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Psychotherapy and Psychosomatics 2023Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and...
INTRODUCTION
Treatment non-response occurs regularly, but psychotherapy is seldom examined for such patients. Existing studies targeted single diagnoses, were relatively small, and paid little attention to treatment under real-world conditions.
OBJECTIVE
The Choose Change trial tested whether psychotherapy was effective in treating chronic patients with treatment non-response in a transdiagnostic sample of common mental disorders across two variants of treatment delivery (inpatient and outpatient).
METHODS
The controlled nonrandomized effectiveness trial was conducted between May 2016 and May 2021. The study took place in two psychiatric clinics with N = 200 patients (n = 108 inpatients and n = 92 outpatients). Treatment variants were integrated inpatient care versus outpatient care based on acceptance and commitment therapy (ACT) for approximately 12 weeks. Therapists delivered individualized and non-manualized ACT. Main outcome measures were symptoms (Brief Symptom Checklist [BSCL]); well-being (Mental Health Continuum-Short Form [MHC-SF]), and functioning (WHO Disability Assessment Schedule [WHO-DAS]).
RESULTS
Both inpatients and outpatients showed decreases in symptomatology (i.e., BSCL: d = 0.68) and increases in well-being and functioning (MHC-SF: d = 0.60 and WHO-DAS: d = 0.70), with more improvement in the inpatients during treatment. Both groups maintained gains 1 year following treatment, and the groups did not significantly differ from each other at this timepoint. Psychological flexibility moderated impact of stress on outcomes.
CONCLUSIONS
Psychotherapy as practiced under routine conditions is effective for a sample of patients with common mental disorders, a long history of treatment experience and burden of disease, in both inpatient and outpatient settings.
TRIAL REGISTRATION
This study was registered in the ISRCTN registry on May 20, 2016, with the registration number ISRCTN11209732.
Topics: Humans; Outpatients; Acceptance and Commitment Therapy; Psychotherapy; Mental Disorders; Ambulatory Care; Treatment Outcome
PubMed: 37023742
DOI: 10.1159/000529411 -
Journal of Patient Safety Apr 2021Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AEs) risk factors include patient- (e.g., advanced age), process-...
OBJECTIVES
Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AEs) risk factors include patient- (e.g., advanced age), process- (e.g., inadequate preoperative assessment), or structure-related characteristics (e.g., low surgical volume); however, these factors may differ from outpatient care where surgeries are often elective and in younger/healthier patients. We undertook an exploratory qualitative research project to identify risk factors for AEs in outpatient surgery.
METHODS
We developed a conceptual framework of patient, process, and structure factors associated with surgical AEs on the basis of a literature review. This framework informed our semistructured interview guide with (1) open-ended questions about a specific outpatient AE that the participant experienced and (2) outpatient surgical patient safety risk factors in general. We interviewed nationwide Veterans Health Administration surgical staff. Results were coded on the basis of categories in the conceptual framework, and additional themes were identified using content analysis.
RESULTS
Fourteen providers representing diverse surgical roles participated. Ten reported witnessing an AE, and everyone provided input on risk factors in our conceptual framework. We did not find evidence that patient race/age, surgical technique, or surgical volume affected patient safety. Emerging factors included patient compliance, postoperative patient assessments/instruction, operating room equipment needs, and safety culture.
CONCLUSIONS
Surgical staff are familiar with AEs and patient safety problems in outpatient surgery. Our results show that processes of care undertaken by surgical providers, as opposed to immutable patient characteristics, may affect the occurrence of AEs. The factors we identified may facilitate more targeted research on outpatient surgical AEs.
Topics: Ambulatory Surgical Procedures; Humans; Outpatients; Patient Safety; Perception; Veterans Health
PubMed: 29112029
DOI: 10.1097/PTS.0000000000000311 -
Circulation Journal : Official Journal... Nov 2022
Topics: Humans; Cardiac Rehabilitation; Outpatients; Heart Diseases; Ambulatory Care
PubMed: 35858824
DOI: 10.1253/circj.CJ-22-0375 -
JPMA. the Journal of the Pakistan... Sep 2021To identify the association among suicidal ideation, deliberate self-harm, and psychopathological distress in normal and deliberate self-harm adults.
OBJECTIVE
To identify the association among suicidal ideation, deliberate self-harm, and psychopathological distress in normal and deliberate self-harm adults.
METHODS
The cross-sectional study was conducted at the Department of Psychiatry, Military Hospital, Rawalpindi, Pakistan, from January to July 2017, and comprised deliberate self harm and normal adults aged 18-25 years. Psychiatric evaluation involved a semi-structured interview based on mental status examination. The self-harm tendency was assessed on the basis of self-harm inventory of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Beck scale for suicide ideation and he depression anxiety and stress scale were also used for data collection. Data was analysed using SPSS 22.
RESULTS
There were 200 subjects with a mean age of 20.89±9.06 years; 100(50%) each in deliberate self-harm and normal groups. Deliberate self-harm was significantly positively associated with suicidal ideation and mental health problems, including depression, anxiety and stress (p<0.05). Deliberate self-harm tendency was also positively associated with mental health problems in normal adults (p<0.05). Normal adults had higher level of mental health problems, such as depression and stress, compared to deliberate self harm adults (p<0.05). Adults having self-harm behaviour were more inclined to have suicidal ideation compared to normal adults behaviour (p<0.05).
CONCLUSIONS
Deliberate self-harm was found to be strongly related to suicidal behaviour and mental health issues in both normal and deliberate self-harm adults.
