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Grewal H, Dhillon G, Buddhavarapu V, Verma RK, Munjal RS, Sharma P, Sidhu G, Kashyap R, Surani S. Strategic insights of telehealth platforms and strengths, weaknesses, opportunities, and threats analysis of Amazon's clinical endeavors. World J Methodol 2025; 15:98513. [DOI: 10.5662/wjm.v15.i2.98513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND The adoption of telehealth services surged after the coronavirus disease 2019 pandemic, revolutionizing traditional healthcare delivery models. Amazon Clinic's recent nationwide launch marks a significant milestone in this trend. This study aims to offer a strengths, weaknesses, opportunities, and threats (SWOT) analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.
AIM To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.
METHODS The initial search terms included were, amazon clinic odds ratio (OR) amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health, from 2000 to 2023. This search yielded 111 articles, from which duplicates were removed, and unrelated titles were filtered out. Eight articles were retained for a final review, including comparative studies, usability research, retrospective analyses, observational studies, and review articles. The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.
RESULTS The review included eight articles focusing on various aspects of telehealth. Comparative studies highlighted differences between Teladoc and traditional physician offices, noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc. User demographics for Teladoc showed younger, less engaged patients. Usability studies emphasized the importance of website design for telemedicine adoption. Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods. Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times. The SWOT analysis identified Amazon Clinic's strengths, such as its vast consumer base and transparent pricing, and weaknesses like the lack of pediatric care. Opportunities included potential partnerships and service expansions, while threats involved competition and regulatory challenges.
CONCLUSION Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities. However, it faces challenges from established healthcare providers and regulatory landscapes. The future success of Amazon Clinic will depend on strategic collaborations, addressing service gaps, and navigating competition and regulations. Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.
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Gómez JA, Valencia S, Franco I, Cardona P, Vanegas JM, Gómez CA, Díaz JS. Clinical outcomes of patients with heart failure and atrial fibrillation: Experience from an outpatient heart failure clinic in Colombia. Curr Probl Cardiol 2024; 49:102841. [PMID: 39242064 DOI: 10.1016/j.cpcardiol.2024.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Heart failure (HF) can coexist with atrial fibrillation in up to 60 % of cases, increasing rates of hospitalizations and death. This study analyzed the clinical characteristics, treatment, hospitalization, and mortality of patients with HF and atrial fibrillation based on left ventricular ejection fraction (LVEF). METHODS A retrospective cohort study included patients from an outpatient HF clinic at Medellín (Colombia) between 2020-2022. Patients were classified into two groups according to LVEF: reduced (LVEF≤40 %) and mildly reduced or preserved ejection fraction (LVEF>40 %). The evaluated outcomes were hospitalization and mortality during follow-up. Values for B-type natriuretic peptide (BNP), LVEF and functional class according to the New York Heart Association (NYHA) were also analyzed at admission and during the last follow-up visit. RESULTS The study included 185 patients, with 51.9% being male. The median age of the participants was 80 years (interquartile range [IQR] 74 - 86). There was an overall improvement in the NYHA functional class, BNP levels, and LVEF compared with the baseline values, irrespective of left systolic function. Atrial fibrillation ablation was performed in 3.2 % of patients, and cardiac device implantation with atrioventricular node ablation in 29 %. No statistically significant differences were found in terms of hospitalization and mortality regarding left systolic function. CONCLUSION Compressive optimal treatment for patients with HF and atrial fibrillation requires pharmacological treatment, ablation strategies, cardiac devices, cardiovascular rehabilitation and close follow-up. In this cohort, hospitalization and mortality rates were similar according to LVEF categories and there was improvement in NYHA functional class and BNP level.
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Pigeaud L, de Veld L, van Blitterswijk A, van der Lely N. Psychological outpatient follow-up after hospitalization for adolescent acute alcohol intoxication. Eur J Pediatr 2024; 184:12. [PMID: 39542887 PMCID: PMC11564360 DOI: 10.1007/s00431-024-05856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 10/08/2024] [Accepted: 10/18/2024] [Indexed: 11/17/2024]
Abstract
Alcohol-related emergency department attendance in adolescents should be considered as a valuable opportunity to address and mitigate future alcohol consumption. Therefore, a paediatric department of a major district hospital in the Netherlands developed an outpatient preventive program targeting adolescents admitted for acute alcohol intoxication. The primary aim of this study is to evaluate how adolescent drinking patterns participating in the preventive program developed over time. This retrospective observational study involved 310 patients from the Reinier de Graaf Hospital, Delft, the Netherlands (years 2014-2022). The outpatient preventive program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions. The alcohol consumption was compared at three time points: before the admission for acute alcohol intoxication(T = 0), 4-6 weeks after hospital admission (T = 1) and 6-12 months after the hospital admission (T = 2). Moreover, sociodemographic variables, adolescent risk-taking behaviour and family and pedagogical factors were included in secondary analysis. Adolescents who experienced an alcohol intoxication exhibited more adolescent risk-taking behaviour (higher rates of lifetime smoking, substance use and sexual intercourse) compared to the Dutch average. Initially, these adolescents had significantly higher rates of alcohol consumption and drunkenness. Alcohol use decreased significantly in the month following intoxication, even below the Dutch average. Though 6-12 months later, their alcohol consumption increased but remained statistically lower and involved less binge drinking than the Dutch average. CONCLUSIONS The findings of this study demonstrate that a preventive program following acute alcohol intoxication contributes to the reduction of adolescent alcohol use and associated risk-taking behaviours. WHAT IS KNOWN • Earlier studies showed that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in a motivational interviewing intervention compared to standard care. • During the follow-up assessment of adolescents with acute alcohol intoxication it is possible to signalize mental disorders and to determine whether the patient requires referral to specialized mental healthcare. WHAT IS NEW • These findings suggest that the preventive program had a short-term impact in reducing alcohol consumption among adolescents with acute alcohol intoxication, as well as a long-term impact in reducing binge-drinking behaviours. • The program's success in mitigating binge-drinking behaviours aligns with its goals of promoting safer drinking habits among adolescents.
