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Zykienė B, Kalibatas V. Evaluating the reasons for nonattendance to outpatient consultations: is waiting time an important factor? BMC Health Serv Res 2022; 22:619. [PMID: 35534875 PMCID: PMC9082880 DOI: 10.1186/s12913-022-08033-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Nonattendance is a common problem worldwide. Important factors for nonattendance are a queue or the waiting time until the planned service. Aims The aims of this study were to identify the reasons for nonattendance to planned consultations, assess the waiting time from registration to access to an outpatient specialist consultation, and identify the associations between the reasons for nonattendance and the waiting time until the planned outpatient specialist consultation. Methods A cross-sectional study based on a phone questionnaire was conducted among patients not attending a planned consultation at the outpatient department of the Lithuanian University of Health Sciences Kaunas Hospital in Kaunas, Lithuania. A total of 972 phone calls were made, and 389 telephone surveys were completed. Results The mean respondents’ waiting time until the planned outpatient consultation was 15.13 ± 10 days. The highest proportion of nonattendance was observed when the wait time was between 6 and 17 days. More often, the patients did not attend the planned outpatient consultation due to worsened health status (24.69%), unidentified personal problems (14.91%), work-related problems (13.62%) and being unaware about the appointment (11.82%). A longer waiting time was significantly associated with the following reasons for nonattendance: work-related problems, health problems solved at another health care institution, unidentified personal problems and unknown reasons for nonattendance. The highest proportions of nonattending patients had consultations registered with neurologists (17.0%), traumatologists (11.3%) and cardiologists (10.5%). Conclusions Patients did not identify the long waiting time until outpatient specialist consultation among the main reasons for nonattendance. The issue of waiting time is not an important aspect of nonattendance.
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Affiliation(s)
- Bernadeta Zykienė
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Tilžės str. 18, Kaunas, Lithuania.
| | - Vytenis Kalibatas
- Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Tilžės str. 18, Kaunas, Lithuania
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202
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Mailis A, Deshpande A, Lakha SF. Long term outcomes of chronic pain patients attending a publicly funded community-based interdisciplinary pain program in the Greater Toronto area: results of a practice-based audit. J Patient Rep Outcomes 2022; 6:44. [PMID: 35524863 PMCID: PMC9079194 DOI: 10.1186/s41687-022-00452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic pain management multi/interdisciplinary programs attempt to address all elements of the biopsychosocial model. The primary objective of this retrospective study (based on practice-based audit) was to determine the effectiveness of a patient-centered, comprehensive and intense interdisciplinary pain management program in a publicly funded community-based pain clinic in the Greater Toronto Area. Method This retrospective longitudinal study was conducted on 218 carefully selected sequential chronic pain patients, with 158 completing a 3–4-month interdisciplinary program between January 2016 and December 2018. Data collected upon exit, at 6 months and 12 months post-discharge included demographic information, pain characteristics, emotional/functional status obtained by validated instruments and global impression of change (GIC). Additionally, social health outcomes (return to work or school) were retrieved through retrospective chart review. Means of pre-and post-program variables were compared to assess changes of each patient’s “journey”. Results Physical and mental/ emotional health outcomes at exit, 6 months and 12 months post-discharge, showed initial and sustained, statistically and clinically significant improvement from pre-treatment levels, with GIC (much/very much improved) reported as 77%, 58% and 76%, respectively. Additionally, a substantial positive change in social health outcomes was noted particularly in patients on disability (29%), part time workers gaining full time employment (55%), and students (71%) who improved their level of schooling. Conclusion The study showed that careful patient selection in a community-based publicly funded interdisciplinary pain management program can produce significant improvement in pain, physical, mental/emotional health and social function, with sustained long-term outcomes.
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Affiliation(s)
- Angela Mailis
- Pain and Wellness Center, 2301 Major Mackenzie Drive West Unit 101, Vaughan, ON, L6A 3Z3, Canada. .,Department of Medicine, University of Toronto, Toronto, L6A 3Z3, Canada.
| | - Amol Deshpande
- Department of Medicine, University of Toronto, Toronto, L6A 3Z3, Canada.,Toronto Rehabilitation Institute, UHN, Toronto, L6A 3Z3, Canada
| | - S Fatima Lakha
- Pain and Wellness Center, 2301 Major Mackenzie Drive West Unit 101, Vaughan, ON, L6A 3Z3, Canada.,Department of Medicine, University of Toronto, Toronto, L6A 3Z3, Canada
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203
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Lu L, Zhong H, Jia R, Su L, Xu M, Cao L, Liu P, Ao Y, Dong N, Xu J. Prevalence and genotypes distribution of group A rotavirus among outpatient children under 5 years with acute diarrhea in Shanghai, China, 2012-2018. BMC Gastroenterol 2022; 22:217. [PMID: 35505284 PMCID: PMC9066839 DOI: 10.1186/s12876-022-02288-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Group A rotavirus (RVA) remains the main causative agent of acute diarrhea among children under five years in countries that have not yet introduced the RVA vaccine worldwide. Long-term and continuous monitoring data on RVA infection in outpatient children were lacking in Shanghai. We investigated the prevalence and distribution of RVA genotypes in outpatient children with acute diarrhea in Shanghai from 2012 to 2018. Methods Stool specimens of outpatient children under five years were collected from the Children’s Hospital of Fudan University in Shanghai, China. All the samples enrolled in this study were detected and characterized for the P and G genotypes of RVA were determined using the semi-multiplex RT-PCR technique. Results Of 1814 children enrolled with acute diarrhea and having specimens collected, 246 (13.6%) were infected with RVA. The highest frequency of RVA was observed in children younger than two years old (87.0%, 214/246). Year-round RVA transmission was observed and the RVA detection rate peaked every winter and troughed in summer. In this study, 12 different RVA strains were identified in children. G9P[8] (49.2%, 121/246) was detected as the most prevalent genotype, followed by G–P[8] (22.8%, 56/246), G3P[8] (11.4%, 28/246), and G9P- (4.9%, 12/246). Although RVA strains detected in this study varied with the time, G9P[8] has been the most predominant circulating genotype since 2012. Furthermore, 12.2% (30/246) RVA positive samples were co-infected with other diarrhea viruses. Conclusion The present analysis showed that RVA was still a major cause of children with acute diarrhea in Shanghai from 2012 to 2018. A great diversity of RVA strains circulated in children with acute diarrhea with G9P[8] being the predominant genotype since 2012. Long-term and continuous monitoring of RVA genotypes is therefore indispensable to refine future vaccine strategy in Shanghai.
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Affiliation(s)
- Lijuan Lu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Huaqing Zhong
- Department of Pediatric Institute, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Ran Jia
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Liyun Su
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Menghua Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Lingfeng Cao
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Pengcheng Liu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Yuanyun Ao
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Niuniu Dong
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China
| | - Jin Xu
- Department of Clinical Laboratory, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China.
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204
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Babinski DE, Saunders EFH, He F, Liao D, Pearl AM, Waschbusch DA. Screening for ADHD in a general outpatient psychiatric sample of adults. Psychiatry Res 2022; 311:114524. [PMID: 35349861 DOI: 10.1016/j.psychres.2022.114524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Adults (n = 805) seeking outpatient psychiatric care completed the Adult ADHD Self-Report Scale (ASRS) and measures of impairment and co-occurring psychopathology as part of a measurement-based care initiative. Diagnostic indicators of ADHD (i.e., formal diagnosis and/or medication treatment) were recorded from the electronic medical record (EMR). Agreement between screening positive for ADHD and EMR indicators for the diagnosis was explored, and clinical characteristics of adults identified with ADHD using these indicators were examined. Lastly, the contribution of ADHD to functional impairment was examined, controlling for the contribution of other demographic and psychiatric comorbidities. In the full sample, 54.78% of adults screened positive for ADHD based on the ASRS, and using EMR indicators, only 11.93% of adults were identified with ADHD. Agreement emerged between self-reported ADHD and ADHD EMR indicators, although adults screening positive for ADHD generally reported greater psychiatric complexity relative to adults identified with ADHD in the EMR. ADHD was associated with clinical impairment even when controlling for other psychiatric comorbidities. The considerable difference in prevalence of ADHD based on self-report screening versus EMR indicators suggests that ADHD may be overlooked in adult psychiatric care. Findings point to the importance of assessing adult ADHD in routine psychiatric care.
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Affiliation(s)
- Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Amanda M Pearl
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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205
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Reinders IMA, Cremers GR, van Rooijen SJ, Leemans JC, Perquin CW, Geomini PMAJ, Maas JWM, Bongers MY. The effect of an informative 360-degree virtual reality video on anxiety for women visiting the one-stop clinic for abnormal uterine bleeding: A randomized controlled trial (VISION-trial). Eur J Obstet Gynecol Reprod Biol 2022; 272:96-103. [PMID: 35299013 DOI: 10.1016/j.ejogrb.2022.02.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/20/2022] [Accepted: 02/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effect of an informative 360-degree virtual reality (VR) video on preoperative anxiety before visiting a one-stop clinic for abnormal uterine bleeding. STUDY DESIGN A randomized controlled trial was performed in a teaching hospital in the Netherlands. A total of 83 women scheduled for a first consultation at the one-stop clinic between April 2017 and September 2017 were included in the analysis. All women received a standard information leaflet about the clinic. 40 women were randomized to receive a 360-degree VR-video of the clinic in addition. The primary outcome was change in the Visual Analogue Scale for Anxiety (VAS-A), measured at baseline (before randomization) and in the waiting room (before visit, after randomization). Anxiety assessed with the State-Trait Anxiety Inventory (STAI-S) was a secondary outcome. Other secondary outcomes included anxiety during the visit and the opinion of the women about the provided information. RESULTS Only 27 out of the 40 women actually watched the VR-video. Women in the VR-group who actually watched the video reported lower levels of anxiety at baseline compared to women in the VR-group who did not watch the video. In the intention-to-treat analysis, there was no difference in change in anxiety between the VR-group and the control group (mean difference VAS-A = 0.07, 95% CI -0.96 to 1.10; mean difference STAI-S = 1.97, 95% CI -1.82 to 5.77). In the per-protocol analysis, women in the VR-group reported lower anxiety scores in the waiting room. However, the change in anxiety scores between baseline and waiting room was comparable in both groups. 31% of the women who watched the VR-video reported that the video resulted in a reduction of anxiety, 69% reported that the video is of added value and 65% would use a VR-video again in future. CONCLUSIONS Adding the informative 360-degree VR-video to conventional information did not result in a reduction of anxiety prior to visiting the one-stop clinic. However, the majority of women who watched the video felt that it was of added value. Remarkable was that women who reported higher anxiety at baseline seemed less willing to watch the video.
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Affiliation(s)
- Imke M A Reinders
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands.
| | - Gaston R Cremers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Jaklien C Leemans
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Christel W Perquin
- Department of Anesthesiology and Pain and Palliative Care, Máxima Medical Center, Veldhoven, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jacques W M Maas
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands
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206
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Khorshiddoust RR, Khorshiddoust SR, Hosseinabadi T, Mottaghitalab F, Mokhtari F, Azadinia F, Mozdarani H, Shabani M, Emadi-Kouchak H, Taheri B, Khani-Juyabad F, Kashani MA, Sadoughi A, Zamanizadeh S, Maddah H, Aminzadeh M, Khanaki M, Saremi S, Rad AP, Fatehi A, Rad MG, Haftbaradaran M, Khosroshahi M, Sadeghi M, Aminnayeri M, Jafari S, Ghiasvand F, Seifi A, Ghaderkhani S, Manshadi SAD, Salehi M, Abbasian L, Hasannezhad M, Meidani M, Hajiabdolbaghi M, Ahmadinejad Z, Parash M, Sedighi Z, Mohammadian A. Efficacy of a multiple-indication antiviral herbal drug (Saliravira®) for COVID-19 outpatients: A pre-clinical and randomized clinical trial study. Biomed Pharmacother 2022; 149:112729. [PMID: 35276467 DOI: 10.1016/j.biopha.2022.112729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. Methods In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. Results On the 8th day, the “mean reduction rates” of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value < 0.05. The improvement of 10 out of 14 COVID-19 symptoms in the intervention group was significantly accelerated. The mean treatment duration of patients in the intervention group was 4.9 days less than the control group. In addition, no patients in the intervention group were hospitalized compared to 28% of the control group needed to be hospitalized.
