Exploring the nurse-patient relationship in caring for the health priorities of older adults: qualitative study.

BACKGROUND: Person-centered care (PCC) is critical in addressing the diverse health priorities of older adults. Nurses play a pivotal role in implementing PCC, yet the nuances of the nurse-patient relationship in outpatient settings remain underexplored. This study aimed to gain insights into nurses' experiences, challenges, and strategies in caring for older adults through the lens of PCC. METHODS: A qualitative descriptive design was employed, involving semi-structured interviews with 12 registered nurses from outpatient clinics serving older adults. Thematic analysis was conducted following the principles of trustworthiness and credibility. RESULTS: Five main themes emerged: (1)Understanding and Implementing Person-Centered Care (PCC) (2) Experiences in Older Adult Care, highlighting the significance of trust-building, adapting care approaches, interdisciplinary collaboration, and emotional rewards; (3) Challenges in Care Delivery, including resource constraints, navigating family dynamics, keeping up with medical advances, and emotional strain; (4) Impact on Care Quality, encompassing consistency in care, patient satisfaction, professional development, and ethical considerations; and (5) Coping Strategies, such as peer support, work-life balance, reflective practice, and resilience building. CONCLUSIONS: The study underscores the complexities and rewards of the nurse-patient relationship in caring for older adults in outpatient settings. Nurses face formidable challenges but employ various coping strategies to maintain high-quality, person-centered care. Findings have implications for nursing practice, education, policy, and future research, emphasizing the need for supportive environments, continuous professional development, and recognition of the critical role nurses play in addressing the health priorities of the aging population.

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor?

INTRODUCTION AND OBJECTIVES: Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit. MATERIALS AND METHODS: An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables. RESULTS: Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien-Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables. CONCLUSIONS: Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

Outpatient treatment of decompensated heart failure: A systematic review and study level meta-analysis.

Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day-care units; the safety and effectiveness of outpatient-based management (OPM) for ADHF has not been established. We conducted a systematic literature review and meta-analysis to investigate the short-term safety and effectiveness of OPM compared with inpatient management (IPM) of ADHF. Pre-specified endpoints were 30 day mortality and 30 day hospitalization. The meta-analysis was conducted using RevMan 5.4 software. Twenty-nine studies of OPM were identified, including 7683 patients. Only five studies directly compared OPM (n = 1303) with IPM (n = 2047), including three observational studies, and two randomized controlled trials (RCTs). The other 24 studies only stated OPM outcomes. For the five studies comparing IPM versus OPM, patients were generally aged >75 years and of similar age for each strategy, with a similar proportion of men (56%). In a study-level, aggregate analysis, 30 day all-cause mortality was 9.3% (121/1303) for OPM, compared with 15.6% (320/2047) for IPM [OR 0.29 (95% CI 0.09, 0.93) P = 0.04]. Four studies reported 30 day all-cause hospitalization; 22.0% for IPM versus 16.8% for OPM [OR 0.73 (95% CI 0.61, 0.89), P = 0.001]. In the two RCTs, we found no difference in 30 day mortality or hospitalization. In observational studies, OPM of ADHF is associated with lower 30 day hospitalization and lower 30 day mortality; such differences were not observed in two small, single-centre RCTs. A substantial, multicentre RCT is required to confirm the safety and effectiveness of OPM for ADHF.

The Outpatient Endovascular & Interventional Society (OEIS)-The Voice of Advocacy for the OBL: Origins, Principles, and Historical Perspective.

The physician office offering imaging guided endovascular and minimally invasive interventional procedures is often referred to as an OBL (office based lab), OIS (office interventional suite), or OES (office endovascular suite). Initially, OBL's depended upon the national societies of interventional radiology (SIR), vascular surgery (SVS) and interventional cardiology (SCAI) to advocate for them. However, the OBL space needed a voice dedicated to advocating for the appropriate reimbursement of procedures in the OBL to allow the OBL to survive as a viable site of service and become integral to healthcare delivery in the US healthcare system. This need led to the formation of the Outpatient Endovascular & Interventional Society (OEIS). The society is multispecialty and ensures safety in outpatient care in all sites of service while maintaining a focus on the OBL. The mission of the OEIS is to advocate for patients to have the ability to choose their provider and be able to receive safe and effective healthcare in a more friendly and far less costly site of service for them.

Business and Corporate Models for Interventional Radiology in the Office Based Lab and Ambulatory Surgical Center Setting.

