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European Annals of Otorhinolaryngology,... Jan 2022The main objective of this study was to determine the rate of outpatient management in a population of patients undergoing bilateral ethmoidectomy. The secondary... (Observational Study)
Observational Study
OBJECTIVES
The main objective of this study was to determine the rate of outpatient management in a population of patients undergoing bilateral ethmoidectomy. The secondary objectives were to evaluate the quality of outpatient management (rate of unscheduled overnight admission, readmission rate, complications) and to compare inpatient and outpatient groups to determine which elements of the phenotype and care pathway favored outpatient management.
MATERIALS AND METHODS
A single-center observational study included 204 patients operated on for bilateral ethmoidectomy. Study variables comprised: type of care pathway (outpatient/inpatient), outpatient quality indicators (unscheduled admission, readmission, complications), care pathway, and population characteristics.
RESULTS
One hundred and twenty (58.8%) outpatients were operated on. No deaths occurred. The unscheduled admission rate was 7.5%, and the readmission rate 4.1%; at the P<0.005 threshold, there were no significant differences between in- and out-patient groups. Outpatients had earlier surgery (P<0.005), and nasal packing rates and pain on VAS were lower (P<0.005).
CONCLUSION
Ethmoidectomy could be carried out as an outpatient procedure in 58.8% of cases, with acceptable quality of care. Selection of patients and the organization of a dedicated care pathway seem to be elements favoring this management.
Topics: Ambulatory Surgical Procedures; Ethmoid Sinus; Humans; Outpatients; Patient Readmission; Postoperative Complications; Retrospective Studies
PubMed: 34083168
DOI: 10.1016/j.anorl.2021.05.003 -
Best Practice & Research. Clinical... Jun 2021This chapter explores ways to reduce the risk of severe acute respiratory syndrome coronavirus-2 transmission to women and staff within gynaecology outpatient clinics.... (Review)
Review
This chapter explores ways to reduce the risk of severe acute respiratory syndrome coronavirus-2 transmission to women and staff within gynaecology outpatient clinics. The likely routes of transmission are discussed, namely through droplets, aerosols and fomites. Using the 'hierarchy of control' categories, elimination, substitution, engineering, administration and personal protective equipment, practical strategies for modifying virus exposure are presented. The management of specific clinical conditions are reviewed based on advice prepared by the specialist societies in conjunction with each other and the Royal College of Obstetricians and Gynaecologists. The need to maintain at least a minimal level of gynaecological services is recognised and that this should provide safe, equitable and effective care. Ways to reduce clinic attendance are discussed with the substitution of face-to-face with remote consultations and when this is relevant. Current recommendations for ambulatory procedures, which include colposcopy and hysteroscopy, are considered so that best use is made of reduced resources.
Topics: Ambulatory Care Facilities; COVID-19; Female; Gynecology; Humans; Outpatients; SARS-CoV-2
PubMed: 33903030
DOI: 10.1016/j.bpobgyn.2021.03.006 -
Family Practice Management 2022
Topics: Humans; Outpatients
PubMed: 35014779
DOI: No ID Found -
Journal of Palliative Medicine Jul 2021Understanding challenges of family caregivers within specific palliative care contexts is needed. To describe the challenges of family caregivers of patients with...
Understanding challenges of family caregivers within specific palliative care contexts is needed. To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.
Topics: Ambulatory Care; Caregivers; Family; Humans; Outpatients; Palliative Care
PubMed: 33691072
DOI: 10.1089/jpm.2021.0010 -
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 -
Deutsches Arzteblatt International Feb 2024Approximately 8.1 million outpatient surgical procedures were performed in Germany in 2021. Little is known about the quality of postoperative pain treatment in the... (Observational Study)
Observational Study
BACKGROUND
Approximately 8.1 million outpatient surgical procedures were performed in Germany in 2021. Little is known about the quality of postoperative pain treatment in the outpatient sector.
METHODS
The AQS1 project comprises a combined survey of patients and staff in the framework of quality control for ambulatory surgery. The primary endpoint of this study was the prevalence of relevant incisional pain (≥ 4/10 on the numerical rating scale) up to postoperative day 3. Secondary endpoints included prognostic variables for pain and pain-associated outcomes, based on the AQS1 patient questionnaire. Moreover, mixed regression models were used to analyze potential prognostic variables and associations of pain with other outcomes (study registration number DRKS00028052).
RESULTS
Data from 330 008 patients were evaluated (from 1 July 2001 to 31 December 2021). The overall prevalence of relevant incisional pain up to postoperative day 3 was 22.5%, with major differences between different types of procedure (3.2%-51.2%). Pain was most common after hemorrhoid surgery (51.2%) and the laparoscopic lysis of large and small bowel adhesions (45.4%). The main associations of relevant pain were with younger age (odds ratio [OR] 1.87, 95% confidence interval [1.82; 1.91]), early postoperative pain (1.34, [1.30; 1.39]), inadequate provision of analgesics (2.90, [2.71; 3.09]), and surgical wound infections (2.60, [2.43; 2.78]). Patients with pain reported lower overall satisfaction with the procedure and a longer inability to work.
CONCLUSION
These data have not been tested for representativeness. They can serve as a point of departure for the optimization of individualized perioperative pain therapy and for the planning of prospective studies.
Topics: Humans; Ambulatory Surgical Procedures; Prospective Studies; Outpatients; Pain, Postoperative; Analgesics
PubMed: 37967288
DOI: 10.3238/arztebl.m2023.0235 -
PloS One 2022Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks...
