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Digestive Diseases and Sciences Jun 2024While most adult ERCPs are performed on an outpatient basis, pediatric ERCPs are typically performed on an inpatient basis, or with ERCP followed by at least one night...
BACKGROUND
While most adult ERCPs are performed on an outpatient basis, pediatric ERCPs are typically performed on an inpatient basis, or with ERCP followed by at least one night inpatient admission. We have begun performing a substantial proportion of our pediatric ERCPs on an outpatient basis, using our clinical judgment to guide the decision process. In the present study, we compare patient characteristics, indications, and adverse events associated with outpatient vs. inpatient ERCP.
METHODS
Using our endoscopy database, we identified patients 18 years of age and under who underwent ERCP from 2019 to 2021. Demographics, hospitalization status, indications, findings, interventions, as well as available adverse event and clinical outcomes data were analyzed.
RESULTS
147 ERCP procedures were performed during the study period by one of two interventional endoscopists. A subset of 51 (34.7%) patients underwent outpatient ERCP. Comparison of the two groups (outpatient vs. inpatient ERCP) was notable for no statistically significant difference in patient age, range of indications, or proportion of index vs. subsequent ERCP. Overall rates of ERCP-associated adverse events were low and there was no statistically significant difference between adverse events in patients who underwent outpatient vs. inpatient ERCP.
CONCLUSION
We analyzed outpatient and inpatient pediatric ERCP patient demographics and ERCP characteristics to identify factors that guide decision to determine whether pediatric ERCPs are performed on an outpatient vs. inpatient basis. There was no significant difference in adverse events associated with outpatient vs. inpatient pediatric ERCPs, attesting to the safety of outpatient ERCP for this subset of patients in the studied context. This is an area worthy of future prospective and multi-center study.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Child; Female; Male; Adolescent; Child, Preschool; Infant; Ambulatory Care; Hospitalization; Inpatients; Outpatients; Retrospective Studies
PubMed: 38418682
DOI: 10.1007/s10620-024-08325-9 -
Current Problems in Cardiology Aug 2024The main objective of the study to compare the effect of hospitalized and outpatient settings on quality of sleep in children with respiratory tract dysfunction. (Comparative Study)
Comparative Study Review
OBJECTIVES
The main objective of the study to compare the effect of hospitalized and outpatient settings on quality of sleep in children with respiratory tract dysfunction.
METHODOLOGY
A descriptive correlational study was carried out at Dhi-Qar Health Directorate pediatric hospitals. The period of the study was from the November 19, 2023 to March 10, 2024. Purposive sample (non-probability) of 250 children (male and female). A total of (125) children were chosen from the children whose admitted to the hospitals, and a total of (125) children were chosen from the outpatient settings. The study instrument consisted of three parts: the sociodemographic sheet, clinical diagnosis sheet, and sleep quality scale. The questionnaire was modified according to experts' recommendation to use it for children with respiratory tract dysfunction. The questionnaire was evaluated by a panel of 15 experts from diverse medical and nursing professions. Both descriptive and inferential statistics were used to analyze the data.
RESULTS
The study findings that effect outpatient settings have more effect from hospitalized settings on quality of sleep in children with respiratory tract dysfunction (M ± SD = 1.322 ± 0.1522).
CONCLUSION
A study showed that the quality of sleep in children with respiratory tract dysfunction was generally average, whether in hospitalized or outpatient settings, outpatient settings had greater difficulties falling asleep and waking than children in hospitalized.
Topics: Humans; Female; Male; Child; Sleep Quality; Outpatients; Child, Preschool; Surveys and Questionnaires; Hospitalization; Child, Hospitalized; Respiratory Tract Diseases; Adolescent; Infant; Sleep Wake Disorders; Ambulatory Care
PubMed: 38754755
DOI: 10.1016/j.cpcardiol.2024.102639 -
AORN Journal Aug 2023
Topics: Humans; Outpatients; Arthroplasty, Replacement, Hip; Ambulatory Surgical Procedures; Retrospective Studies; Postoperative Complications
PubMed: 37493421
DOI: 10.1002/aorn.13968 -
BMC Geriatrics Jul 2023Sex-specific physical and mental functioning trajectory classification could offer a way of understanding the differences in healthcare use at older age.