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Seo Y, Jeong S, Lee S, Kim TS, Kim JH, Chung CK, Lee CH, Rhee JM, Kong HJ, Kim CH. Machine-learning-based models for the optimization of post-cervical spinal laminoplasty outpatient follow-up schedules. BMC Med Inform Decis Mak 2024; 24:278. [PMID: 39350186 PMCID: PMC11440713 DOI: 10.1186/s12911-024-02693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Patients undergo regular clinical follow-up after laminoplasty for cervical myelopathy. However, those whose symptoms significantly improve and remain stable do not need to conform to a regular follow-up schedule. Based on the 1-year postoperative outcomes, we aimed to use a machine-learning (ML) algorithm to predict 2-year postoperative outcomes. METHODS We enrolled 80 patients who underwent cervical laminoplasty for cervical myelopathy. The patients' Japanese Orthopedic Association (JOA) scores (range: 0-17) were analyzed at the 1-, 3-, 6-, and 12-month postoperative timepoints to evaluate their ability to predict the 2-year postoperative outcomes. The patient acceptable symptom state (PASS) was defined as a JOA score ≥ 14.25 at 24 months postoperatively and, based on clinical outcomes recorded up to the 1-year postoperative timepoint, eight ML algorithms were developed to predict PASS status at the 24-month postoperative timepoint. The performance of each of these algorithms was evaluated, and its generalizability was assessed using a prospective internal test set. RESULTS The long short-term memory (LSTM)-based algorithm demonstrated the best performance (area under the receiver operating characteristic curve, 0.90 ± 0.13). CONCLUSIONS The LSTM-based algorithm accurately predicted which group was likely to achieve PASS at the 24-month postoperative timepoint. Although this study included a small number of patients with limited available clinical data, the concept of using past outcomes to predict further outcomes presented herein may provide insights for optimizing clinical schedules and efficient medical resource utilization. TRIAL REGISTRATION This study was registered as a clinical trial (Clinical Trial No. NCT02487901), and the study protocol was approved by the Seoul National University Hospital Institutional Review Board (IRB No. 1505-037-670).
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Reitze A, Voigt M, Klawonn F, Dusch M, Grigull L, Mücke U. Impact of virtual reality on peri-interventional pain, anxiety and distress in a pediatric oncology outpatient clinic: a randomized controlled trial. BMC Pediatr 2024; 24:501. [PMID: 39097718 PMCID: PMC11297639 DOI: 10.1186/s12887-024-04952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/16/2024] [Indexed: 08/05/2024] Open
Abstract
PURPOSE Pain and anxiety-inducing interventions have a major impact on pediatric patients. Pain reduction by virtual reality (VR) during port and vein punctures is well studied. This study investigates peri-interventional reduction of pain, anxiety and distress using VR compared to the standard of care (SOC) in a pediatric oncology outpatient clinic. METHODS In a randomized, controlled cross-over design, patients aged 6-18 years experience potentially painful interventions accompanied by VR. Observational instruments include NRS, FPS-r, BAADS, mYPAS-SF, PedsQL and SSKJ3-8R. All patients undergo two observations: SOC (A) and VR (B) in a randomized order. In addition, parents and staff are interviewed. Specific conditions for VR in an outpatient clinic setting derived from interprofessional focus group discussion are being explored. RESULTS Between July 2021 and December 2022 57 eligible patients were included and randomized to the orders A/B (n = 28) and B/A (n = 29). Thirty-eight patients completed both observations. Characteristics in both groups did not differ significantly. More than half of the patients had no previous experience with VR, 5% decided to discontinue VR prematurely. Peri-interventional pain, anxiety and distress were significantly reduced by VR compared with SOC. 71% of patients and 76% of parents perceived punctures with VR to be more relaxed than previous ones. 95% of patients perceived fun with VR goggles. Detailed questionnaires on individual stress and anxiety were returned from 26 of 38 patients. Focus group discussion with staff yielded evidence for successful implementation of VR in an outpatient clinic. CONCLUSIONS The present study shows that VR can be used for peri-interventional reduction of pain, anxiety, and distress in the special environment of a pediatric outpatient clinic. Specific conditions must be met for successful implementation. Further studies are needed to identify particularly susceptible patients and to illuminate alternatives for distraction that are feasible to implement with limited resources. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov ID): NCT06235723; 01/02/2024; retrospectively registered. This study adheres to the standard checklist of CONSORT guidelines.
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Cova I, Mele F, Nicotra A, Maestri G, Cucumo V, Pomati S, Salvadori E, Pantoni L. The Luigi Sacco Hospital VAS-COG stroke care pathway: A five-year experience. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100210. [PMID: 38357360 PMCID: PMC10865214 DOI: 10.1016/j.cccb.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
Background Psycho-cognitive consequences are a frequent cause of disability in stroke survivors but are often underdiagnosed also because of lack of services dedicated to these aspects. We started assessing systematically cognitive and behavioral functions in acute stroke patients and to follow them up. Here, we report a retrospective analysis of the organization of the Sacco VAS-COG stroke care pathway and the refinements implemented during 5 years of activity. Methods The protocol includes baseline collection of clinical history, general and neurologic examinations, functional, neuropsychological, and neuroimaging assessment. At follow-up, a diagnosis of cognitive decline was made based on best clinical judgment in the first period (January 2018 to May 2019, namely VAS-COG protocol 1.0) and then based on an extensive neuropsychological battery (May 2019 to January 2023, namely VASCOG protocol 2.0); psychiatric and behavioral disturbances are investigated through suitable scales. Results From January 2018 to December 2022, 834 patients (mean age 76±13.6 years; 46.6 % females) with acute cerebrovascular events were admitted to the stroke unit, mostly (80 %) for ischemic strokes. Pre-event cognitive impairment was not assessable in 78 patients (9.3 %) because no reliable informant was present and was reported in 327/756 (43 %) patients. During follow-up, post-stroke cognitive impairment was detected in 124/217 (57.1 %) patients in VAS-COG protocol 1.0 and in 137/201(68.2 %) patients in VAS-COG protocol 2.0, while 95/218 (43.2 %) patients were found to be depressed and patients presented on average 2.5 neuropsychiatric symptoms on Neuropsychiatric Inventory-questionnaire. Conclusions The VAS-COG stroke care pathway represents a model for patients and for their families.
