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Sexual behaviour of men that consulted in medical outpatient clinics in Western Switzerland from 2005-2006: risk levels unknown to doctors?
Fran?oise Dubois-Arber, Giovanna Meystre-Agustoni, André Jeannin, Kim De Heller, Alain Pécoud, Patrick Bodenmann
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-528
Abstract: A survey was conducted among all male patients aged 18-70, recruited from the two main medical outpatient clinics in Lausanne, Switzerland, in 2005-2006. The anonymous self-administered questionnaire included questions on sexual behaviour, HIV/STI information needs, expectations and experiences regarding discussion of sexual matters with a doctor.The response rate was 53.0% (N = 1452). The mean age was 37.7 years. Overall, 13.4% of patients were defined as at STI risk - i.e. having not consistently used condoms with casual partners in the last 6 months, or with a paid partner during the last intercourse - regarding their sexual behaviour in the last year. 90.9% would have liked their physician to ask them questions concerning their sexual life; only 61.4% had ever had such a discussion. The multivariate analysis showed that patients at risk tended to have the following characteristics: recruited from the HIV testing clinic, lived alone, declared no religion, had a low level of education, felt uninformed about HIV/AIDS, were younger, had had concurrent sexual partners in the last 12 months. However they were not more likely to have discussed sexual matters with their doctor than patients not at risk.Recording the sexual history and advice on the prevention of the risks of STI should become routine practice for primary health care doctors.Health authorities and medical associations recommend that general practitioners (GPs) should be active in STI prevention [1-3], and articles that offer guidance on the issue have been published in medical journals [4,5]. In Switzerland, individual advice on STI prevention by GPs is an essential component of the National AIDS Prevention Strategy and it is expected that they identify patients at risk for STIs and offer them prevention advice[6]. However, the current literature suggests that GPs' discussions with patients on sexuality issues and related prevention remain insufficient [7-11]. A lack of discussion on sexual matters with
Opioid Use Is Not Associated with Incomplete Wireless Capsule Endoscopy for Inpatient or Outpatient Procedures  [PDF]
Bryan Kleinman,Peter P. Stanich,Kavita Betkerur,Kyle Porter,Marty M. Meyer
Diagnostic and Therapeutic Endoscopy , 2014, DOI: 10.1155/2014/651259
Abstract: Objective. Wireless capsule endoscopy (WCE) is commonly used to directly visualize the small bowel. Opioids have variably been linked with incomplete studies and prolonged transit times in heterogeneous cohorts. We aimed to investigate the effect of opioid use on WCE for inpatient and outpatient cohorts. Methods. We performed a retrospective review of patients receiving WCE at our institution from April 2010 to March 2013. Demographic data, medical history, and WCE details were collected. Transit times were compared by log-rank analysis. Multivariable logistic regression and Cox proportional hazard models were utilized. Results. We performed 314 outpatient and 280 inpatient WCE that met study criteria. In the outpatient cohort, gastric transit time (GTT) was not significantly different between opioid and nonopioid users. Completion rates were similar as well (88% and 87%, ). In the inpatient cohort, GTT was significantly longer in patients receiving opioids than in patients not receiving opioids (44 versus 23?min, ), but completion rates were similar (71% versus 75%, ). Conclusion. Opioid use within 24 hours of WCE did not significantly affect completion rates for inpatients or outpatients. GTT was prolonged in inpatients receiving opioids but not in outpatients. 1. Introduction Wireless capsule endoscopy has become an increasingly popular method to image the small bowel since its introduction in 2000 [1]. WCE is currently used for many indications and can be performed in both the inpatient and outpatient settings. Despite the increased use of WCE, there are still a significant number of incomplete studies where the WCE does not reach the cecum during the battery lifespan. The current literature suggests that WCE completion is only accomplished in 83.5% of studies [2]. Multiple previous studies have identified inpatient capsule endoscopy as having a higher rate of incomplete studies as compared to outpatient procedures [3–6]. Other reported risk factors for incomplete studies include medications, systemic medical conditions, immobility, and previous small bowel surgery [3–5, 7]. To our knowledge, there has not been a large scale study to date looking at the effect of opioids on WCE transit times and completion rates. With the increasing rates of opioid use, this information would be of benefit to centers that perform WCE. The aim of the current study was to investigate the effects of medications, specifically opioids, and other systemic medical conditions on WCE transit times and completion rates in both inpatients and outpatients at a tertiary care
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.
Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection  [PDF]
Nora E. Burkart,Mary R. Kwaan,Christopher Shepela,Robert D. Madoff,Yan Wang,David A. Rothenberger,Genevieve B. Melton
Gastroenterology Research and Practice , 2011, DOI: 10.1155/2011/626582
Abstract: Background. Diagnosis and management of Clostridium difficile infection (CDI) rely upon clinical assessments and diagnostic studies. Among diagnostic tests, lower gastrointestinal (GI) endoscopy in the setting of CDI remains controversial. Objective. To describe the role of lower endoscopy in CDI management. Methods. Retrospective study of lower endoscopies in CDI at four metropolitan hospitals, July 2005 through December 2007. Results. Of 1760 CDI inpatients, 45 lower endoscopies were performed on 43 patients. Most common indications were ruling out other etiologies (42%), inconclusive stool studies (36%), and worsening course (11%). Most endoscopies (73%) had positive findings, including pseudomembranous colitis (49%) and nonspecific colitis (24%). Biopsies were performed in 31 cases, more with nonspecific colitis (10/11, 92%) compared to pseudomembranous colitis (14/22, 64%). Conclusion. While not recommended as a primary screening tool, lower GI endoscopy can add valuable information in CDI when other colonic pathologies may exist, studies are inconclusive, or clinical status worsens. 1. Introduction Clostridium difficile infection (CDI) is a significant public health problem due to its association with antibiotic use and healthcare settings, increasing overall incidence, evolving epidemiology, and high associated health care costs. For any individual patient with symptomatic CDI, the spectrum of disease can vary widely. While initial treatment is effective in most cases, some cases are highly complex including patients with recalcitrant or recurrent disease [1], infections caused by increasingly virulent strains of Clostridium difficile (C. difficile) that are unresponsive to traditional medical therapy [2–4], and patients with fulminant colitis requiring surgery [5–10]. Stool studies like enzyme immunoassays for C. difficile toxins [3, 11] have improved our diagnostic abilities with CDI. The diagnosis, management, and treatment of CDI, particularly in the acute inpatient setting, rely upon a combination of ongoing clinical assessments and diagnostic studies. Lower gastrointestinal (GI) endoscopy, either flexible sigmoidoscopy or colonoscopy, can be used to (1) visualize the colon looking for inflammation or for the presence of pseudomembranes and (2) to obtain tissue and stool for diagnostic purposes. The optimal role of the lower GI endoscopy in the setting of CDI remains poorly defined and controversial. In the late 1970s and 1980s, some authors stressed the importance of endoscopy as a diagnostic tool [12, 13]. In the 1990s, with the
Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital  [cached]
Jo?o Mangualde,Marie I Cremers,Ana M Vieira,Ricardo Freire
World Journal of Gastrointestinal Endoscopy , 2011, DOI: 10.4253/wjge.v3.i10.195
Abstract: AIM: To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients. METHODS: In total, 789 consecutive outpatients referred for gastrointestinal (GI) endoscopy [381 for esophagogastroduodenoscopy (EGD) and 408 for colonoscopy] were prospectively enrolled in the study. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic findings. RESULTS: The overall inappropriate rate was 13.3%. The indications for EGD and colonoscopy were, respectively, appropriate in 82.7% and 82.6% of the exams, uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%. The diagnostic yield was significant higher for EGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate (EGD: 36.6% vs 36.4% vs 11.4%, P = 0.004; Colonoscopy: 24.3% vs 20.0% vs 3.3%, P = 0.001). Of the 25 malignant lesions detected, all but one was detected in exams judged appropriate or uncertain. CONCLUSION: This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations, namely in detecting neoplastic lesions. It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.
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.
Appropriate use of endoscopy in the diagnosis and treatment of gastrointestinal diseases: up-to-date indications for primary care providers  [cached]
Vien X Nguyen,Vi Thuy Le Nguyen,Cuong C Nguyen
International Journal of General Medicine , 2010,
Abstract: Vien X Nguyen1, Vi Thuy Le Nguyen2, Cuong C Nguyen11Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Pharmacy, Banner Baywood Medical Center, Mesa, AZ, USAAbstract: The field of endoscopy has revolutionized the diagnosis and treatment of -gastrointestinal (GI) diseases in recent years. Besides the ‘traditional’ endoscopic -procedures (esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy, and endoscopic retrograde cholangiopancreatography), advances in imaging technology (endoscopic ultrasonography, -wireless capsule endoscopy, and double balloon enteroscopy) have allowed GI specialists to detect and manage disorders throughout the digestive system. This article reviews various -endoscopic procedures and provides up-to-date endoscopic indications based on the -recommendations of American Society for Gastrointestinal Endoscopy and American Cancer Society for primary care providers in order to achieve high-quality and cost-effective care.Keywords: endoscopy, endoscopic indications, endoscopic procedures, imaging, primary care, gastrointestinal disorders, appropriate use
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.
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