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Furtado TP, Teloken PE, Ortega Y, Narus J, Wolchasty NP, Mulhall JP. Delineating patient errors in an intracavernosal injection program. J Sex Med 2024:qdae031. [PMID: 38660738 DOI: 10.1093/jsxmed/qdae031] [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: 09/19/2023] [Revised: 01/19/2024] [Accepted: 01/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Intracavernosal injection therapy (ICI) is a well-established therapeutic strategy for men with erectile dysfunction. Complications are often related to patient error when performong ICI. AIM The objective of this study was to examine patient errors in an established patient training program for performing ICI and identify factors that could predict major errors. METHODS Patients enrolled in our ICI program are trained on technical aspects, and dose titration is begun. Patients are given explicit instructions during training, both verbally and in written form. Records were reviewed for men using ICI for ≥6 months. Multivariable analysis was used to define predictors of major errors. OUTCOMES Errors were listed as minor (zero-response injection, penile bruising, expired medication) and major (errors potentially leading to priapism: dose self-titration, double injecting). RESULTS Overall, 1368 patients met the inclusion criteria and were included in the analysis. The mean patient age was 66 ± 22 (range 29-91) years. Regarding education, 41% of patients had graduate-level education, 48% had college education, and 11% high school education. Mean follow-up was 3.2 ± 7.6 (range 0.5-12) years. The agents used were trimix (62%), bimix (35%), papaverine (2%), and prostaglandin E1 monotherapy (1%). At least 1 error occurred during self-administration in 42% of patients during their time in the program. Errors included zero response to medication due to technical error (8% of patients), penile bruising (34%), use of an expired bottle (18%), self-titration (5%), and double injecting (4% of patients); 12% of men committed ≥1 error during their time in the program. On multivariable analysis, independent predictors of the occurrence of a major error included: young age, graduate-level education, and <12 months of injection use. CLINICAL IMPLICATIONS To the best of our knowledge, this is the first reported study to investigate ICI errors and risk factors. The identification of factors predictive of major errors allows for more tailored and intensive training in this subset of patients. STRENGTHS AND LIMITATIONS Strengths of this study include a large patient population (1386 men) with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions, enhances the accuracy and reliability of the results. Despite the strengths of the study, recall bias may be a limitation concern. CONCLUSION The majority of patients were error free, and the majority of the errors were minor in nature. Major errors occurred in <10% of patients. Younger age, graduate-level education, and less experience with ICI were independent predictors of major errors.
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Affiliation(s)
- Thiago P Furtado
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
| | - Patrick E Teloken
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
| | - Yanira Ortega
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
| | - Joseph Narus
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
| | - Natalie P Wolchasty
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering, Cancer Center, New York, NY 10022, United States
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Novatt H, Rockhill K, Baker K, Stickrath E, Alston M, Fabbri S. Clinic Versus the Operating Room: Determining the Optimal Setting for Dilation and Curettage for Management of First-Trimester Pregnancy Failure. Cureus 2024; 16:e56490. [PMID: 38638705 PMCID: PMC11026066 DOI: 10.7759/cureus.56490] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction There is no clear guidance for the optimal setting for dilation and curettage (D&C) for the management of first-trimester pregnancy failure. Identifying patients at risk of clinically significant blood loss at the time of D&C may inform a provider's decision regarding the setting for the procedure. We aimed to identify risk factors predictive for blood loss of 200mL or greater at the time of D&C. Methods This is a retrospective cohort study of patients diagnosed with first-trimester pregnancy failure at gestational age less than 11 weeks who underwent surgical management with D&C at a single safety net academic institution between 4/2016 and 4/2021. Patient characteristics and procedural outcomes were abstracted. Women with less than 200mL versus greater than or equal to 200mL blood loss were compared using descriptive statistics, chi-square for categorical variables, and Satterthwaite t-tests for continuous variables. Results A total of 350 patients were identified; 233 met inclusion criteria, and 228 had non-missing outcome data. Mean gestational age was 55 days (SD 9.4). Thirty-one percent (n=70) had estimated blood loss (EBL) ≥200mL. Younger patients (mean 28.7 years vs. 30.9, p=0.038), Latina patients (67.1% vs. 51.9%, p=0.006), patients with higher body mass index (BMI, mean 30.6 vs. 27.3 kg/m2, p=0.006), and patients with pregnancies at greater gestational age (59.5 days vs. 53.6 days, p<0.001) were more likely to have EBL ≥200mL. Additionally, patients with pregnancies dated by ultrasound (34.3% vs. 18.4%, p=0.007), those who underwent D&C in the operating room (81.4% vs. 48.7%, p<0.001), and those who underwent general anesthesia (81.4% vs. 44.3%, p<0.001) were more likely to have EBL ≥200mL. Discussion In this study, patients with EBL ≥200mL at the time of D&C differed significantly from those with EBL<200mL. This information can assist providers in planning the best setting for their patients' procedures.
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Affiliation(s)
- Hilary Novatt
- Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, USA
| | - Kari Rockhill
- Epidemiology and Public Health, Rocky Mountain Poison & Drug Safety, Denver, USA
| | - Kori Baker
- Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, USA
| | - Elaine Stickrath
- Obstetrics and Gynecology, UCHealth Women's Care Clinic, Steamboat Springs, USA
| | - Meredith Alston
- Obstetrics and Gynecology, Intermountain Health Saint Joseph Hospital, Denver, USA
| | - Stefka Fabbri
- Obstetrics and Gynaecology, Denver Health, Denver, USA
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Cotie LM, Pakosh M, Ghisi GLDM. Inpatient vs. Outpatient: A Systematic Review of Information Needs throughout the Heart Failure Patient Journey. J Clin Med 2024; 13:1085. [PMID: 38398398 PMCID: PMC10889710 DOI: 10.3390/jcm13041085] [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: 01/22/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
The objective of this systematic review was to identify and describe information needs for individuals with heart failure (HF) throughout their patient journey. Six databases were searched (APA PsycINFO, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL, and Web of Science Core Collection) from inception to February 2023. Search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. Quality appraisal was assessed using the Mixed-Methods Appraisal Tool. A narrative synthesis was used to analyze all the outcomes according to the Synthesis Without Meta-analysis reporting guidelines. Twenty-five studies (15 quantitative and 10 qualitative) were included. Socioeconomic, cultural, and demographic factors influencing information needs were considered. The top three information needs for outpatients included general HF information, signs and symptoms and disease management strategies. For inpatients, medications, risk factors, and general HF were reported as the top needs. These divergent needs emphasize the importance of tailored education at different stages. Additionally, the review identified gaps in global representation, with limited studies from Africa and South America, underscoring the need for inclusive research. The findings caution against overgeneralization due to varied reporting methods. Practical implications call for culturally sensitive interventions to address nuanced HF patients' needs, while future research must prioritize standardized reporting, consider diverse patient journey timepoints, and minimize biases for enhanced reliability and applicability.
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Affiliation(s)
- Lisa M. Cotie
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
| | - Maureen Pakosh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
| | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada; (L.M.C.)
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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Schubert AK, Wiesmann T, Wulf H, Dinges HC. Spinal anesthesia in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:109-121. [PMID: 37321760 DOI: 10.1016/j.bpa.2023.04.002] [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: 12/20/2022] [Revised: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/17/2023]
Abstract
Spinal anesthesia is a safe alternative to general anesthesia but remains underrepresented in the ambulatory setting. Most concerns relate to low flexibility of spinal anesthesia duration and the management of urinary retention in the outpatient setting. This review focuses on the characterization and safety of the local anesthetics that are available to adapt spinal anesthesia very flexibly to the needs of ambulatory surgery. Furthermore, recent studies on the management of postoperative urinary retention provide evidence for safe, but report wider discharge criteria and much lower hospital admission rates. With the local anesthetics that have current approval for usage in spinal anesthesia, most requirements for ambulatory surgeries can be met. The reported evidence on local anesthetics without approval supports clinically established off-label use and can improve the results even further.
