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Advantages and Perspectives of Teaching in Outpatient Clinics: A Systematic Review  [PDF]
Hani Almoallim, Joan Minguet, Khaled Albazli, Manal Alotaibi, Samar Alwafi, Maun Feteih
Creative Education (CE) , 2015, DOI: 10.4236/ce.2015.616181
Abstract: Although the number of patients seen in outpatient clinics far surpasses those managed in inpatient settings, many medical training programs lack outpatient clinic teaching initiatives. Thus, we have conducted a systematic review of the literature in order to raise awareness of the important role that outpatient clinics can play in enhancing medical education, and to assess current perspectives on improving outpatient training. Our analysis reveals that outpatient clinics can offer an efficient and holistic view of patient care, while covering a wide range of general and specialty medical practices. Moreover, several fundamental skills can be acquired by students in outpatient clinics, which effectively combine elements encountered in routine ward-based teaching (etiology, history, physical examination, laboratory tests, and therapy) with those found in ambulatory care (continuity, context, health education, economics, and responsibility). Approaches to teaching in an outpatient setting vary greatly, with extensive differences in levels of supervision and feedback evident. It is clear that, at present, there is no general consensus on the best strategy for realizing the potential of outpatient clinics in the training of students and junior doctors. With the changing face of health systems, the identification of methods by which maximal benefits of this setting can be achieved would be highly advantageous for future medical trainees.
The Evaluation of Patients Presenting with Chest Pain to Pediatric Cardiology Outpatient Clinics
Mehmet Kervanc?o?lu,Celal Devecio?lu,Nurettin Okur
Dicle Medical Journal , 2005,
Abstract: Although the possibility of the cardiac origin of chest pains in childhood is low, perception of the chest pain as heart pain by families makes this issue more important. A total of 223 patients (134 male, 99 female) with a mean age of 11.3±4.3 years ranging between 4 and 15 years, who were admitted with chest pain to the Pediatric Cardiology Outpatient Clinics of Dicle University Hospital between April 2004 and January 2005, were enrolled into the study. Investigations with electrocardiography, holter monitoring and echocardiography revealed MVP in 12, pulmonary valve stenosis in three, pericardial effusion in two, focal septal hypertrophy in one, mild cardiomyopathic changes in two and operated ASD in two patients. There were Wolf-Parkinson-White in one, premature supraventricular beats in three, sinus tachycardia in two, ventricular tachycardia attack in one, and frequent single ventricular premature beats in one patient. In conclusion, despite scarcity of cardiac origin in chest pain of childhood, differential diagnosis should be made carefully due to possibility of life threatening consequences of cardiac disorders. The chest pains, with acute onset,triggered by exercise, awakening the child from sleep, accompanied with dyspnea, palpitation, dizziness, pre-syncope and syncope should be evaluated in detail for cardiac pathologies.
