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JAMA Network Open May 2021Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated. (Comparative Study)
Comparative Study Meta-Analysis
IMPORTANCE
Arthroscopic meniscectomy is one of the most common orthopedic procedures. The optimal postoperative approach remains debated.
OBJECTIVE
To compare outcomes associated with home-based rehabilitation programs (HBP) vs standard inpatient and/or outpatient supervised physical therapy (IOP) following arthroscopic isolated meniscectomy (AM).
DATA SOURCES
A systematic literature search was conducted on PubMed, Web of Science, Cochrane Library, and Scopus databases on March 15, 2021. The included studies were published from 1982 to 2019.
STUDY SELECTION
Randomized clinical trials of patients treated with HBP vs IOP after AM were included.
DATA EXTRACTION AND SYNTHESIS
Data were independently screened and extracted by 2 authors according to the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guideline. The meta-analysis was performed using a random-effect model; when an I2 < 25% was observed, the fixed-effect model was used. The Hartung-Knapp correction was applied.
MAIN OUTCOMES AND MEASURES
The primary outcome was the Lysholm score (scale of 0-100 with higher scores indicating better knee function) and secondary outcomes were subjective International Knee Documentation Committee (IKDC) score, knee extension and flexion, thigh girth, horizontal and vertical hop test, and days to return to work, as indicated in the PROSPERO registration. Outcomes were measured in the short-term (ranging from 28 to 50 days) and the midterm (6 months).
RESULTS
In this meta-analysis of 8 RCTs including 434 patients, IOP was associated with a greater short-term improvement in Lysholm score compared with HBP, with a mean difference of -8.64 points (95% CI, -15.14 to -2.13 points; P = .02) between the 2 approached, but the sensitivity analysis showed no difference. Similarly, no statistically significant difference was detected at midterm for Lysholm score, with a mean difference between groups of -4.78 points (95% CI, -9.98 to 0.42 points; P = .07). HBP was associated with a greater short-term improvement in thigh girth, with a mean difference between groups of 1.38 cm (95% CI, 0.27 to 2.48 cm; P = .01), whereas IOP was associated with a better short-term vertical hop score, with a mean difference between groups of -3.25 cm (95% CI, -6.20 to -0.29 cm; P = .03). No differences were found for all the other secondary outcomes.
CONCLUSIONS AND RELEVANCE
No intervention was found to be superior in terms of physical and functional outcomes as well as work-related and patient-reported outcomes, both at short-term and midterm follow-up. Overall, these results suggest that HBP may be an effective management approach after AM in the general population.
Topics: Adult; Age Factors; Aged; Female; Home Care Services; Humans; Inpatients; Knee Joint; Male; Meniscectomy; Middle Aged; Outpatients; Patient Satisfaction; Physical Therapy Modalities; Rehabilitation; Sex Factors; Young Adult
PubMed: 34037730
DOI: 10.1001/jamanetworkopen.2021.11582 -
Gastrointestinal Endoscopy Jun 2022
Topics: Endoscopy, Gastrointestinal; Humans; Outpatients
PubMed: 35428489
DOI: 10.1016/j.gie.2022.02.031 -
Gaceta Medica de Mexico 2020User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE).
METHOD
Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach's a, Spearman's correlation and intra-class correlation coefficient (ICC) were used.
RESULTS
Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach's a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman's rho.
CONCLUSION
ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.
Topics: Adolescent; Adult; Ambulatory Care; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Facility Environment; Household Work; Humans; Male; Middle Aged; Outpatients; Patient Admission; Patient Satisfaction; Quality of Health Care; Reproducibility of Results; Statistics, Nonparametric; Surveys and Questionnaires; Young Adult
PubMed: 32026871
DOI: 10.24875/GMM.19005144 -
JAMA Network Open May 2023
Topics: Humans; Outpatients; Antimicrobial Stewardship; Anti-Bacterial Agents
PubMed: 37166803
DOI: 10.1001/jamanetworkopen.2023.12996 -
Pain Practice : the Official Journal of... Sep 2023
Topics: Humans; Outpatients; Low Back Pain
PubMed: 37256548
DOI: 10.1111/papr.13242 -
International Journal For Quality in... Feb 2021Currently, outpatient care in the UK is expensive and needs improvement, with traditional systems having been identified as no longer fit for purpose. Making sustainable...