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Affiliation(s)
- Ann-Kristin Schubert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany; Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum Schwäbisch-Hall, Schwäbisch-Hall, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany.
| | - Hanns-Christian Dinges
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany
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Galliardt M, Betz U, Birklein F, Drees P, Geber C. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies - (lessons learned from) a prospective study. Open Med (Wars) 2023; 18:20230696. [PMID: 37251538 PMCID: PMC10224621 DOI: 10.1515/med-2023-0696] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
This prospective cohort study aimed to characterise the impact of oxaliplatin-based chemotherapy and its neurotoxic side effects (i.e., chemotherapy-induced neuropathy) on functional fall-risk and falls. Twenty chemotherapy-naïve participants (mean age, 59 years; 16 males) were consecutively included. A multimodal fall risk assessment was performed at four time points within 6 months. Polyneuropathy was assessed using the Neurologic Disability Scale; the fall risk was assessed by functional tests (Tinetti Test, Chair-Rising Test, and Timed up and Go Test). Patient-reported outcomes comprised the Hospitality Anxiety and Depression Scale (HADS), the Falls Efficacy Scale - International (FES-I) to assess the fear of falling, and the Physical Activity for the Elderly (PASE) questionnaire. Three falls occurred during the study. All fallen participants had a high fall risk-index (≥4 more risk factors) compared to only 30% of the non-fallen participants (p = 0.03) and suffered more frequently from pre-existing mild polyneuropathy (p = 0.049). Study discontinuation (n = 12) was associated with a higher rate of polypharmacy (p = 0.045), anxiety (HADS-A, p = 0.03), and specific fear of falling (FES-I, p = 0.025). In contrast, study completers (n = 8) reported an improvement in physical activity (PASE) (p = 0.018). In summary, pre-existing fall-risk factors impacted more falls than chemotherapy. A fall risk index offers a time-efficient screening option in an outpatient oncological setting.
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Affiliation(s)
- Melanie Galliardt
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Ulrich Betz
- Institute of Physical Therapy, Prevention and Rehabilitation, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
- DRK Schmerz-Zentrum, Auf der Steig 14-16, Mainz, 55131, Germany
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Hasegawa YU, Kuratsu JI. Goshuyuto Reduced the Monthly Intake of Anti-headache Drugs and Improved Pain Status in Patients with 20-Year History of Medication Overuse Headache in an Outpatient Setting. Kurume Med J 2023. [PMID: 37183017 DOI: 10.2739/kurumemedj.ms682019] [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: 05/16/2023]
Abstract
The management of medication overuse headache (MOH) is sometimes challenging, particularly for patients with a long disease duration. We observed that patients who used goshuyuto, a traditional Japanese medicine, exhibited a favorable clinical course. Two women who had a history of MOH for over 20 years were treated using 5.0-7.5 g/day goshuyuto in an outpatient setting. The treatment reduced their use of habitual drugs, including triptan (33-55%) and non-steroidal anti-inflammatory drugs (75-82%), as well as the headache impact test score-6 (16-23%) over 24 weeks. As goshuyuto has a protective effect on chronic headache and is reported not to lead to MOH, it is a good candidate for the treatment of patients with MOH in an outpatient setting, even for those with an over 20-year history of MOH.
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Affiliation(s)
- Y U Hasegawa
- Department of Neurosurgery, Sakurajyuji Hospital
- Department of Pharmaceutical Science, School of Pharmacy at Fukuoka, International University of Health and Welfare
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Chen CC, Chiang YC, Lin YC, Cheng SH. Continuity of Care and Coordination of Care: Can they Be Differentiated? Int J Integr Care 2023; 23:10. [PMID: 36819617 DOI: 10.5334/ijic.6467] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Introduction Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective. Methods Face-to-face interviews were conducted nationwide with community-dwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%. Results The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified. Conclusion The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective.
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Ribeiro C, Jácome C, Oliveira P, Conde S, Windisch W, Nunes R. Patients experience regarding home mechanical ventilation in an outpatient setting. Chron Respir Dis 2022; 19:14799731221137082. [PMID: 36417310 PMCID: PMC9706049 DOI: 10.1177/14799731221137082] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.
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Affiliation(s)
- Carla Ribeiro
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal,Carla Ribeiro, Pulmonology Department,
Centro Hospitalar de Vila Nova de Gaia/Espinho, Rua Conceição Fernandes s/n,
Vila Nova de Gaia 4434-502, Portugal.
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS,
Faculty of
Medicine of the University of Porto,
Porto, Portugal
| | - Pedro Oliveira
- ISPUP-EPI Unit, Instituto de
Ciências Biomédicas de Abel Salazar, Universidade do
Porto, Portugal
| | - Sara Conde
- Pulmonology Department,
Centro
Hospitalar de Vila Nova de
Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Wolfram Windisch
- Faculty of Health/School of
Medicine, Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt
Köln gGmbH, Witten/Herdecke University, Cologne,
Germany
| | - Rui Nunes
- Faculty of Medicine,
University
of Porto, Porto, Portugal
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Hu X, Jonzén K, Karlsson M, Lindahl OA. Assessments of a novel digital follow-up tool Rehabkompassen ® to identify rehabilitation needs among stroke patients in an outpatient setting. Digit Health 2022; 8:20552076221104662. [PMID: 35677783 PMCID: PMC9168944 DOI: 10.1177/20552076221104662] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/24/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction It remains a huge challenge to identify individual rehabilitation needs in a time-efficient manner for providing patient-tailored rehabilitation during the continuum of stroke care. We have recently demonstrated the usefulness of a paper-version Rehab-Compass as a follow-up tool. The aim of the current study was to develop a digital version of the Rehab-Compass and evaluate its usability and feasibility. Methods The novel digital tool Rehabkompassen® was developed by an iterative and participatory design process. Patients' rehabilitation needs were visualized by the tool and used before, during, and after the consultation. The usability and feasibility of the tool was assessed by task completion rate, the System Usability Scale, and satisfaction questionnaires among 2 physicians and 24 adult stroke patients in an outpatient clinical setting. Results Rehabkompassen® identified and graphically visualized a panoramic view of the stroke patients' multidimensional needs in individual- and group levels. The instrument appeared to be feasible and time efficient in clinical use with a 100% overall task completion rate for both patients and physicians. A majority of the patients reported that it was very easy or fairly easy to answer the digital questionnaires and to understand their own digital Rehab-Compass graph. Two physicians reported a high mean score on the System Usability Scale (95/100) and were positive about using the tool in the future. Conclusions The current results indicated that Rehabkompassen® was a feasible, useful, and time-saving follow-up tool for the identification of rehabilitation needs among stroke survivors in the post-acute continuum of care after stroke. Further research is needed to evaluate the efficacy of the digital instrument among stroke patients.
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Affiliation(s)
- Xiaolei Hu
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Karolina Jonzén
- Department of Radiation Sciences, Radiation Physics, Biomedical
Engineering, Umeå University, Umeå, Sweden
| | - Marcus Karlsson
- Department of Radiation Sciences, Radiation Physics, Biomedical
Engineering, Umeå University, Umeå, Sweden
| | - Olof A Lindahl
- Department of Radiation Sciences, Radiation Physics, Biomedical
Engineering, Umeå University, Umeå, Sweden
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Bhagat N, Pappala S, Chattopadhyay P, Das S. Evaluation of the Safety and Efficacy of Resection of Endometrial Polyps and Submucosal Fibroids in an Outpatient Setting in a Large District General Hospital in the UK. J Midlife Health 2022; 13:133-138. [PMID: 36276625 PMCID: PMC9583366 DOI: 10.4103/jmh.jmh_154_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/22/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic. AIM In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device. METHODS Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies. RESULTS 90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications. CONCLUSION Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.