The landscape of healthcare is shifting towards outpatient settings such as Office-Based Labs (OBLs) and Ambulatory Surgery Centers (ASCs). This transition, driven by the Centers for Medicare & Medicaid Services (CMS), presents various business and corporate models for interventional radiologists seeking to practice outside traditional hospital environments. The role of private equity and management services in facilitating these transitions is highlighted, offering opportunities for growth, efficiency, and enhanced control over practice operations. The document also discusses the financial aspects of establishing an OBL or ASC, the benefits of outpatient procedures, and the adaptability of private equity deals to the specific needs of medical practices. It concludes by emphasizing the potential for long-term wealth creation and the adaptability of these models to individual physician needs.

Interventional radiologists and OBLs: An excellent match.

While office-based laboratories (OBLs) have been increasing in popularity, only a small proportion of the current interventional radiology (IR) workforce works in an OBL. With the relative lack of an IR presence in OBLs compared to other endovascular specialists, combined with the growth of the OBL space, the presence of IR within OBLs will likely increase in the coming years. This article addresses the value interventional radiologists (IRs) can bring to the OBL, with primary impacts being the ability to impact a larger proportion of the population than is traditionally cared for in most hospital settings, the ability to positively influence multidisciplinary care teams and the financial leverage inherent in procedural diversification not readily afforded by other specialists working in the OBL space. IR-specific pitfalls in the OBL space are also addressed, including difficulties in obtaining patient referrals, investor relationships, and group practice arrangements. Despite potential challenges, IRs have a lot to offer within the OBL space, and conversely, the OBL space provides a mechanism for IRs to increase their reach and improve career longevity.

Sole operator: Owning and Operating an Independent Office-Based Lab.

Owning and operating an Office-Based Lab (OBL) creates a unique career, combining the privilege of practicing Interventional Radiology (IR) with the creativity and excitement of running a complex business. No business is more complicated than the American Healthcare system, with a combination of necessary operational systems, government and commercial reimbursement, local and national regulations, an ever-changing landscape, and various patient populations; the business is always shifting. No field is as complex and exciting as Interventional Radiology, with advanced clinical and technical expertise, device development, rocedural ingenuity, and the ability to solve complex medical problems with elegant solutions. A sole owner and operator in an OBL has full autotomy, and thus full responsibility for the medical and business aspects of the practice.

Consensus study on UK weight management services' response to COVID-19: best practices in outpatient management, governance and digital solutions.

BACKGROUND: The COVID-19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID-19 pandemic. METHODS: This study utilised a semi-structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic. RESULTS: Twenty-three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self-monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork. CONCLUSION: Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey.

[The possibilities and advantages of conducting multicenter clinical trials on the basis of outpatient clinics in Moscow].

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

Analysis of pediatric outpatient visits uncovers disparities in molluscum contagiosum treatment across medical specialties in the United States.

Molluscum contagiosum (MC) is a common viral infection that affects the skin of children. In this study, treatment regimens and demographic information for MC patients across US medical specialties were compared. We discovered an average of 471,383 pediatric MC visits annually using the National Ambulatory Medical Care Survey database from 2000 to 2016. Non-Hispanics (82.9%) and Caucasians (91.0%) made up the majority of the visitors. The majority of cases were handled by pediatricians (46.5%), family medicine doctors (10.6%), and dermatologists (36.7%). Compared to pediatricians, dermatologists saw a higher percentage of Caucasian patients (95% vs.84%) and patients with private insurance (83% vs. 73%). Patients were more likely to see family medicine doctors (55.0%) in non-metropolitan areas than pediatricians (26.4%) or dermatologists (16.3%). Dermatologists were less likely than pediatricians (38%) to favor spontaneous resolution (70%). Dermatologists favored terpenoids (20%), imiquimod (12%), and curettage (10%), while pediatricians primarily used terpenoids (12%), steroids (4%), and imiquimod (4%). The majority of MC cases are managed by pediatricians; however, treatment approaches deviate markedly from recommended best practices.

Enhancing pediatric asthma management through multifaceted health education.