Topics: Adolescent; Adult; Child; Cross-Sectional Studies; Humans; Male; Mental Disorders; Outpatients; Risk Factors; Self-Injurious Behavior; Suicidal Ideation; Young Adult
PubMed: 34580503
DOI: 10.47391/JPMA.03-379 -
JAMA Network Open May 2023
Topics: Humans; Outpatients; Antimicrobial Stewardship; Anti-Bacterial Agents
PubMed: 37166803
DOI: 10.1001/jamanetworkopen.2023.12996 -
Cell Metabolism Aug 2019
Topics: Diet; Eating; Humans; Inpatients; Outpatients; Weight Gain
PubMed: 31272848
DOI: 10.1016/j.cmet.2019.06.015 -
Annals of the Royal College of Surgeons... Apr 2023The majority of head and neck cancer referrals are received through primary care. A proportion of cancer referrals are received through secondary care specialties. Local...
INTRODUCTION
The majority of head and neck cancer referrals are received through primary care. A proportion of cancer referrals are received through secondary care specialties. Local delivery plan (LDP) targets in Scotland for cancer investigation are set at 31 days for diagnosis and 62 days to start treatment. The aim was to audit referrals made through non-primary care pathways compared with the standard primary care pathways against LDP targets.
METHODS
New head and neck cancer patients between 1 January 2014 and 1 January 2019 were included. Pathway points were recorded between referral to outpatient clinic, time to multidisciplinary team discussion (MDT) and finally MDT to treatment.
RESULTS
1,276 new patient referrals were received over a 5-year period. Of these, 136 (10%) were referred via non-primary care pathways. The mean time for urgent suspicion of cancer (USoC) referrals to start treatment was 77 days (15 days over target) and for outpatient secondary care referrals was 102 days (40 days over target) (<0.05). When treatment intent was considered, 841/1,131 (75%) of patients referred via primary care were treated curatively compared with 49/99 (49%) (<0.05) of patients referred through the secondary outpatient pathway.
CONCLUSION
Patients with head and neck cancer referred from other outpatient specialties face delays commencing cancer treatment and are also associated with a greater likelihood of being treated with palliative intent.
Topics: Humans; Outpatients; Secondary Care; Critical Pathways; Head and Neck Neoplasms; Referral and Consultation
PubMed: 36260287
DOI: 10.1308/rcsann.2022.0111 -
Clinical Journal of the American... Mar 2021
Topics: Deep Learning; Humans; Outpatients; Renal Dialysis
PubMed: 33574057
DOI: 10.2215/CJN.00450121 -
BMC Health Services Research Nov 2023Outpatient services in the UK, and in particular outpatient neurology services, are under considerable pressure with an ever-increasing gap between capacity and demand....
BACKGROUND
Outpatient services in the UK, and in particular outpatient neurology services, are under considerable pressure with an ever-increasing gap between capacity and demand. To improve services, we first need to understand the current situation. This study aims to explore the patterns of appointment type seen in outpatient neurology, in order to identify potential opportunities for change.
METHODS
We use State Sequence Analysis (SSA) on routinely collected data from a single neurology outpatient clinic. SSA is an exploratory methodology which allows patterns within sequences of appointments to be discovered. We analyse sequences of appointments for the 18 months following a new appointment. Using SSA we create groups of similar appointment sequence patterns, and then analyse these clusters to determine if there are particular sequences common to different diagnostic categories.
RESULTS
Of 1315 patients 887 patients had only one appointment. Among the 428 patients who had more than one appointment a 6 monthly cycle of appointments was apparent. SSA revealed that there were 11 distinct clusters of appointment sequence patterns. Further analysis showed that there are 3 diagnosis categories which have significant influence over which cluster a patient falls into: seizure/epilepsy, movement disorders, and headache.
CONCLUSIONS
Neurology outpatient appointment sequences show great diversity, but there are some patterns which are common to specific diagnostic categories. Information about these common patterns could be used to inform the structure of future outpatient appointments.
Topics: Humans; Outpatients; Appointments and Schedules; Ambulatory Care Facilities; Ambulatory Care; Neurology
PubMed: 37926834
DOI: 10.1186/s12913-023-10218-y -
Scientific Reports Jun 2024Pediatric health service differs between and within countries. To prioritize limited resources, data-driven studies on pediatric tertiary hospital contacts are...
Pediatric health service differs between and within countries. To prioritize limited resources, data-driven studies on pediatric tertiary hospital contacts are warranted. This population-based register study identified all contacts with four Danish tertiary hospitals 2000-2018 by 0-17-year-old patients. During 2000-2018, 2,496,001 individuals resided in Denmark while 0-17 years old, and the study described 829,562 inpatient and 3,932,744 outpatient contacts at tertiary hospitals by hospital, sex, age, diagnosis, department, and residence. Male patients accounted for more contacts overall (inpatient 55.51%, outpatient 52.40%) and more contacts with severe chronic disease (inpatient 56.24%, outpatient 54.41%). Median (interquartile range) patient age was 3.09 (0.26-9.96) and 8.48 (2.78-13.70) years for in- and outpatient contacts. Overall, 28.23% and 21.02% of in- and outpatient contacts included a diagnosis of a severe chronic disease, but the proportions differed across hospitals. A pattern of pediatric healthcare directed towards less severe diseases was observed: While the total number of outpatient visits at tertiary hospitals increased from 2000 to 2018, the proportion of these contacts which had a diagnosis of a severe chronic disease decreased. Future comparisons between hospitals regarding pediatric outcomes should consider potential differences in terms of uptake and diagnosis severity. Such findings may have implications for future pediatric organization, nationally and internationally.
Topics: Humans; Denmark; Child; Child, Preschool; Tertiary Care Centers; Male; Infant; Female; Adolescent; Infant, Newborn; Patient Acceptance of Health Care; Chronic Disease; Child Health Services; Registries; Outpatients
PubMed: 38844805
DOI: 10.1038/s41598-024-63853-8