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JAMA Internal Medicine Jan 2022Systemic corticosteroids are commonly used in treating severe COVID-19. However, the role of inhaled corticosteroids in the treatment of patients with mild to moderate... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Systemic corticosteroids are commonly used in treating severe COVID-19. However, the role of inhaled corticosteroids in the treatment of patients with mild to moderate disease is less clear.
OBJECTIVE
To determine the efficacy of the inhaled steroid ciclesonide in reducing the time to alleviation of all COVID-19-related symptoms among nonhospitalized participants with symptomatic COVID-19 infection.
DESIGN, SETTING, AND PARTICIPANTS
This phase 3, multicenter, double-blind, randomized clinical trial was conducted at 10 centers throughout the US and assessed the safety and efficacy of a ciclesonide metered-dose inhaler (MDI) for treating nonhospitalized participants with symptomatic COVID-19 infection who were screened from June 11, 2020, to November 3, 2020.
INTERVENTIONS
Participants were randomly assigned to receive ciclesonide MDI, 160 μg per actuation, for a total of 2 actuations twice a day (total daily dose, 640 μg) or placebo for 30 days.
MAIN OUTCOMES AND MEASURES
The primary end point was time to alleviation of all COVID-19-related symptoms (cough, dyspnea, chills, feeling feverish, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell) by day 30. Secondary end points included subsequent emergency department visits or hospital admissions for reasons attributable to COVID-19.
RESULTS
A total of 413 participants were screened and 400 (96.9%) were enrolled and randomized (197 [49.3%] in the ciclesonide arm and 203 [50.7%] in the placebo arm; mean [SD] age, 43.3 [16.9] years; 221 [55.3%] female; 2 [0.5%] Asian, 47 [11.8%] Black or African American, 3 [0.8%] Native Hawaiian or other Pacific Islander, 345 [86.3%] White, and 1 multiracial individuals [0.3%]; 172 Hispanic or Latino individuals [43.0%]). The median time to alleviation of all COVID-19-related symptoms was 19.0 days (95% CI, 14.0-21.0) in the ciclesonide arm and 19.0 days (95% CI, 16.0-23.0) in the placebo arm. There was no difference in resolution of all symptoms by day 30 (odds ratio, 1.28; 95% CI, 0.84-1.97). Participants who were treated with ciclesonide had fewer subsequent emergency department visits or hospital admissions for reasons related to COVID-19 (odds ratio, 0.18; 95% CI, 0.04-0.85). No participants died during the study.
CONCLUSIONS AND RELEVANCE
The results of this randomized clinical trial demonstrated that ciclesonide did not achieve the primary efficacy end point of reduced time to alleviation of all COVID-19-related symptoms.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04377711.
Topics: Administration, Inhalation; Adolescent; Adult; Ambulatory Care Facilities; COVID-19; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Metered Dose Inhalers; Middle Aged; Outpatients; Pregnenediones; COVID-19 Drug Treatment
PubMed: 34807241
DOI: 10.1001/jamainternmed.2021.6759 -
Nephrology, Dialysis, Transplantation :... Sep 2018Onconephrology is a rapidly evolving subspeciality that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from... (Review)
Review
Onconephrology is a rapidly evolving subspeciality that covers all areas of renal involvement in cancer patients. The complexity of the field may benefit from well-defined multidisciplinary management administered by a dedicated team. Since there is an increasing need to address the needs of this population in dedicated outpatient clinics, it is critical to highlight basic characteristics and to suggest areas of development. In this brief perspective article, we analyse the requirements of an onconephrology clinic in terms of logistics, critical mass of patients and building a multidisciplinary team. We will further discuss which patients to refer and which conditions to treat. The last part of the article is dedicated to education and performance indicators and to analysis of the potential advantages of applying the hub-and-spoke model to this field. The ultimate aim of this experience-based article is to initiate debate about what an onconephrology outpatient clinic might look like in order to ensure the highest quality of care for this growing population of patients.