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Ali S, Hughes T, Smith A. Long waitlists for outpatient drug allergy referrals: An Australian tertiary centre experience. World Allergy Organ J 2024; 17:100863. [PMID: 38293273 PMCID: PMC10825046 DOI: 10.1016/j.waojou.2023.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
Drug allergy clinic waitlist time data are limited. A 24-month retrospective study of drug allergy referrals was undertaken at a tertiary hospital in Australia. One hundred six patients were reviewed with a median age of 50 years (IQR 40.5-67.3) and a female predominance (n = 76, 71%). Face-to-face consultations were common (n = 83, 78.3%) with the remainder being telephone consultations. General practitioners comprised just over one-third (n = 38, 35.9%) of the referrers but majority being from within the hospital, such as the emergency department (n = 22, 20.8%). Most patients (n = 100, 94.3%) were triaged as Category 1 or urgent. Antibiotic allergies were common (n = 75, 70.8%), of which majority were beta-lactam antibiotics (n = 71, 95%): 55 (73.3%) for penicillins and 16 (15.1%) for cephalosporins. The median waitlist time was 178 days (IQR 48.5-502.5) and only 18 (17%) of Category 1 were seen within urgent timeframe. Telephone consultation had a significantly shorter waitlist time (median 47 days; IQR 6-245) compared to face-to-face consultations (median 267 days; IQR 69-519) (p = 0.026). Large waitlist times are present for drug allergy, and given the majority of referrers are from hospitals, inpatient drug allergy assessment remains paramount. Beta-lactam antibiotic drug allergy labels remain common, and given their negative implications, further work is needed. Economic and human resources evaluations are required to address this shortfall.
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Menegatti M, Del Villano N, Scerrati A, Travaglini F, Ricciardi L, Lofrese G, Cavallo MA, De Bonis P. The neurosurgical outpatient clinic: comparison between accesses in public and private activities. BMC Health Serv Res 2024; 24:137. [PMID: 38267935 PMCID: PMC10809444 DOI: 10.1186/s12913-024-10571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/05/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Neurosurgical clinic assesses presence and extent of pathologies of central and peripheral nervous system or disorders affecting the spine, to identify most effective treatment and possible recourse to surgery. The aim of the study is to evaluate the appropriateness of request for a neurosurgical consult both in private and in public outpatient clinics. MATERIALS AND METHODS We collected and analyzed all the reports of outpatient visits of public and private clinic over a period between January and December 2018. RESULTS There were 0.62% real urgent visits in the public sector and 1.19% in the private sector (p = 0.05). Peripheral pathologies represented 12.53% and 6.21% of pathologies evaluated in public and private sector respectively (p < 0.00001). In addition, 15.76% of visits in public lead to surgery, while they represented 11.45% in private (p = 0.0003). CONCLUSIONS No study is available comparing accesses of patients in neurosurgical outpatient clinics. In public clinic, visits are booked as urgent on the prescription of the general practitioner: in reality, only 5% of these visits were really confirmed as urgent by the specialist. Peripheral pathologies are more frequent in public clinic, while cranial pathologies are more frequent in private one. Patients with cranial pathologies prefer to choose their surgeon by accessing private clinic.
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Lewis AK, Taylor NF, Carney PW, Bryson A, Sethi M, Ooi S, Tse GT, Harding KE. Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic. Heliyon 2024; 10:e23346. [PMID: 38169770 PMCID: PMC10758808 DOI: 10.1016/j.heliyon.2023.e23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Delays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented. Methods This observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods. Results Two years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52-51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45-57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582). Conclusion The STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.
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Ülkü G, Karaavcı NÇ, Elbir Ç, Demirtaş OK. Retrospective Evaluation of Neurosurgery Outpatient Services in 3 Different Tertiary Care Hospitals in Turkey. World Neurosurg 2024; 181:e911-e917. [PMID: 37949297 DOI: 10.1016/j.wneu.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cascading of referrals to health institutions aims to increase the balanced distribution and quality of health services provided. Although health institutions in Turkey are divided into steps in terms of scope, there is no mandatory referral system for patient application. METHODS Patients admitted to the neurosurgery outpatient clinic of 3 different hospitals in the first week of September 2023 were analyzed. The patients' complaints, reasons for referral to the outpatient clinic, by whom or by which system, the department to which they should have applied, and the necessity of the operation were examined to evaluate. RESULTS There were 671 applications made to the neurosurgery outpatient clinic in 3 different health institutions. The average examination time per patient was 6 minutes. Surgical treatment was planned for only 14.8% of the patients. Most patients were referred to physical therapy and neurology departments from neurosurgery. Only 59% of the patients came to the examination by making an appointment, while 41% were examined without an appointment. The ratio of inappropriate admissions to total admissions in these 3 health institutions was 85.1%. CONCLUSIONS Only a minority of patients admitted to the neurosurgery outpatient clinic at a public health institution in Turkey were found to require surgery, while the majority were referred to other outpatient clinics. This study underscores the significance of the referral chain in delivering high-quality health care services, particularly in the field of neurosurgery.