Urologist-operated ultrasound and its use in urological outpatient clinics
Mohammad Kazem Moslemi, Behnam Mahfoozi
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S17132
Abstract: ologist-operated ultrasound and its use in urological outpatient clinics Original Research (3876) Total Article Views Authors: Mohammad Kazem Moslemi, Behnam Mahfoozi Published Date January 2011 Volume 2011:5 Pages 85 - 88 DOI: http://dx.doi.org/10.2147/PPA.S17132 Mohammad Kazem Moslemi1, Behnam Mahfoozi2 1Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran; 2Department of Radiology, Shahid Chamran Hospital, Tehran, Iran Introduction: Ultrasonograghy plays an important role in the evaluation of urinary tract disorders in cases of medical or surgical renal disorders, because of its lower cost, availability, and lack of ionizing radiation and because with it there is no need for contrast material injection or ingestion. It needs no intervention or preparation and specifically can differentiate between the multiple causes of flank pain. Urologist-operated sonography is a quick, cost-effective, and time-saving modality for both the physician and patient for obtaining first or final diagnosis. Based on its results, patients can be selected for appropriate management and further assessment. Materials and methods: The efficacy of ultrasound examination by a trained urologist in the differentiation of urological emergencies admitted in a district private clinic was studied. Between April 2008 and April 2010, a total of 724 patients (1448 renal units) had renal ultrasound performed by a trained urologist on acute admission. The sonographic findings were compared with subsequent definitive radiological investigations performed as needed, such as KUB (kidney, ureter, bladder) or IVP (intravenous pyelogram). Patient satisfaction and permission for ultrasonography were evaluated by oral consent. Loin pain was the presenting symptom in 45% of the patients (n = 326 cases). Results: Diagnosis was achieved in 96% of patients. Further evaluations were requested as needed in suspicious cases. If any hydronephrosis was detected and patients' history and/or complaints were suggestive of renal or ureteral stones, an outpatient KUB was requested. For more complex situations, IVP was the next option. Abnormal findings were recorded in 184 cases (25.5%). Mild to moderate unilateral hydronephrosis with or without hydronephrosis was the most common finding observed sonographically. The sensitivity of our ultrasonography evaluation was 99.7%. Conclusion: Office urologist-operated sonograghy may supplement the information available through routine history, physical examination, and laboratory studies. Our study shows that urological trainees can use ultrasound with high levels of accuracy, thereby improving patient management with a high level of patient satisfaction.
Association Between Asthma Severity and Obesity in Two Asthma Clinics in Tehran
Sanaz Tavasoli,Hassan Heidarnazhad,Anooshirvan Kazemnejad,Sara Miri
Iranian Journal Of Allergy, Asthma and Immunology , 2005,
Abstract: The prevalence of both obesity and asthma has increased in recent years. Thus we decided to investigate the relation between obesity and asthma severity. We undertook a cross-sectional study in outpatient asthma clinics of 2 tertiary hospitals in Tehran. Obesity was defined as a body mass index greater than 30. Asthma severity was defined by using the Guide for Asthma Management and Prevention 2004 guidelines, according to patients’ clinical and/or spirometerical parameters. Active cigarette smoking patients and patients with a history of other lung diseases were excluded. A total of 116 individuals, aged 16-83 years with a mean age of 46.57±15.05 years, met the entry criteria. There were 73 females and 43 males. The prevalence of obesity in our study population was 29.3%. The Spearman correlation coefficient between asthma severity and body mass index was r= 0.275 (p= 0.001). Mean body mass index of females and males were 28.95±5.41 and 25.17±4.17, respectively. Mean body mass index of females with asthma was significantly higher than males (p< 0.0001). The odds ratios for obesity were 8.650, 8.746, and 22.491 for mild, moderate and severe persistent asthma, respectively, compared to patients with mild intermittent asthma. With increasing asthma severity, we observed higher occurrence of obesity in adults. The association of asthma severity with obesity suggests that obesity may be a potentially modifiable risk factor for asthma or asthma exacerbation.