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207
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Singh V, Nduaguba AM, Macaulay W, Schwarzkopf R, Davidovitch RI. Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes. Arch Orthop Trauma Surg 2022; 142:861-869. [PMID: 34075486 DOI: 10.1007/s00402-021-03983-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION As more centers introduce same-day discharge (SDD) total joint arthroplasty (TJA) programs, it is vital to understand the factors associated with successful outpatient TJA and whether outcomes vary for those that failed SDD. The purpose of this study is to compare outcomes of patients that are successfully discharged home the day of surgery to those that fail-to-launch (FTL) and require a longer in-hospital stay. MATERIALS AND METHODS We retrospectively reviewed all patients who enrolled in our institution's SDD TJA program from 2015 to 2020. Patients were stratified into two cohorts based on whether they were successfully SDD or FTL. Outcomes of interest included discharge disposition, 90-day readmissions, 90-day revisions, surgical time, and patient-reported outcome measures (PROMs) as assessed by the FJS-12 (3 months, 1 year, and 2 years), HOOS, JR, and KOOS, JR (preoperatively, 3 months, and 1 year). Demographic differences were assessed with chi-square and Mann-Whitney U tests. Outcomes were compared using multilinear regressions, controlling for demographic differences. RESULTS A total of 1491 patients were included. Of these, 1384 (93%) were successfully SDD while 107 (7%) FTL and required a longer length-of-stay. Patients who FTL were more likely to be non-married (p = 0.007) and ASA class III (p = 0.017) compared to those who were successfully SDD. Surgical time was significantly longer for those who FTL compared to those who were successfully SDD (100.86 vs. 83.42 min; p < 0.001). Discharge disposition (p = 0.100), 90-day readmissions (p = 0.897), 90-day revisions (p = 0.997), and all PROM scores both preoperatively and postoperatively did not significantly differ between the two cohorts. CONCLUSION Our results support the notion that FTL is not a predictor of adverse outcomes as patients who FTL achieved similar outcomes as those who were successfully SDD. The findings of this study can aid orthopedic surgeons to educate their patients who wish to participate in a similar program, as well as patients that have concerns after they failed to go home on the day of surgery. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA
| | - Afamefuna M Nduaguba
- Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA.
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208
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Benito DA, Shaver TB, Cox R, Strum DP, Mehta V, Shim T, Chillakuru Y, Badger C, Joshi AS. Cost-analysis of in-office versus operating room sialendoscopy: Comparison of cost burden and outcomes. Am J Otolaryngol 2022; 43:103424. [PMID: 35339773 DOI: 10.1016/j.amjoto.2022.103424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Office-based procedures in otolaryngology are increasingly utilized to increase efficiency, reduce cost, and eliminate risks associated with surgery. Gland-preserving surgical management of sialadenitis and sialolithiasis are often performed in the operating room, although many surgeons are moving this practice to clinic. We aim to determine the difference in patient charges and perioperative outcomes for salivary gland procedures performed in the clinic versus the OR. METHODS Retrospective series of patients presenting with sialolithiasis, acute or chronic sialadenitis, and stricture between 2010 and 2019. Demographics, perioperative variables, setting, and charge data were collected. RESULTS 528 patients underwent operative intervention (n = 427 office, n = 101 OR). Cohort demographics were comparable. Sialolithiasis was the most common presenting diagnosis in both cohorts. Both cohorts had similar rates of complete (p = 0.09) and partial (p = 0.97) response to treatment. A higher percentage of patients in the OR group reported no improvement (21.4 vs 12.2%, p = 0.034). Overall complications were similar (p = 0.582). Mean charges were statistically greater in the OR ($5560.35 OR vs $1298.33 office, p < 0.001). Operative time was significantly reduced in the office group (21.8 min vs 60.85 min, p < 0.001). CONCLUSIONS Appropriately selected patients can be successfully treated in outpatient clinic without compromising patient safety or quality while significantly reducing the financial burden to patients and the healthcare system.
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209
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Hugel M, Ayari-Khalfallah S, Fieux M, Coudert A, Truy E, Hermann R. Feasibility of day-case pediatric cochlear implantation. Eur Arch Otorhinolaryngol 2022; 279:5123-5133. [PMID: 35476132 DOI: 10.1007/s00405-022-07353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Pediatric cochlear implantation is performed on an outpatient basis in an inconstant way. The aim of this study is to assess the feasibility of day-case pediatric cochlear implantation by determining the acceptability of outpatient-to-inpatient conversion rate (acceptability threshold of 5%) and to assess the safety by comparing outpatient and inpatient postoperative events. We also want to identify conversion predictive factors. METHODS We conducted a monocentric retrospective study including 267 cases aged 6 months to 18 years who underwent unilateral cochlear implantation between 2016 and 2020. This population was divided into two groups: outpatient group (190 cases) and inpatient group (77 cases). RESULTS Among the 190 cases scheduled as day surgery, 9 cases required conversion to conventional hospitalization which leads to an outpatient-to-inpatient conversion rate of 4.7%. Postoperative nausea and vomiting (PONV) were involved in all cases of conversion. Conversion predictive factors were the presence of an inner ear malformation at risk of gusher (OR 32.51, 95% CI [4.98-370.27], p 0.001) and the intraoperative administration of morphine (OR 8.52, 95% CI [1.38-86.84], p 0.035). There was no statistically significant difference in immediate postoperative complications (outpatient 14.2% vs inpatient 16.9% p 0.715), early-stage complications (outpatient 12.6% vs inpatient 10.4% p 0.812) and early-stage unplanned consultations (outpatient 4.7% vs inpatient 3.9% p 0.748) between outpatient and inpatient groups. Unplanned readmissions were found only in the outpatient group. CONCLUSION Day-case pediatric cochlear implantation is a feasible and safe procedure even in infants. The outpatient-to-inpatient conversion rate of 4.7% is considered acceptable but requires anticipation of human and accommodation needs. No causes of conversion were life-threatening. The risk of postoperative complications and unplanned consultations are not influenced by the mode of hospitalization. Special attention should be paid to the prevention of PONV and the presence of inner ear malformations.
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Affiliation(s)
- Margot Hugel
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France. .,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France.
| | - Sonia Ayari-Khalfallah
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France
| | - Maxime Fieux
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, 69495, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Aurélie Coudert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France
| | - Eric Truy
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, F-69500, Bron, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Ruben Hermann
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Département d'oto-rhino-laryngologie, de chirurgie cervico-maxillo-faciale et d'audiophonologie, 69003, Lyon, France.,Université Claude Bernard Lyon 1, 69003, Lyon, France
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Meng G, McAiney C, Perlman CM, McKillop I, Tisseverasinghe T, Chen HH. Service process factors affecting patients' and clinicians' experiences on rapid teleconsultation implementation in out-patient neurology services during COVID-19 pandemic: a scoping review. BMC Health Serv Res 2022; 22:534. [PMID: 35459134 PMCID: PMC9026006 DOI: 10.1186/s12913-022-07908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background The adoption of teleconsultation for outpatient neurology services was limited until the onset of the COVID-19 pandemic which forced many outpatient neurology services to rapidly switch to virtual models. However, it remains unclear how this change has impacted patients’ and clinicians’ perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients’ and clinicians’ experiences of outpatient teleconsultation services during COVID-19. Methods Arksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health Organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients’ and clinicians’ experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients’ and clinicians’ teleconsultation experiences in outpatient neurology services. The need for improvement of triage process and standardizing administrative virtual care pathway are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID era. More research is needed to assess outpatient neurology teleconsultation service quality from patients’ and clinicians’ perspectives. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07908-4.
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Affiliation(s)
- Guangxia Meng
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christopher M Perlman
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Ian McKillop
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | | | - Helen H Chen
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Fesatidou V, Petsatodis E, Kitridis D, Givissis P, Samoladas E. Minimally invasive outpatient management of iliopsoas muscle abscess in complicated spondylodiscitis. World J Orthop 2022; 13:381-387. [PMID: 35582155 PMCID: PMC9048501 DOI: 10.5312/wjo.v13.i4.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 03/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iliopsoas muscle abscess (IPA) and spondylodiscitis are two clinical conditions often related to atypical presentation and challenging management. They are both frequently related to underlying conditions, such as immunosuppression, and in many cases they are combined. IPA can be primary due to the hematogenous spread of a microorganism to the muscle or secondary from a direct expansion of an inflammatory process, including spondylodiscitis. Computed tomography-guided percutaneous drainage has been established in the current management of this condition.
AIM To present a retrospective analysis of a series of 8 immunocompromised patients suffering from spondylodiscitis complicated with IPA and treated with percutaneous computed tomography-guided drainage and drain insertion in an outpatient setting.
METHODS Patient demographics, clinical presentation, underlying conditions, isolated microorganisms, antibiotic regimes used, abscess size, days until the withdrawal of the catheter, and final treatment outcomes were recorded and analyzed.
RESULTS All patients presented with night back pain and local stiffness with no fever. The laboratory tests revealed elevated inflammatory markers. Radiological findings of spondylodiscitis with unilateral or bilateral IPA were present in all cases. Staphylococcus aureus was isolated in 3 patients and Mycobacterium tuberculosis in 2 patients. Negative cultures were found in the remaining 3 patients. The treatment protocol included percutaneous computed tomography-guided abscess drainage and drain insertion along with a course of targeted or empiric antibiotic therapy. All procedures were done in an outpatient setting with no need for patient hospitalization.
CONCLUSION The minimally invasive outpatient management of IPA is a safe and effective approach with a high success rate and low morbidity.
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Affiliation(s)
- Vasiliki Fesatidou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Evangelos Petsatodis
- Department of Interventional Radiology, Papanikolaou General Hospital of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
| | - Efthimios Samoladas
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54124, Greece
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Kaizer AM, Wild J, Lindsell CJ, Rice TW, Self WH, Brown S, Thompson BT, Hart KW, Smith C, Pulia MS, Shapiro NI, Ginde AA. Trial of Early Antiviral Therapies during Non-hospitalized Outpatient Window (TREAT NOW) for COVID-19: a summary of the protocol and analysis plan for a decentralized randomized controlled trial. Trials 2022; 23:273. [PMID: 35395957 PMCID: PMC8990452 DOI: 10.1186/s13063-022-06213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has a heterogeneous outcome in individuals from remaining asymptomatic to death. In a majority of cases, mild symptoms are present that do not require hospitalization and can be successfully treated in the outpatient setting, though symptoms may persist for a long duration. We hypothesize that drugs suitable for decentralized study in outpatients will have efficacy among infected outpatients Methods The TREAT NOW platform is designed to accommodate testing multiple agents with the ability to incorporate new agents in the future. TREAT NOW is an adaptive, blinded, multi-center, placebo-controlled superiority randomized clinical trial which started with two active therapies (hydroxychloroquine and lopinavir/ritonavir) and placebo, with the hydroxychloroquine arm dropped shortly after enrollment began due to external evidence. Each arm has a target enrollment of 300 participants who will be randomly assigned in an equal allocation to receive either an active therapy or placebo twice daily for 14 days with daily electronic surveys collected over days 1 through 16 and on day 29 to evaluate symptoms and a modified COVID-19 ordinal outcome scale. Participants are enrolled remotely by telephone and consented with a digital interface, study drug is overnight mailed to study participants, and data collection occurs electronically without in-person interactions. Discussion If effective treatments for COVID-19 can be identified for individuals in the outpatient setting before they advance to severe disease, it will prevent progression to more severe disease, reduce the need for hospitalization, and shorten the duration of symptoms. The novel decentralized, “no touch” approach used by the TREAT NOW platform has distinction advantages over traditional in-person trials to reach broader populations and perform study procedures in a pragmatic yet rigorous manner. Trial registration ClinicalTrials.gov NCT04372628. Registered on April 30, 2020. First posted on May 4, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06213-z.
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Affiliation(s)
- Alexander M Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, USA.
| | - Jessica Wild
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, USA
| | | | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, USA
| | - Samuel Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Salt Lake City, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University, Nashville, USA
| | - Clay Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Michael S Pulia
- Departments of Emergency Medicine and Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA
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Tarutani S, Omori M, Ido Y, Yano M, Komatsu T, Okamura T. Effects of 4G-beta-D-Galactosylsucrose in patients with depression: A randomized, double-blinded, placebo-controlled, parallel-group comparative study. J Psychiatr Res 2022; 148:110-120. [PMID: 35123322 DOI: 10.1016/j.jpsychires.2022.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 12/20/2022]
Abstract
Advances in genetic research on microbiome have led to several trials on the effectiveness of synbiotics or probiotics in patients with depression; however, none have evaluated the efficacy of prebiotics. 4G-beta-D-Galactosylsucrose (Lactosucrose, LS) is selectively assimilated by Bifidobacterium as a prebiotic and improves microbiome diversity. However, as it is not clear if LS consumption can improve symptoms of depression, we investigated whether LS intake can improve depressive symptoms, quality of life (QOL), and self-efficacy by conducting a single cite, double-blinded, randomized controlled trial in 20 outpatients with depressive episodes (F32, ICD-10) for 24 weeks. Participants (age range, 36-72 years) were randomized to the LS (n = 9) or placebo groups (n = 11). Primary outcome was improvement in total Montgomery Asberg Depression Rating Scale (MADRS) score, and the secondary outcomes were MADRS subscores, global self-efficacy scale (GSES) score, World Health Organization QOL (WHO/QOL-26) score, and 16S rRNA analysis of the fecal microbiome. LS consumption did not significantly improve total MADRS scores (-2 (-16 to 16) vs 0 (-6 to 10), p = 0.552), but GSES tended to improve in the LS group (2.00 ± 4.24 vs -1.36 ± 4.15, p = 0.091) with a large effect size (Cohen's d = 0.802). Sequencing of 16S rRNA revealed individual-level differences in microbiome diversity changes due to the intervention. Thus, we show that LS intake can improve self-efficacy, but not depressive symptoms, even in a small sample. Additional studies that also regulate diet and ensure adherence may help determine a correlation between depression and the gut microbiome.