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Cerruti B, Garavaldi D, Lerario A. Patient's punctuality in an outpatient clinic: the role of age, medical branch and geographical factors. BMC Health Serv Res 2023; 23:1385. [PMID: 38082271 PMCID: PMC10714636 DOI: 10.1186/s12913-023-10379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The efficiency of the management of an outpatient clinic largely depends on the administration of patient flows and waiting times increase costs and affect clinical quality. In this study, we verify if the visit acceptance times are influenced by demographic or geographical factors in a large cohort of patients referred to a city and suburban private outpatient multidisciplinary clinic. METHODS We included all scheduled visits of patients aged from 18 to 75 years who arrived in 2021, 2022 and 2023 in our private outpatient clinics, consisting of 34 medical clinics scattered in Milan metropolitan city and hinterland. The variables collected were age, visit time, check-in time, address of the medical clinic and its distance from the closest underground station, patient typology (new business vs. follow-up patient), and the medical branch of the visit. Outcome is'punctuality', defined as check-in time minus visit time (in minutes). RESULTS We considered a sample of 410.808 visits from January 2021 to April 2023. The majority of patients check-in early (84.4%) and we found that the percentage of punctual patients increases linearly with age. Earlier hours in the morning show the worst punctuality pattern as well as Blood Draws in the analysis of different medical branches. We also observed that patients who already had some activity recorded in our systems show the worst pattern of punctuality. No particular differences emerged considering the geographical location of the clinics. CONCLUSIONS Younger patients have worse punctuality than older patients. Moreover, earlier hour slots are the most disadvantaged and the medical specialty has an influence on the arrival habits. This data should be considered for better clinical quality and efficiency.
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Sha L, Shi X, Zhu M, Wang L, Dai X, Xiao G, Wu L, Jiang X, Chen Y, Chen S, Li X. Implementation of STRONGkids for identifying nutritional risk in outpatients of child health care clinics: Results of a multicentre study. Clin Nutr 2023; 42:2207-2213. [PMID: 37804577 DOI: 10.1016/j.clnu.2023.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
AIM To investigate nutritional risk across children in their first 2 years at child health care clinics in Jiangsu, China, and to highlight the importance of nutritional risk screening in outpatient clinics. METHODS A multi-centre, cross-sectional, observational study was conducted among outpatients in child health care clinics. Nutritional risk screening using the STRONGkids tool and anthropometric assessments were performed on children under 2 years old at outpatient initial visits in ten hospitals from March 2021 to March 2022. RESULTS There were 11,454 children enrolled. The percentages of children with high, moderate and low nutritional risk were 2.0% (228), 28.2% (3229) and 69.8% (7997), respectively. The occurrence rate of high nutritional risk was higher in female children than in male children (p < 0.05). The incidence of moderate nutritional risk in infants was significantly higher than in children aged ≥12 months (p < 0.01). Children with moderate or high nutritional risk more frequently answered 'yes' to the STRONGkids item 'high risk disease or major surgery planned'. The top three diagnoses related to nutritional risk were prematurity (50.5%), food allergy (14.3%) and recurrent respiratory disease (10.7%). In addition, the incidence of chronic undernutrition in children with moderate (14.0%) or high nutritional risk (36.4%) was significantly higher than acute undernutrition (p < 0.01). CONCLUSION Among children up to 2 years of age seen in child health clinics, nutritional risk associated with prematurity and potential disease requires special attention. Nutritional risk screening should be part of child health care, and STRONGkids is a useful screening tool.
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Silva-Batista C, Harker G, Vitorio R, Studer M, Whetten B, Lapidus J, Carlson-Kuhta P, Pearson S, VanDerwalker J, Horak FB, El-Gohary M, Mancini M. Mobility Rehab visual feedback system for gait rehabilitation in older adults. J Neuroeng Rehabil 2023; 20:144. [PMID: 37875971 PMCID: PMC10594752 DOI: 10.1186/s12984-023-01260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Gait and balance impairments are among the main causes of falls in older adults. The feasibility and effectiveness of adding sensor-based feedback to physical therapy (PT) in an outpatient PT setting is unknown. We evaluated the feasibility and effectiveness of PT intervention combined with a therapist-assisted visual feedback system, called Mobility Rehab, (PT + MR) in older adults. METHODS Twenty-eight older adults with and without neurological diseases were assigned either PT + MR (n = 22) or PT alone (n = 6). Both groups performed 8 sessions (individualized) of 45 min long (30 min for gait training and 15 min for endurance, strength, and balance exercises) in an outpatient clinic. Mobility Rehab uses unobtrusive, inertial sensors on both wrists and feet, and at the sternum level with real-time algorithms to provide real-time feedback on five gait metrics (step duration, stride length, elevation at mid-swing, arm swing range-of-motion [ROM], and trunk coronal ROM), which are displayed on a tablet. The primary outcome was the Activities-specific Balance Confidence scale (ABC). The secondary outcome was gait speed measured with wearable inertial sensors during 2 min of walking. RESULTS There were no between-group differences at baseline for any variable (P > 0.05). Neither PT + MR nor PT alone showed significant changes on the ABC scores. PT + MR, but not PT alone, showed significant improvements in gait speed and arm swing ROM. The system was evaluated as 'easy to use' by the PT. CONCLUSIONS Our preliminary results show that PT + MR improves gait speed in older adults with and without neurological diseases in an outpatient clinic. CLINICAL TRIAL REGISTRATION www. CLINICALTRIALS gov , identifier: NCT03869879.