Topics: Ambulatory Care Facilities; Humans; Interdisciplinary Communication; Kidney Neoplasms; Medical Oncology; Nephrology
PubMed: 29982771
DOI: 10.1093/ndt/gfy188 -
Journal of General Internal Medicine Jul 2018
Topics: Ambulatory Care Facilities; Attitude to Death; Humans; Medicine in Literature; Physician's Role
PubMed: 29687434
DOI: 10.1007/s11606-018-4420-z -
Nephrology, Dialysis, Transplantation :... Mar 2020People with advanced chronic kidney disease and evidence of progression have a high risk of renal replacement therapy. Specialized transition clinics could offer a... (Review)
Review
People with advanced chronic kidney disease and evidence of progression have a high risk of renal replacement therapy. Specialized transition clinics could offer a better option for preparing these patients for dialysis, transplantation or conservative care. This review focuses on the different aspects of such transition clinics. We discuss which patients should be referred to these units and when referral should take place. Patient involvement in the decision-making process is important and requires unbiased patient education. There are many themes, both patient-centred and within the healthcare structure, that will influence the process of shared decision-making and the modality choice. Aspects of placing an access for haemodialysis and peritoneal dialysis are reviewed. Finally, we discuss the importance of pre-emptive transplantation and a planned dialysis start, all with a focus on multidisciplinary collaboration at the transition clinic.
Topics: Ambulatory Care Facilities; Delivery of Health Care; Disease Progression; Humans; Patient Participation; Renal Dialysis; Renal Insufficiency, Chronic; Renal Replacement Therapy
PubMed: 32162667
DOI: 10.1093/ndt/gfaa022 -
BMJ Open Mar 2024There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This...
OBJECTIVES
There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria.
DESIGN, SETTING AND PARTICIPANTS
Two cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada.
MEASURES
Twenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa).
RESULTS
Responses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes-criteria also consistent with guidelines.
CONCLUSIONS
There is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.
Topics: Humans; Cross-Sectional Studies; Heart Failure; Ambulatory Care Facilities; Hospitalization; Surveys and Questionnaires
PubMed: 38485484
DOI: 10.1136/bmjopen-2023-076664 -
Revista de NeurologiaThe current level of technological progress in the methods of diagnosis and treatment of epilepsies requires certain resources to be concentrated in so-called epilepsy... (Review)
Review
AIMS
The current level of technological progress in the methods of diagnosis and treatment of epilepsies requires certain resources to be concentrated in so-called epilepsy clinics (EC) or centres.
DEVELOPMENT
Although many epileptic patients can be diagnosed and treated by clinicians who are not specialized in epilepsies, those whose diagnosis is not totally sure and those who do not have their seizures completely controlled should be referred to an EC. EC are stratified according to the degree of complexity of the studies and therapeutic measures carried out there, the most important being video-EEG monitoring and epilepsy surgery. Moreover, they can be both medical and medical-surgical EC, and may be basic or a reference in their field. If they are properly adapted to a certain volume of population by gradually meeting the local medical and social requirements until they reach an optimum level of development, they can be extremely effective and efficient. The different regional EC must be connected to one another and cooperate with common guidelines for action that have been commonly agreed to by all the centres. They must also allow a bidirectional flow of patients. Every EC must fulfil certain minimum requirements to guarantee the quality of the health care offered there.
CONCLUSIONS
Doctors who attend people with epilepsy, with the support of the health authorities, must promote the setting up and development of EC, in order to achieve the maximum possible control over the seizures and a better quality of life for the epileptic patient.
Topics: Ambulatory Care Facilities; Anticonvulsants; Electroencephalography; Epilepsy; Humans; Neurology; Videotape Recording
PubMed: 14593643
DOI: No ID Found -
Physical Therapy Sep 2008
Topics: Ambulatory Care Facilities; Humans; Low Back Pain; Outcome and Process Assessment, Health Care; Physical Therapy Modalities; Physical Therapy Specialty; Quality of Health Care; Workforce
PubMed: 18757442
DOI: 10.2522/ptj.20070110.ic1 -
Fertility and Sterility Jan 2022When a diverse group of individuals is working together in the contemporary fertility clinic to provide time-sensitive and complex care for patients, a high degree of... (Review)
Review
When a diverse group of individuals is working together in the contemporary fertility clinic to provide time-sensitive and complex care for patients, a high degree of coordination and collaboration must take place. When performed dynamically, this process is referred to as teaming. Although the positive impact of teamwork in health care settings has been well established in the literature, the concept of teaming has limited foundation in the clinic. This review will provide an overview of how teaming can be used to improve patient care in today's fertility clinics. Approaches to integrating teaming into the clinic that will be discussed include framing, the creation of a psychologically safe environment for staff input, and facilitating collaborative constructs to support teaming. Best practices to implement teaming and how to address challenges to teaming in today's clinical environment will also be addressed.