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Affiliation(s)
- Nanak Bhagat
- Department of Obstetrics and Gynaecology, Royal Bolton Hospital, Bolton, UK,Royal Preston Hospital, Fulwood, Preston,Address for correspondence: Dr. Nanak Bhagat, No. 101 Princes Reach, Ashton-on-Ribble, Preston, PR22GB, UK. E-mail:
| | - Sumitra Pappala
- Department of Obstetrics and Gynaecology, Royal Bolton Hospital, Bolton, UK,Southport and Ormskirk Hospital NHS Trust, Ormskirk, UK
| | | | - Sangeeta Das
- Department of Obstetrics and Gynaecology, Royal Bolton Hospital, Bolton, UK
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Mehrpooya M, Khorami MR, Mohammadi M, Mohammadi Y, Ahmadimoghaddam D. Clinical Pharmacist's Contribution to Medication Reconciliation in Outpatient Specialty Clinics in Iran. Curr Drug Saf 2021; 17:259-268. [PMID: 34814820 DOI: 10.2174/1574886316666211123101002] [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: 07/09/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The majority of research in medication reconciliation has focused on the inpatient settings, and little is known about the outpatient settings, particularly in developing countries. As such, we conducted this study to evaluate direct clinical pharmacist involvement in medication reconciliation in outpatient specialty clinics in Iran. METHODS This prospective interventional study was conducted from September 2019 to February 2020 in a University-affiliated clinic in Iran. For 196 patients over 18 years of age who were scheduled for an appointment with a physician, medication reconciliation intervention was carried out by a clinical pharmacist. The number and type of unintentional discrepancies, their potential harm to the patients, their correlation with the patients' demographic and clinical characteristics, and the number of accepted recommendations upon the unintentional discrepancies by the clinicians were assessed and recorded. Additionally, patients' understanding of any change made to their current medication regimen was also assessed. The association between the unintentional discrepancies with patients' characteristics was also assessed. RESULTS Totally, 57.14% of patients had at least one or more unintentional medication discrepancies, with an overall rate of 1.51 (±0.62) per patient. This is while the patient understanding of their medication changes was inadequate in a significant proportion of the study patients (62.2%). Patients with older ages, lower educational levels, and a higher number of medications and comorvidities were at a higher risk of having unintentional discrepancies. The most common type of unintentional discrepancy was the omission of a drug, and almost half of the reconciliation errors might have had the potential to cause moderate or severe harm to the patient. From 145 recommendations suggested by the clinical pharmacist upon unintentional discrepancies, 131 cases (90.34%) were accepted and implemented by the clinicians. CONCLUSION These findings further support the need for conducting medication reconciliation in outpatient settings to identify discrepancies and enhance the safety of patient medication use.
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Affiliation(s)
- Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Mohammad-Reza Khorami
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Mojdeh Mohammadi
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Younes Mohammadi
- Modeling of Non-Communicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan. Iran
| | - Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan. Iran
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12
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Jacewicz M, Rud E, Galtung KF, Noor D, Baco E. Cancer Detection Rates in Targeted Transperineal MRI-TRUS Elastic Fusion-guided Prostate Biopsies Performed Under Local Anesthesia. Anticancer Res 2021; 41:4395-4400. [PMID: 34475059 DOI: 10.21873/anticanres.15244] [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] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the cancer detection rate (CDR) using magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion-guided transperineal targeted biopsy (TB). PATIENTS AND METHODS We included 401 consecutive patients, of which 161 were biopsy-naïve. All underwent prebiopsy bi-parametric MRI; patients with positive MRI [prostate imaging reporting and data system (PI-RADS≥3)] underwent TB. Biopsy-naïve patients with positive MRI underwent TB and systematic biopsies (SBs). MRI-negative patients underwent SBs. Clinically significant prostate cancer (csPCa) was defined as ISUP ≥2. The added value of SB was defined as an upgrade from a negative biopsy or ISUP of 1 in TB to csPCa in SB. RESULTS The median (interquartile range) age was 69 (range=63-74) years, and PSA was 6.9 (range=4.5-11) ng/ml. The overall CDR was 65%, with csPCa occurring in 48%. In cases of PI-RADS 5, CDR was 91%, and csPCa was 77%. The added value of SB was 2%. CONCLUSION Transperineal TB biopsies using MRI-TRUS fusion yield a high CDR.
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Affiliation(s)
- Maciej Jacewicz
- Department of Urology, Oslo University Hospital, Oslo, Norway; .,University of Oslo, Oslo, Norway
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristina Flor Galtung
- University of Oslo, Oslo, Norway.,Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Daniyal Noor
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
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13
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Shnaigat M, Downie S, Hosseinzadeh H. Effectiveness of Health Literacy Interventions on COPD Self-Management Outcomes in Outpatient Settings: A Systematic Review. COPD 2021; 18:367-373. [PMID: 33902367 DOI: 10.1080/15412555.2021.1872061] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease which imposes significant health and economic burdens on societies. Self-management is beneficial in controlling and managing COPD and health literacy (HL) is a major driver of COPD self-management. This review aims to summarize the most recent evidence on the effectiveness of HL driven COPD self-management interventions using randomized controlled trials (RCTs). Eight data bases including Science Citation Index, Academic Search Complete, Social Sciences Citation Index, CINAHL Plus, APA PsycInfo, MEDLINE, Scopus and ScienceDirect were searched to find eligible RCTs assessing the effectiveness of HL interventions on COPD self-management outcomes in outpatient settings between 2008 and February 2020. Ten RCTs met the eligibility criteria. The review found that HL interventions led to moderate improvements in physical activity levels (four out of seven trials) and COPD knowledge (three out of six trials). Surprisingly, none of the RCTs led to significant improvement in medication adherence, which warrants further studies. Furthermore, there were inconclusive findings regarding other COPD self-management outcomes such as smoking cessation, medication adherence, dyspnea, mental health, hospital admissions and health related quality of life.
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Affiliation(s)
- Mahmmoud Shnaigat
- School of Health & Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Sue Downie
- Discipline of Medical and Exercise Science, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Hassan Hosseinzadeh
- School of Health & Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia
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14
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Vitale SG, Laganà AS, Caruso S, Garzon S, Vecchio GM, La Rosa VL, Casarin J, Ghezzi F. Comparison of three biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal patients (HYGREB-1): A multicenter, single-blind randomized clinical trial. Int J Gynaecol Obstet 2021; 155:425-432. [PMID: 33686708 DOI: 10.1002/ijgo.13669] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 11/14/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare three types of biopsy forceps for hysteroscopic endometrial biopsy in postmenopausal women. METHODS Postmenopausal women undergoing operative hysteroscopy with endometrial biopsy for abnormal uterine bleeding or endometrial thickness (≥5 mm) were included. Operative hysteroscopy with endometrial biopsy was performed by hysteroscopic forceps. Women were randomized (1:1:1 ratio) in three groups and allocated to undergo endometrial biopsy by hysteroscopy using spoon, alligator, or snake forceps. RESULTS Seventy-five women were included in the study, 25 in each group. The duration of the biopsy was comparable between the three groups (P = 0.334) with a median of 180 seconds (range 20-480 seconds). No differences were observed about the number of attempts (P = 0.602), the use of another instrument (P = 0.276), and the biopsy appropriateness (P = 0.592). The spoon forceps group reported higher levels of pain compared to the alligator and snake forceps groups (P < 0.001). The spoon forceps received significantly lower scores by the operator compared to the alligator and snake forceps (P < 0.001). The alligator and snake forceps reported wider biopsy than the spoon forceps (P < 0.001). CONCLUSION Snake and alligator hysteroscopic forceps may be considered the first choice to perform an endometrial biopsy in postmenopausal women. ClinicalTrials.gov: NCT03427957.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Salvatore Caruso
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Giada Maria Vecchio
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia," Anatomic Pathology, School of Medicine, University of Catania, Catania, Italy
| | | | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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15
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Silva MD, Schack EE. Outpatient Palliative Care Practice for Cancer Patients During COVID-19 Pandemic: Benefits and Barriers of Using Telemedicine. Am J Hosp Palliat Care 2021; 38:842-844. [PMID: 33657873 DOI: 10.1177/1049909121997358] [Citation(s) in RCA: 9] [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] [Indexed: 11/15/2022] Open
Abstract
The current COVID-19 pandemic has impacted the way outpatient palliative care providers deliver care for patients and their families. Operational changes such as the reduction of in-person care to minimize the risk of exposure is a way healthcare has adjusted to the pandemic. Our New York City-based outpatient palliative care practice is embedded in oncology. Adopting telemedicine was an essential tool to continue providing comprehensive palliative care to vulnerable oncology patients during the COVID-19 pandemic. We describe a case illustrating the benefits and barriers of telemedicine in the care of an oncology patient in the outpatient palliative care setting.
