Adaptation of a stoma care pathway and use of telephone clinics during the pandemic: patient experience survey

With the arrival of the COVID-19 pandemic, outpatient clinics had to adjust and reduce the number of face-to-face appointments. The Cambridge stoma service has a recognised pathway of stoma care but needed to adjust this in line with government guidelines. The team took the opportunity to audit the current pathway and complete a patient experience survey to determine the future of the service and potential adaptations to the pathway in the future. Aim: To determine the need for adaptation and improvement of the standard stoma clinics pathway. Method: A survey was conducted using a postal questionnaire to all patients who attended stoma clinics between April and June 2020. Findings: 160 questionnaires were sent and 72 responses returned (45%). All elements of the virtual clinic were rated positive by more than 80% of respondents, with nearly 90% of them feeling that all their stoma care needs were met. When asked to indicate their preferred consultation methods (patients were allowed to choose more than one), face to face received 50 votes, telephone 32 votes and video clinic 5 votes. Conclusion: There is a need to adapt the standard clinic pathway to be able to offer standardised care but with flexibility to adjust to circumstances and patients' preferences.

High Frequency of Microvascular Dysfunction in US Outpatient Clinics: A Sign of High Residual Risk? Data from 7,105 Patients

Previous studies have linked peripheral microvascular dysfunction measured by arterial tonometry to high residual risk in on-statin patients. Digital thermal monitoring (DTM) of microvascular function is a new and simplified technique based on fingertip temperature measurements that has been correlated with the burden of atherosclerosis and its risk factors. Here, we report analyses of DTM data from two large US registries: Registry-I (6,084 cases) and Registry-II (1,021 cases) across 49 US outpatient clinics. DTM tests were performed using a VENDYS device during a 5-minute arm-cuff reactive hyperemia. Fingertip temperature falls during cuff inflation and rebounds after deflation. Adjusted maximum temperature rebound was reported as vascular reactivity index (VRI). VRI distributions were similar in both registries, with mean ± SD of 1.58 ± 0.53 in Registry-I and 1.52 ± 0.43 in Registry-II. In the combined dataset, only 18% had optimal VRI (≥2.0) and 82% were either poor (<1.0) or intermediate (1.0-2.0). Women had slightly higher VRI than men ( 1.62 ± 0.56 vs. 1.54 ± 0.47 , p < 0.001 ). VRI was inversely but mildly correlated with age ( r = − 0.19 , p < 0.001 ). Suboptimal VRI was found in 72% of patients <50 years, 82% of 50-70 years, and 86% of ≥70 years. Blood pressure was not correlated with VRI. In this largest registry of peripheral microvascular function measurements, suboptimal scores were highly frequent among on-treatment patients, possibly suggesting a significant residual risk. Prospective studies are warranted to validate microvascular dysfunction as an indicator of residual risk.

Trust in pathways? Professionals’ sensemaking of care pathways in the Norwegian mental health services system

Background In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle. The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation. Methods Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults. Results The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals’ distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation. Conclusion Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.

Studying the appointment scheduling window considering patient no-show behavior in one public and one private outpatient clinics

Purpose This study is carried out in one public and one private health-care centers based on different probabilities of patient’s no-show rate. The present study aims to determine the optimal queuing system capacity so that the expected total cost is minimized. Design/methodology/approach In this study an M/M/1/K queuing model is used for analytical properties of optimal queuing system capacity and appointment window so that total costs of these cases could be minimized. MATLAB software version R2014a is used to code the model. Findings In this paper, the optimal queuing system capacity is determined based on the changes in effective parameters, followed by a sensitivity analysis. Total cost in public center includes the costs of patient waiting time and rejection. However, the total cost in private center includes costs of physician idle time plus costs of public center. At the end, the results for public and private centers are compared to reach a final assessment. Originality/value Today, determining the optimal queuing system capacity is one of the most central concerns of outpatient clinics. The large capacity of the queuing system leads to an increase in the patient’s waiting-time cost, and on the other hand, a small queuing system will increase the cost of patient’s rejection. The approach suggested in this paper attempts to deal with this mentioned concern.

Contribution of homeopathy to the control of an outbreak of dengue in Macaé, Rio de Janeiro

