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BACKGROUND: Outpatient dietary weight reduction for obesity is unsatisfactory. The objective of this study was to compare the efficacy of an energy prescription diet with usual care (a healthy eating diet) in adult overweight patients referred to a NHS hospital dietetic outpatient clinic, in terms of weight change over 12 weeks. METHODS: Controlled clinical trial (systematic allocation). RESULTS: Of the 53 patients who attended their first appointment, 27 completed the trial. Mean weight loss (kg) after 12 weeks was 4.2 (sd 3.8) on the energy prescription diet (n = 16) and 6.0 (sd 2.8) on the healthy eating diet (n = 11). CONCLUSIONS: Patients on a weight reducing diet based on energy prescription or healthy eating lost, on average, clinically significant amounts of body weight by 12 weeks. Mean weight loss was greater by about 50% in the healthy eating group and supports the development of a larger trial to estimate true effect [corrected].
Perceived health-related quality of life (QOL) of 113 adult people living with HIV/AIDS (PHA) attending an outpatient hospital clinic was assessed upon initial registration using the Medical Outcomes Study SF-36. QOL ratings on both physical functioning and psychological well-being aspects of the SF-36 were lower than for the general population, especially among PHA in the sample who were symptomatic or for whom AIDS had developed. Although not compromised in terms of physical functioning, asymptomatic PHA had well-being QOL scores comparable to other chronic medical conditions. In general, demographic, social, and many of the health and immune status variables examined were not significantly related to QOL. Number of symptoms was negatively associated with both physical status and emotional well-being dimensions of QOL. PHA in the asymptomatic stage of HIV infection reported better QOL than symptomatic/AIDS patients on few QOL dimensions. Mean QOL ratings did not significantly differ between AIDS patients and those with symptomatic (non-AIDS) infection. These findings suggest that although becoming symptomatic has a significant impact on a majority of dimensions of QOL, being diagnosed with HIV affects well-being dimensions the most. An emphasis on support for both adjusting to diagnosis and symptom management is as important as viral suppression in maximizing QOL for PHA.
Using a personal computer and custom-designed software as part of a quality assurance (QA) program dramatically improved the performance of health maintenance in a community hospital outpatient clinic. Previously health maintenance interventions were prompted by a simple review of the records. The computer program tracks each patient encounter with the clinic, recording the dates of immunizations, cancer screenings, and other health maintenance interventions performed by the physician responsible for the patient's care. When indicated, the computer prompts the physician to perform a health maintenance intervention. This system is an inexpensive and acceptable means of promoting and teaching health maintenance in an outpatient hospital clinic.
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OBJECTIVE: To describe a rare condition that occurred for the first time in Iraqi Kurdistan during the UN Sanctions on Iraq in the nireties. Literature review was made to fine possible causes. METHODS: Patients were collected from various sources including private clinics, hospital outpatient clinics and the Centre for Handicapped Children in the city of Arbil. Clinical features and proper history were the main diagnostic tools. Different treatment regimes were used on those patients. RESULTS: 24 patients were collected; the majority was between 6-18 months. Males were more affected than females. Half of the patients were exclusively breast-fed and three quarter have received blood for anemia. CONCLUSION: Infantile tremor syndrome is a rare condition which was described both in India and outside India as well. It was observed among children in Iraqi Kurdistan during the difficult economic situation under the UN Sanctions. The condition has the same features inside and outside India. The etiology is not very clear yet.