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Affiliation(s)
- Milagros D Silva
- Division of Geriatrics and Palliative Medicine, 12295Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Elizabeth E Schack
- Division of Geriatrics and Palliative Medicine, 12295Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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16
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Majorski DS, Duiverman ML, Windisch W, Schwarz SB. Long-term noninvasive ventilation in COPD: current evidence and future directions. Expert Rev Respir Med 2021; 15:89-101. [PMID: 33245003 DOI: 10.1080/17476348.2021.1851601] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Long-term noninvasive ventilation (NIV) is an established treatment for end-stage COPD patients suffering from chronic hypercapnic respiratory failure. This is reflected by its prominent position in national and international medical guidelines. Areas covered: In recent years, novel developments in technology such as auto-titrating machines and hybrid modes have emerged, and when combined with advances in information and communication technologies, these developments have served to improve the level of NIV-based care. Such progress has largely been instigated by the fact that healthcare systems are now confronted with an increase in the number of patients, which has led to the need for a change in current infrastructures. This article discusses the current practices and recent trends, and offers a glimpse into the future possibilities and requirements associated with this form of ventilation therapy. Expert opinion: Noninvasive ventilation is an established and increasingly used treatment option for patients with chronic hypercapnic COPD and those with persistent hypercapnia following acute hypercapnic lung failure. The main target is to augment alveolar hypoventilation by reducing PaCO2 to relieve symptoms. Nevertheless, when dealing with severely impaired patients, it appears necessary to switch the focus to patient-related outcomes such as health-related quality of life.
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Affiliation(s)
- Daniel S Majorski
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Marieke L Duiverman
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
| | - Sarah B Schwarz
- Department of Pneumology, Cologne Merheim Hospital , Cologne, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University , Witten, Germany
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17
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Wieser H, Piccoliori G, Siller M, Comploj E, Stummer H. Living on the Own Island? Aligned Collaboration Between Family Physicians, Nurses, Dieticians, and Patients With Diabetes Type 2 in an Outpatient Care Setting in Northern Italy: Findings From a Qualitative Study. Glob Adv Health Med 2020; 9:2164956120946701. [PMID: 33224632 PMCID: PMC7649872 DOI: 10.1177/2164956120946701] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Diabetes mellitus type 2 (DM2), one of the four most important chronic diseases worldwide, is generally considered to be preventable. However, it is not yet sufficiently clear whether an aligned collaboration between different health professions could facilitate behavioral changes to be made by patients with DM2 regarding their eating and physical activity habits. Objective: To explore if and how far in current outpatient care for 3 health-care professions it is an objective to collaborate with each other supporting patients with DM2 in changing their eating and physical activity habits. Methods: We conducted 18 qualitative problem centered interviews with selected family physicians, nurses, dieticians working in outpatient setting and patients with DM2, transcribed verbatim, and analyzed with qualitative content analysis. Results: Issues identified ranged from description and reflection of current health-care practice, strategies, and hindrances to cope with changes of eating and physical activity behaviors as well as for health-care practice regarding interprofessional collaboration and patient-centered care up to considerations about collaboration and patient centricity (for health professionals and patients to achieve goals) and changes and ideas of “ideal care practice”. Discussion: The included professional groups work predominantly for themselves. Collaboration currently only takes place when individually triggered and neither structured nor organized.
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Affiliation(s)
- Heike Wieser
- Research Unit, College of Health-Care Professions, Claudiana, Bolzano/Bozen, Italy.,Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Giuliano Piccoliori
- Institute for General Medicine, College for Health-Care Professions, Bolzano/Bozen, Italy
| | - Marianne Siller
- Directorate of Nursing, South Tyrolean Health Trust, SABES, Bolzano/Bozen, Italy
| | - Evi Comploj
- Research Unit, College of Health-Care Professions, Claudiana, Bolzano/Bozen, Italy.,Department of Urology, Central Hospital of Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Harald Stummer
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.,University Seeburg Castle, Seekirchen/Wallersee, Austria
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18
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Abstract
Hyperlipemia is a well-established etiology of acute pancreatitis. However, few data are available in the medical literature about the management of triglyceride levels in the outpatient setting in patients with hypertriglyceridemic acute pancreatitis (HTG-AP). We evaluated the blood triglyceride levels and followed the triglyceride management of patients with HTG-AP.This retrospective study enrolled patients with HTG-AP from January 2013 to March 2019 in the Affiliated Hospital of Southwest Medical of University. By reviewing the hospitalization records and the follow-up data, the clinical features, blood triglyceride levels, use of lipid-lowering medications and rate of blood triglyceride levels monitoring after hospital discharge were analyzed.A total of 133 patients (46 women, 87 men; median age at presentation 37.4 years) diagnosed with HTG-AP were enrolled in the study. Thirty-two patients (24.1%) presented with recurrent acute pancreatitis (RAP). Patients who had RAP were younger and had higher blood triglyceride levels than those with a single attack (P < .05). No difference in serum amylase levels, hospitalization duration or mortality rate were observed between non-recurrent acute pancreatitis and RAP patients. Lipid monitoring was only observed in 12.8% of patients and 10 patients (7.5%) took medications to control their blood triglyceride levels after hospital discharge. The follow-up of triglyceride levels in the outpatient setting were higher in RAP patients than in patients with non-recurrent acute pancreatitis (P < .05). Among the patients who measured their triglyceride levels after discharge, 83.3% of patients with RAP had at least 1 follow-up triglyceride level that was higher than 500 mg/dL, while no patients had an HTG-AP attack with a triglyceride level higher than 500 mg/dL.Triglyceride levels after hospital discharge higher than 500 mg/dL may be associated with an increased risk of relapse of clinical acute pancreatitis events. Inappropriate management for triglyceride control in the outpatient setting may be associated with an increased risk of relapse of clinical HTG-AP events.