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Lieberum JL, Siegel H, Wacker K, Reinhard T. [Training concept for personnel in a university outpatient clinic: development and evaluation of a structured introductory training concept]. DIE OPHTHALMOLOGIE 2023; 120:1014-1021. [PMID: 37222788 DOI: 10.1007/s00347-023-01877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The training of new employees is crucial for effective interaction and commitment to the company. OBJECTIVE Development and evaluation of a structured induction into the process flows of a university outpatient clinic. MATERIAL AND METHODS We developed and tested a two-stage model for getting to know staff, premises, nursing and medical process flows, and learning examination techniques: Participants went through all stages of an outpatient clinic visit as fictitious patients and subsequently evaluated learning success by self-assessment of general (process-related) and specific (examination-related) competencies in writing and in a feedback interview. RESULTS In this study, 11 residents, 8 operating room nursing staff, and 6 students underwent the training program. The self-assessed level of competence before and after the run-through as well as the extent of the increase in competence varied depending on the stage and professional group. Residents and students experienced a specific increase in general competences (both 98%; nursing personnel 64%). Specific competence gains for residents were particularly evident in becoming familiar with important process-related interfaces between the occupational groups, in software and examination techniques, and in improved orientation in the outpatient clinic (competence gain at 83% of stages). Operating room nursing staff benefited most from improved communication with staff. CONCLUSION An increase in general competence can be achieved by a structured training with little time expenditure for different professional groups and facilitates, especially the start for new residents. For maximum specific competence gain, an outpatient clinic run tailored to the employee's field of activity seems desirable.
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van Olst N, Vink MRA, de Vet SCP, Hutten BA, Gerdes VEA, Tielbeek JAW, Bruin SC, van Weyenberg SJB, van der Peet DL, Acherman YIZ. A Prospective Study on the Diagnoses for Abdominal Pain After Bariatric Surgery: The OPERATE Study. Obes Surg 2023; 33:3017-3027. [PMID: 37563516 PMCID: PMC10514148 DOI: 10.1007/s11695-023-06756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Long-term follow-up after bariatric surgery (BS) reveals high numbers of patients with abdominal pain that often remains unexplained. The aim of this prospective study was to give an overview of diagnoses for abdominal pain, percentage of unexplained complaints, number and yield of follow-up visits, and time to establish a diagnosis. MATERIALS AND METHODS Patients who visited the Spaarne Gasthuis Hospital, The Netherlands, between December 2020 and December 2021 for abdominal pain after BS, were eligible and followed throughout the entire episode of abdominal pain. Distinction was made between presumed and definitive diagnoses. RESULTS The study comprised 441 patients with abdominal pain; 401 (90.9%) females, 380 (87.7%) had Roux-en-Y gastric bypass, mean (SD) % total weight loss was 31.4 (10.5), and median (IQR) time after BS was 37.0 (11.0-66.0) months. Most patients had 1-5 follow-up visits. Readmissions and reoperations were present in 212 (48.1%) and 164 (37.2%) patients. At the end of the episode, 88 (20.0%) patients had a presumed diagnosis, 183 (41.5%) a definitive diagnosis, and 170 (38.5%) unexplained complaints. Most common definitive diagnoses were cholelithiasis, ulcers, internal herniations, and presumed diagnoses irritable bowel syndrome (IBS), anterior cutaneous nerve entrapment syndrome, and constipation. Median (IQR) time to presumed diagnoses, definitive diagnoses, or unexplained complaints was 16.0 (3.8-44.5), 2.0 (0.0-31.5), and 13.5 (1.0-53.8) days (p < 0.001). Patients with IBS more often had unexplained complaints (OR 95%CI: 4.457 [1.455-13.654], p = 0.009). At the end, 71 patients (16.1%) still experienced abdominal pain. CONCLUSION Over a third of abdominal complaints after BS remains unexplained. Most common diagnoses were cholelithiasis, ulcers, and internal herniations.
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Iffland B, Bartsch LM, Kley H, Neuner F. Growing relevance of reports of adolescent cyberbullying victimization among adult outpatients. BMC Public Health 2023; 23:1503. [PMID: 37553618 PMCID: PMC10410929 DOI: 10.1186/s12889-023-16342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/18/2023] [Indexed: 08/10/2023] Open
Abstract
In the general population, prevalence rates of cyberbullying victimization have continuously increased over the past decades. However, the extent to which these increasing numbers affect clinical populations seeking treatment in outpatient services remains an open question. The present study sought to examine whether the increase of cyberbullying victimization is also reflected by increased reports of cyberbullying victimization in a clinical outpatient population. In addition, we assessed the incremental contribution of experiences of cyberbullying in the prediction of psychological symptoms when controlling for histories of childhood maltreatment and offline peer victimization. For this purpose, we analyzed routine data from N = 827 outpatients who had sought treatment at a University outpatient clinic for psychotherapy between 2012 and 2021 in a cross-sectional study design. Analyses showed that 8.3% of the patients born in the years 1980 to 2002 indicated the experience of cyberbullying victimization in their adolescence. The rate of reported cyberbullying victimization increased from 1 to 3% in patients born in the years 1980 to 1987 to 24% in patients born in the year 2000. A logistic regression revealed that patients born in the years 1995-2002 were up to nineteen times as likely to report cyberbullying victimization as patients born in the years 1980-1982. In addition, hierarchical multiple regression analyses indicated that cyberbullying victimization significantly accounted for an incremental proportion of variance (1%) in the prediction of psychological symptom distress after controlling for child maltreatment and offline peer victimization. In conclusion, this retrospective survey indicates an increase of the clinical relevance of cyberbullying victimization both in frequency of and potential contribution to etiology. Raising attention to cyberbullying in clinical care and research seems to be justified and warranted.