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Affiliation(s)
- Seiichiro Tarutani
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, 4-10-1, Nasahara, Takatsuki, Osaka, 569-1041, Japan.
| | - Maiko Omori
- Faculty of Human Life and Science, Doshisha Women's College, Teramachi Nishiiru, Imadegawa-dori, Kamigyo-ku, Kyoto, 602-0893, Japan; Department of Food Science and Nutrition, Faculty of Agriculture, Kinki University, 3327-204 Nakamachi, Nara, Nara, 631-8505, Japan.
| | - Yumiko Ido
- Faculty of Health and Nutrition Baika Women's University, 2-19-5, Shukunosho, Ibaraki, Osaka, 567-0051, Japan; Department of Food and Nutrition, Faculty of Home Economies, Kyoto Women's University, 35 Kitahiyoshi-cho, Imakumano, Higashiyama-ku, Kyoto, 605-8501, Japan.
| | - Megumu Yano
- Research Institute for Nutrition Sciences, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo, 663-8558, Japan.
| | - Tatsushi Komatsu
- Faculty of Human Life and Science, Doshisha Women's College, Teramachi Nishiiru, Imadegawa-dori, Kamigyo-ku, Kyoto, 602-0893, Japan.
| | - Takehiko Okamura
- Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry, 4-10-1, Nasahara, Takatsuki, Osaka, 569-1041, Japan.
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Hu Q, Chen Z, Lin Z, Li Z, Wei Y, Xu L, Tang X, Hu Y, Chen T, Wang J, Zhang T, Li C. Gender differences in screening self-reported psychotic symptoms in a first help-seeking population. Arch Womens Ment Health 2022; 25:291-9. [PMID: 34417664 DOI: 10.1007/s00737-021-01170-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
Gender differences in the frequency and severity of psychotic symptoms have been widely reported. However, in the screening process for the detection of early psychosis, gender differences were largely overlooked in China. This study investigated gender differences in self-reported psychotic symptoms in a clinical population who initially visited a mental health service. In total, 1931 consecutive new patients were included in the current analysis, with a mean age of 25.3 years, including 852 (44.1%) men and 1079 (55.9%) women, of whom 388 (20.1%) had psychotic disorders and 1543 (79.9%) had non-psychotic disorders. Psychotic symptoms were assessed using the PRIME Screen-Revised (PS-R) questionnaire. The cohort was grouped according to gender, age (adolescents ≤ 21 years, adults > 21 years), and clinical diagnosis. Within the full sample, gender differences in psychotic symptoms were not significant, except that females appeared to have more severe symptoms of disorganized communication than males. However, gender differences began to appear at subgroup levels, after stratification by age and diagnosis. Female adolescents reported more severe psychotic symptoms than male adolescents, especially in the symptom of perceptual abnormalities, which refer to hallucinations. Different patterns and predictors were found to significantly discriminate between psychotic and non-psychotic disorders among age and gender groups. Our study highlights gender differences in the severity, frequency, and pattern of self-reported psychotic symptoms when screening in a first help-seeking population. Therefore, gender differences should be considered during psychotic symptoms screening.
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Rice B, Perin J, Huettner S, Butz A, Yusuf HE, Trent M. Can Automated Text Messaging Successfully Monitor Antibiotic Adherence for Urban Adolescents and Young Women Managed for Pelvic Inflammatory Disease in the Outpatient Setting. Pediatr Neonatal Nurs 2022; 8:14-24. [PMID: 37994348 PMCID: PMC10664842 DOI: 10.17140/pnnoj-8-135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Objective This study evaluates patient responsiveness to an automated text messaging system for pelvic inflammatory disease (PID) self-care support, and measures the reliability of text-reported adherence. Design Patients aged 13-25-years with mild to moderate PID were recruited from urban, academic outpatient settings. Enrolled patients received antibiotics and were randomized into a standard of care or intervention group. During a 14-day treatment period, participants in the intervention arm received a community-based nursing visit and daily text message medication reminders with evening prompts to report the number of doses taken. Result Of the 97 participants randomized into the intervention arm, 91 (94%) were eligible for analysis. Most were African American and low income, with a mean age of 18.3 (SD=2.2) years. Participants responded to ~53% (SD=34%) of all dosage inquiry messages. Responsiveness attenuated at approximately 2.2% per day over the treatment period. Ninety-three percent (n=85) of the analyzed intervention arm returned for the two-week follow-up. Despite overall adherence and general responsiveness, text-reported and self-reported medication adherence were not well correlated (r=0.37, p<0.001). Conclusion Our findings show that text messaging is a feasible strategy for reaching urban adolescents being managed for complicated sexually transmitted infections in outpatient settings. However, patient responsiveness to self-care text messages do vary, limiting the adherence monitoring capacity of this technology. Given the number of unanswered text messages and incomplete text-reported adherence data, additional measures to assess adolescents' adherence to PID medications are needed in clinical trials.
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Affiliation(s)
- Bria Rice
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Jamie Perin
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Steven Huettner
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Arlene Butz
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Hasiya E. Yusuf
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
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Zhou J, Guo C, Ren L, Zhu D, Zhen W, Zhang S, Zhang Q. Gender differences in outpatients with dementia from a large psychiatric hospital in China. BMC Psychiatry 2022; 22:208. [PMID: 35313835 PMCID: PMC8935692 DOI: 10.1186/s12888-022-03852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sociodemographic characteristics and clinical features of dementia patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of dementia patients at a psychiatric hospital in China, with particular emphasis on gender differences. METHODS This retrospective study examined outpatients with dementia from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records. RESULTS Nine thousand four patients were recruited from a specific outpatient clinic of a hospital in Beijing, and the mean number of visits was 6.92. There were 3,433 (38.13%) male patients and 5,571 (61.87%) female patients. The most common comorbidities were generalized anxiety disorder, nonorganic insomnia, delusional disorder and depressive disorder. The proportion of patients using antidementia was the highest, with the rate of 68.3%, followed by benzodiazepines (48.83%), antipsychotics (45.43%), antidepressants (22.24%) and nonbenzodiazepines (19.96%). Patients with dementia showed a significant gender difference in average age (t = 6.36, P < 0.0001). Compared to male patients, female patients had a higher number of visits (7.40 ± 12.90 vs 6.15 ± 10.50, t = 4.81, P < 0.0001). There were significant differences in comorbidity composition between male and female patients (t = 23.09, P < 0.0001). CONCLUSIONS Our present findings suggested significant gender differences in the proportion of age, number of visits and comorbidity composition in outpatients with dementia.
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Affiliation(s)
- Jiaojiao Zhou
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Chengwei Guo
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Li Ren
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Dandi Zhu
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Wenfeng Zhen
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Saina Zhang
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
| | - Qing’e Zhang
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100035 China
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Abstract
Since 2018, the number of total joint arthroplasties (TJAs) performed on an outpatient basis has dramatically increased. Both surgeon and anesthesiologist should be aware of the implications for the safety of outpatient TJAs and potential patient risk factors that could alter this safety profile. Although smaller studies suggest that the risk of negative outcomes is equivalent when comparing outpatient and inpatient arthroplasty, larger database analyses suggest that, even when matched for comorbidities, patients undergoing outpatient arthroplasty may be at increased risk of surgical or medical complications. Appropriate patient selection is critical for the success of any outpatient arthroplasty program. Potential exclusion criteria for outpatient TJA may include age greater than 75 years, bleeding disorder, history of deep vein thrombosis, uncontrolled diabetes mellitus, and hypoalbuminemia, among others. Patient optimization before surgery is also warranted. The potential risks of same-day versus next-day discharge have yet to be elicited in a large-scale manner.
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218
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Jeppesen K, Moos C, Holm T, Pedersen AK, Skjøt-Arkil H. Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022. [PMID: 35294619 DOI: 10.1007/s00405-022-07312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
Purpose After thyroid surgery, the overriding concern is the risk of post-thyroid bleeding (PTB). This systematic review and meta-analysis aimed to assess the safety of hemithyroidectomy in an outpatient setting compared to an inpatient setting. The objectives were to (1) find the proportion of PTB in patients scheduled for outpatient hemithyroidectomy, (2) examine if outpatient hemithyroidectomy is clinically safe compared to an inpatient setting and (3) evaluate which selection criteria are most relevant for hemithyroidectomy in an outpatient setting.
Methods A systematic review was conducted using the following databases: MEDLINE (Ovid), EMBASE (Ovid) and the Cochrane Library from inception until September 2021. We included studies reporting on PTB of patients after hemithyroidectomy in an outpatient setting. The risk of bias was assessed using the Newcastle-Ottawa tool. The results were synthesised using Bayesian meta-analysis. Certainty in evidence was assessed using the GRADE approach.
Results This review included 11 cohort studies and 9 descriptive studies reporting solely on outpatients resulting in a total of 46,866 patients. PTB was experienced by 58 of the 9025 outpatients (0.6%) and 415 of the 37,841 inpatients (1.1%). There was no difference between the PTB rate of outpatients and inpatients (RR 0.715 CrI [0.396–1.243]). The certainty of the evidence was very low due to the high risk of bias. Conclusion The risk of PTB in an outpatient setting is very low, and outpatient hemithyroidectomy should be considered clinically safe. The most relevant selection criteria to consider in outpatient hemithyroidectomy are (1) relevant comorbidities and (2) psycho/-social factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07312-y.
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Shah R, Georgousopoulou EN, Al-Rubaie Z, Sulistio M, Tee H, Melia A, Michael N. Impact of ambulatory palliative care on symptoms and service outcomes in cancer patients: a retrospective cohort study. Palliat Care 2022; 21:28. [PMID: 35241067 PMCID: PMC8896341 DOI: 10.1186/s12904-022-00924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The integration of palliative care into routine cancer care has allowed for improved symptom control, relationship building and goal setting for patients and families. This study aimed to assess the efficacy of an ambulatory palliative care clinic on improving symptom burden and service outcomes for patients with cancer. Methods A retrospective review of data of cancer patients who attended an ambulatory care clinic and completed the Symptom Assessment Scale between January 2015 and December 2019. We classified moderate to severe symptoms as clinically significant. Clinically meaningful improvement in symptoms (excluding pain) was defined by a ≥ 1-point reduction from baseline and pain treatment response was defined as a ≥ 2-point or ≥ 30% reduction from baseline. Results A total of 249 patients met the inclusion criteria. The most common cancer diagnosis was gastrointestinal (32%) and the median time between the initial and follow-up clinic was 4 weeks. The prevalence of clinically significant symptoms at baseline varied from 28% for nausea to 88% for fatigue, with 23% of the cohort requiring acute admission due to unstable physical/psychosocial symptoms. There was significant improvement noted in sleep (p < 0.001), pain (p = 0.002), wellbeing (p < 0.001), and overall symptom composite scores (p = 0.028). Despite 18–28% of patients achieving clinically meaningful symptom improvement, 18–66.3% of those with moderate to severe symptoms at baseline continued to have clinically significant symptoms on follow-up. A third of patients had opioid and/or adjuvant analgesic initiated/titrated, with 39% educated on pain management. Goals of care (31%), insight (28%) and psychosocial/existential issues (27%) were commonly explored. Conclusions This study highlights the burden of symptoms in a cohort of ambulatory palliative care patients and the opportunity such services can provide for education, psychosocial care and future planning. Additionally routine screening of cohorts of oncology patients using validated scales may identify patients who would benefit from early ambulatory palliative care.
