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International Journal of Environmental... Jun 2021Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the...
Ongoing demographic change is leading to an increasingly older society and a rising proportion of people in need of care in the German population. Therefore, the professional group of outpatient caregivers is highly relevant. Their work is characterised not only by interacting with patients in a mobile setting but also by working in shifts. Health behaviour under these specific working conditions is crucial for ensuring long-term work ability and performance. Little is known about the health behaviour of German outpatient caregivers and its potential impact on their work. The aims of the study were (1) to examine health behavioural patterns (nutrition, exercise, smoking, regeneration) of outpatient caregivers, (2) to illuminate their personal health-promoting behaviours, and (3) to identify potential work-related factors influencing their health behaviour. Fifteen problem-centred interviews were conducted with outpatient caregivers working in Northern Germany in the period January-April 2020. Interviews were analysed by using qualitative content analysis. Outpatient caregivers reported improvable nutrition and hydration, with simultaneous high coffee consumption, low physical activity, poor regeneration (breaks and sleep quality), and good personal health-promoting behaviour (e.g., back-friendly habits), although the majority were smokers. Barriers to the implementation of health-promoting behaviours were a high perception of stress due to increased workload and time pressure, while aids to better health-promoting behaviour were described as being social support and personal resources. The respondents perceived their working conditions as potentially influencing their health behaviour. On the basis of their descriptions, various practice-relevant strategies were derived. The data explore a potential need for outpatient care services to develop interventions on behavioural and structural levels that can help create healthier working conditions for their employees so these caregivers can adopt better health behaviours.
Topics: Caregivers; Germany; Health Behavior; Humans; Outpatients; Qualitative Research
PubMed: 34205961
DOI: 10.3390/ijerph18115942 -
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 -
The Knee Jun 2023The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy... (Review)
Review
BACKGROUND
The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy compared to conventional methods, and (2) the therapeutic indications, safety, and reported outcomes.
METHODS
Searches of three databases (MEDLINE, Embase and PubMed) were conducted in November 2021 using MeSH terms: 'needle arthroscopy', 'human', 'in office arthroscopy', 'needle arthroscope', 'nanoscopic', 'surgery', 'nanoscope' and 'percutaneous arthroscopy'. The included studies were catalogued, quality-assessed using Methodological Index for Non-Randomised Studies (MINORS), and analysed using the Cochrane data collection templates for randomised control trials (RCT) and non-randomised control trials (non-RCT). The majority of studies were non-numerical and were examined using qualitative analysis.
RESULTS
The search yielded 314 studies, 22 of which were included for analysis. MINORS assessment was applicable to four studies. Mean MINORS was 10.7/16 with the most frequent limitations being lack of unbiased endpoint or sample size calculation. The level of evidence ranged from level IV-V. Diagnostic and therapeutic indications were described in relation to the: knee (n = 10); shoulder (n = 6); foot/ankle (n = 3); elbow (n = 2), and miscellaneous (n = 1).
CONCLUSIONS
Needle arthroscopy can augment the diagnostic process in patients presenting with musculoskeletal complaints, and may provide benefits in terms of diagnostic accuracy, cost efficiency, timeliness of investigation, and a visually impactful patient-centred consultation. Therapeutic interventions are reported by a small number of pioneer groups who report some benefits over conventional arthroscopy. The available literature remains small and of low quality, and more evidence is needed with regards to patient selection, efficacy, safety, and cost.
LEVEL OF EVIDENCE
Level V (based on the weakest study included in the Systematic Review).
Topics: Humans; Arthroscopy; Outpatients
PubMed: 37105012
DOI: 10.1016/j.knee.2023.04.003 -
Clinical Imaging Feb 2022Medical centers have dramatically increased the use of magnetic resonance imaging (MRI). At 2 large academic tertiary care centers in New York City, nearly half of...
INTRODUCTION
Medical centers have dramatically increased the use of magnetic resonance imaging (MRI). At 2 large academic tertiary care centers in New York City, nearly half of inpatient MRI orders took more than 12 h to complete, delaying patient discharge and increasing avoidable hospital days. We posited that transitioning inpatient MRIs to outpatient facilities, when safe and appropriate, could reduce inpatient MRI orders and avoidable hospital days.
