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At least 307 records · Page 17Linked to original sources
PubMed2005

A survey of open-access endoscopy in primary health care centres: outcome of gastric carcinoma patients diagnosed by general practitioners compared with hospital-referred endoscopy.

BACKGROUND: We examined open-access endoscopy service based on general practitioner endoscopists. METHODS: We compared the survival of the gastric carcinoma patients originally diagnosed in health care centres by general practitioner endoscopists and hospital outpatient clinic by specialists. RESULTS: A total of 159 gastric carcinoma cases diagnosed during 1996-2000 were included in to the present study. Of them, 58% (N = 92) and 42% (N = 67) were detected by general practitioners and specialists, respectively. We observed no difference in the mean age of patients (71.3 years versus 71.4 years, p = 0.97) and stage of tumours [15% (N = 14) versus 21% localised tumours (N = 14, p = 0.30)] between cases diagnosed by general practitioners and specialists. The number of patients who underwent radical extirpation were 14% (N = 13) and 19% (N = 13, p = 0.38), respectively. After a minimum follow-up of 3.5 years, 29 patients (18%) were alive. The mean survival time of hospital-diagnosed carcinoma patients was longer (23.6 months versus 18.7 months, p = 0.23). Eight patients had undergone hospital-referred gastroscopy less than 3 years before cancer diagnosis. In multivariate analysis, radical extirpation of carcinoma (odds ratio 0.11, 95% confidence interval 0.04-0.28) predicted survival; whereas age (odds ratio 1.03 per year, 95% confidence interval 0.99-1.07 per year), female sex (odds ratio 1.785, 95% confidence interval 0.71-4.81) and the open-access endoscopy based on general practitioner endoscopists (odds ratio 1.48, 95% confidence interval 0.60-3.65) predicted neither survival nor carcinoma-related death. CONCLUSION: No significant difference was detected in the outcome of gastric cancer patients diagnosed in primary care centres by general practitioner endoscopists and in hospital outpatient clinic by specialists.

Aged↗
PubMed2002

A randomized controlled trial of shared care versus routine care for patients receiving oral anticoagulant therapy.

OBJECTIVES: To evaluate the effect of a shared care programme (SCP), defined as a scheme based on shared responsibility, enhanced information exchange, continues medical education and explicit clinical guidelines, between general practitioners (GPs) and a hospital outpatient clinic (HOC), on oral anticoagulant therapy (OAT). DESIGN: The study was a 2-year prospective, randomized, controlled trial, preceded by a 1-year period of observation. SETTING: The HOC, GPs, and OAT patients in the admission area of Aarhus University Hospital, Aarhus County, Denmark, covering 310 300 inhabitants. SUBJECTS: A total of 207 GPs, including their enlisted patients on OAT, were invited, and 61.4% accepted participation. They were randomized into an intervention group [group-INT: 64 GPs and 453 patients (170 patients on OAT throughout the study period, i.e. full follow-up)], and a control group [group-CON: 63 GPs and 422 patients (173 with full follow-up)]. The remaining 80 GPs served as a nonresponder group (group-NON) of 485 patients (184 with full follow-up). MAIN OUTCOME MEASURE: Therapeutic control of OAT in terms of time spent by the patients within the therapeutic interval (TI) of an international normalized ratio (INR) between 2.0 and 3.5. RESULTS: The groups did not differ significantly with regard to age, sex, OAT indication, anticoagulant drug used, or the therapeutic control at baseline. In a comparison based on intention-to-treat principles, the therapeutic control increased statistical significance amongst patients with full follow-up in group-INT compared with group-CON (median time within TI: group INT = 86.6% vs. 80.5%, P = 0.007). CONCLUSION: An SCP of anticoagulant management is effective in reducing patient time outside the therapeutic INR interval in OAT patients randomly assigned to an SCP, as compared with a control group.

Administration, Oral↗
PubMed2001

A survey of frequent attenders at a gastroenterology clinic.

