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1.
J Affect Disord ; 320: 590-594, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36181915

RESUMO

BACKGROUND: In the United States, suicide is one of the serious public health problems and a major cause of death. Several researchers and clinical settings use the patient health questionnaires (PHQ-9) to gauge depression and psychological distress among adults and to predict suicide and death. This study aimed to assess the sensitivity, specificity, and predictive potential of suicide Q9 of the PHQ-9 compared to the Columbia-suicide severity rating scale (C-SSRS). METHODS: Adults aged 19 or older, identified with a primary mood disorder diagnosis during their initial clinic visit between 2012 and 2020 from the National Network of Depression Centers, were included in the study. The accuracy of the PHQ-9 suicide item was compared with the gold standard, the C-SSRS. RESULTS: Out of 2677 study participants, 31.6 % (n = 846) and 11.65 % (n = 312) had positive responses to the PHQ-9 suicide item and C-SSRS response, respectively. The sensitivity of the PHQ-9 compared to the C-SSR was 74.7 % (95%CI: 69.6 %-79.2 %), specificity 74.1 % (95%CI: 72.3 %-75.8 %), positive predictive value 27.5 % (95%CI: 24.6 %-30.6 %), and negative predictive value 95.7 % (95%CI: 94.7 %-96.5 %). The secondary analysis results showed better validity results of the PHQ-9 suicide item when compared to the suicide ideation item of the C-SSRS. LIMITATIONS: This study is among mood disorder patients so additional research would be necessary among populations with different conditions. CONCLUSION: For initial suicide screening, the PHQ-9 suicide item would over identify patients as at risk for suicide and the C-SSRS should be used mood disorder clinics to identify suicide risk.


Assuntos
Depressão , Questionário de Saúde do Paciente , Humanos , Adulto , Estados Unidos , Escalas de Graduação Psiquiátrica , Depressão/psicologia , Transtornos do Humor/diagnóstico , Pacientes Ambulatoriais , Ideação Suicida , Inquéritos e Questionários , Reprodutibilidade dos Testes
2.
J Nurs Care Qual ; 38(1): 69-75, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36214674

RESUMO

BACKGROUND: Malignant bowel obstruction (MBO) in patients with advanced gynecologic cancer (GyCa) can negatively impact clinical outcomes and quality of life. Oncology nurses can support these patients with adequate tools/processes. PROBLEM: Patients with GyCa with/at risk of MBO endure frequent emergency or hospital admissions, impacting patient care. APPROACH: Optimizing oncology nurses' role to improve care for patients with GyCa with/at risk of MBO, the gynecology oncology interprofessional team collaborated to develop a proactive outpatient nurse-led MBO model of care (MOC). OUTCOMES: The MBO MOC involves a risk-based algorithm engaging interdisciplinary care, utilizing standardized tools, risk-based assessment, management, and education for patients and nurses. The MOC has improved patient-reported confidence level of bowel self-management and decreased hospitalization. Following education, nurses demonstrated increased knowledge in MBO management. CONCLUSIONS: An outpatient nurse-led MBO MOC can improve patient care and may be extended to other cancer centers, fostering collaboration and best practice.


Assuntos
Obstrução Intestinal , Neoplasias , Humanos , Feminino , Pacientes Ambulatoriais , Qualidade de Vida , Papel do Profissional de Enfermagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Obstrução Intestinal/patologia , Cuidados Paliativos
3.
Neurol Clin ; 41(1): xiii, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36400562
4.
Environ Res ; 216(Pt 2): 114598, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36257448