Urologist-operated ultrasound and its use in urological outpatient clinics  [cached]
Mohammad Kazem Moslemi,Behnam Mahfoozi
Patient Preference and Adherence , 2011,
Abstract: Mohammad Kazem Moslemi1, Behnam Mahfoozi21Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran; 2Department of Radiology, Shahid Chamran Hospital, Tehran, IranIntroduction: Ultrasonograghy plays an important role in the evaluation of urinary tract disorders in cases of medical or surgical renal disorders, because of its lower cost, availability, and lack of ionizing radiation and because with it there is no need for contrast material injection or ingestion. It needs no intervention or preparation and specifically can differentiate between the multiple causes of flank pain. Urologist-operated sonography is a quick, cost-effective, and time-saving modality for both the physician and patient for obtaining first or final diagnosis. Based on its results, patients can be selected for appropriate management and further assessment.Materials and methods: The efficacy of ultrasound examination by a trained urologist in the differentiation of urological emergencies admitted in a district private clinic was studied. Between April 2008 and April 2010, a total of 724 patients (1448 renal units) had renal ultrasound performed by a trained urologist on acute admission. The sonographic findings were compared with subsequent definitive radiological investigations performed as needed, such as KUB (kidney, ureter, bladder) or IVP (intravenous pyelogram). Patient satisfaction and permission for ultrasonography were evaluated by oral consent. Loin pain was the presenting symptom in 45% of the patients (n = 326 cases).Results: Diagnosis was achieved in 96% of patients. Further evaluations were requested as needed in suspicious cases. If any hydronephrosis was detected and patients' history and/or complaints were suggestive of renal or ureteral stones, an outpatient KUB was requested. For more complex situations, IVP was the next option. Abnormal findings were recorded in 184 cases (25.5%). Mild to moderate unilateral hydronephrosis with or without hydronephrosis was the most common finding observed sonographically. The sensitivity of our ultrasonography evaluation was 99.7%.Conclusion: Office urologist-operated sonograghy may supplement the information available through routine history, physical examination, and laboratory studies. Our study shows that urological trainees can use ultrasound with high levels of accuracy, thereby improving patient management with a high level of patient satisfaction.Keywords: ultrasonograghy, kidney, bladder, urologist, CT scan, cystourethroscopy, KUB (kidney, ureter, bladder), urologist-oper
The Impact Of Service Quality On The Loyalty Of Patients Referring To Outpatient Clinics Of Studied Hospitals In Tehran
Seyed jamalodin Tabibi,Mahmud Reza Gohari,Mohammad Sabahi Bidgoli,Somayeh Shahri
Payavard Salamat , 2012,
Abstract: Background and Aim: The present case study aims to investigate the impact of service quality on patients' loyalty to the services rendered in outpatient clinics of the studied hospitals throughout Tehran. Materials and Methods: This is a descriptive-analytical survey in which 242 outpatients referring to the studied hospital clinics in Tehran. For data collection purposes, the standardized SERVQUAL questionnaire(1988) and for the measurement of loyalty for service quality, the standard questionnaire for customer's behavioral tendencies(Zitamel and Berry, 1996) were used. Regarding the validity of the questionnaire, its content validity was confirmed; and its reliability was approved through test-retest method and Cronbach's alpha coefficient. For data analysis, Pearson correlation test was employed. Results: The results revealed that there was a positive and meaningful relationship between the quality of services and the patients' loyalty in Tehran clinics. The most important aspect of loyalty was complaining behavior. Conclusion: Hospital managers should enhance their understanding and awareness to maintain, and even improve, the patients' loyalty to their services and should do their best in this regard. Hospital employees should be aware of the patients' expectations and act beyond it. Finally, they should know that rendering services to patients is teamwork and that the key to providing patients with good services lies in their satisfaction with the quality of services they receive.
Nurses’ Approaches Towards the Pain Problem of Patients Admitted to Physical Therapy and Rehabilitation Inpatient and Outpatient Clinics  [cached]
Nuran AKDEM?R,?matullah AKYAR,ülkü G?RGüLü
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2008,
Abstract: Objective: Chronic pain complaints are mostly made by rheumatology patients and patients admitted to physical therapy and rehabilitation inpatient and outpatient clinics. Due to the subjective and objective qualifications of pain; defining pain in these patients is difficult. Clinical observations and study results of pain treatment showed that, like other health professionals, nurses also do not have sufficient knowledge and ability for pain management and they pay attention to acute pain rather than chronic pain. The aim of the study is to determine the approaches of the nurses working in physical treatment and rehabilitation inpatient and outpatient clinics to defining, evaluating and managing pain. Materials and Methods: The research was conducted as a descriptive study in four university hospitals in Ankara who agreed to join the study, between May 15-June 29, 2007 with 27 nurses. Written permission was obtained from the institutions, oral permission was given by the nurses and a questionnaire, developed by the researchers by reviewing the literature, was used for data collection. Percentage values were used to evaluate the data.Results: In this study it was found that of the nurses who joined the study to evaluate patient pain; 70.4% used scales for evaluating pain, 36.9% used a visual analog scale and 44.4% of nurses did not know the name of the scale they used. 89.5% of nurses who used the scale used it for all the patients in clinics, 36.8% of them use a scale in the admission process and vital sign evaluating process; 76.2% of them consider using the scale according to pain severity. It was determined that 90% of nurses use pharmacologic and non-pharmacologic approaches together to manage pain. Conclusion: Nurses use scales for evaluating pain. They consider using scales according to the pain severity and vital signs and use both pharmacological and non-pharmacological approaches to manage pain. Turk J Phys Med Rehab 2008;54:157-63.