BACKGROUND
Sex-specific physical and mental functioning trajectory classification could offer a way of understanding the differences in healthcare use at older age.
METHODS
Using latent growth mixture models, sex-specific physical and mental functioning trajectory classes were formed for 1991 participants (mean age 61.5 years) of the Helsinki Birth Cohort Study. Physical and mental functioning were evaluated with the SF-36 survey conducted in clinical examinations in 2001-2004, 2011-2013, and 2017-2018. First and follow-up outpatient visits, emergency visits, and hospital days were extracted from a national register between the first clinical examination and the year 2017. We used regression models to examine the associations between healthcare use and trajectory classes.
RESULTS
Two physical and mental functioning trajectory classes, high and intermediate, were observed for both sexes. The intermediate physical functioning trajectory class was associated with higher utilization rates of all examined specialized healthcare services (fully-adjusted IRRs varying 1.36-1.58; 95% CI = 1.03-1.79, 95% CI = 1.21-2.05) compared to the high trajectory class. Relative to the high trajectory class, the intermediate mental trajectory class was associated with the use of first outpatient visits (fully-adjusted IRRs 1.17, 95% CI = 1.03-1.33 for men, and 1.16, 95% CI = 1.04-1.30 for women). The findings were similar among both sexes.
CONCLUSIONS
Compared to the high trajectory class, the intermediate physical functioning trajectory class was associated with greater specialized healthcare use and the intermediate mental trajectory class with first outpatient visits. Public health interventions should be considered to support functioning with aging.
Topics: Male; Humans; Female; Aged; Cohort Studies; Aging; Outpatients; Physical Examination; Delivery of Health Care
PubMed: 37480067
DOI: 10.1186/s12877-023-04157-w -
Minerva Medica Dec 2023With burgeoning evidence for early rhythm control in patients with atrial fibrillation (AF), the management of AF in the outpatient setting has become more challenging.... (Review)
Review
With burgeoning evidence for early rhythm control in patients with atrial fibrillation (AF), the management of AF in the outpatient setting has become more challenging. The primary care clinician often serves as the frontline in the pharmacologic management of AF. Because of drug interactions and the risk of proarrhythmia, many clinicians remain hesitant about the initiation and chronic management of antiarrhythmic drug prescriptions. However, with the likely increased use of antiarrhythmics for early rhythm control, understanding and familiarity with these medications have likewise become more important, especially since patients with AF probably have other non-cardiac medical conditions that can impact their antiarrhythmic therapy. In this comprehensive review, we provide informative, high-yield cases and edifying references that will help primary care providers become comfortable handling various clinical scenarios.
Topics: Humans; Anti-Arrhythmia Agents; Atrial Fibrillation; Outpatients
PubMed: 37338231
DOI: 10.23736/S0026-4806.23.08524-5 -
Einstein (Sao Paulo, Brazil) 2024Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern... (Review)
Review
Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
Topics: Humans; Heart Failure; Telemedicine; Outpatients; Hospitalization
PubMed: 38451690
DOI: 10.31744/einstein_journal/2024RW0393 -
Orthopadie (Heidelberg, Germany) Feb 2024Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an...