RESUMO

BACKGROUND: Although exposure to ambient air pollution has been associated with mental disorder, little is known about its potential effects on children and adolescents, especially in Chinese population. We aimed to reveal the relationship of air pollutants with hospital outpatient visits for child and adolescence psychiatry (HOVCAP) in Shenzhen. METHODS: A case-crossover study based on time-series data was applied, and a distributed lag non-linear model (DLNM) was used to evaluate the non-linear and delayed effects of 4 major air pollutants (NO2, PM2.5, SO2 and O3) on HOVCAP. Least absolute shrinkage and selection operator (LASSO) regression was used to control the multicollinearity between covariates and to filter variables. RESULT: A total of 94,660 cases aged 3-18 were collected from 2014 to 2019 in the Mental Health Center of Shenzhen. Results of pollutants at mode value (M0) showed that in the single lag effect result, when the average daily concentration of NO2 at 24 µg/m3, there was a significant effect on HOVCAP over lag 1, lag 4 and lag 5, respectively. The cumulative RR of NO2 M0 value to the outpatient visits were 1.438 (1.137-1.818) over lag 0-2, 1.454 (1.120-1.887) over lag 0-3, 1.466 (1.084-1.982) over lag 0-4, 1.680 (1.199-2.354) over lag 0-5, 1.993 (1.369-2.903) over lag 0-6, and 2.069 (1.372-3.119) over lag 0-7. However, PM2.5, SO2, O3 were not associated with HOVCAP over neither single lag effects nor cumulative effects. The RR values both shown an increase either when NO2 increases by 10 units or when the maximum concentration of NO2 is reached. CONCLUSION: Our study suggests that exposure to the normal air quality of NO2 in Shenzhen may associated with the risk of HOVCAP. However, PM2.5, SO2, O3 were not associated with HOVCAP.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Psiquiatria , Criança , Adolescente , Humanos , Poluentes Atmosféricos/análise , Estudos Cross-Over , Pacientes Ambulatoriais , Dióxido de Nitrogênio , Poluição do Ar/análise , China/epidemiologia , Hospitais , Material Particulado/análise
5.
PLoS One ; 17(11): e0276982, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36327339

RESUMO

BACKGROUND: The COVID-19 pandemic was associated with far-reaching changes all over the world. Health care systems were and are also affected. Little is known about the impact of these changes and the duration of the pandemic on people with mental disorders. The aim of this longitudinal follow-up study was to investigate the mental health status, medical care provision, and attitudes towards the pandemic of these people at the end of the second pandemic lockdown in Germany in 2021, and to compare these findings with the results of 2020. METHODS: People with mental disorders currently receiving treatment in the psychiatric outpatient department of the University Hospital Leipzig, Germany, were asked about depressive symptoms (PHQ-9), self-reported medical care provision, attitudes and social and emotional aspects of the pandemic (social support [ESSI], perceived stress [PSS-4], loneliness [UCLA-3-LS], and resilience [BRS]) using structured telephone interviews. RESULTS: In total, N = 75 participants who had already participated in the first survey in 2020 took part in the follow-up telephone interviews. The most frequent clinician-rated diagnoses were attention deficit disorder/attention deficit hyperactivity disorder (n = 21; 28.0%) and obsessive-compulsive disorder (n = 16; 21.3%). In comparison to 2020, a significantly higher proportion of participants reported no problems in receiving medical care provision. Compared to the previous year, the resilience of the participants had significantly decreased. Depressive symptoms, social support, perceived stress, and loneliness remained stable. Significantly more participants felt restricted by the pandemic-related government measures in 2021 than in 2020. CONCLUSIONS: This study highlights the importance for continued efforts to maintain stable medical care provision for people with mental disorders during the COVID-19 pandemic, as except for a decrease in resilience, mental health status remained stable. Nonetheless there is still a need for continued treatment to stabilise and improve this status.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Pacientes Ambulatoriais , Seguimentos , Controle de Doenças Transmissíveis , Pesquisa Qualitativa , Telefone
6.
Nephrol Nurs J ; 49(5): 437-450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36332124

RESUMO

This quality improvement project was implemented to improve renal hyperparathyroidism in patients with end stage kidney disease who are on hemodialysis through the implementation of a nurse-led etelcalcetide protocol. Results showed that the post-intervention group had a 16.7% increase of the intact parathyroid hormone (iPTH) range within the target goal compared to the 3-month pre-intervention assessment (95% CI; 20.3% to 48.1%). The odds of being in the PTH target range were 1.73 times higher after the 3-month intervention than measurements obtained before starting the intervention (95% CI for the odds ratio: 0.29 to 10.3). Despite the lack of statistical significance (p = 0.688) due to a small sample size, there was an improvement in reaching goal PTH levels. Further studies are needed to analyze the effectiveness of nurse-led protocols in treating renal hyperparathyroidism in dialysis patients.