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Affiliation(s)
- Ping Yan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University
| | - Hong-Xian Zhao
- Department of Histology and Embryology, Southwest Medical University, Luzhou City, P.R. China
| | - Xia Chen
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University
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19
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Mohana A, Sulaiman T, Mahmoud N, Hassanein M, Alfaifi A, Alenazi E, Radwan N, AlKhalifah N, Elkady E, Almohaizeie A, AboGazalah F, AlabdulKareem K, AlGhofaili F, Jokdar H, Alrabiah F. Hydroxychloroquine Safety Outcome within Approved Therapeutic Protocol for COVID-19 Outpatients in Saudi Arabia. Int J Infect Dis 2020; 102:110-114. [PMID: 33075525 PMCID: PMC7567693 DOI: 10.1016/j.ijid.2020.10.031] [Citation(s) in RCA: 2] [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] [Received: 08/20/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 12/27/2022] Open
Abstract
Background Global healthcare is challenged following the COVID-19 pandemic, since late 2019. Multiple approaches have been performed to relieve the pressure and support existing healthcare. The Saudi Arabian Ministry of Health (MOH) launched an initiative to support the National Healthcare System. Since the 5th of June 2020, 238 outpatient fever clinics were established nationwide. This study aimed to assess the safety outcome and reported adverse events from hydroxychloroquine use among suspected COVID-19 patients. Method A cross-sectional study included 2,733 patients subjected to MOH treatment protocol (hydroxychloroquine) and followed-up within 3-7 days after initiation. Data was collected through an electronic link and cross-checked with the national database (Health Electronic Surveillance Network, HESN) and reports from the MOH Morbidity and Mortality (M&M) Committee. Results 240 patients (8.8%) discontinued treatment because of side effects (4.1%) and for non-clinical reasons in the remaining (4.7%). Adverse effects were reported among (6.7%) of all studied participants, including mainly cardiovascular (2.5%, 0.15% with QTc prolongation), and gastrointestinal (2.4%). No Intensive Care Unit admission or death were reported among these patients. Conclusion Our results show that hydroxychloroquine for COVID-19 patients in mild to moderate cases in an outpatient setting, within the protocol recommendation and inclusion/exclusion criteria, is safe, highly tolerable, and with minimum side effects.
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Affiliation(s)
- Abdulrhman Mohana
- Saudi Centre for Disease Prevention and Control, 70 SCDC Building, Al Aarid, King Abdulaziz Rd, Riyadh, 13354, Saudi Arabia.
| | - Tarek Sulaiman
- King Fahad Medical City, 59046, Riyadh, 11525, Saudi Arabia.
| | - Nagla Mahmoud
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Mustafa Hassanein
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Amel Alfaifi
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Eissa Alenazi
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Nashwa Radwan
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | | | - Ehab Elkady
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Abdullah Almohaizeie
- King Faisal Specialist Hospital and Research Centre, Zahrawi St., Al Maather، Al Maazer, Riyadh, 12713, Saudi Arabia.
| | - Fouad AboGazalah
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Khaled AlabdulKareem
- Assisting Deputyship for Primary Health Care, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | | | - Hani Jokdar
- Deputyship of Public Health, Ministry of Health, 11176, Riyadh, Saudi Arabia.
| | - Fahad Alrabiah
- King Faisal Specialist Hospital and Research Centre, Zahrawi St., Al Maather، Al Maazer, Riyadh, 12713, Saudi Arabia.
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20
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Jain K. Commentary: Orbital Atherectomy in Perspective. J Endovasc Ther 2020; 27:726-727. [PMID: 32744120 DOI: 10.1177/1526602820944610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Krishna Jain
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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21
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Abstract
The National Database of Nursing Quality Indicators (NDNQI, 2020) defines a patient fall as an unplanned descent to the floor with or without injury. A fall occurs in 30%-50% of hospitalized patients with cancer in the United States (Jatoi, 2017). According to the Joint Commission (2015), the average cost of each fall with injury in the United States was about $14,000 to the healthcare system, averaging about $50 billion annually (Kartiko et al., 2020). Fall-related injuries to patients can result in additional treatment, hospital admissions, prolonged hospital stays, delays in cancer treatment, immobility, pain, emotional distress, caregiver fatigue, and depression (Joint Commission, 2015). Patients with cancer are highly susceptible to falls because of the neurologic deficits caused by chemotherapy treatments, medications given to prevent side effects, allergic reactions to the chemotherapy medications, increasing age, cognitive status, disease site, and cancer- and treatment-related fatigue (Jatoi, 2017). The high financial costs to patients and healthcare providers, as well as the physical and mental impact on patients, led to this pilot project.
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Affiliation(s)
- Megha Shah
- Northwestern Medicine Delnor Cancer Center
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22
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Perego G, Gregis F, Rossi L, Mazzoleni M, Nozza S, Nozza R, Gatti VP. Continuous-infusion and outpatient setting: A chance for patients, a challenge for hospital pharmacists. J Oncol Pharm Pract 2020; 26:1715-1720. [PMID: 32594844 DOI: 10.1177/1078155220937389] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of continuous-infusion in outpatient setting could be widely used in oncology and haematology care. Many times the lack of data stability about single drug or admixture of drugs, together with patient education and safety, make difficult the transition from inpatient to outpatient setting. Nowadays, this is a big challenge for hospital pharmacists, who must take into consideration the critical issues related to chemical and physical stability, besides microbiological one, in order to ensure high quality preparations and guarantee the safety and quality of care, to protect patients and their health. The aim of this article is to highlight the critical issues concerning the transition from inpatient to outpatient setting, with particular interest regarding chemotherapy protocols, which require preparation with long-term continuous-infusion.
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Affiliation(s)
- Gianluca Perego
- Pharmacy Unit, IRCCS San Raffaele Hospital, Milan, Italy.,School of Hospital Pharmacy, University of Milan, Milan, Italy
| | | | - Laura Rossi
- School of Hospital Pharmacy, University of Milan, Milan, Italy.,Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Silvia Nozza
- Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Renata Nozza
- School of Hospital Pharmacy, University of Milan, Milan, Italy
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23
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Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Minimally invasive lumbar decompression in an ambulatory surgery center. J Spine Surg 2019; 5:S166-S173. [PMID: 31656871 DOI: 10.21037/jss.2019.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is limited data regarding clinical and surgical outcomes of minimally invasive lumbar decompression (MIS LD) as an outpatient procedure. In this context, our purpose is to evaluate a single surgeon's experience with performing MIS LD in the outpatient versus inpatient setting and determining if there are differences in surgical and clinical outcomes. Methods Patients undergoing primary, one- to three-level MIS LD were retrospectively reviewed and stratified by surgical setting: ambulatory surgical center (ASC) versus hospital. The cohorts were compared with respect to demographics, perioperative characteristics, complications, postoperative pain and narcotics consumption, and improvements in patient-reported outcomes. Results Five hundred and nine patients were included: 332 patients underwent surgery at an ASC and 177 patients underwent surgery at a hospital. The ASC patients were younger, more likely to be male, and carry Workers' Compensation insurance. The hospital patients were older, more likely to be diabetic, and had a greater comorbidity burden. Patients undergoing MIS LD in an ASC were less likely to have multi-level procedures and more likely to have decompression with discectomy compared to patients in the hospital cohort. There were two cases of superficial wound infection in the ASC cohort and a single case of a pulmonary embolus in the hospital cohort. Additionally, a total of 28 patients had recurrent herniated nucleus pulposus in the ASC cohort compared to 12 patients in the hospital cohort. There was one case of residual stenosis in the ASC cohort compared to eight cases in the hospital cohort. Both cohorts demonstrated similar preoperative ODI, VAS back pain, and VAS leg pain scores through 12-month follow-up. Conclusions MIS LD is a safe and effective procedure in an ASC, however, appropriate patient selection and postoperative protocols are imperative in minimizing complications and optimizing safety and efficacy in the outpatient setting.
