Hospital Outpatient Departments Research Articles

Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000–2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.

Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers

Objective: To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs). Method: Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen. Episode claims were used to document demographics, comorbidities and treatments of Medicare enrolees who developed VLUs, as well as important outcomes, such as time to ulcer closure, rates of complications and hospital utilisation rates. Outcomes were compared across key propensity-matched groups. Results: In total, 42% of Medicare enrolees with CVI (n=1,225,278), developed at least one VLU during the study, and 79% had their episode claim completed within one year. However, 59% of patients developed another VLU during the study period. This analysis shows that only 38.4% of VLU episodes received documented VLU conservative care treatment. Propensity-matched episodes that received an advanced treatment or high-cost skin substitutes for a wound which had not progressed by 30 days demonstrated the best outcomes when their cellular, acellular, matrix-like product (CAMP) treatment was applied weekly or biweekly (following parameters for use). Complications such as rates of infection (33%) and emergency department visits (>50%) decreased among patients who received an advanced treatment (following parameters for use). Conclusion: Medicare enrolees with CVI have diverse comorbidities and many do not receive sufficient management, which contributes to high rates of VLUs and subsequent complications. Medicare patients at risk of a VLU who receive early identification and advanced CAMP treatment demonstrated improved quality of life and significantly reduced healthcare resource utilisation.

Financial Impact of Imaging Examination Site of Service in the Medicare Population.

The financial sustainability of the US healthcare system is a growing concern in an environment of declining reimbursement and rising costs. Variable Centers for Medicare and Medicaid (CMS) reimbursement and denial rates for specific imaging examinations exist across sites of service, adding complexity to financial planning for healthcare organizations. Understanding the financial implications of site of service in existing CMS reimbursement for imaging may be of strategic importance for organizations going forward. Current Procedural Terminology (CPT) codes were obtained for common cross-sectional imaging examinations using the 2022 CMS Medicare Physician Fee Schedule. Using reimbursement rates with historical volumes and denial rates, a simulation was created to estimate the overall reimbursement of paired hospital outpatient departments (HOPD) and free-standing office (FSO) sites. A baseline simulation was performed with random allocation of imaging examinations between sites of service, and an optimized simulation was performed to estimate the maximum financial impact of targeted allocation between sites. These simulations were performed for paired CT and MR scanners separately. For CT, the baseline simulation estimated annual average reimbursement for combined HOPD and FSO was $3.25M. Reimbursement increased to $3.51M after optimized reallocation of studies between sites of service, resulting in an expected gain of $260,162 for a set of paired HOPD and FSO scanners. For MR, the same approach resulted in baseline reimbursement of $2.51M, increasing to $2.60M upon reallocation between sites for an expected gain of $87,532. Assuming a stable cost of service delivery, this approach would result in improved margins of 8% for CT and 3.5% for MR. There were 28 CT and 19 MRI daily patient imaging appointments at each respective HOPD and FSO scanners, unchanged between baseline and optimized cases. Differences in reimbursement rates between sites were the dominant driver of increased margins at low denial rates, although denial rates became dominant at values greater than 50%. Given CMS payment and denial rate variability, optimally allocating imaging studies between sites of service may improve reimbursement for the same services delivered. Although financial incentives exist for site allocation, such decisions should require physician input to assess safety and appropriate level of care. This work contributes to an understanding of financial incentives of existing reimbursement policy and may guide future policy design towards high value care.

Self-assessment and clinical diagnosis of periodontal status among patients visiting dental institution in Bangalore city: a cross-sectional study

Background: Periodontal diseases are a group of lesions affecting tissues surrounding and supporting the teeth. Periodontal diseases are considered as a group of highly prevalent infectious, inflammatory conditions of the supporting structures of the teeth which affects more than 50% of the world’s adult population. The present study was undertaken to evaluate the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of Rajarajeswari Dental College and Hospital, Bangalore, India. Methods: A cross-sectional study was done among 250 patients who attended the outpatient department of Rajarajeswari Dental College and Hospital, Bangalore. The study population was subjected to a self-administered questionnaire which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition using CPI and mobility. Results: There was a marked discrepancy between the two values of self-assessed and clinically diagnosed periodontal health status which shows that the self-assessed periodontal tool was a poor indicator of the periodontal health status. Conclusions: The present study showed that there is a discrepancy between the subjectively and objectively assessed periodontal health status. Increasing people’s awareness and knowledge of their own dental disorders and changing their attitudes and behavior towards oral health care will help in improving oral as well as general health.