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Affiliation(s)
- Rajvi Shah
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia. .,School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Ekavi N Georgousopoulou
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ziad Al-Rubaie
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hoong Tee
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Thivolet C, Gaudilliere M, Villar Fimbel S, Bendelac N, Mestre B, Protsenko N, Brunot S, Nicolino M. Hybrid closed Loop improved glucose control compared to sensor-augmented pumps in outpatients with type 1 diabetes in real-life conditions with telehealth monitoring. Acta Diabetol 2022; 59:395-401. [PMID: 34725723 PMCID: PMC8559915 DOI: 10.1007/s00592-021-01820-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings. RESEARCH DESIGN AND METHODS This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM (n = 26) or pump users who only changed their device (n = 51), with predictive low glucose management (n = 8) or with Hybrid Closed Loop using Medtronic 780G (n = 36) systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. All subjects received diabetes and carbohydrate-counting education if needed at time of initiation and were proposed a telehealth monitoring by a diabetic nurse educator. RESULTS There was no episodes of severe hypoglycemia or diabetic ketoacidosis nor serious pump-related adverse events despite outpatient model of care. While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. Time in target range 3.9-10 mmol/L (70-180 mg/dl) also improved and was optimal with closed loop with 30/36 (83%) subjects with time in range above 70%. CONCLUSIONS Initiation of insulin pump therapy for outpatients is safe with a dedicated facility. Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.
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Affiliation(s)
- C Thivolet
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France.
| | - M Gaudilliere
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - S Villar Fimbel
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - N Bendelac
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - B Mestre
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - N Protsenko
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - S Brunot
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
| | - M Nicolino
- DIAB-eCARE Diabetes Center, Hospices Civils de Lyon, Lyon, France
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Nopp S, Moik F, Klok FA, Gattinger D, Petrovic M, Vonbank K, Koczulla AR, Ay C, Zwick RH. Outpatient Pulmonary Rehabilitation in Patients with Long COVID Improves Exercise Capacity, Functional Status, Dyspnea, Fatigue, and Quality of Life. Respiration 2022; 101:593-601. [PMID: 35203084 DOI: 10.1159/000522118] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/03/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND COVID-19 survivors face the risk of long-term sequelae including fatigue, breathlessness, and functional limitations. Pulmonary rehabilitation has been recommended, although formal studies quantifying the effect of rehabilitation in COVID-19 patients are lacking. METHODS We conducted a prospective observational cohort study including consecutive patients admitted to an outpatient pulmonary rehabilitation center due to persistent symptoms after COVID-19. The primary endpoint was change in 6-min walk distance (6MWD) after undergoing a 6-week interdisciplinary individualized pulmonary rehabilitation program. Secondary endpoints included change in the post-COVID-19 functional status (PCFS) scale, Borg dyspnea scale, Fatigue Assessment Scale, and quality of life. Further, changes in pulmonary function tests were explored. RESULTS Of 64 patients undergoing rehabilitation, 58 patients (mean age 47 years, 43% women, 38% severe/critical COVID-19) were included in the per-protocol-analysis. At baseline (i.e., in mean 4.4 months after infection onset), mean 6MWD was 584.1 m (±95.0), and functional impairment was graded in median at 2 (IQR, 2-3) on the PCFS. On average, patients improved their 6MWD by 62.9 m (±48.2, p < 0.001) and reported an improvement of 1 grade on the PCFS scale. Accordingly, we observed significant improvements across secondary endpoints including presence of dyspnea (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Also, pulmonary function parameters (forced expiratory volume in 1 s, lung diffusion capacity, inspiratory muscle pressure) significantly increased during rehabilitation. CONCLUSION In patients with long COVID, exercise capacity, functional status, dyspnea, fatigue, and quality of life improved after 6 weeks of personalized interdisciplinary pulmonary rehabilitation. Future studies are needed to establish the optimal protocol, duration, and long-term benefits as well as cost-effectiveness of rehabilitation.
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Affiliation(s)
- Stephan Nopp
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Florian Moik
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Milos Petrovic
- Outpatient Pulmonary Rehabilitation, Therme Wien Med, Vienna, Austria
| | - Karin Vonbank
- Clinical Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas R Koczulla
- Department of Pulmonary Rehabilitation, Member of the German Center for Lung Research (DZL), Philipps-University of Marburg, Marburg, Germany.,Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ralf Harun Zwick
- Outpatient Pulmonary Rehabilitation, Therme Wien Med, Vienna, Austria.,Ludwig Boltzmann Institute Rehabilitation Research, Vienna, Austria
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McCoy JL, Shaffer AD, Dohar JE. Pediatric otolaryngology telemedicine amid a pandemic - And beyond. Int J Pediatr Otorhinolaryngol 2022; 153:111014. [PMID: 34974276 DOI: 10.1016/j.ijporl.2021.111014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/05/2021] [Accepted: 12/25/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The coronavirus disease of 2019 (COVID-19) pandemic catalyzed an unprecedented redesign and innovative overhaul of health care delivery thrusting from fringe to mainstream virtual care. With a return to conventional practice, we now must create a research and policy agenda using the changes wrought by COVID-19 to help create a better health care system in its aftermath. The purpose of this study was to assess satisfaction of otolaryngology outpatient visits during the pandemic. METHODS A prospective survey study was performed on caregivers of all patients ages 0-26 years old seen in the Division of Pediatric Otolaryngology at our large tertiary care children's hospital from February-April 2020. The three study groups were those seen in-person 6 weeks before telemedicine was implemented (IBTM), those seen in telemedicine during the first 6 weeks (TM) it was implemented at our hospital, and those seen in-person during the telemedicine period (IDTM) in the same timeframe. The survey consisted of satisfaction questions related to their visit, if their child was recommended surgery at the time of the visit, and if the caregiver agreed with the recommendation. A medical record review was also performed. RESULTS A total of 176 caregivers completed the survey with 113(64.2%) completing the survey for an IBTM appointment, 59(33.5%) for a TM appointment, and 4(2.3%) for an IDTM appointment. There were 100(56.8%) male patients and 167(94.9%) were white. Families gave a higher response for the statement "The ability to communicate with the physician" (p = .012) and "The overall outpatient experience" (p = .004) in the IBTM cohort compared to the TM group. There were no significant differences for the other statements regarding the ability to understand recommendations, courtesy, and knowledge of the physician. Regardless of group, 98.6% of caregivers agreed with surgical recommendation when surgery was recommended. However, when surgery was not recommended at the appointment, caregivers were 11x more likely to disagree with the surgical recommendations, OR:11.49,95%CI:1.44-91.38,p = .005. CONCLUSION We conclude that telemedicine was equally well received by patients as compared to traditional live assessments suggesting that virtual care is a viable post-pandemic paradigm change. Satisfaction was rated as "Good" or "Excellent", however, messaging when surgery is not recommended was less acceptable and must be improved to obtain increased caregivers' agreement in an era of shared decision making.
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Schulz C, Messikh Z, Reboul P, Cariou S, Ahmadpoor P, Pambrun E, Prelipcean C, Garo F, Prouvot J, Delanaye P, Moranne O. Characteristics of outpatients referred for a first consultation with a nephrologist: impact of different guidelines. J Nephrol 2022; 35:1375-1385. [PMID: 35028894 DOI: 10.1007/s40620-021-01204-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) affects > 10% of the population but not all CKD patients require referral to a nephrologist. Various recommendations for referral to nephrologists are proposed worldwide. We examined the profile of French patients consulting a nephrologist for the first time and compared these characteristics with the recommendations of the International Kidney Disease: Improving Global Outcomes (KDIGO), the French "Haute Autorité de Santé" (HAS), and the Canadian Kidney Failure Risk Equation (KFRE). METHODS University Hospital electronic medical records were used to study patients referred for consultation with a nephrologist for the first time from 2016 to 2018. Patient characteristics (age, sex, diabetic status, estimated glomerular filtration rate (eGFR) and urine protein-to-creatinine ratio (PCR), etiology reported by the nephrologist) and 1-year patient follow-up were analyzed and compared with the KDIGO, HAS and Canadian-KFRE recommendations for referral to a nephrologist. The stages were defined according to the KDIGO classification, based upon kidney function and proteinuria. RESULTS: The 1,547 included patients had a median age of 71 [61-79] years with 56% males and 37% with diabetes. The main nephropathies were vascular (40%) and glomerular (20%). The KDIGO classification revealed 30%, 47%, 19%, 4% stages G1-2 to G5, and 50%, 22%, 28% stages A1-A3, respectively. According to KDIGO, HAS and KFRE scores, nephrologist referral was indicated for 42%, 57% and 80% of patients respectively, with poor agreement between recommendations. Furthermore, we observed 890 (57%) patients with an eGFR> 30 ml/min and a urine protein to creatinine ratio 0.5 g/g, mostly aged over 65 years (67%); 40% were diabetic, and 57% had a eGFR > 45 ml/min/1.73m2, 56% were diagnosed as vascular nephropathy and 11% with unknown nephropathy. CONCLUSION These results underline the importance of better identifying patients for referral to a nephrologist and informing general practitioners. Other referral criteria (age and etiology of the nephropathy) are debatable.
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Affiliation(s)
- Céline Schulz
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Ziyad Messikh
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Pascal Reboul
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Sylvain Cariou
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Pedram Ahmadpoor
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Emilie Pambrun
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Camelia Prelipcean
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Florian Garo
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
| | - Julien Prouvot
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France.,IDESP, INSERM Montpellier, Montpellier, France
| | - Pierre Delanaye
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France.,Service Nephrologie Dialyse Transplantation, Hopital Universitaire de Liege, Liège, Belgium
| | - Olivier Moranne
- Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France. .,IDESP, INSERM Montpellier, Montpellier, France.
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Ndiaye D, Raimbeau G, Jeudy J, Rabarin F, Saint-Cast Y, Cesari B, Petit A, Bigorre N. Septic arthritis of the fingers: is short-term oral antibiotic therapy appropriate? Hand Surg Rehabil 2022; 41:240-245. [PMID: 35038605 DOI: 10.1016/j.hansur.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
The management of septic arthritis of the hand is poorly described and there is no consensus. It is based on how septic arthritis of the large joints is managed, despite certain specificities related to the hand, typically involving inpatient management and intravenous antibiotic therapy. The primary objective of this work was to evaluate our postoperative protocol for the management of septic arthritis of the hand with short-term antibiotic therapy. The secondary objective was to determine the risk factors for treatment failure. We conducted a retrospective, descriptive, single-center study and analyzed the medical records of patients managed for septic arthritis of the fingers over a 1-year period from January 2018 to December 2018. We collected patient demographics and all pre-, intra-, and postoperative data. A total of 128 patients were included. The median age was 52.4 years (41-66). An exogenous source of contamination was reported in 98% of cases (animal bite, plant thorn, wound, cyst trituration, etc.). The most frequently isolated microorganism was Staphylococcus aureus (45%), followed by Streptococcus spp. (22%) and Pasteurella spp. (18%). The vast majority of patients (79%) were treated with oral amoxicillin/clavulanic acid. This treatment was continued in 91% of patients after microbiological results were obtained for a median treatment duration of 8 days (7-15). Nine percent of patients failed treatment. The risk factors identified were crush wounds (p = 0.04), initial radiological abnormalities (chondrolysis and/or osteolysis) (p = 0.016) and infection with Pasteurella spp. (p = 0.015). Our study suggests that simplified antibiotic therapy is feasible for the management of septic arthritis of the hand with short duration, broad spectrum oral antibiotics in the absence of identified risk factors.
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Affiliation(s)
- Diama Ndiaye
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Guy Raimbeau
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Jérome Jeudy
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Fabrice Rabarin
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Yann Saint-Cast
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Bruno Cesari
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Alexandre Petit
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France
| | - Nicolas Bigorre
- Centre de la Main, 47 Rue de la Foucaudière, 49800 Trélazé, France.
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225
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Ploussard G, Grabia A, Barret E, Beauval JB, Brureau L, Créhange G, Dariane C, Fiard G, Fromont G, Gauthé M, Mathieu R, Renard-Penna R, Roubaud G, Ruffion A, Sargos P, Rouprêt M, Lequeu CE. Same-day-discharge Robot-assisted Radical Prostatectomy: An Annual Countrywide Analysis. EUR UROL SUPPL 2022; 36:23-25. [PMID: 35005649 PMCID: PMC8715288 DOI: 10.1016/j.euros.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
There are no countrywide data regarding the utilization of same-day-discharge (SDD) surgery for robot-assisted radical prostatectomy (RARP). We aimed to evaluate the annual number of SDD RARP procedures in France and to compare postoperative outcomes in SDD versus non-SDD centers. Data for all 9651 patients undergoing RARP in France in 2020 were extracted from the central database of the national healthcare system. Endpoints were length of hospital stay, patient age, center volume, lymph node dissection, and the hospital readmission rate. Overall, 184 SDD cases (1.9%) were reported in 14.2% of RARP centers. The annual RARP and SDD RARP caseload ranged from 41 to 485, and from one to 47, respectively, in SDD centers. SDD was significantly associated with higher-volume centers (p < 0.001). No difference in readmission rate (7.9% vs 5.1%; p = 0.141) was observed for SDD versus non-SDD centers. Direct stay costs were estimated at €1457 in SDD centers compared to €2021 in non-SDD centers. The main limitation is the lack of detailed patient characteristics and readmission causes. This annual nationwide analysis suggests that SDD RARP remains infrequently used in routine practice in France despite being associated with comparable short-term outcomes after RARP and potential cost benefits. Patient summary We evaluated the use of robot-assisted removal of the prostate (RARP) with same-day hospital discharge in France for men with prostate cancer. In 2020, only 1.9% of the 9651 RARP procedures involved same-day discharge, even though the data show that this approach has lower costs and comparable safety.