Currently, outpatient care in the UK is expensive and needs improvement, with traditional systems having been identified as no longer fit for purpose. Making sustainable changes to outpatient appointment systems is vital in order to meet increasing demands and cost. Shifting to data and technology-driven outpatient care may be one way to tackle these demands. As technology becomes more diverse and accessible, its implementation into healthcare systems can make services more efficient and help with transitioning from outdated practices to more effective protocols. Patient Recorded Outcome Measures (PROMs) and home-monitoring devices could be the key step in identifying which patients require input and help shift to more data-driven appointment scheduling based on clinical need, rather than at regular intervals of time. Virtual care and technology-driven service provision could also revolutionise outpatient systems, maintaining high quality care while improving accessibility to patients. Patient involvement and empowerment while making these changes will assist shared decision making surrounding their care and allow them to be champions of their own health, helping clinicians to provide a patient-centred service. Understanding how these may be implemented will help clinicians take an active role in the development of these practices.
Topics: Ambulatory Care; Appointments and Schedules; Humans; Outpatients; Quality of Health Care; State Medicine
PubMed: 33351094
DOI: 10.1093/intqhc/mzaa150 -
Der Urologe. Ausg. A Oct 2021With the introduction of the MDK (Medizinischer Dienst der Krankenversicherung) Reform Act, there have been multiple new regulations for hospitals, some of which are... (Review)
Review
BACKGROUND
With the introduction of the MDK (Medizinischer Dienst der Krankenversicherung) Reform Act, there have been multiple new regulations for hospitals, some of which are confusing and interact with one another. A major focus of the legal changes is directly or indirectly on expanding the provision of outpatient services.
OBJECTIVES
It can be assumed that-as a result of the new version of the framework conditions and the AOP catalog-the relevant OPS list will be expanded in the future. With the revision of the AOP catalog and the effects of the MDK Reform Act, the number of cases with outpatient potential will increase. Can the effects and challenges for hospitals and especially urology be identified?
METHODS
Evaluation of official statistics of inpatient and outpatient treatments. Focusing on the problem based on a fictitious practical example from urology.
RESULTS
A strategy is developed for dealing with cases with outpatient potential and identification of different solutions to compensate for this shift in services and enabling an increase in performance or a deliberate reduction in the provision of services.
CONCLUSIONS
The choice of the type of service provision is increasingly no longer an issue, and the short-term inpatient treatment of many urological cases is coming under considerable pressure due to political measures such as the MDK Reform Act and the demands of health insurance companies. The reduction of different parts of the inpatient reimbursement for special patient groups must be anticipated. Individual strategies will range from simply not providing outpatient services to complex models of cooperation. This change also means opportunities for hospitals!
Topics: Ambulatory Care; Hospitalization; Humans; Outpatients; Urology
PubMed: 34476550
DOI: 10.1007/s00120-021-01624-3 -
Der Internist Sep 2020Outpatient specialist medical care targets the intersectoral and interdisciplinary cooperation between hospital physicians and panel physician structures in the... (Review)
Review
Outpatient specialist medical care targets the intersectoral and interdisciplinary cooperation between hospital physicians and panel physician structures in the diagnostics and treatment of certain disease symptoms under the same framework conditions. The administrative coordination bundled through one person has contributed to an effective placement of applications. In this way the daunting effect of bureaucratic hurdles for potential team members could be intercepted. A close and constructive collaboration of all participants is helpful to come to terms with the new treatment structure and to achieve the anticipated targets for patients, panel physicians and hospitals.
Topics: Ambulatory Care; Humans; Outpatients; Patient Care Team; Practice Guidelines as Topic; Rheumatology; Specialization
PubMed: 32681226
DOI: 10.1007/s00108-020-00841-w -
Praxis Feb 2024
Topics: Humans; Outpatients; Ambulatory Care; Delivery of Health Care
PubMed: 38536189
DOI: No ID Found -
Clinical Infectious Diseases : An... May 2023
Topics: Humans; Outpatients; Anti-Infective Agents; Anti-Bacterial Agents
PubMed: 36633574
DOI: 10.1093/cid/ciad018