OBJECTIVE: To examine a group of patients satisfying criteria for "frequent attending" as part of an audit of an outpatient gastroenterology service, and to note the prevalence of those with no conspicuous organic disease to account for their symptomatology. METHODS: We used the hospital computer (Oxford Patient Administration System, OXPAS) to identify 2530 consecutive patients who were given an appointment to attend the gastroenterology clinic during an 11-month period. Patients designated "frequent attenders" had their notes flagged before the clinic attendance and were examined in more detail. A frequent attender was defined as a patient who had attended any hospital outpatient clinic in the three Oxford general hospitals on four or more occasions in the previous 12 months. The gastroenterologist then interviewed the patients satisfying these criteria and indicated whether he/she was satisfied that there was no relevant organic disease to account for the symptoms. RESULTS: Of the total 2530 patients, 762 (30%) satisfied our criteria for frequent attendance (FA). Of these, 452 (59%) had organic disease, 128 (17%) either did not attend or cancelled and 159 (21%) had no relevant organic disease. The diagnosis was uncertain in 23 patients (3%). Of patients satisfying our criteria for frequent attending, approximately 20-25% had no established gastroenterological disease. CONCLUSIONS: Frequent attenders present formidable management problems for the gastroenterologist. If they can be identified by computer before the outpatient visit then assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff.

Adolescent↗
PubMed2006

Malnourished children treated in day-hospital or outpatient clinics exhibit linear catch-up and normal body composition.

The nutritional programming hypothesis proposes that early life malnutrition is related to an increase in body fat later in life. Brazilian boys and girls (n = 94; 4-14 y old) were studied. Malnourished children treated in a Nutrition Recovery Center, were followed up and divided into 2 groups: the Outpatient group (recovered after outpatient care, n = 28), and the Day-hospital group (recovered after day-hospital care, n = 38). They were compared with a Control group (healthy individuals without intervention, n = 28). Nutritional recovery was confirmed by anthropometry. Body composition was evaluated by dual-energy X-ray absorptiometry. Both recovered groups had a greater increase in height-for-age Z-scores than in weight-for-age Z-scores after treatment (P < 0.03). Body fat mass (kg) and the percentage of body fat were significantly lower in recovered groups of girls and boys compared with controls. Among boys, lean mass/height (kg/cm), fat-free mass (kg) and the fat-free mass index (kg/m(2)) were significantly lower in the Outpatient and Day-hospital groups than in Controls, but girls did not differ. Bone mineral content (BMC)/height (g/cm) did not differ between the recovered girls and the girls in the Control group (P < 0.15) or between the boys in the Day-hospital group and those in the Control group (P = 0.06). The Outpatient boys group had lower BMC/height than boys in the Control group (P = 0.02). This study demonstrates that when malnourished children receive adequate treatment, linear catch-up growth occurs and is followed by appropriate gain in lean body mass and BMC.

Adipose Tissue↗
PubMed1992

A study of referrals of black children to a general hospital psychiatric outpatient clinic.

Five hundred and seventy-seven children who attended a child psychiatric out-patient clinic during 1987 were evaluated. Their clinical and demographic characteristics are described and management discussed. High on the list of presenting complaints were poor school performance and behavioural problems. Factors considered as influencing referrals are socio-economic, political, lack of school psychological services and facilities for the management of the intellectually handicapped. The most common diagnoses were mental retardation (39.5%) and epilepsy (16.2%).

Black or African American↗
PubMed2004

Biomedicine globalized and localized: western medical practices in an outpatient clinic of a Mexican hospital.

Following contemporary globalization, biomedicine and western style hospitals have penetrated most corners of the world. We must therefore ask, "How has the diffusion of biomedicine impacted biomedicine's core features of practice cross culturally? How do physicians in different countries make diagnoses, explain etiology and treat patients? To what degree does a physician's cultural understanding shape biomedicine?" Based on extensive fieldwork in a Mexican hospital (Physicians at work, patients in pain. Revised with new preface, Carolina Academic Press, Durham, 2001), this study analyzes the ways in which biomedicine becomes culturally reinterpreted as it moves from one cultural venue to another, and explores the theoretical and practical consequences of this reinterpretation. This analysis illuminates the relationship between biomedicine and the nature of social transformations and refines our understanding of globalization. From a practical perspective, the study is important because a nation's epidemiological profiles are based on statistics drawn from the diagnoses that physicians make. We must not assume that because the same medical nomenclature is used to make the diagnoses, these diagnoses are based on culturally neutral and uniform assessments.

