also constitutes an alternative concept challenging the traditional inpatient rehabilitation approach. The patient, hence, no longer is to fit into the institutional framework of outpatient or inpatient rehabilitation, but the team will fit into the specifics of the patient's unique social and material situation.

  13. Childhood physical abuse in outpatients with psychosomatic symptoms

    Directory of Open Access Journals (Sweden)

    Kubo Chiharu

    2008-03-01

    Full Text Available Abstract Background In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. Methods We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. Results A history of childhood physical abuse was reported by patients with depressive disorders(12.7%, anxiety disorders(16.7%, eating disorders (16.3%, pain disorders (10.8%, irritable bowel syndrome (12.5%, and functional dyspepsia(7.5%. In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety and STAI-II (trait anxiety were higher in the abused group than in the non-abused group (p In the patients with depressive disorders, the abused group was younger than the non-abused group (p Conclusion A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.

  14. Is outpatient brain tumor surgery feasible in India?

    Science.gov (United States)

    Turel, Mazda K; Bernstein, Mark

    2016-01-01

    The current trend in all fields of surgery is towards less invasive procedures with shorter hospital stays. The reasons for this change include convenience to patients, optimal resource utilization, and cost saving. Technological advances in neurosurgery, aided by improvements in anesthesia, have resulted in surgery that is faster, simpler, and safer with excellent perioperative recovery. As a result of improved outcomes, some centers are performing brain tumor surgery on an outpatient basis, wherein patients arrive at the hospital the morning of their procedure and leave the hospital the same evening, thus avoiding an overnight stay in the hospital. In addition to the medical benefits of the outpatient procedure, its impact on patient satisfaction is substantial. The economic benefits are extremely favorable for the patient, physician, as well as the hospital. In high volume centers, a day surgery program can exist alongside those for elective and emergency surgeries, providing another pathway for patient care. However, due to skepticism surrounding the medicolegal aspects, and how radical the concept at first sounds, these procedures have not gained widespread popularity. We provide an overview of outpatient brain tumor surgery in the western world, discussing the socioeconomic, medicolegal, and ethical issues related to its adaptability in a developing nation.

  15. [The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder].

    Science.gov (United States)

    Kaess, Michael; Ghinea, Denisa; Fischer-Waldschmidt, Gloria; Resch, Franz

    2017-07-01

    The Outpatient Clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk) - A Pioneering Approach of Outpatient Early Detection and Intervention of Borderline Personality Disorder Self-harm and risk-taking behaviors are frequently occurring problems in adolescents' everyday life and commonly challenge the present child and adolescent health-care system. Those behaviors are typical features of borderline-personality disorder (BPD), a severe mental disorder that is associated with immense psychological strain, increased risk of mortality and poor psychosocial functioning. Despite controversy in the past, recent evidence shows that BPD is a valid and reliable diagnosis in adolescence. Consequently, specified and effective intervention programs for this age group are necessary. Instead, present health-care services for children and adolescents in Germany are usually characterized by long waiting periods for specialized outpatient treatments and unnecessary expanses of unnecessary long inpatient stays. Alternatively, and in order to prevent serious long-term consequences, new concepts - integrated in an ambulatory setting and close to patients' daily routines - should focus on early detection and treatment of adolescents at-risk presenting with borderline personality features. The specialist outpatient clinic AtR!Sk at the University Hospital Heidelberg ensures a low-threshold initial contact service, comprehensive and accurate diagnosis of BPD features, and rapidly "tailored" therapy for young people presenting with any types of risk-taking and self-harm behavior. AtR!Sk - as a pioneering approach in south Germany - provides evidence-based early detection and intervention for adolescent BPD.

  16. Effectiveness of short-term psychodynamic group therapy in a public outpatient psychotherapy unit

    DEFF Research Database (Denmark)

    Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin

    2010-01-01

    BACKGROUND: Short-term psychodynamic group therapy in heterogeneous patient groups is common in the public Danish psychiatric system but is in need of evaluation. AIM: To investigate improvement in 39-session psychodynamic group therapy using three criteria: 1) effect size (Cohen's d), 2...... compared with Danish norms. Clinical implications: Patients referred to public outpatient treatment settings may need alternative or longer treatment than 39 sessions of psychodynamic group therapy over 3 months.......) and subscales. Analyses were conducted on the total sample and after exclusion of 32 GSI pre-treatment no-cases. RESULTS: The total sample GSI effect size was 0.74 indicating a moderate to large effect size (ranging from 0.67 in depressed to 0.74 in neurotic and personality disorder patients), which increased...