Assuntos
Calcimiméticos , Hiperparatireoidismo Secundário , Humanos , Diálise Renal , Pacientes Ambulatoriais , Melhoria de Qualidade , Papel do Profissional de Enfermagem , Cálcio
7.
BMC Gastroenterol ; 22(1): 445, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333660

RESUMO

BACKGROUND: This study aimed to evaluate the usefulness of discharge standards in outpatients undergoing sedative endoscopy by comparing the modified post-anesthetic discharge scoring system (MPADSS) and the modified Aldrete score. METHODS: We prospectively enrolled 376 outpatients who underwent gastrointestinal endoscopy under midazolam sedation; 181 outpatients were assessed regarding discharge after sedative endoscopy using the MPADSS (group M), and 195 patients were assessed by the modified Aldrete score (group A). The clinical characteristics, types of endoscopy, endoscopic outcomes, and anesthesia outcomes were evaluated between the two groups. We compared discharge score, recovery time, and adverse events using propensity-score matching. RESULTS: Propensity-score matching created 120 matched pairs. The proportion of patients who had a recovery time within 60 min after endoscopy was significantly higher in group A than that in group M (42.5% versus 25.0%, respectively; P < 0.01). The proportion of patients who required > 120 min of recovery time after endoscopy was significantly lower in group A than that in group M (0.0% versus 5.0%, respectively; P = 0.03). However, significantly more patients had drowsiness at discharge in group A compared with group M (19.1% versus 5.0%, respectively; P < 0.01). There was no significant difference in the adverse event rate within 24 h of discharge between the groups. CONCLUSIONS: Patients assessed by the modified Aldrete score were allowed to discharge earlier than those assessed by the MPADSS. However, a patient's level of consciousness should be assessed carefully, especially in patients who visit the hospital alone.


Assuntos
Anestésicos , Propofol , Humanos , Hipnóticos e Sedativos/efeitos adversos , Sedação Consciente/efeitos adversos , Pacientes Ambulatoriais , Alta do Paciente , Pontuação de Propensão , Endoscopia Gastrointestinal/efeitos adversos , Propofol/efeitos adversos
8.
Crit Care Nurs Clin North Am ; 34(4): 431-441, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36336433

RESUMO

The incidence and prevalence of inpatient acute kidney injury is continuing to increase. Acute kidney injury (AKI) is an all-encompassing topic in renal care as well as critical care. The definition and criteria for diagnosis of AKI have evolved over time. There are many causes of AKI and identifying the cause is key in reversing and controlling the progression of disease. Metabolic acidosis, fluid overload, and sepsis require detailed evaluation to best provide the most appropriate plan and execution. Critical care nurses are vitally important when identifying and managing acute kidney injury. Renal replacement therapy is a remarkable tool that requires expertise from the critical nurse. Once it is mastered, the most vulnerable patient in the ICU can become the recipient of good and positive outcomes.


Assuntos
Injúria Renal Aguda , Sepse , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Terapia de Substituição Renal/efeitos adversos , Sepse/terapia
9.
Health Informatics J ; 28(4): 14604582221137446, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345921

RESUMO

BACKGROUND: Malaria contributes 20% of outpatient cases in health facilities in Uganda. Data also show that there is a severe shortage of skilled health care personnel in sub-Saharan Africa. Electronic Medical Record (EMR) systems have been shown to provide benefits to health care providers and patients alike, making them important for low resourced settings. METHODS: A comparative study was performed from March 2018 to March 2019 in which an integrated EMR system was implemented with treatment guidelines for malaria, and its effect was evaluated on malaria outpatient case management in one Ugandan health facility. Another health facility was used as a control site. RESULTS: Malaria outpatient visits were 1.3 h shorter in the EMR group (p < .0001), and 80% more participants in the EMR group had age and weight information available to clinicians at the point of prescribing (p < .0001). Fewer participants in the EMR group had recurring malaria with no statistical significance (p = .097). Malaria surveillance reporting was significantly more accurate at the EMR intervention site (p < .05). CONCLUSION: The EMR system probably improved malaria outpatient case management by reducing outpatient visit durations, improving the availability of patient age and weight information to inform prescribing and improving the accuracy of malaria surveillance reporting.