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Asfuroğlu ZM, Gümüşoğlu E. Changes in patient admission patterns at orthopedics and traumatology outpatient clinics before and after the earthquakes on 6 February 2023 in Turkey. J Orthop Surg Res 2023; 18:494. [PMID: 37434228 DOI: 10.1186/s13018-023-03987-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/09/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The increase in orthopedic injuries after earthquakes imposes a significant burden on the health system. However, the impact of earthquakes on outpatient admissions remains unclear. This study compared patient admissions to the orthopedics and traumatology outpatient clinics before and after earthquakes. METHODS The study was conducted at a tertiary university hospital near the earthquake zone. In total, 8549 outpatient admissions were retrospectively analyzed. The study population was divided into pre-earthquake (pre-EQ) and post-earthquake (post-EQ) groups. Factors such as gender, age, city of origin, and diagnosis were compared between the groups. In addition, unnecessary outpatient utilization (UOU) was defined and analyzed. RESULTS The pre-EQ and post-EQ groups included 4318 and 4231 patients, respectively. The two groups had no significant differences in age and sex distribution. However, the proportion of non-local patients increased after the earthquake (9.6% vs. 24.4%, p < 0.001). UOU was the most common reason for admission in both groups. The distribution of diagnoses differed significantly between the pre-EQ and post-EQ groups, with an increase in the number of trauma-related diagnoses (15.2% vs. 27.3%, p < 0.001) and a decrease in UOU (42.2% vs. 31.1%, p < 0.001) after the earthquake. CONCLUSIONS Patient admission patterns at orthopedics and traumatology outpatient clinics changed significantly after the earthquake. The number of non-local patients and trauma-related diagnoses increased, whereas the number of unnecessary outpatients decreased. Level of evidence Observational study.
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van Lummel EVTJ, Meijer Y, Tjan DHT, van Delden JJM. Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study. BMC Palliat Care 2023; 22:24. [PMID: 36922796 PMCID: PMC10015131 DOI: 10.1186/s12904-023-01139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Advance Care Planning (ACP) enables patients to define and discuss their goals and preferences for future medical treatment and care. However, the structural implementation of ACP interventions remains challenging. The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention has recently been developed which takes into account existing barriers and facilitators. We aimed to evaluate the MUTUAL intervention and identify the barriers and facilitators healthcare professionals experience in the implementation of the MUTUAL intervention and also to identify suggestions for improvement. METHODS We performed a sequential exploratory mixed-methods study at five outpatient clinics of one, 300-bed, non-academic hospital. Firstly, semi-structured interviews were performed with a purposive sample of healthcare professionals. The content of these interviews was used to specify the Measurement Instrument for Determinants of Innovations (MIDI). The MIDI was sent to all healthcare professionals. The interviews and questionnaires were used to clarify the results. RESULTS Eleven healthcare professionals participated in the interviews and 37 responded to the questionnaire. Eight barriers and 20 facilitators were identified. Healthcare professionals agreed that the elements of the MUTUAL intervention are clear, correct, complete, and simple - and the intervention is relevant for patients and their proxies. The main barriers are found within the user and the organisational domain. Barriers related to the organisation include: inadequate replacement of staff, insufficient staff, and insufficient time to introduce and invite patients. Several suggestions for improvement were made. CONCLUSION Our results show that healthcare professionals positively evaluate the MUTUAL intervention and are very receptive to implementing the MUTUAL intervention. Taking into account the suggestions for improvement may enhance further implementation.
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Rotter G, Binting S, Teut M, Ortiz M, Willich SN, Brinkhaus B. Characteristics of Patients Presenting at a University Outpatient Department for Complementary and Integrative Medicine. Complement Med Res 2023; 30:279-288. [PMID: 36804827 DOI: 10.1159/000529798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/20/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Complementary and integrative medicine (CIM) is increasingly provided at university outpatient departments (OPDs) in Germany, but its scientific evaluation is sparse. Therefore, we aimed to investigate and evaluate feasibility, patients' characteristics and complaints at a university's CIM-OPD. METHODS A prospective evaluation included new patients without age restriction. At baseline, and after 6 and 12 months, patients filled out paper questionnaires. Patients rated their mean subjectively perceived severity of the main complaint within the last 7 days on a numerical rating scale (NRS) from 0 = no complaints to 10 = maximum complaints, their perceived resilience capacity in everyday life within the last 7 days (0 = not resilient to 10 = very resilient), and their contentment with the treatment (0 = not content to 10 = very content). Diagnoses were provided by physicians and coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. All data were analyzed descriptively. RESULTS During two years, 536 new patients {72.6% response, age (mean ± standard deviation [SD] and range) 49.6 ± 15.8 and 1-86 years, 75.7% female} chose to participate. The most frequent diagnosis groups were neoplasms (C00-C97, n = 143, 18.6%) and musculoskeletal