BACKGROUND: Pediatric asthma is a significant public health issue that impacts the quality of life of children globally. Traditional management approaches focus on symptom control and medication adherence but often overlook the comprehensive educational needs of patients and their families. A multifaceted health education approach may offer a more holistic strategy in managing pediatric asthma, especially in outpatient settings. AIM: To evaluate the efficacy of a comprehensive health education strategy in improving disease management, medication adherence, and quality of life among children with asthma in outpatient settings. METHODS: In total, 100 pediatric patients with severe asthma were enrolled from January 2021 to November 2022 and randomly allocated to a control group (n = 50) or an observation group (n = 50). The control group received standard nursing care, including basic nursing interventions and health education upon admission. In contrast, the observation group was exposed to a broad spectrum of health education methodologies, including internet-based hospital systems, social media channels, one-on-one verbal education, informational brochures, slide presentations, telephone check-ins, animated videos, and illustrated health education manuals. Data on asthma management knowledge, symptom control, quality of life [St. George's Respiratory Questionnaire (SGRQ)], treatment adherence, and nursing satisfaction were collected and analyzed. RESULTS: The scores of the observation group in knowledge areas, such as medication, home care, disease understanding, symptom management, prevention strategies, and nutritional guidance, were significantly higher than those of the control group (P < 0.05). In addition, the observation group exhibited greater symptom control, improved quality of life based on their SGRQ scores, and higher treatment adherence post-intervention (P < 0.05). Nursing satisfaction was also rated higher in the observation group across all evaluated areas (P < 0.05). CONCLUSION: Implementing a diversified health education approach in pediatric asthma management significantly enhances disease understanding, symptom management, and treatment adherence, leading to improved quality of life for affected children. These findings underscore the importance of multifaceted clinical health education in augmenting disease awareness and facilitating continuous improvements in asthma control rates, highlighting the potential benefits of incorporating comprehensive educational strategies into pediatric asthma care protocols.

PICC Your Poison: Resident Beliefs and Attitudes Regarding Discharge Parenteral Antibiotics for Patients Who Inject Drugs.

Background: Serious injection-related infections (SIRIs) in people who inject drugs often lead to prolonged hospitalizations or premature discharges. This may be in part due to provider reluctance to place peripherally inserted central catheters (PICCs) for outpatient parenteral antibiotic therapy in this population. Because internal medicine (IM) residents are often frontline providers in academic centers, understanding their perspectives on SIRI care is important to improve outcomes. Methods: We surveyed IM residents in a large urban multicenter hospital system about SIRI care with a novel case-based survey that elicited preferences, comfort, experience, and stigma. The survey was developed using expert review, cognitive interviewing, and pilot testing. Results are reported with descriptive statistics and linear regression. Results: Of 116 respondents (response rate 34%), most (73%) were uncomfortable discharging a patient with active substance use home with a PICC, but comfortable (87%) with discharge to postacute facilities. Many (∼40%) endorsed high levels of concern for PICC misuse or secondary line infections, but larger numbers cited concerns about home environment (50%) or loss to follow-up (68%). While overall rates were low, higher stigma was associated with more concerns around PICC use (r = -0.3, P = .002). A majority (58%) believed hospital policies against PICC use in SIRI may act as a barrier to discharge, and 74% felt initiation of medications for opioid use disorder (MOUD) would increase their comfort discharging with a PICC. Conclusions: Most IM residents endorsed high levels of concern about PICC use for SIRI, related to patient outcomes and perceived institutional barriers, but identified MOUD as a mitigating factor.

Safety evaluation of outpatient vs inpatient unicompartmental knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to evaluate the safety of outpatient and inpatient Unicompartmental Knee Arthroplasty (UKA) based on the incidence of adverse events. METHOD: A systematic search of the literature was performed in October 2022 on PubMed, Web of Science, Cochrane library, and Embase. The Meta package for R was used to perform the meta-analysis. RESULT: Five studies with a total of 26,301 patients were included. 5813 patients (22.1%) were treated with outpatient UKA, and 20,488 patients (77.9%) were treated with inpatient UKA. There were no statistically significant differences in the incidence of total complications (RR = 1.36, 95% CI = 0.64-2.89, Z = 0.79, P = 0.43), readmission (RR = 1.02, 95% CI = 0.40-2.60, Z = 0.05, P = 0.96), and venous thrombosis (RR = 1.43, 95% CI = 0.96-2.11, Z = 1.78, P = 0.08). Incidence rates were lower in outpatient UKA regarding urinary tract infection (RR = 1.48, 95% CI = 1.07-2.04, Z = 2.40, P = 0.02), pulmonary embolus (RR = 7.48, 95% CI = 1.80-31.17, Z = 2.76, P < 0.01), and transfusion (RR = 2.77, 95% CI = 1.63-4.71, Z = 3.78, P < 0.01). CONCLUSION: In summary, outpatient UKA shows lower incidences of hospital-acquired complications such urinary tract infection, pulmonary embolus, and transfusion. It's worth noting that the incidences of total complications, readmission, and venous thrombosis in outpatient UKA were not higher than the incidences of inpatient UKA, suggestting that outpatient UKA can be considered a safe alternative to inpatient UKA.

Cannabis-related treatment demand at the eve of German cannabis legalization - a 20-years trend analysis.