Assuntos
Administração de Caso , Malária , Humanos , Pacientes Ambulatoriais , Uganda , Registros Eletrônicos de Saúde , Instalações de Saúde , Malária/terapia , Malária/epidemiologia
10.
Rev Esc Enferm USP ; 56: e20220127, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36346186

RESUMO

OBJECTIVE: To analyze management styles in outpatient clinics of university hospitals and their impacts on the nursing workers' health. METHOD: Quantitative, cross-sectional study with 388 nursing professionals working in 11 outpatient clinics linked to public universities in Rio de Janeiro. The Management Styles Scale, the Pathogenic Suffering at Work Scale, and the Work-Related Physical and Psychosocial Harms Scale were used. RESULTS: The managerial and collective management styles showed a moderate presence for the outpatient clinics nursing staff. The characteristics of the predominantly managerial management style, evidenced by the lack of participation in decision-making, the strongly hierarchical work, focused on norms and control, acted as predictors of the experiences of suffering and of the physical, psychological, and social damages presented by the professionals working in this context. CONCLUSION: The analysis of management styles allowed elucidating characteristics that have the potential to negatively impact the workers' health, highlighting the need to review the management models currently adopted for the outpatient nursing team.


Assuntos
Saúde do Trabalhador , Pacientes Ambulatoriais , Humanos , Brasil , Estudos Transversais , Universidades
11.
BMJ Open ; 12(11): e064306, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36323484

RESUMO

OBJECTIVES: To determine rate of blood pressure (BP) control and to analyse patient-related, medication-related and healthcare system-related factors associated with poor BP control in outpatients with hypertension (HT). DESIGN: Cross-sectional study. SETTING: Two study sites with different levels of healthcare (primary healthcare (PHC) and secondary level of healthcare (SHC)) in Vojvodina, Northern Serbia. PARTICIPANTS: A total of 581 patients (response rate 96.8%) visiting their primary care physician between July 2019 and June 2020 filled out a pretested semistructured questionnaire and had a BP reading during their regular appointments. PRIMARY AND SECONDARY OUTCOME MEASURES: Data on demographics, medication, BP control (target systolic BP≤140 mm Hg and∕ or diastolic BP≤90 mm Hg) and knowledge on HT was collected. Based on the median of knowledge score, patients were classified as having poor, average and adequate knowledge. RESULTS: Majority of the respondents (74.9%) had poorly controlled BP and had HT longer than 10 years. Larger number of patients at PHC site was managed with monotherapy while at the SHC majority received three or more antihypertensive drugs. Respondents from SHC showed a significantly lower knowledge score (9, 2-15) compared with the respondents from PHC (11, 4-15, p=0.001). The share of respondents with adequate knowledge on HT was significantly higher in the group with good BP control (26% and 9.2%, respectively). In a multivariate regression analysis, factors associated with poor BP control were knowledge (B=-1.091; p<0001), number of drugs (B=0536; p<0001) and complications (B=0898; p=0004). CONCLUSIONS: Poor BP control is common in outpatients in Serbia, irrespective of the availability of different levels of healthcare. Patients with poor knowledge on HT, with complications of HT and those with multiple antihypertensive drugs, were at particular risk of poor BP control. Our study could serve as a basis for targeted interventions to improve HT management.


Assuntos
Anti-Hipertensivos , Hipertensão , Humanos , Pressão Sanguínea , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/farmacologia , Estudos Transversais , Pacientes Ambulatoriais , Sérvia/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adesão à Medicação
12.
BMC Psychiatry ; 22(1): 671, 2022 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-36316661

RESUMO

BACKGROUND: Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. METHODS: We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. RESULTS: The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. CONCLUSION: Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.