diseases (M00-M99, n = 137, 17.9%). In n = 165 patients (30.8%), more than one diagnosis was provided. In a subgroup of 187 patients, who returned the questionnaire after 6 months, we compared baseline to 6-month values: severity of main complaint (mean ± SD) 5.2 ± 2.6 changed to 3.9 ± 2.6; resilience capacity 5.1 ± 2.6 to 5.6 ± 2.4. After 6 months, respondents rated their contentment with the treatment with (mean ± SD) 7.7 ± 2.6. Data after 12 months (n = 113) are comparable to data after 6 months. CONCLUSION Patients of our CIM-OPD had a broad age range, were predominantly female, and suffered mostly from oncologic-related complaints and musculoskeletal diseases. In the responding subgroup after 6 months, patients were content with the treatment. These results should be verified by further prospective evaluations. Hintergrund Komplementäre und integrative Medizin (CIM) wird in Deutschland zunehmend in Hochschulambulanzen (OPDs) angeboten, deren wissenschaftliche Evaluation ist jedoch unzureichend. Deshalb war es unser Ziel, die Durchführbarkeit einer Evaluation, die Charakteristika und die Beschwerden der Patienten und Patientinnen an einer CIM-ODP zu untersuchen. Methoden Eine prospektive Evaluation schloss neue Patienten und Patientinnen ohne Altersbeschränkung ein. Zu Baseline sowie nach sechs und 12 Monaten füllten die Patienten und Patientinnen Papierfragebögen aus. Die Patienten und Patientinnen bewerteten ihre mittlere subjektiv empfundene Schwere der Hauptbeschwerden in den letzten sieben Tagen auf einer numerischen Ratingskala (NRS) von 0 = keine Beschwerden bis 10 = maximale Beschwerden, ihre mittlere subjektiv empfundene Belastbarkeit im Alltag in den letzten sieben Tagen (0 = nicht belastbar bis 10 = sehr belastbar) und ihre Zufriedenheit mit der Behandlung (0 = nicht zufrieden bis 10 = sehr zufrieden). Die Diagnosen wurden von den Ärzten und Ärztinnen gestellt und nach der International Statistical Classification of Diseases and Related Health Problems, 10. Revision, kodiert. Die Daten wurden deskriptiv ausgewertet. Ergebnisse Im Laufe von zwei Jahren nahmen 536 neue Patienten und Patientinnen (72.6% Rücklauf, Alter (Mittelwert ± SD und Range) 49.6 ± 15.8 und 1–86 Jahre, 75.7% weiblich) teil. Die häufigsten Diagnosen waren Neoplasmen (C00-C97, n = 143, 18.6%) und Erkrankungen des Bewegungsapparates (M00-M99, n = 137, 17.9%). Bei n = 165 (30.8%) Patienten und Patientinnen wurde mehr als eine Diagnose vergeben. In einer Subgruppe von 187 Patienten und Patientinnen, die den Fragebogen nach 6 Monaten zurücksendeten, verglichen wir die Ausgangs-und 6-Monats-Werte: Schweregrad der Hauptbeschwerden (Mittelwert±SD) 5.2 ± 2.6 veränderte sich zu 3.9 ± 2.6; Belastbarkeit 5.1 ± 2.6 zu 5.6 ± 2.4. Nach sechs Monaten bewerteten die Befragten ihre Zufriedenheit mit der Behandlung mit (Mittelwert±SD) 7.7 ± 2.6. Die Daten nach 12 Monaten ( n = 113) sind mit den Daten nach 6 Monaten vergleichbar. Schlussfolgerung Die Patienten und Patientinnen unserer CIM-OPD hatten eine breite Altersspanne, überwiegend weiblich und litten zumeist unter onkologisch bedingten Beschwerden und Erkrankungen des Bewegungsapparates. Patienten und Patientinnen der nach sechs Monaten antwortenden Subgruppe waren mit der Behandlung zufrieden. Die Ergebnisse sollten durch weitere prospektive Evaluationen verifiziert werden.
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Non-hospital healthcare center's preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study. BMC Health Serv Res 2023; 23:70. [PMID: 36690961 PMCID: PMC9872316 DOI: 10.1186/s12913-023-09053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs' preparedness to provide initial emergency care. METHODS This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach's alpha, Intra-class Correlation Coefficient, and Kendal's Tau-b. All the statistical analyses were performed using Stata 14. RESULTS In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: "Environmental Infrastructures of Centers", "Protocols, Guidelines and Policies", "Medical Supplies and Equipment", "Emergency Medicines", "Human Resources", "Clinical Interventions", "Maintenance of equipment", "Medicine Storage Capability", and "Management Process". The toolbar had acceptable validity and reliability. CONCLUSIONS This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.
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Iordani MM, Polikandrioti M, Kapadohos T, Maggita A, Kourea K, Koutelekos I, Dousis E, Zartaloudi A. Depression and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator in Women. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:131-139. [PMID: 37581787 DOI: 10.1007/978-3-031-31986-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Cardiovascular disease remains a major cause of morbidity and premature mortality worldwide. The aim of the present study was to investigate the association of atherosclerotic cardiovascular disease (ASCVD) risk estimator with depression in women undergoing cardiological evaluation. MATERIAL AND METHOD Three hundred women undergoing cardiological evaluation completed the Zung Self-Rating Depression Scale (ZSDS) questionnaire which included women's characteristics. RESULTS A percentage of 57.4% of our participants exhibited ASCVD risk <5%; while the 18.3% had ASCVD risk between 5% and 7.4%, the 18.3% between 7.5% and 20%, and the remaining 6% > 20%. In terms of depression, 50% of the women had a score of less than 38 (median), according to Zung scale and mean score was 38.4. In addition, 25% of women had a score below 32. These scores indicate low levels of depression in women. Statistically significant higher rates of depression were found in women who were not involved with physical activities (p = 0.030). CONCLUSIONS The negative impact of depression on the ASCVD risk could potentially be prevented by modifying individuals' behavior with regard to their engagement in physical activity.