Identifying the Characteristics of Geriatric Patients who Referred to Outpatient Clinics of Physical Medicine and Rehabilitation: A Multicenter Descriptive Study  [cached]
Asuman Do?an,Esma Ceceli,Müyesser Okumu?,N. Kutay Ordu G?KKAYA
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2011,
Abstract: Aim: The aim of this study was to define the demographic and clinical characteristics of geriatric patients who referred to physical medicine and rehabilitation (PMR) outpatient clinics and to detect the differences between these characteristics in regard to age, sex and education level.Materials and Methods: 820 patients over 65 years old who attended 20 outpatient clinics were included in the study. In addition to demographic data, the complaints, comorbid diseases, pain levels, drugs being used, exercise and medical status of the patients were recorded. The effects of age, sex and education level on complaints, comorbid diseases and exercise habits were investigated.Results: The mean age of the patients was 71.7±5.5 years. 16.7% were living alone, 61.7% were housewives. 86% of the patients had one or more comorbid diseases - hypertension, gastric problems and heart disease were mostly encountered. The most common complaints were joint pain, fatigue and widespread body pain. The average number of pills taken per day was 4.02±0.9 (median 4), and the VAS pain score was 5.1±1.3 (median 5.0). History of falling was present in 16.5% of patients. 30.1% were routinely walking and 15.4% were performing exercise at home. In patients over 75 years, vertebral pain and deformity, urinary incontinence, eye problem, difficulty in swallowing, decrease in hearing, as well as balance and teeth problems were significantly more frequent than in younger subjects.Conclusion: Aged population constitutes most of the PMR outpatient clinic patients. Considering comorbid diseases, high number of daily taken drugs and falls, PMR specialist should be cautious in prescribing drugs and planning rehabilitation programme. For independence in activities of daily living in this age group, besides the musculoskeletal system, all other systems should be evaluated and a comprehensive geriatric rehabilitation programme should be constructed. Turk J Phys Med Re-hab 2011;57:143-9.
Handling the transition of adolescents with diabetes: participant observations and interviews with care providers in paediatric and adult diabetes outpatient clinics  [cached]
Carina Sparud Lundin,Ella Danielson,Ingbritt ?hrn
International Journal of Integrated Care , 2007,
Abstract: Purpose: The purpose of this study was to explore how care providers handle the transition process from paediatric to adult diabetes outpatient clinic and to describe their perception of adolescents' needs during this process. Methods: Participant observations of patient visits to nurses and physicians and 10 semi-structured interviews with care providers in two paediatric and two adult clinics in Sweden were carried out. Data were analysed using the constant comparative method developed in the grounded theory tradition. Results: The integrated framework developed in the analysis consists of subcategories, process categories and a core phenomenon. The preparation phase showed in this study that preparing transition requires modified strategies. The transition phase implied transferring responsibility and changing care relations while the evaluation phase revealed that care providers are creating mutual understanding through appraisal. All categories are related to the generated core phenomenon: enabling integration through professional meetings. The way care providers construct meeting arenas has a crucial impact on the possibility to bridge uncertainty, insufficient knowledge, routines and strategies. Conclusions: The way participating clinics handle transition greatly influences the process. Professional meetings appeared to be of vital importance to enable the building of bridges between paediatric and adult diabetes care in this study.
The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics  [PDF]
Stefanos Kachrilas, Christian Bach, Pryia Kumar, Faruqz Zaman, Nicola Dickens, Junaid Masood, Noor Buchholz
Health (Health) , 2011, DOI: 10.4236/health.2011.311118
Abstract: Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.
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