METHODS
We manually reviewed 59 inpatient MRI orders delayed on the estimated date of discharge (EDD). These orders were often delayed due to no standard process to escalate orders for medical reasons or no system to coordinate outpatient orders. We developed a revised workflow involving an automation platform that flagged inpatient MRI orders requested within 24 h of the EDD and emailed the care team to request a second review of the order. The care team reconsidered whether the order was (1) required for discharge, (2) non-urgent and could be converted to an outpatient order, or (3) unnecessary and could be canceled.
RESULTS
Over 9 months, the automation platform flagged 618 inpatient MRI orders, of which 53.9% (333/618) were reviewed by the care team. Among the orders, 24.0% (80/333) of reviewed orders and 12.9% (80/618) of all orders were transitioned to either outpatient or canceled orders. These transitioned orders were associated with 267 fewer avoidable hospital days and a cost savings of $199,194.
CONCLUSION
A standardized process and second review of inpatient MRI orders on the EDD can reduce inappropriate orders and more effectively use inpatient imaging resources.
PRECIS
A standardized workflow and automation platform encouraged a second review of inpatient MRI orders to reduce inappropriate orders, avoidable hospital days, and hospital costs.
Topics: Hospitals; Humans; Inpatients; Magnetic Resonance Imaging; Outpatients; Workflow
PubMed: 34844100
DOI: 10.1016/j.clinimag.2021.11.014 -
Journal of Patient-reported Outcomes Aug 2023To further develop the Person-Centred Care instrument for outpatient care (PCCoc), evaluate its user-friendliness and content validity, and to explore its basic...
AIM
To further develop the Person-Centred Care instrument for outpatient care (PCCoc), evaluate its user-friendliness and content validity, and to explore its basic psychometric properties in various outpatient settings for adults with long-term conditions.
BACKGROUND
Person-centred care (PCC) has been identified as a key factor to provide high-quality care. However, there is still a lack of instruments that are based on a clearly defined framework for PCC for persons with long-term conditions in an outpatient context. The PCCoc is a patient-reported experience measure under development aiming to fill this gap.
METHODS
First, the 35-item PCCoc was reviewed and further developed in collaboration with a user-council. Second, the revised 36-item PCCoc was tested among persons receiving outpatient care for various long-term conditions. A total of 179 persons with long-term conditions from four different specialties participated in the study. User-friendliness and content validity were assessed through structured interviews and relevance ratings of each item. Content validity index (CVI) for individual items (I-CVI) and for the overall scale (S-CVI) were calculated, and basic psychometric properties of the PCCoc using classical test theory were explored.
RESULTS
It took a median of 8 min for participants to complete the PCCoc. The majority found items easy to understand, response categories distinct and that no important areas were missing. Results from the CVI analyses suggested that participants found the content of the PCCoc relevant (I-CVI range 0.82-1, S-CVI = 0.95). All psychometric properties examined were satisfactory (e.g., item-total correlations, 0.45-0.75; Cronbach's alpha, 0.96; test-retest stability, 0.83).
CONCLUSION
The PCCoc was considered user-friendly and relevant by the intended users, and its psychometric properties were satisfactory. This implies that the PCCoc can be a valuable instrument for evaluating and developing PCC in outpatient care for persons with long-term conditions. However, further studies of the PCCoc are needed to establish its measurement properties in various outpatient settings.
Topics: Adult; Humans; Outpatients; Ambulatory Care; Medicine; Patient-Centered Care; Psychometrics
PubMed: 37610497
DOI: 10.1186/s41687-023-00623-6 -
Medicine Feb 2022This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual...