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Smoking cessation treatment by anesthesiologists. J Anesth 2022; 37:319-320. [PMID: 36562813 DOI: 10.1007/s00540-022-03155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
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Briedé S, de Winter MA, van Charldorp TC, Kaasjager KAH. The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic. BMC Health Serv Res 2022; 22:1569. [PMID: 36550522 PMCID: PMC9773541 DOI: 10.1186/s12913-022-08901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Care decision discussions are intended to align treatment with the patient's wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians' training and a conversation aid for patients about care decisions on patient and physician outcomes. METHODS At the internal medicine outpatient clinic of the University Medical Centre Utrecht, a 1:1 randomized, parallel-group study (patient conversation aid) was combined with a pre-post intervention (physicians' training) design. Primary outcome was patient satisfaction, secondary outcomes were patient-doctor relationship, shared-decision-making, doctor preparedness and patient appreciation of the conversation aid. RESULTS Between October 2018 and February 2020 11 physicians (36% residents, 73% female) and 185 patients (median age 58 years (interquartile range (IQR) 50-68), 60% male) participated. Only 28% of the patients reported a care decision discussion during the consultation. We found no effect of the interventions on patient satisfaction (effect sizes -0.14 (95% confidence interval (CI) -0.56-0.27) for conversation aid; 0.04 (95% CI -0.40-0.48) for physician's training), nor on the patient-doctor relationship or shared-decision-making. However, physicians felt more prepared to discuss care decisions after training (median 3 (IQR 1-4) vs 1 (IQR 0-3), p = 0.015). Patients assessed the conversation aid informative and gave an overall mark of median 7 (IQR 7-8). CONCLUSIONS First steps towards fruitful discussions about care decisions were made: patients considered the conversation aid informative and physicians felt better prepared to discuss care decisions after training. The low number of care decision conversations patients reported shows exactly how important it is to focus on interventions that facilitate these discussions, for both the patient and physician. Further work needs to be done to establish the best way to empower patients and physicians. TRIAL REGISTRATION Dutch trial register, trial 6998 (NTR 7188), registered 04/05/2018, https://www.trialregister.nl/trial/6998 .
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Guiráo TN, de Oliveira STP, Bezerra AE, Françoso BS, Dos Santos BD, Sicchieri JMF, Chiarello PG. Development of a nutritional risk screening tool for cancer patients undergoing outpatient treatment. Clin Nutr ESPEN 2022; 52:240-244. [PMID: 36513459 DOI: 10.1016/j.clnesp.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/07/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Malnutrition is a common reality in many hospitals, especially in cancer patients. In order to avoid its late diagnosis, there are screening instruments that help professionals detect nutritional risk early, thus avoiding further damage to the nutritional status. OBJECTIVE To develop a nutritional screening tool for cancer patients undergoing outpatient treatment. MATERIAL AND METHODS This cross-sectional, observational study was carried out in cancer patients assisted at an outpatient clinic for nutritional care. Data were collected from nutritional care records, including bioelectrical and body composition data (by electrical bioimpedance spectroscopy), anthropometry (adductor pollicis muscle thickness, circumferences, and body mass index), routine clinical biochemical tests, and dynamometry. Malnourished patients were identified through screening using the NRS-2002 method, and all participants were classified according to the GLIM criterion as the control group (no risk and no malnutrition) and the malnourished group. The logistic regression method was used to select the variables that were more sensitive to nutritional risk, thus composing the final screening instrument. RESULTS The study sample consisted of 72 patients, 58% male, with a mean age of 63 years (±13.3). The malnourished group had a higher frequency of sarcopenia, worse Karnofsky Performance Status (KPS), and lower values for weight, adductor pollicis muscle thickness (APMT), body mass index (BMI), calf circumference (CC), dynamometry (HAND), and fat mass index (FMI) than the control group. After multivariate analyses and analysis of covariance, the final model was devised in the form of an equation containing two variables, which were more associated with malnutrition, the BMI and the KPS. CONCLUSION The screening instrument developed in this study resulted in an equation for screening nutritional risk, which included the variables KPS and BMI with 84% assertiveness.
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Chan E, Rooprai J, Rodger J, Visintini S, Rodger N, Philip S, Mielniczuk L, Sun LY. Sex-based differences in referral of heart failure patients to outpatient clinics: a scoping review. ESC Heart Fail 2022; 9:3702-3712. [PMID: 36069110 PMCID: PMC9773741 DOI: 10.1002/ehf2.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Guidelines recommend that hospitalized patients newly diagnosed with HF be referred to an outpatient HF clinic (HFC) within 2 weeks of discharge. Our study aims were (i) to assess the current literary landscape on the impact of patient sex on HFC referral and outcomes and (ii) to provide a qualitative overview of possible considerations for the impact of sex on referral patterns and HF characteristics including aetiology, symptom severity, investigations undertaken and pharmacologic therapy. METHODS AND RESULTS We conducted a scoping review using the Arksey and O'Malley framework and searched Medline, EMBASE, PsychINFO, Cochrane Library, Ageline databases and grey literature. Eligible articles included index HF hospitalizations or presentations to the Emergency Department (ED), a description of the HFC referral of patients not previously followed by an HF specialist and sex-specific analysis. Of the 11 372 potential studies, 8 met the inclusion criteria. These studies reported on a total of 11 484 participants, with sample sizes ranging between 168 and 3909 (25.6%-50.7% female). The included studies were divided into two groups: (i) those outlining the referral process to an HFC and (ii) studies which include patients newly enrolled in an HFC. Of the studies in Group 1, males (51%-82.4%) were more frequently referred to an HFC compared with females (29%-78.1%). Studies in Group 2 enrolled a higher proportion of males (62%-74% vs. 26%-38%). One study identified independent predictors of HFC referral which included male sex, younger age, and the presence of systolic dysfunction, the latter two more often found in males. Two studies, one from each group reported a higher mortality amongst males compared with females, whereas another study from Group 2 reported a higher hospitalization rate amongst females following HFC assessment. CONCLUSIONS Males were more likely than females to be referred to HFCs after hospitalization and visits to the Emergency Department, however heterogeneity across studies precluded a robust assessment of sex-based differences in outcomes. This highlights the need for more comprehensive longitudinal data on HF patients discharged from the acute care setting to better understand the role of sex on patient outcomes.
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