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Obstetrics and Gynecology Feb 2022To evaluate whether outpatient cervical ripening with a balloon catheter results in a shorter amount of time in the labor and delivery unit when compared with use in the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate whether outpatient cervical ripening with a balloon catheter results in a shorter amount of time in the labor and delivery unit when compared with use in the inpatient setting.
DATA SOURCES
PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from their inception until December 2020. No restrictions for language or geographic location were applied.
METHODS OF STUDY SELECTION
Using a predefined protocol and search strategy, 1,152 titles were identified and screened. Randomized controlled trials that compared outpatient and inpatient cervical ripening with balloon catheters were included.
TABULATION, INTEGRATION, AND RESULTS
Data extraction and risk of bias assessments were performed by two reviewers. Meta-analysis was performed to produce mean difference for continuous data and risk ratio (RR) for dichotomous data, both with a 95% CI. The primary outcome was the amount of time from admission to the labor ward until delivery. Additional secondary maternal and neonatal outcomes were evaluated. Eight trials (740 patients) were included; six studies (571 patients) reported on our primary outcome. Compared with the inpatient group, outpatient balloon cervical ripening was associated with significantly less time in the labor and delivery unit (outpatient 16.3±9.7 hours vs inpatient 23.8±14.0 hours; mean difference -7.24 hours, 95% CI -11.03 to -3.34). There were no differences in total induction time or total hospital admission. The outpatient group was significantly less likely than the inpatient group to undergo cesarean delivery (21% vs 27%), RR 0.76 (95% CI 0.59-0.98). There were no differences in other maternal or neonatal outcomes. There were no deliveries outside of the hospital and no stillbirths.
CONCLUSION
Outpatient balloon cervical ripening in low-risk patients is associated with a decreased amount of time from admission to labor and delivery until delivery. Outpatient balloon cervical ripening is a safe alternative for low-risk patients and has the potential for significant benefits to patients, and labor and delivery units.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019140503.
Topics: Ambulatory Care; Cervical Ripening; Delivery Rooms; Female; Humans; Inpatients; Labor, Induced; Outpatients; Pregnancy; Time Factors
PubMed: 34991144
DOI: 10.1097/AOG.0000000000004644 -
Journal of Clinical Nursing Feb 2021The aim of this review was to identify key competences of outpatient nurses, as perceived by patients attending nurse-led clinics. (Review)
Review
AIM
The aim of this review was to identify key competences of outpatient nurses, as perceived by patients attending nurse-led clinics.
BACKGROUND
The increased demand for nurses to manage treatment and care in hospital outpatient clinics requires a better understanding of nurses' competences important to outpatients.
DESIGN
An integrative review using Whittemore and Knafl's five-stage model.
METHODS
Relevant studies were located by systematically searching PubMed, CINAHL and Scopus. A group of three researchers assessed the studies found and the quality of the included studies using the CASP tool. Data were extracted and analysed by thematic analyses. The current study was evaluated using PRISMA checklist.
RESULTS
Nine studies met the inclusion criteria. Three key competences emerged: providing access, sharing knowledge and establishing relationships. The key competences were supported by ten sub-themes that were characterised by nurses' actions and qualities, derived from the included studies.
CONCLUSIONS
The identified key competences reflected a holistic approach that encompasses knowledge, skills and attitudes, indicating outpatient nurses being able to manage different ways of involving patients, which may lead to the consideration of outpatient consultations as a kind of negotiation, based on a respectful dialogue.
RELEVANCE TO CLINICAL PRACTICE
The findings are usable when optimising the performance and quality of the health workforce, including outpatient nurses, as recommended by WHO (World Health Organization, Global strategy on human resources for health: Workforce 2030, 2016). Furthermore, the identified knowledge emphasises the need for clinical skills training and academic education, specially targeted outpatient nurses, in order to enable the nurses to become experts in specific practice settings.
Topics: Clinical Competence; Humans; Nurses; Outpatients; Practice Patterns, Nurses'
PubMed: 33169469
DOI: 10.1111/jocn.15557 -
BMJ (Clinical Research Ed.) Jul 2023
Topics: Humans; State Medicine; Outpatients; Follow-Up Studies; England; Politics
PubMed: 37495245
DOI: 10.1136/bmj.p1689 -
Soins. Gerontologie 2022Outpatient psychiatry and its health action for the elderly has taken a certain boom in the 2010s. The health policies wanted undoubtedly to mitigate the will to close... (Review)
Review
Outpatient psychiatry and its health action for the elderly has taken a certain boom in the 2010s. The health policies wanted undoubtedly to mitigate the will to close hospital beds, and to limit hospitalizations in a good way. Ambulatory teams and governments have often provided the means in terms of personnel and logistics to meet the demands in urban and rural areas. Probably, in the image of the clinical history, this ambulatory effort is necessary and positive for the patient, even if these actions will not be able to replace the hospital care in complex cases.
Topics: Aged; Humans; Outpatients; Psychiatry
PubMed: 35926971
DOI: 10.1016/j.sger.2022.05.007 -
Praxis Sep 2021Outpatient Management of Primary Spontaneous Pneumothorax Pneumothorax (PT) is defined as a collapse of the lung due to the collection of air in the pleural space. In...