INTRODUCTION
Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks within these years and faced many inadequacies and shortages of resources and hospital beds. Hence the healthcare system started using in-hospital medication such as Remdesivir in outpatients to reduce the load of patients admitted to the hospital. This study aimed to evaluate and compare the reported signs, symptoms, and outcomes of COVID-infected hospitalized and out-patients receiving Remdesivir.
METHODS
In this retrospective cohort study, 214 patients (121 outpatient and 93 hospitalized) with moderate levels of Covid infection between October 2021 and February 2022 were studied. Both groups were treated with 200mg of Remdesivir, followed by 100 mg daily intravenous injections for five days; signs and symptoms, such as pain, shortness of breath, cough, fever and etc., of patients at the initiation and the end of treatment were recorded. Moreover, the patients' blood oxygen saturation was assessed two to three times a day, and the mean of the recorded measures was considered as the daily oxygen saturation. The outpatient group had to visit the hospital daily for treatment and assessment. At the treatment's end, mortality rates, disease signs, and symptoms alleviations were compared between the groups.
RESULTS
The outpatient and hospitalized group's mean age was 40.30 ± 12.25 and 37.70 ± 12.00 years, and 51.2% and 55.9% were males, respectively. There was no statistical difference between baseline and clinical characteristics in the outpatients and hospitalized groups. After adjusting for oxygen saturation at baseline and gender in the multivariable Cox regression analysis, the risk of death did not statistically differ between the hospitalized and outpatient group (hazard ratio: 0.99, 95% confidence interval: 0.39-2.50)) at the end of the study.
CONCLUSION
Based on the results of this study, the outcome, signs, and symptoms of inpatient and outpatient Remdesivir treatment groups did not differ significantly. Hence in COVID-19 surges where we have limitations in admitting patients, outpatient Remdesivir treatment for those without any underlying diseases can be a proper management method.
Topics: Male; Humans; Adult; Middle Aged; Female; Outpatients; SARS-CoV-2; Inpatients; Prognosis; Retrospective Studies; COVID-19 Drug Treatment
PubMed: 36356035
DOI: 10.1371/journal.pone.0277413 -
International Journal For Equity in... Aug 2023Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is...
BACKGROUND
Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance.
METHODS
This study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017-2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances.
RESULTS
Except for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%).
CONCLUSIONS
The priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.
Topics: Aged; Humans; Health Expenditures; Outpatients; Multimorbidity; Health Status; China
PubMed: 37580728
DOI: 10.1186/s12939-023-01953-z -
Frontiers in Public Health 2022This study aimed to explore the time-series relationship between air pollutants and the number of children's respiratory outpatient visits in coastal cities.
OBJECTIVE
This study aimed to explore the time-series relationship between air pollutants and the number of children's respiratory outpatient visits in coastal cities.
METHODS
We used time series analysis to investigate the association between air pollution levels and pediatric respiratory outpatient visits in Zhoushan city, China. The population was selected from children aged 0-18 who had been in pediatric respiratory clinics for eight consecutive years from 2014 to 2020. After describing the population and weather characteristics, a lag model was used to explore the relationship between outpatient visits and air pollution.
RESULTS
We recorded annual outpatient visits for different respiratory diseases in children. The best synergy lag model found a 10 μg/m increase in PM for every 4-10% increase in the number of pediatric respiratory outpatient visits ( < 0.05). The cumulative effect of an increase in the number of daily pediatric respiratory clinics with a lag of 1-7 days was the best model.
CONCLUSIONS
PM is significantly related to the number of respiratory outpatient visits of children, which can aid in formulating policies for health resource allocation and health risk assessment strategies.
Topics: Air Pollutants; Air Pollution; Child; China; Humans; Outpatients; Particulate Matter
PubMed: 35444995
DOI: 10.3389/fpubh.2022.865798 -
Revista Da Escola de Enfermagem Da U S P 2022To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds.
OBJECTIVE
To analyze the average direct costs of outpatient, hospital, and home care provided to patients with chronic wounds.
METHOD
Quantitative, exploratory-descriptive case study, carried out in a Comprehensive Wound Care Unit. Costs were obtained by multiplying the time spent by professionals by the unit cost of labor in the respective category, adding to the costs of materials and topical therapies.
RESULTS
Outpatient care costs corresponded to US$4.25 (SD ± 7.60), hospital care to US$3.87 (SD ± 17.27), and home care to US$3.47 (SD ± 5.73). In these three modalities, direct costs with dressings and medical consultations were the most representative: US$7.76 (SD ± 9.46) and US$6.61 (SD ± 6.54); US$7.06 (SD ± 24.16) and US$15.60 (SD ± 0.00); US$4.09 (SD ± 5.28) and US$15.60 (SD ± 0.00), respectively.
CONCLUSION
Considering comprehensive care for patients with chronic wounds, the mean total direct cost was US$10.28 (SD ± 17.21), with the outpatient modality being the most representative in its composition. There was a statistically significant difference (p value = 0.000) between the costs of home and outpatient, home and hospital, and outpatient and hospital care.
Topics: Humans; Outpatients; Home Care Services; Hospitals; Ambulatory Care; Bandages; Graft vs Host Disease
PubMed: 36448569
DOI: 10.1590/1980-220X-REEUSP-2022-0295en