  17. 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

    , 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....... Followup exceeded 90.0%. A total of 422 falls were registered in the intervention group, 398 in the control group. Intention-to-treat analysis revealed no effect of the intervention on fall rates (relative risk=1.06, 95%confidence interval (CI)=0.75 -1.51), proportion with falls (odds ratio (OR)=1.20, 95......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...

  18. Exploratory factor analysis of borderline personality disorder criteria in monolingual Hispanic outpatients with substance use disorders†

    Science.gov (United States)

    Becker, Daniel F.; Añez, Luis Miguel; Paris, Manuel; Grilo, Carlos M.

    2009-01-01

    This study examined the factor structure of the DSM-IV criteria for borderline personality disorder (BPD) in Hispanic patients. Subjects were 130 monolingual Hispanic adults who had been admitted to a specialty outpatient clinic that provides psychiatric and substance abuse services to Spanish-speaking individuals. All were reliably assessed with the Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders. After evaluating internal consistency of the BPD criterion set, an exploratory factor analysis was performed using principal axis factoring. Results suggested a unidimensional structure, and were consistent with similar studies of the DSM-IV criteria for BPD in non-Hispanic samples. These findings have implications for understanding borderline psychopathology in this population, and for the overall validity of the DSM-IV BPD construct. PMID:20472296

  19. 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.

  20. 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

  1. The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing.

    Science.gov (United States)

    Livorsi, Daniel J; Linn, Carrie M; Alexander, Bruce; Heintz, Brett H; Tubbs, Traviss A; Perencevich, Eli N

    2018-01-01

    OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.

  2. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial.

    Science.gov (United States)

    Arakaki, Ryan Y; Strazzula, Lauren; Woo, Elaine; Kroshinsky, Daniela

    2014-10-01

    Cellulitis is a common and costly problem, often diagnosed in the outpatient setting. Many cutaneous conditions may clinically mimic cellulitis, but little research has been done to assess the magnitude of the problem. To determine if obtaining dermatology consultations in the outpatient primary care setting could assist in the diagnosis of pseudocellulitic conditions and reduce the rate of unnecessary antibiotic use. Nonblinded randomized clinical trial of competent adults who were diagnosed as having cellulitis by their primary care physicians (PCPs), conducted at outpatient internal medical primary care offices affiliated with a large academic medical center. Outpatient dermatology consultation. Primary outcomes were final diagnosis, antibiotic use, and need for hospitalization. A total of 29 patients (12 male and 17 female) were enrolled for participation in this trial. Nine patients were randomized to continue with PCP management (control group), and 20 patients were randomized to receive a dermatology consultation (treatment group). Of the 20 patients in the dermatology consultation group, 2 (10%) were diagnosed as having cellulitis. In the control group, all 9 patients were diagnosed as having cellulitis by PCPs, but dermatologist evaluation determined that 6 (67%) of these patients had a psuedocellulitis rather than true infection. All 9 patients (100%) in the control group were treated for cellulitis with antibiotics vs 2 patients (10%) in the treatment group (P Dermatology consultation in the primary care setting improves the diagnostic accuracy of suspected cellulitis and decreases unnecessary antibiotic use in patients with pseudocellulitic conditions. Obtaining an outpatient dermatology consultation may be a cost-effective strategy that improves quality of care. clinicaltrials.gov Identifier:NCT01795092.

  3. A Live Threat Violence Simulation Exercise for Psychiatric Outpatient Departments: A Valuable Aid to Training in Violence Prevention.