Topics: Ambulatory Care Facilities; Calibration; Delivery of Health Care; Female; Fertility Clinics; Humans; Male; Organizational Culture; Patient Care; Patient Care Team; Precision Medicine; Pregnancy
PubMed: 34753600
DOI: 10.1016/j.fertnstert.2021.09.032 -
Knee Surgery, Sports Traumatology,... Jun 2020The aim of this manuscript is to review the available strategies in the international literature to efficiently and safely return to both normal orthopaedic surgical... (Review)
Review
PURPOSE
The aim of this manuscript is to review the available strategies in the international literature to efficiently and safely return to both normal orthopaedic surgical activities and to normal outpatient clinical activities in the aftermath of a large epidemic or pandemic. This information would be beneficial to adequately reorganize outpatient clinics and hospitals to provide the highest possible level of orthopaedic care to our patients in a safe and efficient manner.
METHODS
A literature search was performed for relevant research articles. In addition, the World Health Organisation (WHO), the US Centers for Disease Control (CDC), American Association of Orthopaedic Surgeons (AAOS), the EU CDC and other government health agency websites were searched for any relevant information. In particular, interest was paid to strategies and advise on managing the orthopaedic patient flow during outpatient clinics as well as surgical procedures including the necessary safety measures, while still providing a high-quality patient experience. The obtained information is provided as a narrative review.
RESULTS
There was not any specific literature concerning the organization of an outpatient clinic and surgical activities and the particular challenges in dealing with a high-volume practice, in the afterwave of a pandemic.
CONCLUSION
As the COVID-19 crisis has abruptly halted most of the orthopaedic activities both in the outpatient clinic and the operating room, a progressive start-up scenario needs to be planned. The exact timing largely depends on factors outside of our control. After restrictions will be lifted, clinical and surgical volume will progressively increase. This paper offers key points and possible strategies to provide the highest level of safety to both the orthopaedic patient and the orthopaedic team including administrative staff and nurses, during the start-up phase.
LEVEL OF EVIDENCE
Review, Level V.
Topics: Ambulatory Care Facilities; Betacoronavirus; COVID-19; Coronavirus Infections; Disease Transmission, Infectious; Efficiency, Organizational; Humans; Infection Control; Orthopedic Procedures; Orthopedics; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Practice Guidelines as Topic; SARS-CoV-2; Safety
PubMed: 32342140
DOI: 10.1007/s00167-020-06031-3 -
Journal of Infection and Public Health 2016The Kingdom of Saudi Arabia (KSA) gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the... (Review)
Review
The Kingdom of Saudi Arabia (KSA) gives great attention to improving the quality of services provided by health care sectors including outpatient clinics. One of the main drawbacks in outpatient clinics is long waiting time for patients-which affects the level of patient satisfaction and the quality of services. This article addresses this problem by studying the Outpatient Management Software (OMS) and proposing solutions to reduce waiting times. Many hospitals around the world apply solutions to overcome the problem of long waiting times in outpatient clinics such as hospitals in the USA, China, Sri Lanka, and Taiwan. These clinics have succeeded in reducing wait times by 15%, 78%, 60% and 50%, respectively. Such solutions depend mainly on adding more human resources or changing some business or management policies. The solutions presented in this article reduce waiting times by enhancing the software used to manage outpatient clinics services. Both quantitative and qualitative methods have been used to understand current OMS and examine level of patient's satisfaction. Five main problems that may cause high or unmeasured waiting time have been identified: appointment type, ticket numbering, doctor late arrival, early arriving patient and patients' distribution list. These problems have been mapped to the corresponding OMS components. Solutions to the above problems have been introduced and evaluated analytically or by simulation experiments. Evaluation of the results shows a reduction in patient waiting time. When late doctor arrival issues are solved, this can reduce the clinic service time by up to 20%. However, solutions for early arriving patients reduces 53.3% of vital time, 20% of the clinic time and overall 30.3% of the total waiting time. Finally, well patient-distribution lists make improvements by 54.2%. Improvements introduced to the patients' waiting time will consequently affect patients' satisfaction and improve the quality of health care services.
Topics: Ambulatory Care Facilities; Health Services Administration; Humans; Saudi Arabia; Software; Time Factors
PubMed: 27663518
DOI: 10.1016/j.jiph.2016.09.005