Anthropology, Cultural↗
PubMed1978

[Hospital and outpatient clinic for dentistry-past and future].

A short historical survey deals with the development of the Clinic and Policlinic of Stomatology of the Magdeburg Medical Academy. Apart from especially marked stages prior to the erection of the new building in 1958 and the appreciation of the merits of F. Meyer, founder of the Clinic, the present paper treats the interdisciplinary connexion of the Clinic with other institutions of the Magdeburg Medical Academy and indicates its tasks in the fields of medical care, of medical education, training and continuing education, and of research. From a discussion on its significance and importance in the framework of the health policy of the Socialist Health Service of the GDR, certain speculations on its prospects are deduced (with reference to certain facts), and the consequences necessary for the continuation of its present development are pointed to.

Dental Clinics↗
PubMedDate not supplied

Allocation of resources for ambulatory care -a staffing model for outpatient clinics.

The enormous commitment of resources to ambulatory health care services requires that flexible and easily implementable management techniques be developed to improve the allocation of health manpower and funds. This article develops a feasible model for staffing outpatient clinics and thereby potentially provides an important analytical tool for allocating and monitoring the utilization of the most critical and expensive of ambulatory care resources-professional and nonprofessional clinic personnel. The model is simplistic, extremely flexible, and can be applied to many modes of delivering ambulatory care-from HMOs to traditional hospital outpatient clinics. To employ the model, certain decision variables must be specified so that the model can produce a least-cost staffing configuration to meet the demand for service in accordance with the desired mode and intensity of care. The key decision varables that require input from administrators and medical personnel include standards for physician-patient contact time, a desired ratio of staff time actually spent treating patients to total paid staff time, and the desired mix of various staff categories to achieve program objectives. Specific benefits of using the model include determining staffing for new, expanded, or existing outpatient clinics, determining budget requirements for such staffing needs, and providing quantitative productivity and utilization objectives and measurements.

Ambulatory Care↗
PubMed2001

Radiofrequency tissue volume reduction: multilesion vs single-lesion treatments for snoring.

OBJECTIVE: To compare the safety and efficacy of single-lesion and multilesion radiofrequency tissue reduction (RFTR) of the soft palate for the treatment of snoring. DESIGN: Prospective, nonrandomized clinical trial. SETTING: University hospital outpatient clinic. PATIENTS: Nonrandomized patients undergoing RFTR to treat socially unacceptable snoring. Of 47 patients, 16 received single-lesion treatments and 31 received multilesion treatments. INTERVENTION: Soft-palate RFTR was performed using a radiofrequency generator. Patients required 1 to 3 treatments based on improvement or withdrawal from the study, and each received 1, 3, or 4 lesions per treatment. Patients who received single-lesion therapy did not cross over into the multilesion group; however, 5 patients in the multilesion group received 4-lesion therapy after a treatment with 3 lesions. MAIN OUTCOME MEASURES: Outcome measures were determined using visual analog scale questionnaires assessing level of snoring (snoring index) and level of pain (pain index) associated with the procedure. Adverse events and complications during treatment were cataloged. Data were collected before the procedure, 6 weeks after each treatment, and an average of 16 months after the last procedure. RESULTS: Single-lesion and multilesion groups showed significant improvement in snoring after RFTR treatments (P<.01 for both). However, compared with the single-lesion group, the multilesion group required fewer treatments (1.94 vs 2.38; P =.05) and was more than twice as likely to be cured after 2 treatments (61% vs 25%; P =.02). A trend toward improved clinical outcomes with increased number of lesions and total energy per treatment was observed when patients treated with 1, 3, or 4 lesions were compared. The 4-lesion group had the most pronounced improvement in snoring index score per treatment, the lowest number of treatments required for cure, and the greatest percentage of patients cured after 2 treatment sessions. Follow-up demonstrated minimal relapse of snoring in the multilesion group at a mean of 16 months. Although there was a statistically significant increase in pain in the multilesion group vs the single-lesion group, this increase did not increase narcotic use or time off work and was considered minimal by reporting patients. CONCLUSION: Multilesion RFTR using higher energy levels per treatment is safe and has increased efficacy without increased complications relative to single-lesion therapy.

Adult↗