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Investigated whether the Mini-Mult could differentiate outpatient heroin addicts from outpatient psychiatric and normal populations. A multiple discriminant analysis was done with 30 Ss that compared the three groups across the 11 Mini-Mult scales. Significant results were obtained at the .05 level for the following scales: L, F, 1, 2, 3, 4.
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The results of a 1978 survey of outpatient pharmacies in university-affiliated hospitals are reported. A questionnaire with 55 items was sent to 75 university-affiliated hospitals with outpatient clinics. Sixty hospitals responded. Of the 47 usable responses, 44 were from hospitals with outpatient pharmacies. The outpatient pharmacies served a mean of 163 patients/day, dispensing a mean of 295 prescriptions/day. Prescriptions from outpatient clinics accounted for a mean of 57% of the outpatient pharmacies' prescriptions. Only four outpatient pharmacies provided 24-hour, seven-day/week services; the remainder provided a mean 11.1 hours of service per day on weekdays. The mean number of full-time equivalent pharmacists employed in the outpatient pharmacies (2.9) correlated positively with the number of prescriptions dispensed daily. The straight-fee pricing system was used by 62% of outpatient pharmacies but pricing systems varied with the type of product dispensed. Computer services were used in 28% of the outpatient pharmacies but were restricted mainly to accounting and inventory functions. Only 15% of the outpatient pharmacies maintained patient profiles for all patients served, and only 21% conducted special patient education programs in drug therapy.
The anaesthesia outpatient clinic can be a new concept of preanaesthetic preparation and treatment. Related to the figures of 1977, a report is given about our 2-years experience. Patients from the usual outpatient clinics, like gynecology, urology, ENT, who are expected to be operated upon are immediately sent to the anaesthesia outpatient clinic for preanaesthetic check up. After the overall state of the patient has been examined, the original outpatient clinic and/or the family doctor are given information about the patients condition, and probably proposals for a preanaesthetic treatment are made. In 1977, 15% of all anaesthetized patients were checked as outpatients, another 40% were only examined after entering the hospital, whereas as few as 17% were not checked in the anaesthesic outpatient clinic. In patients, checked as outpatients, the period between the first day of hospitalisation and operation was evidently shorter than in patients, having been hospitalized at the time of preanaesthetic examination. This gives the opportunity to save money and beds. Furthermore, the anaesthesia outpatient clinic improves the organisation and efficiency of surgery, urology, gynecology etc., improves the relationship between patients and anaesthetists, decreases the risk of anaesthesia and operation, saves personnel and gives a qualified additional background for the purposes of graduation and student training.
"Outpatient hyperkalemia" is a new clinical syndrome in which high serum potassium levels (SK) are found in the outpatient condition returning toward normal without any specific treatment after admission to the hospital. We report here of six patients with high blood pressure of various origin (chronic glomerulonephritis, interstitial nephritis, diabetic nephropathy, Gordon syndrome) in whom dietary and postural factors were found to be responsible for the outpatient hyperkalemia. The Na content of the "ad libitum" outpatient diet was definitely higher than that of the regular hospital diet. Increasing the Na intake from 120 mEq to 300 mEq induced a marked elevation of SK (from 5.21 +/- 0.16 to 6.34 +/- 0.40 mEq/l; p less than 0.001) in two hospitalized, recombent patients. On the other hand, Na restriction induced a dramatic improvement in hyperkalemia (from 5.89 +/- 0.11 mEq/l to 4.79 +/- 0.08 mEq/l:; p less than 0.001) in 4 patients in whom the effect was studied in the outpatient state. Although the mean plasma aldosterone (PA) was significantly lower in the patient group than in the healthy group, during normal Na intake there was a considerable overlap. A clearer distintion was made by using the new index of PA per SK ratio expressing the diminution in the apparently normal PA when related to the abnormally high SK. During high Na intake, PA was definitely suppressed and during Na restriction there was a dramatic relief from suppression. The present studies confirmed the previously described phenomenon of "upright hyperkalemia" which may have played an additional role in the development of outpatient elevation of SK. The knowledge of the clinical syndrome of "outpatient hyperkalemia" may be important to single out certain cases of easily correctable insufficient (suppressed) aldosterone production.
Nine hundred ninety-seven breast biopsies that were performed at one hospital over the five-year period from 1971 through 1975 were reviewed because of a changing pattern in the use of breast biopsies on outpatients who were under local anesthesia. In 1971, 17% of all breast biopsies were performed as outpatient procedures; by 1975, the figure was 60%. In 1971, 5% of all malignant neoplasms were diagnosed by the use of biopsies as outpatient procedures and 30% in 1975. Hospital charges for biopsy on an inpatient basis of benign breast disease were 7.2 times higher than for biopsy on an outpatient basis. Interviews of 102 patients clearly suggested that most patients were satisfied with the outpatient breast biopsy experience. Outpatient breast biopsy under local anesthesia is a safe procedure that is more economical in terms of medical cost, surgeons' time, and patients' time away from home and/or job. Preliminary biopsy of malignant lesions using local anesthesia permits more efficient use of diagnostic procedures to stage the extent of disease prior to treatment. Patient acceptance of breast biopsy as an outpatient procedure under local anesthesia was similar to their acceptance of biopsy on an inpatient basis under general anesthesia.
This study compares Navy outpatient alcoholics, inpatient alcoholics, and a general outpatient psychiatric population on a number of demographic and clinical variables. Compared to inpatients, the outpatient alcoholics were younger, more often married, and were more frequently given favorable discharges. Compared to nonalcoholic outpatients, the outpatients were older, had lower socioeconomic origins, and were more often given favorable discharges. The characteristics of outpatient alcoholics are discussed, and an attempt is made to lay the groundwork for early case finding and prevention of alcoholism in the service.