This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; COVID-19; Female; Humans; Internal Medicine; Male; Middle Aged; Outpatients; Pandemics; Pediatrics; SARS-CoV-2; Telemedicine; Young Adult
PubMed: 35212289
DOI: 10.1097/MD.0000000000028884 -
Clinical Journal of the American... Mar 2021
Topics: Deep Learning; Humans; Outpatients; Renal Dialysis
PubMed: 33574057
DOI: 10.2215/CJN.00450121 -
Illnesses and hardship financing in India: an evaluation of inpatient and outpatient cases, 2014-18.BMC Public Health Jan 2023Progress towards universal health coverage requires strengthening the country's health system. In developing countries, the increasing disease burden puts a lot of...
BACKGROUND
Progress towards universal health coverage requires strengthening the country's health system. In developing countries, the increasing disease burden puts a lot of stress on scarce household finances. However, this burden is not the same for everyone. The economic burden varies across the disease groups and care levels. Government intervention is vital in formulating policies in addressing financial distress at the household level. In India, even when outpatient care forms a significant proportion of out-of-pocket expenditure, government schemes focus on reducing household expenditure on inpatient care alone. Thus, people resort to hardship financing practices like informal borrowing or selling of assets in the event of health shocks. In this context, the present study aims to identify the disease(s) that correlates with maximum hardship financing for outpatients and inpatients and to understand the change in hardship financing over time.
METHODS
We used two waves of National Sample Survey Organisation's data on social consumption on health- the 71 and the 75 rounds. Descriptive statistics are reported, and logistic regression is carried out to explain the adjusted impact of illness on hardship financing. Pooled logistic regression of the two rounds is estimated for inpatients and outpatients. Marginal effects are reported to study the changes in hardship financing over time.
RESULTS
The results suggest that cancer had the maximum likelihood of causing hardship financing in India for both inpatients (Odds ratio 2.41; 95% Confidence Interval (CI): 2.03 - 2.86 (71 round), 2.54; 95% CI: 2.21 - 2.93 (75 round)) and outpatients (Odds ratio 6.11; 95% CI: 2.95 - 12.64 (71 round), 3.07; 95% CI: 2.14 - 4.40 (75 round)). In 2018, for outpatients, the hardship financing for health care needs was higher at public health facilities, compared to private health facilities (Odds ratio 0.72; 95% CI: 0.62 - 0.83 (75 round). The marginal effects model of pooled cross-section analysis reveals that from 2014 to 2018, the hardship financing had decreased for inpatients (Odds ratio 0.747; 95% CI:0.80 - -0.70), whereas it had increased for outpatients (Odds ratio 0.0126; 95% CI: 0.01 - 0.02). Our results also show that the likelihood of resorting to hardship financing for illness among women was lesser than that of men.
CONCLUSION
Government intervention is quintessential to decrease the hardship financing caused by cancer. The intra-household inequalities play an important role in explaining their hardship financing strategies. We suggest the need for more financial risk protection for outpatient care to address hardship financing.
Topics: Male; Humans; Female; Inpatients; Outpatients; Financing, Personal; Delivery of Health Care; Health Expenditures; India
PubMed: 36717824
DOI: 10.1186/s12889-023-15062-7 -
PloS One 2023Reasonable and accurate forecasting of outpatient visits helps hospital managers optimize the allocation of medical resources, facilitates fine hospital management, and...
BACKGROUND
Reasonable and accurate forecasting of outpatient visits helps hospital managers optimize the allocation of medical resources, facilitates fine hospital management, and is of great significance in improving hospital efficiency and treatment capacity.
METHODS
Based on conjunctivitis outpatient data from the First Affiliated Hospital of Xinjiang Medical University Ophthalmology from 2017/1/1 to 2019/12/31, this paper built and evaluated Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) models for outpatient visits prediction.
RESULTS
In predicting the number of conjunctivitis visits over the next 31 days, the LSTM model had a root mean square error (RMSE) of 2.86 and a mean absolute error (MAE) of 2.39, the GRU model has an RMSE of 2.60 and an MAE of 1.99.
CONCLUSIONS
The GRU method can better predict trends in hospital outpatient flow over time, thus providing decision support for medical staff and outpatient management.
Topics: Humans; Outpatients; Conjunctivitis; Health Personnel; Hospitals; Medical Staff
PubMed: 37733673
DOI: 10.1371/journal.pone.0290541