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Affiliation(s)
- Dil V Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sailee S Karmarkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eric H Lamoutte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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24
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Konttila J, Pesonen HM, Kyngäs H. Violence committed against nursing staff by patients in psychiatric outpatient settings. Int J Ment Health Nurs 2018; 27:1592-1605. [PMID: 29766630 DOI: 10.1111/inm.12478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Accepted: 04/22/2018] [Indexed: 02/03/2023]
Abstract
Violence against nurses has increased particularly in psychiatric outpatient settings as psychiatric care shifts from being inpatient-based to being outpatient-based. Violence is a complex phenomenon that must be explored in different psychiatric nursing environments and settings. Violence in psychiatric outpatient settings should especially be explored as violence in this context has scarcely been examined. The aim of this systematic review was to elucidate violence committed against nursing staff by patients in adult psychiatric outpatient settings, based on reports from previous studies. A literature search was conducted in the CINAHL (EBSCO), Ovid MEDLINE, and PsycARTICLES (Ovid) databases. Fourteen studies emerged after the selection and quality assessment process. These studies indicated that violence in psychiatric outpatient settings is a multidimensional phenomenon comprising the reasons for, forms of, and consequences of violence. Reasons for violence could be related to the patient as well as to nursing staff. In psychiatric outpatient settings, verbal violence was the most common form of violence, and violence most frequently led to psychological consequences for nursing staff. The findings of this review highlight the importance of nursing staff developing skills and interventions for managing different kinds of violent situations. Given the multidimensional consequences of violence, attention must be given to the occupational well-being and coping ability of nursing staff at work. Furthermore, it would be worthwhile to compare cultural and intercountry differences of violent exposures in psychiatric outpatient settings.
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Affiliation(s)
- Jenni Konttila
- Faculty of Medicine, Research Unit of Nursing Science and Health Management, Medical Research Center, University of Oulu Finland, Oulu, Finland
| | | | - Helvi Kyngäs
- Faculty of Medicine, Research Unit of Nursing Science and Health Management, Medical Research Center, University of Oulu Finland, Oulu, Finland
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25
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Weijenberg A, van Rijn M, Callenbach PMC, de Koning TJ, Brouwer OF. Ketogenic Diet in Refractory Childhood Epilepsy: Starting With a Liquid Formulation in an Outpatient Setting. Child Neurol Open 2018; 5:2329048X18779497. [PMID: 29872664 PMCID: PMC5977420 DOI: 10.1177/2329048x18779497] [Citation(s) in RCA: 6] [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: 03/09/2018] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Ketogenic diet in children with epilepsy has a considerable impact on daily life and is usually adopted for at least 3 months. Our aim was to evaluate whether the introduction of an all-liquid ketogenic diet in an outpatient setting is feasible, and if an earlier assessment of its efficacy can be achieved. Methods: The authors conducted a prospective, observational study in a consecutive group of children with refractory epilepsy aged 2 to 14 years indicated for ketogenic diet. Ketogenic diet was started as an all-liquid formulation of the classical ketogenic diet, KetoCal 4:1 LQ, taken orally or by tube. After 6 weeks, the liquid diet was converted into solid meals. The primary outcome parameter was time-to-response (>50% seizure reduction). Secondary outcome parameters were time to achieve stable ketosis, the number of children showing a positive response, and the retention rate at 26 weeks. Results: Sixteen children were included. Four of them responded well with respect to seizure frequency, the median time-to-response was 14 days (range 7-28 days). The mean time to achieve stable ketosis was 7 days. The retention rate at 26 weeks was 50%. Of the 8 children who started this protocol orally fed, 6 completed it without requiring a nasogastric tube. Conclusions: Introduction of ketogenic diet with a liquid formulation can be accomplished in orally fed children without major complications. It allowed for fast and stable ketosis.
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Affiliation(s)
- Amerins Weijenberg
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Margreet van Rijn
- Department of Pediatrics, Metabolic diseases section, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - Petra M C Callenbach
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tom J de Koning
- Department of Pediatrics, Metabolic diseases section, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, the Netherlands.,Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Zweigner J, Meyer E, Gastmeier P, Schwab F. Rate of antibiotic prescriptions in German outpatient care - are the guidelines followed or are they still exceeded? GMS Hyg Infect Control 2018; 13:Doc04. [PMID: 29619292 PMCID: PMC5858674 DOI: 10.3205/dgkh000310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: The consequences of antibiotic overuse are substantial. We combined and analyzed the infection diagnoses and antibiotic prescribing practices of physicians in outpatient settings. Recommendations for targeting policy efforts to focused areas are given. Methods: Antibiotic prescriptions and infections diagnosed were provided by a German statutory health insurance provider over a 12-month period. Antibiotic use was expressed as prescriptions per 100 patients. Results: 2,594,000 patient-physician contacts within twelve months were analyzed. A median of 6.5 antibiotics was prescribed to 100 patients. Antibiotic use in private practice showed large variations between and within medical specialties (the upper quarter of physicians who prescribed above the 75th percentile of all prescriptions, at a rate of approximately 43%), by season (antibiotic prescription was 50% higher in winter than in summer) and a considerable proportion of the antibiotics prescribed did not conform with the recommendations of national guidelines. Fluoroquinolones, predominantly ciprofloxacin, were among the top three antibiotics prescribed by all physicians (except pediatricians), although national guidelines do not recommend these agents for uncomplicated respiratory or urinary tract infections. Respiratory tract infections headed the list for the prescription of antibiotics. Conclusions: Antibiotics were still not prescribed appropriately in respect to indication and selection (often unnecessary and/or too broad). We recommend focusing on I) high/over-prescribers, because improved and appropriate antibiotic prescription by this group would result in an over-proportionally lower antibiotic prescription rate, II) respiratory tract infections, because they represent the vast majority of infections treated in primary care and III) intelligent implementation strategies of guidelines.
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Affiliation(s)
- Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Elisabeth Meyer
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Berlin, Berlin, Germany
| | - Petra Gastmeier
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Berlin, Berlin, Germany
| | - Frank Schwab
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Berlin, Berlin, Germany
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St John J, Strazzula L, Vedak P, Kroshinsky D. Estimating the health care costs associated with recurrent cellulitis managed in the outpatient setting. J Am Acad Dermatol 2018; 78:749-753. [PMID: 29428738 DOI: 10.1016/j.jaad.2017.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent cellulitis is diagnosed in 22% to 49% of all cellulitis cases, but little is known about the costs associated with these cases. OBJECTIVE To characterize patients with recurrent cellulitis in the outpatient setting and estimate the associated costs. METHODS A retrospective chart review was conducted for adult patients who presented to the outpatient facilities at our institution from January 1, 2007, to December 31, 2011, with recurrent cellulitis. Data provided by the Centers for Medicare and Medicaid Services were used. RESULTS A total of 157 patients were identified; 56% were male, with a mean age of 62.7 years. The mean number of episodes of cellulitis per patient was 3. Antibiotics were prescribed for all patients with a diagnosis of recurrent cellulitis, with 93% treated with oral antibiotics and 17.6% treated with intravenous antibiotics. A total of 1081 laboratory and 175 radiologic imaging tests were ordered. The minimum average cost per cellulitis episode was $586.91; the average cost per visit was $292.50. LIMITATIONS Retrospective study; use of a single, large academic institution; and utilization of cost estimates that may not adequately reflect the variation of costs across closed-system sites or geographic regions. There was no accounting for the nonfinancial or opportunity costs associated with hospitalization, such as lost days of employment or child care and any long-term morbidities, among others. CONCLUSIONS Recurrent cellulitis in the outpatient setting costs about $586.91 per episode. Although there is no criterion standard for diagnosis or treatment of cellulitis, our analysis demonstrates the need for more evidence-based management to achieve better outcomes and reduce the significant health care costs.