Assuntos
Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Psicometria , Inquéritos e Questionários , Humanos , Pacientes Ambulatoriais , Satisfação Pessoal , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários/normas , Noruega
13.
BMC Infect Dis ; 22(1): 818, 2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36344927

RESUMO

BACKGROUND: Neutralizing monoclonal antibodies (mAbs) are highly effective in reducing hospitalization and mortality among early symptomatic COVID-19 patients in clinical trials and real-world data. While resistance to some mAbs has since emerged among new variants, characteristics associated with treatment failure of mAbs remain unknown. METHODS: This multicenter, observational cohort study included patients with COVID-19 who received mAb treatment between November 20, 2020, and December 9, 2021. We utilized electronic health records from a statewide health system plus state-level vaccine and mortality data. The primary outcome was mAb treatment failure, defined as hospitalization or death within 28 days of a positive SARS-CoV-2 test. RESULTS: COVID-19 mAb was administered to 7406 patients. Hospitalization within 28 days of positive SARS-CoV-2 test occurred in 258 (3.5%) of all patients who received mAb treatment. Ten patients (0.1%) died within 28 days, and all but one were hospitalized prior to death. Characteristics associated with treatment failure included having two or more comorbidities excluding obesity and immunocompromised status (adjusted odds ratio [OR] 3.71, 95% confidence interval [CI] 2.52-5.56), lack of SARS-CoV-2 vaccination (OR 2.73, 95% CI 2.01-3.77), non-Hispanic black race/ethnicity (OR 2.21, 95% CI 1.20-3.82), obesity (OR 1.79, 95% CI 1.36-2.34), one comorbidity (OR 1.68, 95% CI 1.11-2.57), age ≥ 65 years (OR 1.62, 95% CI 1.13-2.35), and male sex (OR 1.56, 95% CI 1.21-2.02). Immunocompromised status (none, mild, or moderate/severe), pandemic phase, and type of mAb received were not associated with treatment failure (all p > 0.05). CONCLUSIONS: Comorbidities, lack of prior SARS-CoV-2 vaccination, non-Hispanic black race/ethnicity, obesity, age ≥ 65 years, and male sex are associated with treatment failure of mAbs.


Assuntos
COVID-19 , Humanos , Masculino , Idoso , SARS-CoV-2 , Anticorpos Neutralizantes , Pacientes Ambulatoriais , Vacinas contra COVID-19 , Hospitalização , Obesidade , Falha de Tratamento , Anticorpos Monoclonais/uso terapêutico
14.
Chron Respir Dis ; 19: 14799731221137082, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36417310

RESUMO

BACKGROUND: The patient's experience of treatment is a cornerstone of high-quality healthcare, along with clinical safety and effectiveness. We aimed to evaluate the patients' perspectives regarding home mechanical ventilation (HMV) follow up in an outpatient setting and ascertain differences between patients that started HMV in the outpatient setting compared to other settings. METHODS: This cross-sectional study was conducted with patients with chronic respiratory failure under HMV in the Outpatient Ventilation Clinic. Patients filled in a patient experience questionnaire and the S3-NIV questionnaire. RESULTS: The study included 235 patients (127, 54% male), median 70 [25-75 percentiles 64-76] years) and about half were adapted to HMV in the outpatient setting (117, 49.8%). Patients had a daily ventilator usage of 8.0 [6.0-10.0] hours and have been on ventilator for a median of 35.0 [12.0-66.0] months. Patients reported an overall good experience regarding education at initiation (209 [88.9%] considered the information given was enough), short time to adaptation [104 (44.3%) felt adapted after some hours], with perceived benefits (171 [72.8%] reported less shortness of breath, 158 (67.2%) improved quality of life and 150 (63.8%) less tiredness). Benefits overcame the treatment side-effects (158 [67.2%] reported mucosal dryness, 109 (46.4%) mask sores and 96 (40.9%) leaks). There was no difference in terms of reported health gains, side effects or time to adaptation between adaptation settings, but patients starting HMV in the outpatient setting reported better communication and education at adaptation. CONCLUSIONS: Outpatient setting was perceived as a positive experience, both in HMV initiation and follow up, with good patient-physician communication leading to significant health reported gains, improvement of health status and well-being and good treatment adherence.