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BACKGROUND: Evidence suggests that preoperative clinics, like other hospital outpatient clinics and inpatient wards, fail to systematically provide smoking cessation care to patients having planned surgery. METHODS: The aim of the study was to assess the efficacy, acceptability, and cost of a multifaceted intervention to facilitate the provision of comprehensive smoking cessation care to patients attending a preoperative clinic. Two hundred ten smoking patients attending a preoperative clinic at a major teaching hospital in Australia took part in the study. One hundred twenty-four patients were randomly assigned to an experimental group and 86 patients to a usual cessation care group. A multifaceted intervention was developed that included the use of opinion leaders, consensus processes, computer-delivered cessation care, computer-generated prompts for care provision by clinic staff, staff training, and performance feedback. RESULTS: Ninety-six percent of experimental group patients received behavioral counseling and tailored self-help material. Experimental group patients were significantly more likely than usual care patients to report receiving brief advice by nursing (79% vs. 47%; P < 0.01) and anaesthetic (60% vs. 39%; P < 0.01) staff. Experimental group patients who were nicotine dependent were also more likely to be offered preoperative nicotine replacement therapy (NRT) (82% vs. 8%; P < 0.01) and be prescribed postoperative NRT (86% vs. 0%; P < 0.01). The multifaceted intervention was found to be acceptable by staff. CONCLUSION: A multifaceted clinical practice change intervention may be effective in improving the delivery of smoking cessation care to preoperative surgical patients.
Hospital pharmacists have been challenged to face the paradigm shift in their model of services in the 21st century in Taiwan. Patients are increasingly concerned about drug safety and medication errors. Because of the financial crisis of our national insurance bureau, pharmacists are required to care for more patients, use fewer resources, and work faster, better, and more efficiently than ever before while striving to enhance customer satisfaction and quality of care. Under these circumstances, patient safety needs to be a priority of pharmacists. According to a preliminary report on medication error announced by the nonofficial medication error reporting system, pharmacist dispensing error ranked second in the list of errors in Taiwan. In our drive to improve quality, reduce costs, and enhance financial performance, our department has tried the traditional quality-improvement strategy with varying degrees of success. We wanted to achieve a breakthrough result, hence we implemented Six-Sigma methodology. This program is the catalyst needed to combine quality, cost, and patient safety. This article describes our experience using Six-Sigma methodology to reduce dispensing error in our pharmacy department.
AIMS: The objective of this study was to investigate drug utilization in the management of hypertension in Hong Kong. METHODS: We conducted a prescription survey to examine the use of antihypertensive drugs in a hypertension clinic in a regional hospital and the resulting expenditure incurred. The use of concurrent medications such as antidiabetic drugs and lipid-lowering agents was also examined. RESULTS: During a 7-week study period, 530 prescriptions were collected. All except 14 patients received antihypertensive drugs with 262 (50.8%) on monotherapy and 254 (49.2%) on combination therapy. Calcium channel blocking agents and beta-adrenoceptor blocking agents were the two most popular antihypertensive drugs used in both monotherapy (38% and 31%, respectively) and combination therapy (27% and 33%, respectively). Forty-nine patients (19%) received three antihypertensive drugs or more. The number of antihypertensive drugs showed a significant positive correlation with the duration of attendance at the clinic (r=0.88, P < 0.001). Of the total 530 prescriptions, 5.6% and 10% contained antidiabetic drugs and lipid-lowering agents, respectively. Calcium channel blocking agents, angiotensin converting enzyme (ACE) inhibitors and lipid lowering agents, accounted for 82% (HK$211,654; pounds sterling 1 approximately HK$12) of the total drug expenditure (HK$258,115). Seventy-nine percent of the lipid lowering agents prescribed were hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors. Amlodipine accounted for 26% of usage but contributed to 41% of the overall costs of calcium channel blocking agents. Alpha1-adrenoceptor blocking agents were only used infrequently and were the most expensive class of drugs, due to the preferred use of doxazosin rather than prazosin which is far cheaper than the former. CONCLUSIONS: In view of the use of these often costly drugs for long-term therapy, monitoring of their use and its correlation with clinical outcomes and quality of life is essential to ensure the optimal use of health care resources.
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Client flow analysis (CFA) is a practical technique to help address one of the most frequently cited causes of patient disquiet with quality of health services--waiting times. It allows clinic managers and workers to look at the way that clients and patients move through the clinic. It gives information on waiting times, time spent in contact with different service providers, bottle-neck areas in services and staff utilization patterns. It is a technique which is simple, quickly performed, cost effective, easy to learn and easily transferrable. This paper gives two illustrative examples of sites where CFA has been initiated in Africa--a free-standing family planning clinic and a provincial hospital outpatient clinic. Waiting times were reduced by over one-half and by one-third, respectively. By reducing waiting times for clients and patients and addressing some of the problems of staff time allocation, the quality of clinic operations can be improved for both providers and clients.