An examination of tardive dyskinesia in 213 schizophrenic outpatients using the Abnormal Involuntary Movement Scale (AIMS) indicates that increasing age is significantly associated with the presence of this disorder while sex is not. Both sexes showed significant linear increases with increasing age. Although males did not evidence the statistically significant curvilinear trend previously reported in an inpatient study using the same methodology, they displayed an attenuated effect at the older age levels. A comparison of prevalence values between the outpatient sample and the inpatient sample previously studied indicated no greater prevalence in the outpatients. However, an examination of differences in AIMS total scores between these samples suggested the presence of many more marginal and mild movements in the outpatients. Reasons for the differences between the inpatient and outpatient studies are discussed.
106 patients with anxiety, phobic, and depressive neuroses referred to the outpatient clinics of 6 psychiatrists were randomly assigned to outpatient care or two forms of psychiatric day care. Ratings of symptoms and social adjustment were recorded before treatment and after 4 and 8 months in 89 patients. There were no important differences in the outcome of day care and outpatient treatment although patients were more satisfied with the outpatient service. Because outpatient care is more economical of time and personnel it should be preferred to psychiatric day care for many neurotic disorders.
Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.
BACKGROUND: Perioperative administration of esketamine has been reported to improve early quality of recovery (QoR). However, data on its effects in outpatient surgery are limited. This study aimed to assess the impact of esketamine on QoR in patients undergoing outpatient gynecological procedures. METHODS: In this investigator-initiated, double-blind, randomized clinical trial, patients aged 18-65 years scheduled for outpatient gynecological surgery under sedation were allocated to receive esketamine (0.2 mg/kg) or sufentanil (0.1 μg/kg) combined with propofol (1.5-3 mg/kg). The primary outcome was quality of recovery on postoperative day (POD) 1. Secondary outcomes included quality of recovery on POD2, sedation success rate, length of post-anesthesia care unit (PACU) stay, injection pain, postoperative pain, nausea and vomiting, fatigue, patient and clinician satisfaction, sleep quality, and anxiety and depression. RESULTS: A total of 126 patients were randomized, with 63 assigned to the esketamine group and 63 to the sufentanil group. Of these, 125 patients were included in the final analysis (62 in the esketamine group and 63 in the sufentanil group), as one patient lacked follow-up data. The mean (SD) QoR-15 score on POD1 was 137.9 (14.5) in the esketamine group and 137.8 (10.7) in the sufentanil group, with no significant difference between groups (absolute difference, 0.2; 95% CI, -4.2 to 4.6; p = 0.93). For secondary outcomes, the esketamine group had a longer PACU stay (median, 28.0 vs. 23.0 min; p < 0.001), a lower incidence of severe injection pain (22.6% vs. 50.8%; p = 0.002), a higher proportion of patients with pain scores ≥ 4 at 30 min postoperatively (30.6% vs. 6.3%; p = 0.001), and higher fatigue scores (median, 3.0 vs. 2.0; p = 0.01). Other secondary outcomes did not differ significantly between groups. CONCLUSION: Among patients undergoing sedation for outpatient gynecological procedures, esketamine did not significantly improve quality of recovery on POD1 compared to sufentanil. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2500098466.
Changes in provision of health care by the province of Ontario have included forced reduction in the number of hospital beds. In this situation the needs of patients with orthopedic disabilities have been met by a dramatic increase in outpatient surgery. At the Hotel Dieu Hospital, Kingston, the total number of surgical procedures increased from 5516 in 1970 to 7260 in 1975. During this period the number of outpatient surgical procedures performed under general anesthesia rose from 820 in 1970 to 2927 in 1975, an increase of 264%. Of 1197 orthopedic procedures performed in 1975, 632 (52%) were performed on an outpatient basis. In the author's personal experience of outpatient surgery, which in 1975 included 38 meniscectomies, 10 major shoulder repairs, 28 foot reconstructions, 11 nerve releases, 14 tendon releases and 4 elbow arthroplasties, patient acceptance has been good. Adequate clinic facilities, trained nurses, appropriate anesthesia and patient education are essential if management in this locale is to be successful.
To test the contention that patients in outpatient departments and private practices differ, variables were assessed that might affect both the process and the outcome of medical care. Two groups of 60 patients consulting nine Montreal internists who worked in both private practice and in an outpatient department of a university teaching hospital were surveyed. The internists served as their own controls. The two groups of patients were compared for 57 demographic, socioeconomic, access, utilization, attitudinal and current medical status variables. Financial factors were minimized by the existence of universal health insurance. The outpatient group was found to be older, less fluent in English, less likely to be employed, less educated, less wealthy, more dependent on public transportation, more disabled, more likely to use ambulatory services, more anxious about health, and more sceptical about physicians, yet more dependent on them than the private practice group. The outpatient group tended to have more active, significant medical conditions and to receive more prescriptions for medication than the private practice group, in contrast to the national patterns in the practice of internal medicine in the United States. Medical educators, researchers, administrators and providers of health care who have assumed that these two groups of patients are comparable must re-evaluate their practices.
A total of 129 patients were operated on for meniscus lesion in the knee joint. Of these, 64 were operated as outpatients and 65 as inpatients. The outpatients reported to the operation department in the morning and left the hospital in the evening of the same day, after the operations. The inpatients were admitted to the hospital the day before the operation and were discharged 1--3 days after the operation. Objective postoperative findings, sick-leave periods and the number of visits to the outpatient clinic show no differences between the groups. The end result in the two groups is the same. This investigation also shows that it is possible to operate on patients with meniscus injury as outpatients without increased discomfort for the individual and without medical risks. Thus expensive nursing resources are released for other groups requiring more nursing care.