Assuntos
Serviços de Assistência Domiciliar , Respiração Artificial , Humanos , Masculino , Feminino , Pacientes Ambulatoriais , Qualidade de Vida , Estudos Transversais
15.
J Wound Ostomy Continence Nurs ; 49(6): 559-563, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36417379

RESUMO

PURPOSE: The purpose of this quality improvement initiative was to increase adherence to follow-up appointments in patients with diabetes mellitus for prevention of diabetic foot ulcers. PARTICIPANTS AND SETTING: The sample comprised 33 adults with diabetes mellitus being cared for at an outpatient wound care clinic affiliated with a large metropolitan hospital in the state of Mississippi, located in the Southern United States. APPROACH: This quality improvement approach used the Plan-Do-Study-Act method. Educational flyers and verbal instruction were provided to enhance adherence to preventive nail care and follow-up appointments. The goal for this quality improvement initiative was to increase adherence with preventive nail care and follow-up care. OUTCOMES: Participants were provided with educational flyers and verbal instruction that emphasized the importance of follow-up clinic appointments, which promoted increased attendance at follow-up appointments. The proportion of patients who did not attend follow-up appointments fell from 9.2% prior to the intervention to 5.8% after its introduction. IMPLICATIONS FOR PRACTICE: This quality improvement initiative positively impacted practice at a local wound care clinic in Mississippi resulting in a clinically relevant reduction in no-show follow-up visits when compared to the previous year.


Assuntos
Diabetes Mellitus , Melhoria de Qualidade , Adulto , Humanos , Estados Unidos , Agendamento de Consultas , Instituições de Assistência Ambulatorial , Pacientes Ambulatoriais
16.
JCO Clin Cancer Inform ; 6: e2200084, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36417685

RESUMO

PURPOSE: This systematic review aimed to investigate the efficacy of telemedicine (TM) using videoconferencing systems in outpatient care for patients with cancer. METHODS: We searched six electronic databases (CENTRAL, MEDLINE, EMBASE, CINAHL, ICTRP, and ClinicalTrials.gov) through June 2021 to identify randomized controlled trials that evaluated the use of TM using videoconferencing systems compared with usual face-to-face care in outpatient care for patients with cancer. We assessed the certainty of evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: From the 2,400 articles screened, six randomized controlled trials were eligible for this study. Two studies evaluated the use of TM in cancer follow-up and four investigated psychotherapy for cancer. TM using videoconferencing systems may result in no differences in primary outcomes such as patient satisfaction (standardized mean difference, 0.11; 95% CI, -0.18 to 0.40) and outpatient attendance complete proportion (risk difference, 0.02%; 95% CI, -0.04 to 0.09), and secondary outcomes such as medical professional satisfaction, time devoted to outpatient care, and depression score. The certainty of evidence for these outcomes was low. Although the average money spent on outpatient visit was a primary outcome, the level of evidence was uncertain. CONCLUSION: Our results suggest that TM using videoconferencing systems in outpatient care for patients with cancer may be as effective as usual face-to-face care. Use of TM more frequently may be considered for patients with cancer who are expected to obtain benefit from TM using videoconference systems.


Assuntos
Neoplasias , Telemedicina , Humanos , Comunicação por Videoconferência , Assistência Ambulatorial , Neoplasias/diagnóstico , Neoplasias/terapia , Pacientes Ambulatoriais , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
World J Emerg Surg ; 17(1): 59, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36419071

RESUMO

OBJECTIVE: To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol. METHODS: Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay. RESULTS: Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. CONCLUSION: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. TRIAL REGISTRATION: Registration: www. CLINICALTRIALS: gov (NCT05401188) Clinical Trial ID: NCT05401188.


Assuntos
Apendicite , Laparoscopia , Adulto , Humanos , Apendicectomia , Apendicite/cirurgia , Pacientes Ambulatoriais , Doença Aguda
19.
J Nutr Sci ; 11: e101, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36405092

RESUMO

Mid-upper arm circumference (MUAC) is simple to use and inexpensive in Ethiopia; both MUAC and target weight are employed, although the time to cure for MUAC is not indicated. The present study is aimed to determine cure time of MUAC for children in outpatient therapeutic program. A prospective cohort study was conducted among 414 severe acute malnourished under-five children admitted to selected health twenty-two posts from 1 February to 30 July 2021, in Oromia, Ethiopia. Data were coded, entered to Ep-data version 4.2 software, and transferred to SPSS for windows version 25 software for analysis. The Multivariate Cox Proportional Hazards model was used to fit independent determinants of time to cure. All tests were two-sided and statistical implications at P-values < 0⋅05. In the present study, the minimum week for a cure was 4 weeks, the maximum was 16 weeks and the overall time to cure severe acute malnutrition as measured by MUAC is judged to be 10 at 95 % CI (9⋅65-10⋅35). Families with six or more members are 2⋅16 times more at risk, children from homes with the lowest wealth index are at 1⋅4 times more risk, and children from food insecure families were 2⋅61 times more likely to require long-term treatment for MUAC. In the present study, the time to cure severe acute malnutrition by MUAC is determined as 10 weeks. Moreover, family size, low wealth index, and household food insecurity were risks to delay in cure time MUAC.