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BACKGROUND: Encouraged by the increased purchasing power of general practitioners (GPs), specialist-run clinics in general practice and community health care settings (known as specialist outreach clinics) have increased rapidly across England. The activities of local commissioning schemes within primary care groups are likely to accelerate this trend. AIM: To evaluate the costs, processes, and benefits of specialists' outreach clinics held in GPs' surgeries, compared with hospital outpatient clinics. DESIGN OF STUDY: A case-referent (comparative) study comparing the characteristics of outreach clinics (cases) with matched outpatient control clinics. SETTING: Thirty-eight outreach clinics, compared with 38 matched outpatient clinics as controls, covering 14 hospital trust areas across England. METHOD: Self-administered questionnaires were given to patients in both clinic settings. These covered processes, satisfaction, personal costs, and health status, with postal follow-up at six months to assess health outcomes. Self-administered questionnaires were also given to the specialists and GPs whose clinics were included in the study (individual patient clinical sheet and an attitude questionnaire), practice managers, and trust accountants (process and costs questionnaire). Evaluation of the costs, processes, and benefits of specialist outreach clinics versus hospital outpatient clinics was carried out by comparing questionnaire responses. RESULTS: In comparison with outpatients, outreach clinic patients spent less time on the waiting lists for appointments to see the specialist, they had shorter waiting times in clinics, fewer follow-up appointments, and were more likely to be completely discharged after the sampled attendance. Outreach patients were more satisfied than outpatients with the range of clinic process items asked about. Most doctors felt that the outreach clinic was 'worthwhile'. While patients' personal costs were lower in outreach than in outpatients clinics, NHS costs were more expensive per patient in outreach. The benefits of outreach clinics on patients' health status at six months' follow-up were relatively small. CONCLUSIONS: Outreach clinics are a means of improving access to specialist services for patients, in addition to improving the efficiency and quality of health care. Most results were similar across specialties and areas. The benefits of the outreach service need to be weighed against their substantially higher NHS costs, in comparison with outpatients clinics. Outreach clinics are unlikely to be financially justifiable for NHS funding given that the impact on patients' health status was small.
OBJECTIVE--To assess the completeness of acquired immunodeficiency syndrome (AIDS) case reporting in New York City (NYC), and to determine whether the completeness of reporting differs in various populations. DESIGN--Retrospective record review of hospital laboratory logs, death certificates, hospital discharge records, and patient registries at private physicians' offices and hospital outpatient clinics. SETTING--Public and private hospitals, and private physicians' offices in NYC. PATIENTS--Adults and adolescents with AIDS or with illnesses suggestive of AIDS were identified using both population-based and nonrandom sampling techniques. These persons were matched with the NYC AIDS case registry, and the medical records of nonmatching persons were reviewed to determine whether they met the 1987 Centers for Disease Control and Prevention surveillance case definition for AIDS. MAIN OUTCOME MEASURES--The completeness of reporting was calculated for the five individual projects and for the aggregate database by gender, race/ethnicity, risk, borough of residence, age, first AIDS diagnosis, and year of diagnosis. RESULTS--Of 7015 persons with AIDS identified in the five projects, 5912 (84%) had been previously reported (range, 77% to 89%). The completeness of reporting ranged from 81% to 87% in all major gender, race/ethnicity, risk, borough of residence, and age subgroups. In a multivariate analysis, the odds of being unreported were significantly higher among outpatients in hospital clinics, out-of-state residents, persons with diagnoses other than Pneumocystis carinii pneumonia, and persons recently diagnosed with AIDS. CONCLUSIONS--This study indicates that the NYC AIDS surveillance system functioned effectively during the first decade of the AIDS epidemic. Completeness-of-reporting studies are an integral part of AIDS surveillance, providing data that are critical for assessing the validity of the AIDS surveillance database.