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Affiliation(s)
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Laurent Brureau
- Department of Urology, CHU de Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris University, Paris, France
| | - Gaëlle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, Grenoble, France
| | | | - Mathieu Gauthé
- INSERM UMR 1153, Unité de Recherche Clinique en Économie de la Santé, Paris, France
| | | | - Raphaële Renard-Penna
- Department of Radiology, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Alain Ruffion
- Service d'Urologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,Centre d'Innovation en Cancérologie de Lyon, Faculté de Médecine Lyon Sud, Université Lyon 1, Lyon, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Department of Urology, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France
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226
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Dillen H, Burvenich R, De Burghgraeve T, Verbakel JY. Using Belgian pharmacy dispensing data to assess antibiotic use for children in ambulatory care. BMC Pediatr 2022; 22:12. [PMID: 34980037 PMCID: PMC8720940 DOI: 10.1186/s12887-021-03047-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The desired effect of antibiotics is compromised by the rapid escalation of antimicrobial resistance. Children are particularly at high-risk for unnecessary antibiotic prescribing, which is owing to clinicians' diagnostic uncertainty combined with parents' concerns and expectations. Recent Belgian data on ambulatory antibiotic prescribing practices for children are currently lacking. Therefore, we aim to analyse different aspects of antibiotic prescriptions for children in ambulatory care. METHODS Pharmacy dispensing data on antibiotics for systematic use referring from 2010 to 2019 were retrieved from Farmanet, a database of pharmaceutical dispensations in community pharmacies. Population data were obtained from the Belgian statistical office (Statbel). Descriptive statistics were performed in Microsoft Excel. The Mann-Kendall test for trend analysis and the seasplot function for seasonality testing were conducted in R. RESULTS The past decade, paediatric antibiotic use and expenditures have relatively decreased in Belgian ambulatory care with 35.5% and 44.3%, respectively. The highest volumes of antibiotics for children are prescribed by GPs working in Walloon region and rural areas, to younger children, and during winter. The most prescribed class of antibiotics for children are the penicillins and the biggest relative reduction in number of packages is seen for the sulfonamides and trimethoprim and quinolone antibacterials. CONCLUSIONS Paediatric antibiotic use has decreased in Belgian ambulatory care. Further initiatives are needed to promote prudent antibiotic prescribing in ambulatory care.
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Affiliation(s)
- Hannelore Dillen
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.
| | - Ruben Burvenich
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Tine De Burghgraeve
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX26GG, UK
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227
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Kim J, Rim SJ, Jo M, Lee MG, Park S. The Trend of Psychiatric Visits and Psychiatric Medication Prescription Among People Tested for SARS-CoV-2 During the Initial Phase of COVID-19 Pandemic in South Korea. Psychiatry Investig 2022; 19:61-71. [PMID: 35086193 PMCID: PMC8795598 DOI: 10.30773/pi.2021.0247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/27/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to monitor the trend of psychiatric visits and medication prescriptions among people tested for SARS-CoV-2 during the initial phase of coronavirus disease 2019 (COVID-19) pandemic in South Korea. METHODS We conducted a population-based cohort study using data from the National Health Insurance Service (NHIS) linked to the Korea Disease Control and Prevention Agency (KDCA) data. The overall trend of psychiatric visits during COVID-19 for each month was compared to the month prior to COVID-19. The number of psychiatric medication prescription records was monitored from January 2019 to May 2020. RESULTS A total of 212,678 individuals were tested for SARS-CoV-2 between January 2020 and May 2020. Among these individuals, 72.1% (n=153,309) did not have pre-existing mental illness, and 27.9% (n=59,369) had pre-existing mental illness. We found that most psychiatric visits were made in March, and patients without pre-existing mental illness significantly increased in psychiatric outpatients during the COVID-19 pandemic (p trend<0.001). In addition, psychiatric medication prescriptions were the most prescribed between March and April 2020. CONCLUSION We identified a rising trend in psychiatric visits and medication prescriptions among people who were tested for SARSCoV-2 during the initial phase of COVID-19 pandemic in South Korea.
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Affiliation(s)
- Jungeun Kim
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Soo Jung Rim
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Minkyung Jo
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Min Geu Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Subin Park
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
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228
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Pigg R, Fazendin J, Porterfield J, Chen H, Lindeman B. Patient Satisfaction is Equivalent for Inpatient and Outpatient Minimally-Invasive Adrenalectomy. J Surg Res 2022; 269:207-211. [PMID: 34601371 PMCID: PMC8688216 DOI: 10.1016/j.jss.2021.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions. Outpatient adrenalectomy has been shown to be safe and effective, but patients' perspectives have yet to be addressed. This study compares patient satisfaction following inpatient and outpatient adrenalectomy. METHODS An institutional database was queried for minimally-invasive adrenalectomies performed from 2017 to 2020. Patients were contacted up to two times to participate in a phone survey consisting of 25 questions modeled after the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS) assessing preparation for surgery, discharge experience, post-operative course, and overall satisfaction. Statistical analysis was performed using Kruskal Wallis, Wilcoxon-Mann Whitney, and Chi-square tests, as appropriate. RESULTS One hundred five adrenalectomy patients were identified, of which 98 were contacted and 58 responded (59%). Two surgeons contributed patients, with no difference in the percentage of patients in the outpatient group (51.7% versus 62.1%, P = 0.423). Outpatient adrenalectomy patients had slightly higher overall experience scores, but this difference was not statistically significant (9.12 ± 1.36 versus 8.93 ± 1.51, P = 0.367). Patients undergoing outpatient adrenalectomy were more likely to have their discharge plan discussed pre-operatively (94% versus 62%, P = 0.005), but no significant differences were noted between inpatient and outpatient groups regarding preparation for surgery, readiness for discharge, night of surgery experiences, or self-reported pain or complications (P > 0.05 for all). Significantly higher overall experience scores were reported by patients counseled about their discharge plan (9.27 versus 7.9, P = 0.036), felt prepared for recovery (9.39 versus 5.5, P < 0.001), received information about pain control (9.13 versus 7.00, P = 0.031), felt prepared at time of discharge (9.33 versus 5.80, P < 0.001), and received information about potential complications (9.29 versus 7.00, P = 0.001). Although not statistically significant, there was a trend towards outpatients being more likely to choose the same approach if they were to undergo surgery again (97% versus 84%, P = 0.081). CONCLUSIONS Patient satisfaction following adrenalectomy is significantly associated with patients' self-reported degree of preparation for surgery and discharge, with no significant difference in patient satisfaction between inpatient and outpatient groups. Patients undergoing outpatient adrenalectomy would be likely to choose the same approach compared to inpatients. Targeted pre-operative counseling can contribute to enhanced patient outcomes for all patients undergoing adrenalectomy.
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Affiliation(s)
- R.A. Pigg
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL,Corresponding Author. Brenessa Lindeman, MD, MEHP, 1808 7th Ave S, Boshell Diabetes Building 506, Birmingham, AL 35294, Phone: (205) 975-5000, Fax: (205) 975-5971, Twitter: @BrenessaL,
| | - J.M. Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - J.R. Porterfield
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - H. Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - B. Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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Sabatelli L, Keränen M, Viayna E, Roset M, Lara N, Thunström D, Pfeiffer M, Nicklasson M, Itälä-Remes M. Burden of hospitalizations and outpatient visits associated with moderate and severe acute graft-versus-host disease in Finland and Sweden: a real-world data study. Support Care Cancer 2022; 30:5125-35. [PMID: 35235039 DOI: 10.1007/s00520-022-06915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to describe patient characteristics and quantify hospital stays and outpatient visits (H&OV) following diagnosis with moderate-to-severe acute graft-versus-host disease (aGVHD) in Finland and Sweden. METHODS A retrospective chart audit collected data from patient medical records of 3 specialized centers performing allogeneic hematopoietic stem cell transplantation (HSCT; Finland, n = 2; Sweden, n = 1). Eligible patients received allogeneic HSCT (January 1, 2016-June 30, 2017) from any donor source, were diagnosed with grade II-IV aGVHD (MAGIC or modified Glucksberg criteria) at any time from transplantation to 12 months before data collection, and were ≥ 18 years old at diagnosis. Criteria for comparing patients graded with modified Glucksberg and MAGIC severity scales were defined. RESULTS Fifty-five patients (Finland, n = 45; Sweden, n = 10) were included. Myeloablative conditioning was the most common conditioning regimen (81.8%); immunosuppression regimens were based on combinations of methotrexate (96.4%), in vivo T-cell depletion (80.0%), cyclosporine (63.6%), mycophenolate (40.0%), and tacrolimus (34.5%). Sixteen patients (29.1%) developed grade III/IV aGVHD; skin was the most common organ involved (80.0%). Most patients required ≥ 1 hospital stay (89.1%; median of 2 hospitalizations per patient); 7 patients (14.3%) required admission to an intensive care unit. Median hospitalization duration from HSCT to discharge was 26 days. Most patients also required outpatient or emergency department visits (90.9%). Subgroup analyses showed longer hospital stays for patients receiving multiple treatment lines; no clear differences in H&OV were observed between prophylactic regimens. CONCLUSION Based on this retrospective study, moderate-to-severe aGVHD is associated with considerable healthcare resource utilization in Finland and Sweden, particularly in patients who received multiple lines of therapy.
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Kavalieratos D, Harinstein ME, Rose B, Lowers J, Hoydich ZP, Bekelman DB, Allen LA, Rollman BL, Ernecoff NC, Moreines LT, Bakitas MA, Arnold RM. Primary palliative care for heart failure provided within ambulatory cardiology: A randomized pilot trial. Heart Lung 2022; 56:125-132. [PMID: 35863099 PMCID: PMC9941979 DOI: 10.1016/j.hrtlng.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heart failure is characterized by physical and emotional symptoms and decreased quality of life (QoL). Palliative care can reduce burdens of serious illness but often is limited to inpatient or academic settings. OBJECTIVES To develop and test the Primary Education for Nurses in Palliative care-HF (PENPal-HF) intervention, training outpatient cardiology nurses to address symptom burden, patient priorities for care and QoL, and advance care planning as part of quarterly HF visits. METHODS We conducted a pilot randomized clinical trial for adults with NYHA Stage III or IV HF and ≥ 2 hospitalizations in the past 12 months, recruited from a community-based cardiology clinic. Participants were randomized 2:1, PENPal-HF plus usual care versus usual care alone. Primary outcomes were feasibility and acceptability. RESULTS We randomized 30 adults with Stage III HF - 20 to PENPal-HF and 10 to usual care. Most in the intervention group (71%) and in the control group (62%) completed the study through the final outcome assessment in week 56; 5 participants died. Of 20 participants in the intervention, 14 (70%) remained in the study through the end of intervention visits; 11 (55%) completed all visits. Most intervention participants (93.75%) agreed or strongly agreed that they were satisfied with their care, and 87.5% agreed or strongly agreed that all people with HF should receive the intervention. Most intervention group participants (93.75%) reported a perceived improvement in physical symptoms, mood, and/or QoL. CONCLUSIONS This pilot study suggests that nurse-led primary palliative care in outpatient cardiology settings is promising. Research is warranted to determine efficacy and effectiveness.
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Affiliation(s)
| | | | - Beth Rose
- University of Pittsburgh Medical Center.
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231
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Bensted K, Kim C, Freiman J, Hall M, Zekry A. Gastroenterology hospital outpatients report high rates of satisfaction with a Telehealth model of care. J Gastroenterol Hepatol 2022; 37:63-68. [PMID: 34402105 DOI: 10.1111/jgh.15663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/19/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to capture patient satisfaction with a Telehealth model of care in a tertiary hospital gastroenterology outpatient setting. An in-depth patient questionnaire addressed patients' experience with telephone based consultations, as well as capturing demographic data to predict patients who may benefit from a Telehealth model of care. METHODS Patients aged ≥ 18 years who had a telephone appointment from 1st March 2020 to 1st September 2020 at the St George Hospital and Sutherland Hospital Gastroenterology Clinics in Sydney, Australia, were invited to complete an anonymous online survey detailing their experience. Clinics included general gastroenterology, inflammatory bowel disease, hepatology and swallow disorders. Chi squared analysis was used to investigate if demographic data (age, gender, educational status, English-spoken at home, and presence of IBD or cirrhosis) impacted on a patients rating of care they received. RESULTS 1894 patients were invited to complete with survey, with 302 responses. 294 respondents (88.4%) rated the care they received as "very good" or "good". 254 (84.1%) stated the main reason for attending the clinic was dealt with to their satisfaction. There was no statistical relationship between age, gender, educational status and the rating of care received. 49.7% preferred their telephone appointment, and 63.6% would like the option of a telephone appointment in the future. CONCLUSION Gastroenterology outpatients reported a very high satisfaction with Telehealth, demonstrating a potential for Telehealth to be incorporated into usual care.