Patient education is a key obligation for doctors under the treatment contract. The expansion of the AOP catalogue (catalogue of operations that can be performed on an outpatient basis in accordance with Section 115b of the Fifth Book of the German Social Code (SGB V)) from January 2023 opens up new outpatient treatment options that tend to involve higher risks. This risk profile must be taken into account when informing patients.In any case, the timing of the information should be chosen so that the patient can give their consent in a well-considered manner. There is no fixed "blocking period" between information and consent, so the patient can consent immediately. In the case of high-risk procedures, the patient should be informed several days in advance. Criteria for determining the right time are the type and severity of the procedure, urgency and individual circumstances of the patient. The information provided should be complete and comprehensible, including the diagnosis, need for treatment, risks and alternatives. Comprehensive documentation of the information provided goes without saying.Telemedical counselling is possible in suitable cases, but the risk of timely and complete counselling remains with the doctor performing the procedure. In view of outpatient procedures that require follow-up care at home, the safety information should be more comprehensive.The expansion of the AOP catalogue opens up new opportunities for outpatient procedures, but harbours legal risks. Adapted risk and safety information is required, whereby telemedicine can optimise practice organisation.
Topics: Humans; Informed Consent; Outpatients; Patient Education as Topic; Telemedicine
PubMed: 38206424
DOI: 10.1007/s00132-023-04470-7 -
Hu Li Za Zhi the Journal of Nursing Oct 2023Outpatient clinics in medical centers are the most common location where people seek medical treatment. Because they must provide patients with treatment information in...
BACKGROUND
Outpatient clinics in medical centers are the most common location where people seek medical treatment. Because they must provide patients with treatment information in a timely manner, good communication skills are a key competency for outpatient nurses. However, the tools available for communication behavior assessment are general and rarely tailored for outpatient settings.
PURPOSE
The purpose was to develop a communication behavior inventory for outpatient nurses and to examine its reliability and validity.
METHODS
During phase one, the authors conducted a literature search and synthesis, using the findings to develop the Outpatient Nurses Communication Behavior Inventory. During phase two, two expert validation rounds were conducted to confirm content validity. During phase three, 220 licensed outpatient nurses were recruited from a medical center in northern Taiwan to complete the instrument (December 2018 - January 2019.) The construct validity and internal consistency of the inventory were evaluated.
RESULTS
The literature search and synthesis identified six domains of communication, including connect, introduce, communicate, ask, respond, and exit. A total of 25 items were generated. Following the two expert panel validation rounds, the six domains remained but the inventory items were reduced to 21. Both item-content validity index and scale-level content validity index were 1.0. In phase three, the results of the confirmatory factor analysis retained six factors with a total of 16 items. Model three showed that the inventory demonstrated goodness of fit (Χ ² = 155.75, p < .001, RMSEA = .06, GFI = .92, AGFI = .87, NNFI = .97, NFI = .95, Model AIC = 253.75). Internal consistency was demonstrated with a Cronbach's α of .89.
CONCLUSIONS / IMPLICATIONS FOR PRACTICE
The Outpatient Nurses Communication Behavior Inventory exhibits good reliability and validity and may be used to assess outpatient nurses' communication behaviors and as a basis for education. The six CICARE (connect, introduce, communicate, ask, respond and exit) domains may be utilized to remind outpatient nurses to demonstrate effective communication consistently, promote outpatient nurses' communication with patients, and improve quality of care.
Topics: Humans; Outpatients; Reproducibility of Results; Communication; Ambulatory Care Facilities; Nurses
PubMed: 37740264
DOI: 10.6224/JN.202310_70(5).07 -
Journal of Pediatric Urology Aug 2023Outpatient surgery and pediatric ambulatory surgery centers continue to have increasing popularity among pediatric urologist for minor surgeries. Past studies have shown... (Review)
Review
INTRODUCTION
Outpatient surgery and pediatric ambulatory surgery centers continue to have increasing popularity among pediatric urologist for minor surgeries. Past studies have shown that open renal and bladder surgeries (i.e. nephrectomy, pyeloplasty and ureteral reimplantation) can also be done in an outpatient setting. With health care costs continuing to rise, it may be reasonable to explore performing these surgeries as an outpatient and consider performing them in a pediatric ambulatory surgery center.
OBJECTIVE
Our study assesses the safety and utility of outpatient open renal and bladder surgeries in children compared to those done as inpatients.