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Affiliation(s)
- Jessica St John
- Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Lauren Strazzula
- Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Priyanka Vedak
- Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
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Formago M, Schrauder MG, Rauh C, Hack CC, Jud SM, Hildebrandt T, Schulz-Wendtland R, Frentz S, Graubert S, Beckmann MW, Lux MP. Should Breast Cancer Surgery Be Done in an Outpatient Setting?: Health Economics From the Perspective of Service Providers. Geburtshilfe Frauenheilkd 2017; 77:879-886. [PMID: 28845052 DOI: 10.1055/s-0043-114427] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION The care of patients with breast cancer is extremely complex and requires interdisciplinary care in certified facilities. These specialized facilities provide numerous services without being correspondingly remunerated. The question whether breast cancer surgery should be performed in an outpatient setting to reduce costs is increasingly being debated. This study compares inpatient surgical treatment with a model of the same surgery performed on an outpatient basis to examine the potential financial impact. MATERIAL AND METHODS A theoretical model was developed and the DRG fees for surgical interventions to treat primary breast cancer were calculated. A theoretical 1-day DRG was then calculated to permit comparisons with outpatient procedures. The costs of outpatient surgery were calculated based on the remuneration rates of the AOP (Outpatient Surgery) Contract and the EBM (Uniform Assessment Scale) and compared to the costs of the 1-day DRG. RESULTS The DRG fee for both breast-conserving surgery and mastectomy is higher than the fee paid in the context of the EBM system, although the same procedures were carried out in both systems. If a hospital were to carry out breast-conserving surgery as an outpatient procedure, the fee would be € 1313.81; depending on the type of surgery, the hospital would therefore only receive between 39.20% and 52.82% of the DRG fee. This was the case even for a 1-day treatment. Compared to the real DRG fees the difference would be even more striking. CONCLUSION Carrying out breast cancer surgery as an outpatient procedure would result in a significant shortfall of revenues. Additional services from certified centers, such as the interdisciplinary planning of treatment, psycho-oncological and social-medical care with the involvement of relatives, detailed documentation, etc., which are currently provided without surcharge or adequate remuneration, could no longer be maintained. The quality of processes and excellent results which have been achieved and ultimately the care given by certified facilities would be significantly at risk.
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Affiliation(s)
- Margaret Formago
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Michael G Schrauder
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Claudia Rauh
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Carolin C Hack
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Sebastian M Jud
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Thomas Hildebrandt
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Rüdiger Schulz-Wendtland
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Radiology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Frentz
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Commercial Directorate, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Graubert
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Commercial Directorate, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Matthias W Beckmann
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Michael P Lux
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
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Gizzo S, Noventa M, Quaranta M, Vitagliano A, Saccardi C, Litta P, Antona D. A novel hysteroscopic approach for ovarian cancer screening/early diagnosis. Oncol Lett 2016; 13:549-553. [PMID: 28356928 DOI: 10.3892/ol.2016.5493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/22/2015] [Accepted: 04/12/2016] [Indexed: 12/14/2022] Open
Abstract
The lethality of epithelial ovarian cancer (EOC) may be due to common misconceptions regarding etiology and the absence of effective screening and early diagnostic tools. Reviews of histopathological surveys performed on the resected fallopian tubes of breast cancer (BRCA) mutation carriers, who underwent risk-reducing salpingo-oophorectomy, unexpectedly revealed the presence of occult carcinomas of the fallopian tubes. This finding prompted studies that demonstrated the most accredited theory of type II EOC development, which suggests that a large proportion of these tumors are derived from the fallopian tube. At present, no diagnostic tools or screening programs have been demonstrated to be effective or cost-effective in improving the outcome of EOC; it is therefore imperative that the scientific community unite its efforts in the identification of a valid screening and/or early diagnostic method for the treatment of this lethal gynecological malignancy. To this end, the present paper proposes a novel tool for the screening/early diagnosis of EOC: The 'Tuba-check'. This novel approach is based on the possibility of acquiring specimens for tubal lumen cytology via hysteroscopy in a minimally-invasive outpatient setting. The present study protocol aimed to validate the technical feasibility and oncological accuracy of the proposed approach, commencing with a cohort of patients with an expected increased oncological risk, including BRCA mutation carriers or those with a gene expression profile of 'BRCA-ness'. If the data collected by the present study protocol validates this approach, the 'Tuba-check' may, in the near future, be extended for the treatment of all women, therefore reducing the number of victims of epithelial ovarian carcinoma.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Pietro Litta
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
| | - Donato Antona
- Department of Woman and Child Health, University of Padua, I-35128 Padua, Italy
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Abstract
BACKGROUND Many large lipomas are removed under general anesthesia, because more local anesthesia than is safe to inject may be required for complete excision of such large tumors. METHODS The authors performed total excision using tumescent local anesthesia in an outpatient clinic for 23 patients with solitary large lipomas. RESULTS The longest diameter of the lesions on magnetic resonance imaging ranged from 10 to 22 cm. Mean length of the skin incision was 4.8 cm, and 56 mL of the tumescent solution on average was used for each patient. The postoperative courses of all patients, except for 1 patient who developed a hematoma, were uneventful. CONCLUSIONS With judicious patient selection after physical examination and magnetic resonance imaging findings, total excision of large lipomas under tumescent local anesthesia can be performed safely in an outpatient setting.
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Affiliation(s)
- Daichi Morioka
- Department of Plastic and Reconstructive Surgery, Showa University, Tokyo, Japan
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University, Tokyo, Japan
| | - Fumio Ohkubo
- Department of Plastic and Reconstructive Surgery, Showa University, Tokyo, Japan
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García-Marchena N, Araos PF, Barrios V, Sánchez-Marín L, Chowen JA, Pedraz M, Castilla-Ortega E, Romero-Sanchiz P, Ponce G, Gavito AL, Decara J, Silva D, Torrens M, Argente J, Rubio G, Serrano A, de Fonseca FR, Pavón FJ. Plasma Chemokines in Patients with Alcohol Use Disorders: Association of CCL11 (Eotaxin-1) with Psychiatric Comorbidity. Front Psychiatry 2016; 7:214. [PMID: 28149283 PMCID: PMC5242327 DOI: 10.3389/fpsyt.2016.00214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 09/27/2016] [Accepted: 12/26/2016] [Indexed: 12/16/2022] Open
Abstract
Recent studies have linked changes in peripheral chemokine concentrations to the presence of both addictive behaviors and psychiatric disorders. The present study further explore this link by analyzing the potential association of psychiatry comorbidity with alterations in the concentrations of circulating plasma chemokine in patients of both sexes diagnosed with alcohol use disorders (AUD). To this end, 85 abstinent subjects with AUD from an outpatient setting and 55 healthy subjects were evaluated for substance and mental disorders. Plasma samples were obtained to quantify chemokine concentrations [C-C motif (CC), C-X-C motif (CXC), and C-X3-C motif (CX3C) chemokines]. Abstinent AUD patients displayed a high prevalence of comorbid mental disorders (72%) and other substance use disorders (45%). Plasma concentrations of chemokines CXCL12/stromal cell-derived factor-1 (p < 0.001) and CX3CL1/fractalkine (p < 0.05) were lower in AUD patients compared to controls, whereas CCL11/eotaxin-1 concentrations were strongly decreased in female AUD patients (p < 0.001). In the alcohol group, CXCL8 concentrations were increased in patients with liver and pancreas diseases and there was a significant correlation to aspartate transaminase (r = +0.456, p < 0.001) and gamma-glutamyltransferase (r = +0.647, p < 0.001). Focusing on comorbid psychiatric disorders, we distinguish between patients with additional mental disorders (N = 61) and other substance use disorders (N = 38). Only CCL11 concentrations were found to be altered in AUD patients diagnosed with mental disorders (p < 0.01) with a strong main effect of sex. Thus, patients with mood disorders (N = 42) and/or anxiety (N = 16) had lower CCL11 concentrations than non-comorbid patients being more evident in women. The alcohol-induced alterations in circulating chemokines were also explored in preclinical models of alcohol use with male Wistar rats. Rats exposed to repeated ethanol (3 g/kg, gavage) had lower CXCL12 (p < 0.01) concentrations and higher CCL11 concentrations (p < 0.001) relative to vehicle-treated rats. Additionally, the increased CCL11 concentrations in rats exposed to ethanol were enhanced by the prior exposure to restraint stress (p < 0.01). Concordantly, acute ethanol exposure induced changes in CXCL12, CX3CL1, and CCL11 in the same direction to repeated exposure. These results clearly indicate a contribution of specific chemokines to the phenotype of AUD and a strong effect of sex, revealing a link of CCL11 to alcohol and anxiety/stress.