    Science.gov (United States)

    Feinstein, Robert E; Yager, Joel

    2017-10-30

    Violence in psychiatric outpatient settings is a ubiquitous concern. This article describes the development, implementation, and evaluation of a live threat violence simulation exercise, designed to reduce the risk of future outpatient clinic violence and minimize the effects of future incidents on staff. The psychiatric outpatient clinic at the University of Colorado Hospital developed, implemented, and evaluated a 4-hour live violence threat simulation exercise as a companion to a 7-hour violence prevention program. The simulation includes an orientation, two threat simulation scenarios, three debriefings, satisfaction surveys, problem identification, action plans, and annual safety and process improvements. The authors have conducted live violence simulation exercises from 2011-2016, and have collected survey data about our annual simulation exercise from 2014-2016. Each year ≥ 52% of participants responded, and each year ≥ 90% of respondents rated the simulation as "very helpful/helpful", ≥ 86% believed themselves to be "much better/better" prepared to deal with violent episodes, and simulation side effects such as worries about past trauma; anxiety; sleep problems; increase in workplace concerns. From 2011-2016, the clinic experienced 4 major violent episodes and 36 episodes of potential violence with no staff injuries and minimal psychological sequelae to one staff member. Violence prevention efforts and the development of close police/staff relationships may have contributed to these fortunate outcomes. Satisfaction surveys suggest that the simulations are very helpful/helpful, with participants feeling much better/ better prepared to manage violence. The exercises led the authors to initiate staff safety related behavioral changes as well as physical space and safety processes improvements. The violence prevention program and simulation exercises have promoted excellent relationships with police and a consistent safety record over six years. This

  4. Short or Long End of the Lever? Associations between Provider Communication of the "Asthma-Action Plan" and Outpatient Revisits for Pediatric Asthma.

    Science.gov (United States)

    Rangachari, Pavani; Mehta, Renuka; Rethemeyer, R Karl; Ferrang, Carole; Dennis, Clifton; Redd, Vickie

    2015-10-01

    At the Children's Hospital of Georgia (CHOG), we found that outpatient revisits for pediatric asthma were significantly above national norms. According to the NIH, costly hospital revisits for asthma can be prevented through guidelines-based self-management of asthma, central to which, is the use of a written Asthma-Action Plan (AAP). The asthma services literature has emphasized the role of the healthcare provider in promoting asthma self-management using the AAP, to prevent hospital revisits. On the other hand, the asthma policy literature has emphasized the need for community-based interventions to promote asthma self-management. A gap remains in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma, through effective communication of AAP in the outpatient setting. Our study sought to address this gap. We conducted a 6-month intervention to implement "patient-and-family-centered communication of the AAP" in CHOG outpatient clinics, based on the "change-management" theoretical framework. Provider communication of AAP was assessed through a survey of "Parent Understanding of the Child's AAP." A quasi-experimental approach was used to measure outpatient revisits for pediatric asthma, pre- and post-intervention. Survey results showed that provider communication of the AAP was unanimously perceived highly positively by parents of pediatric asthma patients, across various metrics of patient-centered care. However, there were no statistically significant differences in outpatient "revisit behavior" for pediatric asthma between pre- and post-intervention periods after controlling for several demographic variables. Additionally, revisits remained significantly above national norms. Results suggest limited potential of "effective provider communication of AAP," in reducing outpatient revisits for pediatric asthma; and indicate need for broader community-based interventions to address patient life variables

  5. Early detection and successful treatment of Wernicke's encephalopathy in outpatients without the complete classic triad of symptoms who attended a psycho-oncology clinic.

    Science.gov (United States)

    Onishi, Hideki; Ishida, Mayumi; Tanahashi, Iori; Takahashi, Takao; Ikebuchi, Kenji; Taji, Yoshitada; Kato, Hisashi; Akechi, Tatsuo

    2018-02-26

    Wernicke's encephalopathy (WE) is a neuropsychiatric disorder caused by a thiamine deficiency. Although WE has been recognized in cancer patients, it can be overlooked because many patients do not exhibit symptoms that are typical of WE, such as delirium, ataxia, or ocular palsy. Furthermore, outpatients with WE who intermittently present at psycho-oncology clinics have not been described as far as we can ascertain. This report describes two patients who did not exhibit the complete classic triad of symptoms among a series with cancer and WE, and who attended a psycho-oncology outpatient clinic. Result Case 1, a 76-year-old woman with pancreatic cancer and liver metastasis, periodically attended a psycho-oncology outpatient clinic. She presented with delirium and ataxia as well as appetite loss that had persisted for 8 weeks. We suspected WE, which was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. Case 2, a 79-year-old man with advanced stomach cancer, was referred to a psycho-oncology outpatient clinic with depression that had persisted for about 1 month. He also had appetite loss that had persisted for several weeks. He became delirious during the first visit to the outpatient clinic. Our initial suspicion of WE was confirmed by low serum thiamine levels and the disappearance of delirium after thiamine administration. The key indicator of a diagnosis of WE in both patients was appetite loss. Significance of results This report emphasizes awareness of WE in the outpatient setting, even when patients do not exhibit the classical triad of WE. Appetite loss might be the key to a diagnosis of WE in the absence of other causes of delirium.