STUDY DESIGN
IRB-approved chart review was performed on patients undergoing nephrectomy, ureteral reimplantation, complex ureteral reimplantation, and pyeloplasty by a single pediatric urologist between January 2003-March 2020. Procedures were performed at a freestanding pediatric surgery center (PSC) and a children's hospital (CH). Demographics, type of procedures, American Society of Anesthesiologists score, operative times, time to discharge, ancillary procedures, readmission or ER visits within 72 h were reviewed. Home zip codes were used to determine the distance from pediatric surgery center and children's hospital.
RESULTS
980 procedures were evaluated. Of these, 94% procedures were performed as an outpatient and 6% procedures were performed as inpatients. 40% of patients underwent ancillary procedures. Outpatients had a significantly lower age, ASA score, operative time, and readmission or return to ER within 72 h (1.5% vs. 6.2%). Twelve patients were readmitted (9 outpatient, 3 inpatient) and six returned to the ER (5 outpatient, 1 inpatient). 15/18 of these patients underwent reimplantations. Four required early reoperation on postoperative day (POD)2-3. Only one outpatient reimplant was admitted one day later. PSC patients lived farther away.
DISCUSSION
Outpatient open renal and bladder surgery was found to be safely performed in our patients. In addition, it did not matter whether the operation was done in the children's hospital or pediatric ambulatory surgery center. Since outpatient surgery has been shown to be significantly less expensive than inpatient surgery, it is reasonable for pediatric urologist to consider performing these operations in the outpatient setting.
CONCLUSIONS
Our experience shows that an outpatient approach to open renal and bladder procedures is safe and should be considered when counseling families about treatment options.
Topics: Humans; Child; Outpatients; Inpatients; Urinary Bladder; Ureter; Ambulatory Surgical Procedures; Retrospective Studies; Postoperative Complications
PubMed: 37210299
DOI: 10.1016/j.jpurol.2023.04.033 -
Developmental Medicine and Child... Jun 2024To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP).
AIM
To describe the relationships between outpatient encounters, continuity of care, and unplanned hospital care in children/young people with cerebral palsy (CP).
METHOD
In this population-based data-linkage cohort study we included children/young people with CP identified in the New South Wales/Australian Capital Territory CP Register (birth years 1994-2018). We measured the frequency of outpatient encounters and unplanned hospital care, defined as presentations to emergency departments and/or urgent hospital admissions (2015-2020). Continuity of outpatient care was measured using the Usual Provider of Care Index (UPCI).
RESULTS
Of 3267 children/young people with CP, most (n = 2738, 83.8%, 57.6% male) had one or more outpatient encounters (123 463 total encounters, median six outpatient encounters per year during childhood). High UPCI was more common in children/young people with mild CP (Gross Motor Function Classification System levels I-III, with no epilepsy or no intellectual disability), residing in metropolitan and areas of least socioeconomic disadvantage. Low UPCI was associated with four or more emergency department presentations (adjusted odds ratio [aOR] 2.34; 95% confidence interval [CI] 1.71-3.19) and one or more urgent hospital admissions (aOR 2.02; 95% CI 1.57-2.61).
INTERPRETATION
Children/young people with CP require frequent outpatient services. Improving continuity of care, particularly for those residing in regional/remote areas, may decrease need for unplanned hospital care.
WHAT THIS PAPER ADDS
Many children with cerebral palsy use multiple and frequent outpatient services. Better continuity of care is associated with living in metropolitan and less socioeconomically disadvantaged areas. Outpatient service utilization reduces at the time of transition to adult services. High outpatient utilization is associated with unplanned hospital care. Decreased continuity of care is associated with unplanned hospital care.
Topics: Humans; Cerebral Palsy; Continuity of Patient Care; Child; Male; Female; Adolescent; Child, Preschool; Hospitalization; Infant; Cohort Studies; Ambulatory Care; New South Wales; Emergency Service, Hospital; Young Adult; Outpatients
PubMed: 37946594
DOI: 10.1111/dmcn.15800