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Affiliation(s)
- Karen Bensted
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,Department of Gastroenterology and Hepatology, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Christy Kim
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - John Freiman
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Matthew Hall
- Department of Gastroenterology and Hepatology, The Sutherland Hospital, Sydney, New South Wales, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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232
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Almand J, Pickering T, Parsell D, Stronach B, Carlisle R, McIntyre L. The successful migration of total joint arthroplasty from the hospital inpatient to outpatient ASC setting. Knee 2022; 34:17-23. [PMID: 34871973 DOI: 10.1016/j.knee.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/09/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was undertaken to analyze the clinical results and complication rate of patients undergoing outpatient total joint arthroplasty by a single orthopedic group. All surgeries were performed in the practice-owned ambulatory surgery center (ASC). METHODS All patients indicated for outpatient total joint arthroplasty from 2016-2019 with complete pre and post-operative patient reported outcomes were enrolled in the study including hip, knee and partial knee replacements. Patient reported outcomes including HOOS, KOOS and VR-12 were collected at six months. Patient complication and satisfaction data was also collected. RESULTS There were 1007 patients enrolled in the study. At six months, THA HOOS and VR-12 scores improved to 82.2 and 54.5/45. TKA KOOS and VR-12 scores improved to an average of 74.3 and 54.0/43.6. At six months, UKA scores improved to an average of 73.6 and 55.1/41.2. All HOOS, KOOS and VR-12 PCS scores improvements were statistically significant (p < 0.001) and met MCID thresholds. A separate cohort of 1898 regionally tracked cases with comprehensive global complication data exhibited 111 complications (unplanned post-operative events generating a medical expense) including manipulation 13 (0.68%), DVT/PE 4 (0.2%), medical 45 (2.4%), wound 8 (0.4%), infection 8 (0.4%). Sixty-six outpatient cases (3.5%) experienced clinical complications requiring some form of additional treatment. CONCLUSION Outpatient joint arthroplasty performed in the ASC is safe and effective in appropriately selected patients with complication rates that compares favorably to inpatient procedures.
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Affiliation(s)
- Jeff Almand
- Mississippi Sports Medicine and Orthopedic Care, United States
| | | | - Doug Parsell
- Mississippi Sports Medicine and Orthopedic Care, United States
| | - Ben Stronach
- University of Mississippi Medical Center, United States
| | - Robert Carlisle
- Mississippi Sports Medicine and Orthopedic Care, United States
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233
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Halaji M, Pournajaf A, Sadeghi F, Hasanzadeh A, Chehrazi M, Gholinia H, Hejazi Amiri F, Saber Amoli S, Javanian M, Bayani M, Sadeghi Haddad Zavareh M, Shokri M, Babazadeh A, Bazi Broun M, Mohammadi M, Mehdinezhad H, Monadi M, Amri Maleh P, Nouri HR, Daraei A, Yousefnia Pasha M, Tourani M, Ahmadian SR, Esmailzadeh N, Mirtabar SM, Asadi S, Yousefghahary B, Babaei M, Nabipour M, Vakili Sadeghi M, Pourkia R, Jafarypour I, Zieaie Amiri N, Akbary R, Asgharpour M, Oliaei F, Zahedpasha Y, Mahmoodi H, Akbarian Rad Z, Haghshenas Mojaveri M, Seyfi S, Shokri Shirvani J, Alhooee S, Abedi H, Behzad K, Bayani MA, Kheirkhah F, Saadat P, Nasiraie E, Ezami N, Gorjinejad S, Fallhpour K, Fakhraie F, Beheshti Y, Baghershiroodi M, Rasti F, Salehi M, Aleahmad A, Nasrollahian S, Babapour R, Malekzadeh R, Habibzadeh Kashi R, Shams Esmaili MA, Javadian Kotnaei M, Ghanbarpour A, Yahyapour Y. One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021). Caspian J Intern Med 2022; 13:244-253. [PMID: 35872672 PMCID: PMC9272954 DOI: 10.22088/cjim.13.0.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 03/10/2023]
Abstract
BACKGROUND The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. METHODS This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. RESULTS Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). CONCLUSION In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.
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Affiliation(s)
- Mehrdad Halaji
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.,These authors contributed equally to this work
| | - Abazar Pournajaf
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.,These authors contributed equally to this work
| | - Farzin Sadeghi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Hasanzadeh
- Department of Medical Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Hemmat Gholinia
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Hejazi Amiri
- Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Saghar Saber Amoli
- Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Masoumeh Bayani
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahmoud Sadeghi Haddad Zavareh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mehran Shokri
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mana Bazi Broun
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Mohammadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Mehdinezhad
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mahmoud Monadi
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Parviz Amri Maleh
- Department of Anesthesiology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Hamid Reza Nouri
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Abdolreza Daraei
- Department of Medical Genetics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Mehdi Tourani
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Nadia Esmailzadeh
- Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | | | - Shakiba Asadi
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Behnaz Yousefghahary
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Majid Nabipour
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Vakili Sadeghi
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Pourkia
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Iraj Jafarypour
- Department of Cardiology, School of Medicine , Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Zieaie Amiri
- Department of Cardiology, School of Medicine , Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Roghayeh Akbary
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Masoumeh Asgharpour
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farshid Oliaei
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yadollah Zahedpasha
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hasan Mahmoodi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Akbarian Rad
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Haghshenas Mojaveri
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahram Seyfi
- Department of Anesthesiology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Javad Shokri Shirvani
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Saman Alhooee
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Hasan Abedi
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Katrin Behzad
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ali Bayani
- Department of Internal Medicine, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Farzan Kheirkhah
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Payam Saadat
- Part of Infectious Control, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ebrahim Nasiraie
- Part of Infectious Control, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Nafiseh Ezami
- Part of Medical Records, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Shahrbano Gorjinejad
- Part of Infectious Control, Amirkola Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Kobra Fallhpour
- Part of Infectious Control, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Fakhraie
- Part of Infectious Control, Shahid Yahyanejad Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Yousef Beheshti
- Department of Medical Genetics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mahnaz Baghershiroodi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Faeze Rasti
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Salehi
- Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Atiyeh Aleahmad
- Department of Clinical Biochemistry, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Sina Nasrollahian
- Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Rahman Babapour
- Babol Health Center, Babol University of Medical Sciences, Babol, Iran
| | - Rahim Malekzadeh
- Babol Health Center, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Maryam Javadian Kotnaei
- Department of Obstetrics and Gynecology, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Azita Ghanbarpour
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Yousef Yahyapour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Medical Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
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Carbone A, Vervaecke AJ, Ye IB, Patel AV, Parsons BO, Galatz LM, Poeran J, Cagle P. Outpatient versus inpatient total shoulder arthroplasty: A cost and outcome comparison in a comorbidity matched analysis. J Orthop 2021; 28:126-133. [PMID: 34937996 DOI: 10.1016/j.jor.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies comparing total and reverse shoulder arthroplasty (TSA/RSA) are subject to surgeon selection bias. This study objective is to compare the outcomes and cost of outpatient TSA/RSA to inpatient TSA/RSA. Methods 108,889 elective inpatient and outpatient TSA/RSA from Medicare claims data (2016-2018). 90-day readmission and total 90-day costs were compared following propensity score matching. Results Younger and healthier patients are receiving outpatient TSA/RSA. Outpatient TSA/RSA was associated with fewer 90-day readmissions (OR 0.48 CI 0.38-0.59, p < 0.001) and lower 90-day costs (-20.1% CI -19.1%; -21.1%, p < 0.001). Conclusions Outpatient TSA/RSA surgery offers lower complication rates and total costs. Level of evidence III.
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Affiliation(s)
- Andrew Carbone
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ivan B Ye
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akshar V Patel
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bradford O Parsons
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leesa M Galatz
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Healthy Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Li W, Yan H, Liu B, Tian Y, Chen Y, Jia L, Gao Z, Wang Q. Epidemiological characteristics and genetic diversity of norovirus infections among outpatient children with diarrhea under 5 years of age in Beijing, China, 2011-2018. Gut Pathog 2021; 13:77. [PMID: 34952625 PMCID: PMC8709959 DOI: 10.1186/s13099-021-00473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Human noroviruses are the leading cause of sporadic cases and outbreaks of viral acute gastroenteritis in all age groups worldwide. Methods Epidemiological data and fecal specimens were collected between January 2011 and December 2018 from 4911 children < 5 years of age with diarrhea in three districts of Beijing. From 2011 to 2013, One-Step Reverse Transcription Polymerase Chain Reaction (RT-PCR) was used to detect noroviruses, and from January 2014 to December 2018, norovirus GI and GII were screened using duplex quantitative real-time RT-PCR (qRT-PCR). One-Step RT-PCR and RT-seminested PCR were performed to amplify the RNA-dependent polymerase and capsid genes of noroviruses in positive sample. Amplified products were sequenced directly; norovirus was typed using the online Norovirus Genotyping Tool v2.0 and phylogenetic analyses were conducted using MEGA-X. Results From 2011 to 2018, noroviruses were detected in 16.5% of specimens from children with diarrhea. The highest prevalence was observed in children aged 12 to 23 months (22.4%, 319/1421), followed by children aged 6 to 11 months (17.6%, 253/1441). The highest prevalence of norovirus infections occurred in autumn followed by winter, spring, and summer. From 2011 to 2018, the most prevalent dual types (genotype and polymerase type) were GII.4 Sydney[P31] (51.6%, 239/463), followed by GII.3[P12] (24.0%, 111/463), GII.4 2006b[P4 2006b] (7.3%, 34/463), GII.2[P16] (5.0%, 23/463), GII.17[P17] (2.6%, 12/463) and GII.6[P7] (2.6%, 12/463). GII.4 2006b[P4 2006b] predominated in 2011 and 2012. GII.4 Sydney[P31] predominated from 2013 to 2018. In total, 15 genotypes, 15 P-types and 19 dual types were detected in this study, reflecting the genetic diversity. Conclusions There were significant epidemiological characteristics and genetic diversity among outpatient children with norovirus infections < 5 years of age in Beijing from 2011 to 2018. These characteristics differ from those of norovirus outbreaks in Beijing. The complete genome sequences of each genotype are needed to better understand norovirus evolutionary mechanisms.
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Affiliation(s)
- Weihong Li
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Hanqiu Yan
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Baiwei Liu
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Yi Tian
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Yanwei Chen
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Lei Jia
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Zhiyong Gao
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China.
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China.
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Monico LB, Ludwig A, Lertch E, Schwartz RP, Fishman M, Mitchell SG. Post-residential treatment outpatient care preferences: Perspectives of youth with opioid use disorder. J Subst Abuse Treat 2021; 137:108692. [PMID: 34920900 DOI: 10.1016/j.jsat.2021.108692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION We know little about what youth with opioid use disorders (OUD) think about outpatient substance use treatment and 12-step meetings following discharge from residential substance use treatment. This study explores youths' preferences between intensive outpatient treatment (IOP) and community-based 12-step groups. METHOD The study recruited youth (n = 35) from a larger randomized trial (N = 288) that examined the effectiveness of extended-release naltrexone versus treatment-as-usual. This study asked the youth to participate in semi-structured qualitative interviews at baseline, 3 months, and 6 months post-residential treatment discharge. Qualitative interviews probed youths' key decision points during the six-months following residential treatment for OUD, including medication and counseling, and 12-step continuation in the community. RESULTS Qualitative analyses revealed three overarching themes related to youths' preferences for either IOP or 12-step meetings: structure of recovery support, mechanisms of accountability, and relationships. CONCLUSION Despite varying preferences, this analysis highlights the complexity of benefits that youth report receiving from each approach. Research has yet to determine the degree to which these approaches are complementary or supplementary for this population.