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Affiliation(s)
- Nuria García-Marchena
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain; Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Fernando Araos
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Vicente Barrios
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain; CIBER Fisiopatología de la obesidad y nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Sánchez-Marín
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Julie A Chowen
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain; CIBER Fisiopatología de la obesidad y nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - María Pedraz
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Estela Castilla-Ortega
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Pablo Romero-Sanchiz
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Guillermo Ponce
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Ana L Gavito
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Juan Decara
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Daniel Silva
- Facultad de Psicología, Universidad Complutense de Madrid , Madrid , Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria i Addiccions (INAD), Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Psychiatry, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jesús Argente
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain; CIBER Fisiopatología de la obesidad y nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel Rubio
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - Antonia Serrano
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Fernando Rodríguez de Fonseca
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain; Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javier Pavón
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga , Málaga , Spain
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Scaramuzzo LA, Wong Y, Voitle KL, Gordils-Perez J. Cardiopulmonary arrest in the outpatient setting: enhancing patient safety through rapid response algorithms and simulation teaching. Clin J Oncol Nurs 2015; 18:61-4. [PMID: 24476726 DOI: 10.1188/14.cjon.61-64] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ambulatory and outpatient centers constantly are challenged with administrating cancer treatments in an efficient and safe way. With the advent of numerous novel cancer medications known to cause hypersensitivity reactions, nurses have become experts in managing these emergencies. However, patients rarely exhibit severe infusion reactions or cardiopulmonary arrest. Outpatient nurse knowledge and comfort with grade 4, life-threatening emergencies requiring cardiopulmonary resuscitative measures often is low because of infrequent occurrence. That is largely a result of nurses' ability to immediately identify the need for emergency intervention, thus preventing the sequelae of patient deterioration that could lead to cardiopulmonary arrest. This article describes how the authors' institution developed methods to improve emergency care by bridging the gap between knowledge and experience of handling life-threatening emergencies.
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Affiliation(s)
| | - Yuk Wong
- Rutgers Cancer Institute of New Jersey
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Takahashi T, Saikawa Y, Fukuda K, Nakamura R, Wada N, Kawakubo H, Takeuchi H, Takaishi H, Kitagawa Y. Phase I study of S-1 plus fractional cisplatin as adjuvant chemotherapy for advanced gastric cancer in an outpatient setting (KOGC-03). Anticancer Res 2015; 35:467-471. [PMID: 25550589] [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: 06/04/2023]
Abstract
AIM The aim of this phase I study was to adjust the dose of cisplatin as adjuvant combination chemotherapy with S-1 in an outpatient setting for gastric cancer. PATIENTS AND METHODS The first course was initiated with S-1 monotherapy on days 1-28. From the second to the sixth course, S-1 was administered on days 1-28 and cisplatin was added on days 1, 15, and 29. The dose level of cisplatin was escalated as follows: 20 mg/m(2) (level 1); 25 mg/m(2) (level 2); 30 mg/m(2) (level 3). Dose-limiting toxicity was a delay factor of the start of the next course due to incomplete recovery. RESULTS The maximum tolerated and recommended doses were confirmed as level 3 and level 2, respectively. CONCLUSION Although further clinical trials are recommended to evaluate efficacy, this combination of S-1 plus cisplatin regimen is expected to become a standard adjuvant treatment for gastric cancer in the outpatient setting.
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Affiliation(s)
| | - Yoshiro Saikawa
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiromasa Takaishi
- Keio Cancer Center, Keio University Hospital, Shinjuku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Moczygemba LR, Osborn RD, Lapane KL. Adherence to behavioral therapy and psychiatry visits in a safety-net setting in Virginia, USA. Health Soc Care Community 2014; 22:469-478. [PMID: 24601944 DOI: 10.1111/hsc.12102] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 06/03/2023]
Abstract
Little is known about predictors of adherence to outpatient behavioural therapy and psychiatry visits in those who experience homelessness. Yet, consistent receipt of services in the community is critical to preventing use of acute care psychiatric services, which cause a significant cost burden to the mental health system. This retrospective study examined sociodemographic, housing instability and health-related factors associated with adherence to behavioural therapy and psychiatry appointments among 1711 clients served by an urban healthcare for the homeless centre in Virginia, USA. Clients ≥18 years old with a behavioural health condition who had an intake assessment and at least one behavioural therapy or psychiatry appointment scheduled during October 2005-September 2009 were eligible for the study. Of those with scheduled behavioural therapy visits, 27.7% were high adherers and 19.3% did not attend any appointments, whereas of those with scheduled psychiatry visits, 13.6% were high adherers and 22.1% did not attend any appointments. African Americans, when compared with whites, and those with a primary diagnosis of bipolar disorder were less likely to be high adherers to behavioural therapy. Women and being ≥35 years old were associated with a decreased likelihood of failing to attend psychiatry appointments, whereas African Americans, when compared with whites, and those with co-occurring disorders were more likely to not attend any psychiatry appointments. Understanding factors related to adherence to behavioural health services can help homeless care providers tailor strategies for improving visit adherence.
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Affiliation(s)
- Leticia R Moczygemba
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, Virginia, USA
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Bernardo M, Coma A, Ibáñez C, Zara C, Bari JM, Serrano-Blanco A. Antipsychotic polypharmacy in a regional health service: a population-based study. BMC Psychiatry 2012; 12:42. [PMID: 22587453 PMCID: PMC3511232 DOI: 10.1186/1471-244x-12-42] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 02/17/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To analyse the extent and profile of outpatient regular dispensation of antipsychotics, both in combination and monotherapy, in the Barcelona Health Region (Spain), focusing on the use of clozapine and long-acting injections (LAI). METHODS Antipsychotic drugs dispensed for people older than 18 and processed by the Catalan Health Service during 2007 were retrospectively reviewed. First and second generation antipsychotic drugs (FGA and SGA) from the Anatomical Therapeutic Chemical classification (ATC) code N05A (except lithium) were included. A patient selection algorithm was designed to identify prescriptions regularly dispensed. Variables included were age, gender, antipsychotic type, route of administration and number of packages dispensed. RESULTS A total of 117,811 patients were given any antipsychotic, of whom 71,004 regularly received such drugs. Among the latter, 9,855 (13.9%) corresponded to an antipsychotic combination, 47,386 (66.7%) to monotherapy and 13,763 (19.4%) to unspecified combinations. Of the patients given antipsychotics in association, 58% were men. Olanzapine (37.1%) and oral risperidone (36.4%) were the most common dispensations. Analysis of the patients dispensed two antipsychotics (57.8%) revealed 198 different combinations, the most frequent being the association of FGA and SGA (62.0%). Clozapine was dispensed to 2.3% of patients. Of those who were receiving antipsychotics in combination, 6.6% were given clozapine, being clozapine plus amisulpride the most frequent association (22.8%). A total of 3.800 patients (5.4%) were given LAI antipsychotics, and 2.662 of these (70.1%) were in combination. Risperidone was the most widely used LAI. CONCLUSIONS The scant evidence available regarding the efficacy of combining different antipsychotics contrasts with the high number and variety of combinations prescribed to outpatients, as well as with the limited use of clozapine.
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Affiliation(s)
- Miguel Bernardo
- Schizophrenia Clinic Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic de Barcelona, Barcelona, Spain.
| | - Anna Coma
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Cristina Ibáñez
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Corinne Zara
- Pharmacy Direction. Catalan Health Service, Barcelona, Spain
| | - Josep Maria Bari
- Schizophrenia Clinic Program, Department of Psychiatry, Neuroscience Institute, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Servicios de Salud Mental y Fundación Sant Joan de Déu, Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
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