  6. 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.

  7. 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.

  8. Positive mental health in outpatients: comparison within diagnostic groups.

    Science.gov (United States)

    Sambasivam, Rajeswari; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Jeyagurunathan, Anitha; Seow, Lee Seng Esmond; Pang, Shirlene; Subramaniam, Mythily

    2016-11-18

    Positive mental health (PMH) supplements the definition of mental health which is not just the mere absence of mental illness. It encompasses an individual's social, emotional and psychological well-being. This cross-sectional study examines the PMH levels in a multi-ethnic outpatient population and the socio-demographic correlates of PMH across the various diagnostic groups. In addition comparisons with the general population were conducted. Outpatients with schizophrenia spectrum, depressive or anxiety disorders seeking treatment at a tertiary psychiatric care hospital were included in the study sample. All respondents completed the PMH instrument. Independent t-tests and ANOVA with Bonferroni post-hoc tests were used to establish differences between the PMH levels and domains. Three hundred and sixty outpatients with a mean age of 39.2 years were included in the study. 52.5% were younger adults (21-39 years). There were slightly more males (50.8%) and 56.1% of the sample was unemployed. PMH scores differed between the patient and general populations. There were significant associations of the PMH domains with socio-demographic variables such as age, ethnicity, gender and education status in the patient population. PMH can be viewed as a protective factor of mental illnesses. As such it is critical that mental health professionals examine the domains of PMH in individuals with mental illnesses. This will in turn allow them to develop coping strategies that can look into focusing on emotional, psychological and social well-being appropriately to allow these individuals to thrive.

  9. [Evaluation of 12 pilot projects to improve outpatient palliative care].

    Science.gov (United States)

    Schmidt-Wolf, G; Elsner, F; Lindena, G; Hilgers, R-D; Heussen, N; Rolke, R; Ostgathe, C; Radbruch, L

    2013-12-01

    With a priority programme the German Cancer Aid supported the development of quality-assured outpatient palliative care to cover the whole country. The 12 regional pilot projects funded with the aim to improve outpatient palliative care in different models and different frameworks were concurrently monitored and evaluated. The supported projects, starting and ending individually, documented all patients who were cared for using HOPE (Hospice and palliative care evaluation) and MIDOS (Minimal documentation system for palliative patients). Total data were analyzed for 3239 patients decriptively. In addition to the quantitative data the experiences of the projects were recorded in a number of workshops (2008, 2009, 2010, and 2012). In particular, the experiences reported in the final meeting in July 2012 were considered for this article as well as the final reports for the German Cancer Aid. In the quantitative evaluation 85.6% of 3239 palliative care patients had a cancer diagnosis. In all model projects the goal of a network with close cooperation of primary providers, social support, and outpatient and inpatient specialist services has been achieved. For all projects, the initial financing of the German Cancer Aid was extremely important, because contracts with health insurance funds were negotiated slowly, and could then be built on the experiences with the projects. The participants of the project-completion meeting emphasized the need to carry out a market analysis before starting palliative care organizations considering the different regional structures and target groups of patients. Education, training and continuing education programs contribute significantly to the network. A reliably funded coordination center/case management across all institutions is extremely important. © Georg Thieme Verlag KG Stuttgart · New York.