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Affiliation(s)
- Laura B Monico
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America.
| | - Ariel Ludwig
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Elizabeth Lertch
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Robert P Schwartz
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
| | - Marc Fishman
- Mountain Manor Treatment Center, 3800 Frederick Ave, Baltimore, MD 21229, United States of America
| | - Shannon Gwin Mitchell
- Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, United States of America
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Heinold S, Fassmer AM, Schmiemann G, Hoffmann F. Characteristics of outpatient emergency department visits of nursing home residents: an analysis of discharge letters. Aging Clin Exp Res 2021; 33:3343-51. [PMID: 33939126 DOI: 10.1007/s40520-021-01863-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/13/2021] [Indexed: 10/30/2022]
Abstract
BACKGROUND Unplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. However, there is little research on what diagnostic and therapeutic measures are performed during visits. AIMS We analyzed underlying diagnoses, characteristics and performed medical procedures of unplanned outpatient ED visits by NHR. METHODS We conducted a multi-center study of 14 nursing homes (NHs) in northwestern Germany in 03/2018-07/2019. Hospital transfers were documented by nursing staff using a standardized questionnaire for 12 months. In addition, discharge letters were used to collect information about the respective transfer, its reasons and the extend of the medical services performed in the ED. RESULTS A total of 161 unplanned ED visits were included (mean age: 84.2 years; 68.3% females). The main transfer reasons were trauma (59.0%), urinary catheter and nutritional probe problems (overall 10.6%; male NHR 25.5%) and altered mental state (9.9%). 32.9% where discharged without imaging or blood test prior. 67.4% of injured NHR (n = 95) required no or only basic wound care. Catheter-related problems (n = 17) were mainly treated by changing an existing suprapubic catheter (35.3%) and by flushing the pre-existing catheter (29.4%). DISCUSSION Our data suggest that the diagnostic and therapeutic interventions performed in ED, often do not exceed general practitioner (GP) care and many ED visits seem to be unnecessary. CONCLUSION Better coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits.
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Qian ZJ, Megwalu UC, Cheng AG, Balakrishnan K. Outpatient healthcare use and outcomes after pediatric tracheostomy. Int J Pediatr Otorhinolaryngol 2021; 151:110963. [PMID: 34736006 DOI: 10.1016/j.ijporl.2021.110963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To 1) describe health outcomes and outpatient healthcare use after pediatric tracheostomy, and 2) identify populations with higher morbidity that may benefit from improved post-operative monitoring. METHODS Optum's commercial insurance database was queried from 2003 to 2019. Children aged 0-18 who received tracheostomy identified. Mortality, decannulation, tracheostomy complications, and home ventilator dependence were determined, as well as physician office visits and specialty type. The effect that patient characteristics (age, sex, ethnicity, prematurity, and presence versus absence of chronic lung disease [CLD], congenital heart disease [CHD], neurologic impairment [NI], and upper airway obstruction [UAO]) had on outcomes were compared. RESULTS 1231 children were identified. Infants accounted for 33% of patients and 40% of the cohort was premature. The most common comorbid conditions were NI (76%), UAO (69%), CLD (48%), and CHD (35%). Within 5 years postoperatively, 25% died, 45% had home ventilator dependence, 53% had a complication, and 10% were decannulated. CHD was associated with higher risk of death (HR,1.98; 95% CI 1.22, 3.21), while UAO was associated with lower risk of death (HR,0.51; 95% CI 0.32, 0.83) and higher probability of decannulation (HR,3.56, 95% CI 1.08, 11.74). The median number of physician office visits was 6 per year (IQR 3,10). The most common specialty types were pediatrics (32%), pulmonary medicine (10%), and otolaryngology (8%). NI was associated with greater number of office visits (mean difference/year, 4.10; 95% CI 2.00, 6.19) while Hispanic ethnicity was associated with fewer visits (mean difference/year, -2.94; 95%CI -5.42, -0.45). CONCLUSIONS UAO was associated with lower risk of mortality and higher probability of decannulation, while NI was associated with greater outpatient healthcare utilization. Social disparities in outpatient tracheostomy care were observed.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 94305, Stanford, CA, USA.
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Okonta KE, Ogaji DS. Pattern and Predictors of Patients' Willingness to Comply with Recommendations after Surgical Consultations in a Teaching Hospital in Nigeria. West Afr J Med 2021:1080-1087. [PMID: 34921722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Willingness of patients to comply with decisions taken during surgical consultations may influence the quality of care and health outcome. OBJECTIVE This study determined the pattern and predictors of patients' willingness to adhere to surgical recommendations. METHODS A descriptive cross-sectional study involving about 490 adults recruited by systematic sampling. The content validity and internal consistency reliability of the tool which assessed patients' willingness to comply with recommendations for follow-up visit, drug prescription, investigation and surgical procedure were determined. Frequencies distribution and multivariate ordinal logistic regressions were conducted and p-value <0.05 was considered significant. RESULTS A total of 466 respondents' data was analysed giving a response rate of 95.1%. The Cronbach's alpha of the questionnaire was 0.7 and the mean age of the respondents was 43.7 +15.7 years. About a fifth (18.2%) earned more than N==150,000 ($385) and out-of-pocket payment was the prevalent mode of making payments (83.3%). Follow-up visit was the most frequent recommendation (31.8%) and patients' willingness to accept recommendations ranged from 62.7% (admission) to 93.2% (prescription). The visit status was the most consistent predictors of patients' willingness to accept the various recommendations. CONCLUSION Fewer patients were willing to accept the recommendation for an admission than other recommendations. Findings are useful in developing strategies to improve patients' adherence with recommendations following consultations with surgeons.
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Affiliation(s)
- K E Okonta
- Department of Surgery, University of Port Harcourt, East-West Road, Choba, PMB 5323, Nigeria
| | - D S Ogaji
- Department of Preventive and Social Medicine, University of Port Harcourt,East-West Road, Choba, PMB 5323, Nigeria
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Tiago V, Sousa D, Luque J, Rei MJ, Borrega R, Cabedal M, Raimundo PO. Circumstances of the ambulatory prescription of quinolones in Urology and opportunities for intervention. J Healthc Qual Res 2021; 37:254-262. [PMID: 34862151 DOI: 10.1016/j.jhqr.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Antimicrobial stewardship programmes (AMSP) seldom focus on ambulatory prescribing. Our AMSP primarily supervises in-hospital prescribing, but as we aim to include the ambulatory setting, we sought opportunities for intervention on ambulatory quinolone prescription. MATERIALS AND METHODS We selected the prescriptions made by urologists during 2018 for analysis, and manually checked them for adequacy. RESULTS We analyzed 237 prescriptions. Of 136 therapeutic prescriptions, 18.4% had no reported diagnosis and 31.6% had no reported symptoms. Most patients (60.3%) did not have any urinalysis or urine culture; among those who had, 27.7% had a urinalysis not suggestive of urinary tract infection and 67.4% had a positive culture, 83.9% of which had a suitable oral alternative to quinolones. Antimicrobial therapy was not indicated in 13.9% of cases; when it was, quinolones were considered inadequate in 67.8% of cases. Incorrect duration was found in 51.1% of cases. Forty-six prescriptions were made for prophylaxis; all of these were considered inadequate. CONCLUSION We found a high prevalence of inadequate ambulatory quinolone prescriptions in Urology. Many followed incomplete recordings, lack of laboratory use, or inattention to alternatives. Treatment duration and quinolone choice were frequently inadequate. Quinolone prescribing for prophylaxis was always considered inadequate. These prescribing errors could serve as a starting point for future interventions.
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Affiliation(s)
- V Tiago
- Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
| | - D Sousa
- Hospital da Luz Lisboa, Lisboa, Portugal
| | - J Luque
- Hospital da Luz Lisboa, Lisboa, Portugal
| | - M J Rei
- Hospital da Luz Lisboa, Lisboa, Portugal
| | - R Borrega
- Hospital da Luz Lisboa, Lisboa, Portugal
| | - M Cabedal
- Hospital da Luz Lisboa, Lisboa, Portugal
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Cui J, Zhao L, Liu X, Liu M, Zhong L. Analysis of the potential inappropriate use of medications in pediatric outpatients in China. BMC Health Serv Res 2021; 21:1273. [PMID: 34823520 PMCID: PMC8614069 DOI: 10.1186/s12913-021-07300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background The appropriate use of medications is essential in children. Yet, detailed information on how drugs are being prescribed and dispensed to pediatric populations is not documented in China. Aim The study objective was to analyze the details of medicine use and categorize the types of inappropriate use of medications on children. Methods A retrospective cross-sectional study was conducted on the prescriptions of pediatric outpatients aged < 18 years from 2019 to 2020 at a major Chinese tertiary academic center. Each age group’s demographic and clinical characteristics were collected, and the ratios of inappropriate prescriptions were analyzed. Results The total number of pediatric outpatients was 652,152, and 49.37% (322000) were prescribed medications, in which the most widely used medicines were respiratory, anti-infectives, and Traditional Chinese Medicines (TCMs). The prevalence rate of inappropriate prescriptions reached 20.49%, and in 2019 it was higher (21.71%) than that in 2020 (18.36%). The top three common inappropriate categories were indication-related off-label drug use, improper administration frequency, and overdosing, accounting for 67.93, 17.80 and 11.06% of all inappropriate prescriptions, respectively. The inappropriate prescriptions were more likely seen in patients aged 2–5 years and respiratory medicines. Conclusions The study findings indicate that inappropriate drug use in pediatric outpatients is still common, and great attention needs to be paid. More prospective trials are required to identify the effectiveness, safety, and necessity of off-label drug use of medicines in children.
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Affiliation(s)
- Jing Cui
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Zhao
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
| | - Xianghong Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
| | - Mengyujie Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China
| | - Lihong Zhong
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, China.
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Hardy A, Gervais-Hupé J, Desmeules F, Hudon A, Perreault K, Vendittoli PA. Comparing ERAS- outpatient versus standard-inpatient hip and knee replacements: a mixed methods study exploring the experience of patients who underwent both. BMC Musculoskelet Disord 2021; 22:978. [PMID: 34814889 PMCID: PMC8611950 DOI: 10.1186/s12891-021-04847-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Optimizing patients' total hip and knee arthroplasty (THA/TKA) experience is as crucial for providing high quality care as improving safety and clinical effectiveness. Yet, little evidence is available on patient experience in standard-inpatient and enhanced recovery after surgery (ERAS)-outpatient programs. Therefore, this study aimed to gain a more in-depth understanding of the patient experience of ERAS-outpatient programs in comparison to standard-inpatient programs. METHODS We conducted a convergent mixed methods study of 48 consecutive patients who experienced both standard-inpatient and ERAS-outpatient THA/TKA contralaterally. A reflective thematic analysis was conducted based on data collected via a questionnaire. Bivariate correlations between the patient experience and patients' characteristics, clinical outcomes and care components satisfaction were performed. Then, the quantitative and qualitative data were integrated together. RESULTS The theme Support makes the difference for better and for worse was identified by patients as crucial to their experience in both joint replacement programs. On the other hand, patients identified 3 themes distinguishing their ERAS-outpatient from their standard-inpatient experience: 1) Minimizing inconvenience, 2) Home sweet home and 3) Returning to normal function and activities. Potential optimization expressed by patients were to receive more preoperative information, additional postoperative rehabilitation sessions, and ensuring better coherence of care between hospital and home care teams. Weak to moderate positive and statistically significant correlations were found between patients' THA/TKA experience and satisfaction with pain management, hospital stay, postoperative recovery, home care, and overall results (rs = + [0.36-0.66], p-value < 0.01). CONCLUSION Whatever the perioperative program, the key to improving patients' THA/TKA experience lies in improving support throughout the care episode. However, compared to standard-inpatient care, the ERAS-outpatient program improves patients' experience by providing dedicated support in postoperative care, reducing postoperative inconvenience, optimizing pain management, returning home sooner, and recovering and regaining function sooner. Patients' THA/TKA experience could further be enhanced by optimizing the information provided to the patient, the rehabilitation program and the coherence between care teams.
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Affiliation(s)
- Alexandre Hardy
- Department of Biomedical Sciences, Faculty of Graduate and Postdoctoral Studies, Université de Montréal, Montreal, Quebec, Canada
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
| | - Jonathan Gervais-Hupé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Centre de recherche en éthique (CRÉ), Université de Montréal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada
| | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Surgery Department, Université de Montréal, Montreal, Quebec, Canada.
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Quebec, Montreal, Canada.
- Personalized Arthroplasty Society, Atlanta, Georgia, USA.
- Duval Orthopaedic Clinic, Laval, Quebec, Canada.