Homeopathy has contributed throughout history to the control and eradication of epidemic diseases. Facing the challenge of controlling an outbreak of dengue, the Secretary of Health of the county of Macaé, Rio de Janeiro, Brazil, in early 2007 carried out a “Homeopathy Campaign against Dengue”. 156,000 doses of homeopathic remedy were freely distributed in April and May 2007 to asymptomatic patients and 129 doses to symptomatic patients treated in outpatient clinics, according to the notion of “epidemic genus”. The remedy used was a homeopathic complex against dengue containing Phosphorus 30cH, Crotalus horridus 30cH and Eupatorium perfoliatum 30cH. The incidence of the disease in the first three months of 2008 fell 93% by comparison to the corresponding period in 2007, whereas in the rest of the State of Rio de Janeiro there was an increase of 128%. While confounding factors were not controlled for, these results suggest that homeopathy may be an effective adjunct in Dengue outbreak prevention. Keywords: Homeopathy; Collective Health; Epidemics; Dengue.  Contribuição da Homeopatia para o controle da epidemia de dengue em Macaé, Rio de Janeiro, Brasil Resumo A Homepatia tem contribuído através da História no controle e erradicação de epidemias. Em face ao desafio de controlar uma epidemia de dengue, a Secretaria de Saúde do município de Macaé, Rio de Janeiro, Brasil, iniciou em 2007 a “Campanha da Homeopatia contra a Dengue”. 156,000 doses de medicamento foram gratuitamente distribuídas entre Abril e Maio de 2007 para pacientes assintomáticos e 129 doses para pacientes que já apresentavam os sintomas. Seguindo o conceito de “Génio Epidémico” foi usado um complexo homeopático contendo Phosphorus 30cH, Crotalus horridus 30cH e Eupatorium perfoliatum 30cH. A incidéncia da doença, nos primeiros 3 meses de 2008, revelou uma queda de 93% em comparação com o período correspondente em 2007, enquanto que no resto do estado do Rio de Janeiro houve um aumento de 128% dos casos. Apesar de alguns fatores não terem sido controlados, estes resultados sugerem que o tratamento homeopático pode ser um complemento efetivo na prevenção da epidemia de Dengue. Palavras-chave: Homeopatia; Saúde Pública; Epidemia; Dengue.  Contribución de la homeopatía para el control de un brote de dengue en Macaé, Río de Janeiro, Resumen La homeopatía ha contribuido a lo largo de la historia em el control y la erradicación de las enfermedades epidémicas. Al enfrentar el reto de controlar un brote de dengue, el Secretario de Salud de la provincia de Macaé, Río de Janeiro, Brasil, a principios de 2007, llevó a cabo una "Campaña de la homeopatía contra el Dengue". 156.000 dosis de remedio homeopático se distribuyeron libremente entre abril y mayo de 2007 a pacientes asintomáticos y 129 dosis a los pacientes sintomáticos tratados en ambulatorios, de acuerdo con la noción de "epidemia de género". El recurso utilizado fue un complejo homeopático contra el dengue que contiene Phosporus 30cH, Crotalus horridus 30cH y Eupatorium perfoliatum 30cH. La incidencia de la enfermedad en los tres primeros meses de 2008 se redujo 93% en comparación con el período correspondiente en 2007, mientras que en el resto del Estado de Río de Janeiro hubo un aumento de 128%. Si bien hay factores no controlados, estos resultados sugieren que la homeopatía puede ser un complemento eficaz en la prevención del brote de dengue. Palabras-clave: Homeopatía; Salud Colectiva; epidemias; dengue.  Correspondence author: Laila Aparecida de Souza Nunes, [email protected] How to cite this article: Nunes LAS. Contribution of homeopathy to the control of an outbreak of dengue in Macaé, Rio de Janeiro. Int J High Dilution Res [online]. 2008 [cited YYYY Mmm DD]; 7(25): 186-192. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/315/374. ÂÂÂ

Frequency of Dydrogesterone Use in the Gynecological Outpatient Clinics

Aim: This study aimed to describe the use of dydrogesterone in the outpatient setting in Al-Kharj. Methodology: This is a retrospective study that includes reviewing the electronic prescriptions of dydrogesterone among outpatients in a public hospital in Alkharj. Results: During the study period between January 2018 to June 2018, 48 patients received dydrogesterone. The age of 41.67% of the patients was between 20 and 29 years. Most of dydrogesterone prescriptions were written by residents (89.58%) and more than 60% of dydrogesterone prescriptions were written by emergency department (60.42%). Conclusion: The present study showed that the prescribing of dydrogesterone was uncommon in the outpatient setting. More studies are needed to explore the frequency of its prescribing in other settings and to explore the prescribing of other medications that are used for gynecological conditions.

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China

Background: Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.Methods: In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.Results: The number of patients was the significant independent predictor of the number of interruptions(p<0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (Χ2 =16.988, p = 0.049). Conclusion: The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: cross-sectional facility-based study, Addis Ababa, Ethiopia

ObjectiveTo determine the prevalence of intimate partner violence (IPV), and associated factors, in reproductive-aged women attending psychiatric outpatient departments.DesignCross-sectional facility-based study.SettingOutpatient psychiatric clinics of public hospitals in Addis Ababa.ParticipantsReproductive aged women with chronic mental illness (CMI) who attended follow-up in psychiatric outpatient clinics.Primary and secondary outcome measuresThe data were collected using a multi-culturally validated instrument from randomly sampled women with CMI. Multiple logistic regression was used to identify factors independently associated with IPV.ResultFour hundred and twenty-two women who were attending the psychiatric outpatient clinics took part in the study. The majority of participants 62.0% (95% CI 56.1 to 68.8) experienced IPV at least once in their lifetime. The most common form of IPV experienced by women was emotional violence (60%; 95% CI 55.0 to 64.7). One hundred and eighty-six (44.1%; (95% CI 39.3 to 48.8)) respondents experienced physical or sexual violence during the last year. A history of divorce (Adjusted Odds Ratio [AOR]=5.64; 95% CI 2.75 to 11.56) and having a mental illness for more than 5 years (AOR=2.23; 95% CI 1.26 to 3.93) were associated with any form of IPV.ConclusionThe high prevalence of IPV among women attending psychiatric outpatient services highlights the need to routinely inquire about IPV and develop effective strategies to prevent it among this vulnerable group.