Outpatient Management of Primary Spontaneous Pneumothorax Pneumothorax (PT) is defined as a collapse of the lung due to the collection of air in the pleural space. In primary spontaneous pneumothorax (PSP) there is no underlying pulmonary pathology. Treatment, either conservative or invasive, depends on the size of the PT, the patient's clinical situation and the patient's setting/environment. According to the actual literature, the uncomplicated PSP can at best be treated conservatively and on an outpatient basis. Management with intervention (needle aspiration or chest drainage) is historically carried out on an inpatient basis, but outpatient management (without comorbidities and without symptoms) is also possible. In these cases, the patient compliance (motivation, cognition, support, housing situation …) has to be proven. For outpatient management with intervention, a small-caliber chest tube (<14 F) with a Heimlich valve should be used.
Topics: Chest Tubes; Drainage; Humans; Outpatients; Pneumothorax
PubMed: 34465191
DOI: 10.1024/1661-8157/a003723 -
Japan Journal of Nursing Science : JJNS Oct 2023This study aimed to explore the experiences of senior nursing students working in a pediatric outpatient clinic.
OBJECTIVES
This study aimed to explore the experiences of senior nursing students working in a pediatric outpatient clinic.
METHODS
This study adopted a descriptive phenomenological approach, through semi-structured interviews. Purposive sampling was used to select 12 senior nursing students in the pediatric outpatient clinic of West China Second University Hospital, Sichuan University, China, from August 2020 to March 2021. The collected data were analyzed using the Colaizzi method.
RESULTS
Four themes were identified in this study: knowledge and skills (triage, emergency care), communication (courage, communication skills), value re-evaluation (understand of outpatient nurses, judgment of outpatient nurses), and outpatient feelings (satisfaction, empathy, pressure).
CONCLUSION
Pediatric outpatient internships have a positive impact on senior nursing students. Research has found that constructing a nursing clinical practice pathway in pediatric outpatient clinics helps teachers and students clarify the objectives and content of internships, and the "shadow teaching" model is conducive to nursing students' empathy and thinking. In addition, outpatient internship experience can help students gain communication courage.
Topics: Humans; Child; Students, Nursing; Outpatients; Education, Nursing, Baccalaureate; Qualitative Research; Empathy
PubMed: 37470318
DOI: 10.1111/jjns.12553 -
Family Practice Management 2022
Topics: Humans; Outpatients
PubMed: 35014779
DOI: No ID Found -
Drug and Alcohol Dependence Dec 2019Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of... (Review)
Review
BACKGROUND
Systematic reviews and meta-analyses (reviews) conflict regarding the efficacy and feasibility of substance disorder treatments for young people (YP). This overview of reviews, synthesizes, and methodologically assesses reviews examining substance disorder interventions for YP in outpatient settings.
METHODS
Reviews published between 1990 and March 2018 were searched using EBM Reviews, PsycINFO, Embase, Ovid Medline, and Campbell Collaboration. Reviews investigating efficacy and/or feasibility of YP substance disorder treatments in outpatient settings were included.
FORTY-THREE REVIEWS MET ALL INCLUSION CRITERIA
To appraise methodological biases, 40 reviews were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2) and 3 were narratively assessed. One reviewer (NS) extracted study data and evaluated all 43 reviews. For inter-rater reliability, 13 (30%) reviews were extracted and appraised in duplicate by a second reviewer (JA, RC or ES). Agreement on AMSTAR2 ratings reached 100%. Agreement was moderate; κ = .52 (p < .05), 95% CI (.20, .84).
RESULTS
All high quality methodological reviews (n = 6) focused on intervention efficacy and none on treatment feasibility. One (n = 1) high quality review reported evidence for an intervention. Multidimensional Family Therapy (MDFT) has possible efficacy in reducing YP substance use when compared to treatment as usual, Cognitive Behavior Therapy, Adolescent Community Reinforcement Approach and Multifamily Educational Therapy.
CONCLUSIONS
Methodological and reporting quality of reviews require improvement. High quality reviews focused on intervention efficacy but treatments commonly lacked evidence. One high quality review found MDFT demonstrated promising outcomes. Reviews examining feasibility of interventions were of low methodological quality.
Topics: Ambulatory Care; Cognitive Behavioral Therapy; Family Therapy; Humans; Outpatients; Reproducibility of Results; Review Literature as Topic; Substance-Related Disorders; Treatment Outcome
PubMed: 31778903
DOI: 10.1016/j.drugalcdep.2019.107582 -
The Yale Journal of Biology and Medicine Jun 2023Healthcare systems intend to address health needs of a community, but unfortunately may also inadvertently exacerbate the climate crisis through increased greenhouse gas... (Review)
Review
Healthcare systems intend to address health needs of a community, but unfortunately may also inadvertently exacerbate the climate crisis through increased greenhouse gas (GHG) emissions. Clinical medicine has not evolved to promote sustainability practices. New attention to the enormous impact of healthcare systems on GHG emissions and an escalating climate crisis has resulted in some institutions taking proactive measures to mitigate these negative effects. Some healthcare systems have made large-scale changes to conserve energy and materials, resulting in significant monetary savings. In this paper, we share our experience with developing an interdisciplinary work "green" team within our outpatient general pediatrics practice to implement changes, albeit small, to reduce our workplace carbon footprint. We share our experience with reducing paper usage by consolidating vaccine information sheets into a single use information sheet with quick response (QR) codes. We also share ideas for all workplaces to raise awareness of sustainability practices and to foster new ideas to address the climate crisis in both our professional and personal realms. These can help promote hope for the future and shift the collective mindset about climate action.
Topics: Humans; Child; Outpatients; Greenhouse Gases
PubMed: 37396977
DOI: 10.59249/VCAH6394 -
Journal of Hospital Medicine Apr 2022
Topics: Hospitalists; Humans; Outpatients; Telemedicine
PubMed: 35403338
DOI: 10.1002/jhm.12820