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Nørskov KH, Fridthjof K, Kampmann P, Dünweber A, Andersen CL, Renaberg T, Schöllkopf C, Ahmad SA, Schou K, Jensen CF, Møller P, Lundholm BW, Marcher C, Jepsen L, Ørntoft AK, Ommen HB, Andersen L, Behrentzs A, Hasselgren CF, Severinsen M, Grand MK, Jarden M, Møller T, Kjeldsen L. A national Danish proof of concept on feasibility and safety of home -based intensive chemotherapy in patients with acute myeloid leukemia. Leuk Res 2021; 112:106756. [PMID: 34839055 DOI: 10.1016/j.leukres.2021.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/12/2022]
Abstract
Technological advances have made it possible to offer home-based chemotherapy to patients without health care professionals being present. Prior studies on effects of home-based treatment lack inclusion of patients with hematologic malignancies. We present data from a multicenter single-arm feasibility and safety study of home-based intensive chemotherapy in patients with newly diagnosed acute myeloid leukemia and their quality of life and psychological wellbeing. This national study included patients from six sites in Denmark who received intensive chemotherapy on programmed CADD Solis infusion pumps through a central venous catheter and were also managed as outpatients during treatment-induced pancytopenia. Data are presented from 104 patients, receiving 272 treatments with 1.096 (mean 4.57, SD 3.0) home infusion days out of 1.644 treatment days (67 %). Sixty-two of 168 (36.9 %) reinduction and consolidation treatment cycles ensuing pancytopenia phases were solely handled in the outpatient clinic. Patients reported high satisfaction with home-based treatment, which had a positive influence on their ability to be involved in their treatment and be socially and physically active. No unexpected events occurred during the intervention. Overall, patients improved in all quality of life outcomes over time. Home-based intensive chemotherapy treatment was feasible and safe in this population. ClinicalTrials.gov identifier: NCT04904211.
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Affiliation(s)
- Kristina Holmegaard Nørskov
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | | | - Peter Kampmann
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Anne Dünweber
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Christen Lykkegaard Andersen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Toni Renaberg
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Claudia Schöllkopf
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Syed Azhar Ahmad
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Katrine Schou
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Cecilie Fremming Jensen
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Peter Møller
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Birgitte Wolf Lundholm
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Claus Marcher
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Lene Jepsen
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Anne Katrine Ørntoft
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus C, Denmark.
| | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus C, Denmark.
| | - Lotte Andersen
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Anni Behrentzs
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | | | - Marianne Severinsen
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Mia Klinten Grand
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Copenhagen, Denmark.
| | - Tom Møller
- University Hospital Center for Health Research, Ryesgade 27, 2200, Copenhagen N, Denmark.
| | - Lars Kjeldsen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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Savilahti EM, Lintula S, Häkkinen L, Marttunen M, Granö N. Adolescent psychiatric outpatient care rapidly switched to remote visits during the COVID-19 pandemic. BMC Psychiatry 2021; 21:586. [PMID: 34800997 PMCID: PMC8605888 DOI: 10.1186/s12888-021-03580-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The COVID-19-pandemic and especially the physical distancing measures drastically changed the conditions for providing outpatient care in adolescent psychiatry. METHODS We investigated the outpatient services of adolescent psychiatry in the Helsinki University Hospital (HUH) from 1/1/2015 until 12/31/2020. We retrieved data from the in-house data software on the number of visits in total and categorized as in-person or remote visits, and analysed the data on a weekly basis. We further analysed these variables grouped according to the psychiatric diagnoses coded for visits. Data on the number of patients and on referrals from other health care providers were available on a monthly basis. We investigated the data descriptively and with a time-series analysis comparing the pre-pandemic period to the period of the COVID-19 pandemic. RESULTS The total number of visits decreased slightly at the early stage of the COVID-19 pandemic in Spring 2020. Remote visits sharply increased starting in 3/2020 and remained at a high level compared with previous years. In-person visits decreased in Spring 2020, but gradually increased afterwards. The number of patients transiently fell in Spring 2020. CONCLUSIONS Rapid switch to remote visits in outpatient care of adolescent psychiatry made it possible to avoid a drastic drop in the number of visits despite the physical distancing measures during the COVID-19 pandemic.
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Affiliation(s)
- Emma M. Savilahti
- grid.7737.40000 0004 0410 2071Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland
| | - Sakari Lintula
- grid.7737.40000 0004 0410 2071Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland
| | - Laura Häkkinen
- grid.7737.40000 0004 0410 2071Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland
| | - Mauri Marttunen
- grid.7737.40000 0004 0410 2071Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland ,grid.14758.3f0000 0001 1013 0499Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Niklas Granö
- grid.7737.40000 0004 0410 2071Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland
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Millet F, Wislez M, Fallet V, Antoine M, Assouad J, Baud M, Canellas A, Ruppert AM, Guegan S, Rosencher L, Epaud C, Moal D, Cadranel J, Lavolé A. [Rapid outpatient diagnostic pathways for lung cancer: Evaluation after one year]. Rev Mal Respir 2021; 38:904-13. [PMID: 34756758 DOI: 10.1016/j.rmr.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The introduction of coordinated care pathways for lung cancer diagnosis and treatment is a complex process. The purpose of the French Cancer Plan 2014-2019 was to improve referral to treatment waiting times in people with suspected malignancy. The aim of this study was to assess a rapid outpatient diagnostic program for lung cancer established in 2016. METHOD This retrospective study was carried out in the Pulmonology Department at Tenon Hospital, Paris, France between May 2016 and May 2017. RESULTS During this period, 118 patients (60%) of patients in the pathway were diagnosed with lung cancer. The median waiting time to first consultation (D1) was 4 (2-7) days. The median waiting time between diagnosis and treatment decision (D4) was 4 (0-8) days. The median waiting time to the first treatment (D5) was 10 (4-15) days for chemotherapy and 27 (16-34) days for surgery. The median waiting time between the first abnormal chest X-ray and the first treatment (D6) was 49 days (34-70). CONCLUSION Referral to treatment waiting times was consistent with international recommendations. Coordinating nurses improved care pathways in lung cancer patients.
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Zeitler M, Rayala B. Outpatient Vasectomy: Safe, Reliable, and Cost-effective. Prim Care 2021; 48:613-625. [PMID: 34752273 DOI: 10.1016/j.pop.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.
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Affiliation(s)
- Matthew Zeitler
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA.
| | - Brian Rayala
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA
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247
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Kaushik A, Papachristou E, Telesia L, Dima D, Fewings S, Kostaki E, Gaete J, Ploubidis GB, Kyriakopoulos M. Experience of stigmatization in children receiving inpatient and outpatient mental health treatment: a longitudinal study. Eur Child Adolesc Psychiatry 2021; 32:675-683. [PMID: 34751811 PMCID: PMC10115721 DOI: 10.1007/s00787-021-01904-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children's perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8-12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.
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Affiliation(s)
- Anya Kaushik
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Efstathios Papachristou
- Department of Psychology and Human Development, UCL Institute of Education, University College London, London, UK
| | - Laurence Telesia
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (PO66), King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra Fewings
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Evgenia Kostaki
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Learning Disability Specialist Health Services, Hertfordshire Partnership University NHS Foundation Trust, Braintree, Essex, UK
| | - Jorge Gaete
- Faculty of Education, Universidad de los Andes, Santiago, Chile.,Millennium Nucleus To Improve the Mental Health of Adolescents and Youths, Santiago, Chile
| | - George B Ploubidis
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, London, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children Unit, South London and Maudsley NHS Foundation Trust, London, UK. .,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (PO66), King's College London, De Crespigny Park, London, SE5 8AF, UK. .,First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece.
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248
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Frostad S, Calugi S, Engen CBN, Dalle Grave R. Enhanced cognitive behaviour therapy (CBT-E) for severe and extreme anorexia nervosa in an outpatient eating disorder unit at a public hospital: a quality-assessment study. J Eat Disord 2021; 9:143. [PMID: 34727976 PMCID: PMC8561966 DOI: 10.1186/s40337-021-00499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this quality-assessment study was to determine the outcome of patients with severe and extreme anorexia nervosa (AN) in a real-world outpatient setting. METHODS Twenty-one adults with AN and a body mass index (BMI) of < 16 were recruited from consecutive referrals to an outpatient clinic at a public hospital in Western Norway. All enrolled patients were provided with enhanced cognitive behaviour therapy (CBT-E) to treat their AN, commencing between January 2013 and December 2016. Their BMI was recorded at baseline, at the end of CBT-E and 1 year after the end of treatment. RESULTS Ten patients completed the CBT-E treatment and achieved a large weight gain with the change remaining stable at follow-up. Eleven patients did not complete the treatment but had a significant increase in BMI at the premature end of treatment. One year after end of therapy 14/21 (66.7%) of the patients had BMI above 18.5 kg/m2. No severe complications were observed during therapy. CONCLUSIONS Although 52.4% of the patients did not complete outpatient CBT-E, the findings of this quality-assessment study support previous findings indicating that CBT-E may represent a valid alternative to inpatient treatment in patients with severe and extreme AN.
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Affiliation(s)
- Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
| | | | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, VR, Italy
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249
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Hozayen SM, Zychowski D, Benson S, Lutsey PL, Haslbauer J, Tzankov A, Kaltenborn Z, Usher M, Shah S, Tignanelli CJ, Demmer RT. Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients. EClinicalMedicine 2021; 41:101139. [PMID: 34585129 PMCID: PMC8461367 DOI: 10.1016/j.eclinm.2021.101139] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. METHODS We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. FINDINGS Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38-0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17-4.37), p = 0.015. INTERPRETATION Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. FUNDING No funding was obtained for this study.
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Key Words
- %, percentage
- (n), number
- ACEi, angiotensin-converting enzyme inhibitors
- ARBs, angiotensin receptor blockers
- Anticoagulation
- CI, confidence intervals
- CKD, chronic kidney disease
- CO2, carbon dioxide
- COPD, chronic obstructive pulmonary disease
- COVID-19
- COVID-19, coronavirus disease 2019
- D-dimer
- DIC, disseminated intravascular coagulation
- DOAC, direct oral anticoagulant
- EHR, electronic health records
- EMR, electronic medical records
- HCT, hematocrit
- HIT, heparin-induced thrombocytopenia
- HR, hazard ratio
- Hospitalization
- IPAC, inpatient anticoagulation therapy
- IRB, institutional review board
- Inpatient
- MI, prior myocardial infarction
- Mortality
- OPAC, outpatient persistent anticoagulation therapy
- Outpatient
- RDW, red blood cell distribution width
- SARS-CoV-2, severe Acute Respiratory Syndrome Coronavirus-2
- SBP, systolic blood pressure
- SBP-min, minimum systolic blood pressure
- SD, standard deviations
- SE, standard errors
- SpO2-min, minimum oxygen saturation
- T1DM, type 1 diabetes mellitus
- T2DM, type 2 diabetes mellitus
- VTE, venous thromboembolism
- WBC, white blood cell
- mg/dl, milligram per deciliter
- rt-PCR, reverse transcriptase-polymerase chain reaction
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Affiliation(s)
- Sameh M. Hozayen
- Department of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United States
- Corresponding author.
| | - Diana Zychowski
- Department of Medical Education, University of Minnesota, United States
| | - Sydney Benson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Jasmin Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Zachary Kaltenborn
- Department of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United States
| | - Michael Usher
- Department of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United States
| | - Surbhi Shah
- Department of Hematology and oncology, Mayo Clinic, Arizona, United States
| | - Christopher J. Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN, United States
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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250
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Cozzaglio L, Monzani R, Zuccarelli A, Cananzi F, Sicoli F, Ruspi L, Quagliuolo V. Quality of life and patient satisfaction in outpatient thyroid surgery. Updates Surg 2021; 74:317-323. [PMID: 34677759 DOI: 10.1007/s13304-021-01190-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
In the last three decades surgeons have begun to perform outpatient thyroid surgery (OTS). Important outcome measures of a day-hospital procedure are the patient's quality of life (QoL) and satisfaction, but information on these issues in the OTS setting is scanty. The aim of this pilot study was to explore how early discharge after thyroidectomy affects patients' QoL and satisfaction. Postoperative QoL and satisfaction were assessed retrospectively by giving each patient a self-report questionnaire specifically created in our center for OTS and derived from the post-discharge surgical recovery (PSR) scale to assess physical and mental well-being. Twenty-three of 24 patients (96%), 16 women and 7 men with a median age of 48 years (range 16-72), completed the questionnaire, answering 92% of the questions. QoL based on this scale gave a median score of 81.8% (range 62-98.8%). No major or minor complications occurred in the study group. Regarding QoL eight patients (35%) reported feeling "tired all the time" and six patients (26%) reported mild pain, which in two cases resolved spontaneously. Regarding patient satisfaction two-thirds of patients judged OTS positively while the remaining one-third would not recommend it. Our study showed very good uptake by patients of a new questionnaire dedicated to OTS as a possible aid in the identification of areas for improvement of OTS management. However, to be considered a safe procedure with maximum patient compliance and satisfaction, OTS was found to require considerable effort by hospital staff and patients' caregivers compared to inpatient thyroid surgery.
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Affiliation(s)
- Luca Cozzaglio
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Roberta Monzani
- Department of Anesthesiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Zuccarelli
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of General Surgery, Belfast Health and Social Care Trust, Northern Ireland Foundation School, NI Medical and Dental Training Agency (NIMDTA), Belfast, Northern Ireland, UK
| | - Ferdinando Cananzi
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Federico Sicoli
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Laura Ruspi
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Vittorio Quagliuolo
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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