Post-2000, the prevalence of cannabis consumption has been rising internationally. This paper investigates whether cannabis-related treatment demand in German outpatient addiction care facilities (OACFs) has been following this trend. Treatment demand related to cannabis use disorder (CUD) for the period 2001 to 2021 was investigated using data from the nation-wide standardized German Addiction Care Statistical Service. Analyses covered all and first-time treatment admissions, demographics, and treatment outcomes. We identified years with significant changes in slope or direction of trends through joinpoint regression. Trends within the CUD client population were contrasted with trends among the entire OACF client population. CUD is the second-most common cause for OACF admissions in Germany. Between 2001 and 2021, the share of CUD-related cases among total OACF caseload increased from 7.1 to 19.9%, whereby the share of first-time treatment admissions declined from 79.6 to 55.6%. The share of CUD client population > 35 years almost tripled from 6.0 to 17.4%, that of female client population rose from 15.6 to 18.1%. From 2001 to 2007, the share of CUD-related treatments completed with improved symptomatology increased from 54.7 to 65.6%, followed by a marginal decline. CUD-related treatment demand is growing in Germany's OACFs, involving a client population that is increasingly older and more experienced with the addiction care system. As current intervention programmes mainly target adolescents and young adults who have been consuming cannabis only for a short time, adapting service offers to the changing client profiles appears paramount to improve treatment effectiveness.

Evaluation of no-show rate in outpatient clinics with open access scheduling system: A systematic review.

Background: Patients' missed appointments can cause interference in the functions of the clinics and the visit of other patients. One of the most effective strategies to solve the problem of no-show rate is the use of an open access scheduling system (OA). This systematic review was conducted with the aim of investigating the impact of OA on the rate of no-show of patients in outpatient clinics. Methods: Relevant articles in English were investigated based on the keywords in title and abstract using PubMed, Scopus, and Web of Science databases and Google Scholar search engine (July 23, 2023). The articles using OA and reporting the no-show rate were included. Exclusion criteria were as follows: (1) review articles, opinion, and letters, (2) inpatient scheduling system articles, and (3) modeling or simulating OA articles. Data were extracted from the selected articles about such issues as study design, outcome measures, interventions, results, and quality score. Findings: From a total of 23,403 studies, 16 articles were selected. The specialized fields included family medicine (62.5%, 10), pediatrics (25%, four), ophthalmology, podiatric, geriatrics, internal medicine, and primary care (6.25%, one). Of 16 articles, 10 papers (62.5%) showed a significant decrease in the no-show rate. In four articles (25%), the no-show rate was not significantly reduced. In two papers (12.5%), there were no significant changes. Conclusions: According to this study results, it seems that in most outpatient clinics, the use of OA by considering some conditions such as conducting needs assessment and system design based on the patients' and providers' actual needs, and cooperating of all system stakeholders through consistent training caused a significant decrease in the no-show rate.

The effect of a local anesthetic cocktail in a serratus anterior plane and PECS 1 block for implant-based breast reconstruction.

Introduction: Enhanced recovery after surgery (ERAS) protocols have been implemented to decrease opioid use and decrease patient hospital length of stay (LOS, days). Serratus anterior plane (SAP) blocks anesthetize the T2 through T9 dermatomes of the breast and can be applied intraoperatively. The purpose of this study was to compare postoperative opioid (OME) consumption and LOS between a control group, an ERAS group, and an ERAS/local anesthetic cocktail group in patients who underwent implant-based breast reconstruction. Methods: In this study, 142 women who underwent implant-based breast reconstruction between 2004 and 2020 were divided into Group A (46 patients), a historical cohort; Group B (73 patients), an ERAS/no-block control group; and Group C (23 patients), an ERAS/anesthetic cocktail study group. Primary outcomes of interest were postanesthesia care unit (PACU), inpatient and total hospital OME consumption, and PACU LOS. Results: A significant decrease was observed from Group A to C in PACU LOS (103.3 vs. 80.2 vs. 70.5; p = 0.011), OME use (25.1 vs. 11.4 vs. 5.7; p < 0.0001), and total hospital OME (120.3 vs. 95.2 vs. 35.9; p < 0.05). No difference was observed in inpatient OMEs between the three groups (95.2 vs. 83.8 vs. 30.8; p = 0.212). Despite not reaching statistical significance, Group C consumed an average of 50-60 % less opioids per patient than did Group B in PACU, inpatient, and total hospital OMEs. Conclusion: Local anesthetic blocks are important components of ERAS protocols. Our results demonstrate that a combination regional block with a local anesthetic cocktail in an ERAS protocol can decrease opioid consumption in implant-based breast reconstruction.