Assuntos
Braço , Alta do Paciente , Desnutrição Aguda Grave , Humanos , Braço/anatomia & histologia , Etiópia , Pacientes Ambulatoriais , Estudos Prospectivos , Desnutrição Aguda Grave/terapia , Pré-Escolar
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(10): 1418-1424, 2022 Oct 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-36411693

RESUMO

OBJECTIVES: Obsessive-compulsive disorder (OCD) is a chronic and refractory mental disorder with early onset, low response rate, and poor prognosis. Studies have shown that the age of onset, severity, course of disease, and untreated course of disease may affect its clinical efficacy. At present, there are few studies on the duration of untreated illness (DUI) of OCD patients. The current medical status and untreated course of OCD patients in China are still unclear. This study aims to investigate the current medical status of OCD patients in psychiatric outpatients of a general hospital, including the course of disease and DUI as well as its influencing factors. METHODS: A total of 310 outpatients with OCD who visited the Department of Mental Health, Guangdong Provincial People's Hospital for the first time, were recruited and interviewed. The information including age, gender, years of education, marital status, work status, age of onset, comorbid mental disorders, age of first treatment, course of disease, and DUI were collected. We also calculated the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Global Assessment Function (GAF) scores for total sample to analyze the demographic characteristics and clinical data of patients with OCT. The median DUI was used as the cut-off value, and the patients were divided into a short DUI group and a long DUI group. The differences in demographic characteristics and clinical data between the 2 groups were compared, and the factors affecting the DUI were analyzed. RESULTS: There were 158 males (51%) and 152 females (49%). The age of onset was (19.48±7.97) years. The years of education were 13.49±3.13; 215 (69.4%) were single and 95 (30.6%) were married; 103 (33.2%) were employed and 207 (66.8%) were unemployed. The median course of OCD was 4 years and the median DUI was 3 years. There were 177 cases in the short DUI (≤3 years) group and 133 cases in the long DUI (>3 years) group. Compared with the long DUI group, the patients in the short DUI group were younger (P<0.01); they had mild obsessive-compulsive symptoms (P<0.05) and a shorter education period and course of disease (P<0.01 and P<0.001, respectively); and they were more unemployed and single (both P<0.001). Correlation analysis showed that DUI was positively correlated with age, course of disease, years of education, and Y-BOCS score (r=0.45, P<0.001; r=0.74, P<0.001; r=0.27, P<0.001; r=0.17, P<0.01). When the DUI of OCD patients was used as the dependent variable, Y-BOCS, age, course of disease, whether to work, marital status, and years of education were used as the independent variables for binary logistic regression analysis, which showed that the duration of illness could predict the short and long DUI of OCD [Wald χ2=49.78, Exp(B)=1.34, P<0.001]. CONCLUSIONS: Investigation for the medical status of OCD patients in the psychiatric outpatients of a general hospital in Guangdong, China shows that the duration of illness of OCD patients in the psychiatric outpatients and the DUI of OCD patients are generally shorter than previous foreign reports. The DUI of OCD patients is affected by the course of disease, age, severity of symptoms, and other factors. In the future, large sample, multi-center, and follow-up studies could be considered to further explore the influencing factors for the DUI of OCD and the impact on the prognosis of the disease, to help improve the status of delayed treatment for OCD and improve the effective rate of OCD treatment.


Assuntos
Transtorno Obsessivo-Compulsivo , Pacientes Ambulatoriais , Masculino , Feminino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Transtorno Obsessivo-Compulsivo/epidemiologia , Resultado do Tratamento , Fatores de Tempo , China/epidemiologia
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