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

    Science.gov (United States)

    Sowden, Evin; Mitchell, William S

    2007-07-04

    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. 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. 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 risk factors was confirmed as significant in determining vaccination status by logistic regression for both influenza (OR 10.89, p < 0.001) and streptococcus pneumoniae (OR 4.55, p = 0.002). The diagnosis of rheumatoid arthritis was also found to be a significant factor for pneumococcal vaccination (OR 5.1, p = 0.002). There was a negative trend suggesting that patients on major immunosuppressants are less likely to be immunised against pneumococcal antigen (OR 0.35, p = 0.067). 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.

  11. Prevalence of actinic keratosis among dermatology outpatients in Spain.

    Science.gov (United States)

    Ferrándiz, C; Plazas, M J; Sabaté, M; Palomino, R

    2016-10-01

    Actinic keratoses (AKs) are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence. To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients. Observational, cross-sectional, multicentre study conducted in 19 hospitals (dermatology outpatient services) around Spain. A total of 204 consecutive patients per hospital who were ≥45 years old were screened for the presence of AKs. 3877 patients were assessed and the overall AKs prevalence was 28.6%. Prevalence was significantly higher in men than women (38.4% vs. 20.8%, p<0.0001) and increased with age for both sexes (45.2% in 71-80 years). Scalp and ear lesion locations were significantly more frequent in men (51.9% vs. 2.7% and 16.9% vs. 2.4%, respectively, p<0.0001 both cases) and the cheek, nose and neckline in women (46.3% vs. 34.0% [p<0.0001], 43.0% vs. 24.8% [p<0.0001] and 5.3% vs. 1.8% [p=0.002]). Men showed a significantly higher frequency of ≥2 affected areas than women (42.7% vs. 20.3%, p<0.0001). Among patients with AK lesions, only 65% confirmed that they were the reason for the visit to the clinic. Approximately a quarter of the dermatology outpatient population in Spain aged ≥45 years old have AKs, with the prevalence rate being highest in men and in older age groups. AK is underdiagnosed and a proactive strategy is needed for the diagnosis and early treatment of these lesions. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Antibiotic resistance patterns of outpatient pediatric urinary tract infections.

    Science.gov (United States)

    Edlin, Rachel S; Shapiro, Daniel J; Hersh, Adam L; Copp, Hillary L

    2013-07-01

    We characterize the current national patterns of antibiotic resistance of outpatient pediatric urinary tract infection. We examined outpatient urinary isolates from patients younger than 18 years in 2009 using The Surveillance Network®, a database with antibiotic susceptibility results and patient demographic data from 195 United States hospitals. We determined the prevalence and antibiotic resistance patterns for the 6 most common uropathogens, ie Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence between males and females using chi-square analysis. We identified 25,418 outpatient urinary isolates. E. coli was the most common uropathogen overall but the prevalence of E. coli was higher among females (83%) than males (50%, p Resistance among E. coli was highest for trimethoprim-sulfamethoxazole (24%) but lower for nitrofurantoin (less than 1%) and cephalothin (15%). Compared to 2002 Surveillance Network data, E. coli resistance rates increased for trimethoprim-sulfamethoxazole (from 23% to 31% in males and from 20% to 23% in females) and ciprofloxacin (from 1% to 10% and from 0.6% to 4%, respectively). E. coli remains the most common pediatric uropathogen. Although widely used, trimethoprim-sulfamethoxazole is a poor empirical choice for pediatric urinary tract infections in many areas due to high resistance rates. First-generation cephalosporins and nitrofurantoin are appropriate narrow-spectrum alternatives given their low resistance rates. Local antibiograms should be used to assist with empirical urinary tract infection treatment. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology.

    Science.gov (United States)

    Hay, Casey M; Lefkowits, Carolyn; Crowley-Matoka, Megan; Bakitas, Marie A; Clark, Leslie H; Duska, Linda R; Urban, Renata R; Creasy, Stephanie L; Schenker, Yael

    2017-09-01

    Concern that patients will react negatively to the idea of palliative care is cited as a barrier to timely referral. Strategies to successfully introduce specialty palliative care to patients have not been well described. We sought to understand how gynecologic oncologists introduce outpatient specialty palliative care. We conducted a national qualitative interview study at six geographically diverse academic cancer centers with well-established palliative care clinics between September 2015 and March 2016. Thirty-four gynecologic oncologists participated in semistructured telephone interviews focusing on attitudes, experiences, and practices related to outpatient palliative care. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductiv