Search Results (21)

Introduction: Patients undergoing surgery are exposed to various stressors that may increase psychological distress during the perioperative period. These repercussions may be substantial, affecting both physical and mental health, as well as the ability to resume regular activities and overall quality of life. Aim: This study aimed to compare the preoperative psychological distress levels of patients admitted to long-term preoperative hospitalization (LONG) to those of patients admitted to day care (DC) facilities for ambulatory surgery within an oncology hospital and to examine potential sociodemographic predictors. Methods: This was a prospective observational study that included 176 individuals who underwent surgery in two cohorts. Patients in the DC cohort (n = 88) were treated in a day care surgery clinic, whereas patients in the LONG cohort (n = 88) were treated in a long-term oncology hospital. Demographic and clinical data were collected. Patients’ psychological distress (depression, anxiety, and stress) was preoperatively evaluated using the DASS-42. Univariate and multivariate logistic regression analyses were performed. Results: The DASS-42 scale’s Cronbach’s alpha was 0.923. There was no significant difference between the cohorts in terms of age; however, waiting time before surgery differed significantly (U = 2884, p = 0.002). Stress levels differed significantly between the two cohorts (p = 0.05). Conclusions: Health managers and health care providers should consider gender, surgical severity, and rural/urban residence as factors associated with preoperative psychological distress. Studies assessing gender-specific dynamics, as well as mixed-methods approaches, could provide deeper insights into patients’ experiences and the correlations of distress and highlight implications for oncology nursing practice across different hospitalization models. Full article

Research on climate-related disasters and healthcare infrastructure has largely focused on short-term, localized impacts. This study examined the long-term association between climate-related disasters and healthcare facilities across 3108 contiguous United States counties from 2000 to 2014. Utilizing databases like the National Establishment Time Series and the Spatial Hazards and Events Losses Database, we classified county-level infrastructure changes (“never had”, “lost”, “gained”, and “always had”) and disaster severity (minor, moderate, severe), respectively. Autoregressive linear models were used to estimate the total number of moderate and severe disasters (2000–2013) associated with the change in the number of healthcare establishments in 2014, after adjusting for healthcare establishments, total population, and poverty in 2000. Results demonstrate that an increase in one moderate disaster was significantly associated with increased hospital infrastructure (Count, 0.14; 95% CI, 0.03–0.25), while severe disasters were significantly associated with a decrease (Count, −0.31; 95% CI, −0.47–−0.14). Similar but stronger associations were observed for ambulatory care (Moderate: Count, 2.52; 95% CI 0.91–4.12 and Severe: Count, −5.99; 95% CI, −8.53–−3.64, respectively). No significant associations were found among pharmacies. These findings highlight the varying impacts of climate-related disasters on healthcare accessibility. Future initiatives should prioritize strengthening existing infrastructure and enhance disaster recovery strategies. Full article

Background: Femoroacetabular impingement (FAI) is a condition caused by abnormal contact between the femur head and the acetabulum, which damages the labrum and articular cartilage. While the prevalence and the type of impingement may vary across human groups, the variability among populations with short height or with a high prevalence of overweight has not yet been explored. Latin American studies have rarely been conducted in reference to this condition, including the Mayan and mestizo populations from the Yucatan Peninsula. Objective: We aimed to describe the prevalence of morphological changes in femoroacetabular impingement by measuring radiological angles in abdominopelvic tomography studies in a sample of patients from a population with short height. Methods: In this prospective study, patients with programmed abdominopelvic tomography unrelated to femoroacetabular impingement but with consistent symptoms were included. Among the 98 patients, the overall prevalence of unrelated femoroacetabular impingement was 47%, and the pincer-type was the most frequent. The cam-type occurred more frequently among individuals with taller stature compared to their peers. Alpha and Wiberg angles predicted cam- and pincer-type, respectively, with over 0.95 area under the curve values in ROC analyses. The inter-rater agreement in the study was >91%. Conclusions: In a patient population from Yucatan, Mexico, attending ambulatory consultations unrelated to femoroacetabular impingement, an overall morphological changes prevalence of 47% was observed. Angle measurements using tomographic techniques can be used to predict cam- and pincer-type femoroacetabular impingement. Average stature was observed to be shorter in patients with cam-type femoroacetabular impingement, but body mass index did not vary between groups. Full article

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations. Full article

Purpose: The usual workup for patients newly diagnosed with advanced non-small cell lung cancer (NSCLC) occurs in the ambulatory setting. A subset of patients present with acute care needs and receive the diagnosis while hospitalized. Palliative therapies are typically initiated when patients are outpatients, even when diagnoses are made when they are inpatients. Lengthy admission, rehabilitation needs after discharge, and readmissions are possible barriers to timely and adequate outpatient follow-up. The outcomes for these patients diagnosed in the hospital are not well characterized. We hypothesized that patients have been ill-served by current treatment patterns, as reflected by low rates of cancer-directed treatment and poor survival. Patients and methods: We performed a retrospective study of new inpatient diagnoses of metastatic NSCLC at our institution between 1 January 2012 and 1 January 2022. The primary outcome was the proportion of patients ultimately receiving cancer-directed therapy. Other outcomes included time to treatment, use of targeted therapy, palliative care/hospice utilization, and overall survival (OS). Results: Seventy-three patients were included, with a median age of 57 years. Twenty-seven patients (37%) ultimately received systemic therapy with a median time from diagnosis to treatment of 37.5 days. Overall, 5.4% patients died while admitted, 6.8% were discharged to a hospice, 21.9% were discharged to a facility, and 61.6% were discharged home. Only 20 patients (27%) received palliative care consultation. The median OS for our entire population was 2.3 months, with estimated 6-month and 1-year OS rates of 32% and 22%, respectively. Conclusion: Patients with new inpatient diagnoses of metastatic NSCLC have extremely poor outcomes. Current management strategies resulted in few patients starting systemic therapy, yet most of the patients did not receive palliative care or hospice involvement. These findings demonstrate that there is a high unmet need to optimally support and palliate these patients. Full article

The COVID-19 pandemic has significantly impacted the healthcare industry and its workforce, particularly nurses, who have been at the forefront of patient care. As the world begins to emerge from the pandemic, attention is turning to the long-term effects of the crisis on nurses’ mental health and well-being, and specifically nursing burnout. Prevalent risk factors related to nursing burnout often historically involve high workload, insufficient support and/or resources, work–life imbalance, and even lack of autonomy and organization climate challenges. Understanding the factors that contribute to nursing burnout to help mitigate it is vital to ensuring the ongoing health and well-being of the nursing workforce, especially since the ongoing waning of coronavirus (COVID-19). This rapid review identifies 36 articles and explores the latest research on nursing burnout in outpatient (ambulatory care) healthcare facilities as the global pandemic continues to subside, and therefore identifies constructs that suggest areas for future research beyond previously identified contributing factors of nursing burnout while the pandemic virus levels were high. Full article

A transient ischemic attack (TIA), a constellation of temporary neurological symptoms, precedes stroke in one-fifth of patients. Thus far, many clinical models have been introduced to optimize the quality, time to treatment, and cost of acute TIA care, either in an inpatient or outpatient setting. In this article, we aim to review the characteristics and outcomes of outpatient TIA clinics across the globe. In addition, we discussed the main challenges for outpatient management of TIA, including triage and diagnosis, and the system dynamics of the clinics. We further reviewed the potential developments in TIA care, such as telemedicine, predictive analytics, personalized medicine, and advanced imaging. Full article

The importance of developing an effective action-based model of care for multimorbid patients has become common knowledge, but it remains unclear why researchers in Nigeria have not paid attention to the issue. Hence, this study assessed the quality of health services using the Donabedian model and aimed to recommend an effective hospital care delivery model for older people in Nigeria with multimorbidity. A cross-sectional study using face-to-face data was conducted between October 2021 and February 2022. The reported data were collated, checked, coded, and entered into JISC online survey software and then exported to IBM Statistical Package for Social Science (SPSS) version 27 for analysis, sourced from the University of West London, London, United Kingdom. The data were collected from the outpatient department of four high-volume public secondary hospitals in Niger State (the largest hospital in the three senatorial zones and that of the state capital). Systematic random sampling was used to select 734 patients with two or more chronic diseases (multimorbidity) aged 60 years and above who presented for routine ambulatory outpatient and consented to participate in the study. A Service Availability and Readiness Assessment (SARA) tool was used to assess the structure, and the process quality was assessed by the patients’ experiences as they navigated the care pathway, whereas the outcome was measured using the patients’ overall satisfaction. Using Spearman’s correlation, no statistically significant association was observed between satisfaction level with the healthcare that was received and the five domains of health facility readiness (Total score Basic Amenities, Total score Basic Equipment, Total score infection control, Total score diagnostic capacity, Total score essential drugs), and the general facility readiness. Finally, the process component superseded the structure as the determinant of the quality of healthcare among multimorbid patients in Niger State. The emphasis of the process should be on improving access to quality of care, improving patient–physician relationships and timing, reducing the financial burden of medical care, and building confidence and trust in medical care. Therefore, these factors should be incorporated into designing the healthcare model for multimorbid patients in Nigeria. Full article

Patients who achieve smoking cessation following a cancer diagnosis can experience an improvement in treatment response and lower morbidity and mortality compared to individuals who continue to smoke. It is therefore imperative for publicly funded cancer centres to provide appropriate training and education for healthcare providers (HCP) and treatment options to support smoking cessation for their patients. However, system-, practitioner-, and patient-level barriers exist that hamper the integration of evidence-based cessation programs within publicly funded cancer centres. The integration of evidence-based smoking cessation counselling and pharmacotherapy into cancer care facilities could have a significant effect on smoking cessation and cancer treatment outcomes. The purpose of this paper is to describe the elements of a learning health system for smoking cessation, implemented and scaled up in community settings that can be adapted for ambulatory cancer clinics. The core elements include appropriate workflows enabled by technology, thereby improving both practitioner and patient experience and effectively removing practitioner-level barriers to program implementation. Integrating the smoking cessation elements of this program from primary care to cancer centres could improve smoking cessation outcomes in patients attending cancer clinics. Full article

Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is not universally accepted. This study used Taiwan as the backdrop to understand why many health clinics have chosen not to accept the National Health Insurance (NHI), despite it covering 99.93% of the country’s population. The clinics’ operational details were garnered from the datasets of Taiwan’s open government data platforms and checked against the list of contracting clinics within the NHI. Of 10,907 Western medicine primary care clinics in 2016, as many as 9846 (90.3%) clinics had signed contracts with the NHI. The remaining 1061 noncontracting clinics were distributed in urban (94.5%, n = 1003), suburban (4.9%, n = 52), and rural/remote areas (0.6%, n = 6). The NHI did not have contracts with 183 plastic surgery, 88 internal medicine, and 85 surgery clinics. In conclusion, nearly one-tenth of clinics practiced independently of the NHI in Taiwan. Their reasons for declining the contract and practices for delivering their services deserve further studies. Full article

Although dispensing is usually separated from prescribing in healthcare service delivery worldwide, primary care clinics in some countries can hire pharmacists to offer in-house dispensing or point-of-care dispensing for patients’ convenience. This study aimed to provide a general overview of pharmacists working at primary care clinics in Taiwan. Special attention was paid to clarifying the relationship by location, scale, and specialty of clinics. The data source was the Government’s open database in Taiwan. In our study, a total of 8688 pharmacists were hired in 6020 (52.1%) 11,546 clinics. The result revealed significant differences in the number of pharmacists at different specialty clinics among levels of urbanization. Group practices did not have a higher probability of hiring pharmacists than solo practices. There was a higher prevalence of pharmacists practicing in clinics of non surgery-related specialties than in surgery-related specialties. Although the strict separation policy of dispensing and prescribing has been implemented for 2 decades in Taiwan, most primary care clinics seem to circumvent the regulation by hiring pharmacists to maintain dominant roles in dispensing drugs and retaining the financial benefits from drugs. More in-depth analyses are required to study the impact on pharmacies and the quality of pharmaceutical care. Full article

Prevention quality indicators (PQIs) constitute a set of measures that can be combined with hospital inpatient data to identify the quality of care for ambulatory care sensitive conditions (ACSC). Geographical information system (GIS) web mapping and applications contribute to a better representation of PQI spatial distribution. Unlike many countries in the world, in Portugal, this type of application remains underdeveloped. The main objective of this work was to facilitate the assessment of geographical patterns and trends of health data in Portugal. Therefore, two innovative open source applications were developed. Leaflet Javascript Library, PostGIS, and GeoServer were used to create a web map application prototype. Python language was used to develop the GIS application. The geospatial assessment of geographical patterns of health data in Portugal can be obtained through a GIS application and a web map application. Both tools proposed allowed for an easy and intuitive assessment of geographical patterns and time trends of PQI values in Portugal, alongside other relevant health data, i.e., the location of health care facilities, which, in turn, showed some association between the location of facilities and quality of health care. However, in the future, more research is still required to map other relevant data, for more in-depth analyses. Full article

Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC. Full article

How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs. Full article

Late-arriving patients have become a prominent concern in several ambulatory care clinics across the globe. Accommodating them could lead to detrimental ramifications such as schedule disruption and increased waiting time for forthcoming patients, which, in turn, could lead to patient dissatisfaction, reduced care quality, and physician burnout. However, rescheduling late arrivals could delay access to care. This paper aims to predict the patient-specific risk of late arrival using machine learning (ML) models. Data from two different ambulatory care facilities are extracted, and a comprehensive list of predictor variables is identified or derived from the electronic medical records. A comparative analysis of four ML algorithms (logistic regression, random forests, gradient boosting machine, and artificial neural networks) that differ in their training mechanism is conducted. The results indicate that ML algorithms can accurately predict patient lateness, but a single model cannot perform best with respect to predictive performance, training time, and interpretability. Prior history of late arrivals, age, and afternoon appointments are identified as critical predictors by all the models. The ML-based approach presented in this research can serve as a decision support tool and could be integrated into the appointment system for effectively managing and mitigating tardy arrivals. Full article