Clinical Status of Patients with Type 2 Diabetes Patients at the Time of the Diagnosis

Background: Since patients with type 2diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients at the time of the diagnosis. Methods: This cross-sectional analytical study, conducted from January 2019 to December 2019, was a collaborative effort between the Department of Physiology at Rajshahi Medical College and Diabetic Association Hospital in Rajshahi. The primary aim was to investigate diabetes mellitus (DM) among patients presenting clinical symptoms suggestive of DM at the hospital's outpatient department (OPD). Following initial assessment, patients underwent an oral glucose tolerance test (OGTT) for definitive diagnosis. Once DM was confirmed, subjects were meticulously screened based on specific inclusion and exclusion criteria. Study group A comprised 80 diabetic subjects, while study group B included an equal number of age- and sex-matched non-diabetic subjects, drawn from hospital staff, patients' relatives, and volunteers, resulting in 80 participants in each group. Results: The study findings showed that overall mean age of the respondents were 52.61±7.70 years and majority were female. In DM2 group among all, a little higher of 4/5th (85%) of the respondents were non smoker and 4/5th (80%) were non tobacco user. Among the respondents only 4 of them were alcoholic. In DM group, the mean SBP was 128.88 mm HG with SD of 10.93 and the mean DBP was 78.25 with SD of 10.70. Plus, according to the measured systolic blood pressure 39 of the respondents belonged to normal, 95 showed prehypertensive and 26 showed hypertensive systolic blood pressure were found DM2 group. Besides that, high level of serum creatinine and serum uric level are seen in DM2 group comparing healthy group. Conclusion: This study ...........

Knowledge regarding dengue and its prevention in Morang district of Nepal

This cross-sectional study was carried out in Purbanchal University teaching hospital outpatient department among 175 respondents to assess the level of knowledge and awareness in dengue prevention. Nearly 53% of the respondents were aged ≤40 years. Similarly, more than half (61.7%) of the respondents were male. The mean score of knowledge was 5.41 ± 3.41 regarding dengue fever and 5.29 ± 3.34 regarding dengue prevention. More than half of the respondents had correct knowledge regarding the breeding season, common presentation, source of transmission and susceptibility of dengue fever however, very few knew about the drug of choice, route of transmission and specific symptoms like skin-rash, muscle pain, etc. It was also interesting to note that people were more aware regarding basic ways to prevent dengue like using mosquito bed nets, reducing source of stagnant water, using mosquito repellents, etc. than some modern techniques like window screening. Even though dengue is an epidemic people seem to have lower than average knowledge regarding its prevention hence, sufficient informational and educational materials must be made available to the public and community centers where maximum people can get it for enhancement of their knowledge on dengue and improve the good practice on dengue prevention.

Identification model of tooth number abnormalities on pediatric panoramic radiographs based on deep learning

Objective: To identify tooth number abnormalities on pediatric panoramic radiographs based on deep learning. Methods: Eight hundred panoramic radiographs of children aged 4 to 11 years meeting the inclusion and exclusion criteria were selected and randomly assigned by writing programs in Python (version 3.9) to the training set (480 images), verification set (160 images) and internal test set (160 images), taken in Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between November 2012 to August 2020. And all panoramic radiographs of children aged 4 to 11 years taken in the First Outpatient Department of Peking University School and Hospital of Stomatology from June 2022 to December 2022 were collected as the external test set (907 images). All of the 1 707 images were obtained by operators to determine the outline and to label the tooth position of each deciduous tooth, permanent tooth, permanent tooth germ and additional tooth. The deep learning model with ResNet-50 as the backbone network was trained on the training set, validated on the verification set, tested on the internal test set and external test set. The images of test sets were divided into two categories according to whether there was abnormality of tooth number, to calculate sensitivity, specificity, positive predictive value and negative predictive value, and then divided into four types of extra teeth and missing permanent teeth both existed, extra teeth existed only, missing permanent teeth existed only, and normal teeth number, to calculate Kappa values. Results: The sensitivity, specificity, positive predictive value and negative predictive value were 98.0%, 98.3%, 99.0% and 96.7% in the internal test set, and 97.1%, 98.4%, 91.9% and 99.5% in the external test set respectively, according to whether there was abnormality of tooth number. While images were divided into four types, the Kappa value obtained in the internal test set was 0.886, and that in the external test set was 0.912. Conclusions: In this study, a deep learning-based model for identifying abnormal tooth number of children was developed, which could identify the position of additional teeth and output the position of missing permanent teeth on the basis of identifying normal deciduous and permanent teeth and permanent tooth germs on panoramic radiographs, so as to assist in diagnosing tooth number abnormalities.

Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly

Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

Evaluating the Effectiveness of Combination Antibiotic Therapy for Recurrent Cystitis in Women

Background: Investigating the Effectiveness of Combined Antibiotic Therapy for Recurrent Cystitis in Females. A study was conducted on twenty women with recurrent cystitis who received combination antibiotic therapy. The primary outcome measure for cystitis was the absence of all clinical and laboratory indicators of infection. The secondary objective was to assess symptom improvement related to cystitis. The findings revealed that, after using the combination antibiotic medication, cystitis symptoms disappeared completely in 18 out of the 20 women (90%), while 2 women (10%) experienced symptom improvement. According to these results, combination antibiotic therapy seems safe and effective for women with recurrent cystitis. Objective: The primary aim of this study was to evaluate the curative effects of combination antibiotic therapy in female repetitive cystitis (RC) patients who presented at the Main Gul Jehanzeb Hospital, Swat, during January 2018 and January 2019. Secondarily, we wanted to find out how well combination antibiotic therapy worked for female RC patients. Study Design: A retrospective study Duration and place of study: Main Gul Jehanzeb Hospital, Swat, from January 2018 to January 2019. Methods: A retrospective study of combination antibiotic therapy for curing recurrent cystitis in female patients was carried out at the Main Gul Jehanzeb Hospital, Swat, Pakistan. All women aged between 18 and 50 years who had a history of repeated cystitis, if they received medical treatment in the hospital's outpatient department during research periods and are outpatients now for one research visit, were included on this study. The drug cooperation mode of general practice co-operation network was used, while the principle of vaccination prevention was implemented to everyone for education against sexually transmitted diseases. In the clinic, clinical and laboratory diagnostics were utilized to make a comprehensive diagnosis and all cases were gave a standard questionnaire designed by research personnel. Phase 1 and Phase 2 of treatment: After a comprehensive medical history appraisal and physical examination, each patient received specific combination antibiotic therapy according to her diagnosis. The main purpose of our study was to obtain complete symptomatic remission of cystitis, as gauged by the absence of any clinical or laboratory evidence of infection. Additionally, a secondary object was to alleviate cystitis symptoms, or allay them to some extent. Results: In this study, 20 females who had RC were included. After receiving a combination of antibiotics, 18 of them (90%) had their cystitis symptoms completely eliminated, and the other 2 (10%) only had milder symptoms. Conclusion: This study has demonstrated that combined antibiotic therapy is safe and effective as a treatment for female recurrent cystitis. In recurrent cystitis, most women obtain relief from their symptoms using mixed antibiotics. Keywords:Recurrent Cystitis, Combination Antibiotic Therapy, Women

A cross-sectional observational study to estimate the psychosocial adjustment in patients with schizophrenia

Abstract Context: Psychosocial dysfunction is the dysfunction in the various psychosocial areas, such as personal, vocational/occupational, familial, and social, which ultimately depends on the cognitive functioning of an individual. Any disturbances and failure to adjust in one or more areas have a sufficient impact on the patient’s quality of life and daily living. For everyday living and maintaining a good quality of life, the influence of the level of dysfunction in different areas needs to be understood, and psychosocial interventions and rehabilitation programs must be designed accordingly to facilitate better psychosocial adjustment. Aims: The aim of this study was to estimate the psychosocial adjustment of individuals with Schizophrenia presenting at the psychiatry outpatient department (OPD) of a teaching hospital. Materials and Methods: A cross-sectional study was conducted at the psychiatry OPD of a tertiary care teaching hospital. Eligible subjects were aged between 18 and 65 years and diagnosed with Schizophrenia according to the International Classification of Diseases-10. Sociodemographic characteristics and current treatment details were obtained. The psychosocial adjustment was assessed using the Psychosocial Adjustment to Illness Scale-interview version. Results: Sixty subjects were included, all with some impairment in one or the other social functioning domain. The domain with the highest proportion of subjects showing marked/severe degrees of disability is the vocational environment. Moderate-to-severe impairment of functioning is seen in the domains of domestic environment, social environment, sexual relationship, and extended family relationships. In the health-care environment, mild impairment is seen among most subjects. Only mild psychological distress was found among those with impaired functioning in this domain. It was also found that individuals with mild adjustment problems had a shorter duration of illness. Variables that showed significant statistical associations (P &lt; 0.05) with poor/severe social adjustment were marital status and duration of illness. Age and Gender had a statistically significant association with psychosocial dysfunction in the social environment domain. Conclusion: This study shows that there is definite and substantial psychosocial dysfunction in definitive areas of personal, familial, social, and vocational spheres in patients with schizophrenia. Psychosocial interventions, along with antipsychotics, are needed to target these areas to improve the overall quality of life of patients with schizophrenia.

Knowledge of prostate cancer and its screening among males attending Urology OPD in a tertiary care hospital in Kathmandu

Prostate cancer is a global burden on public health and it has been ranked as the second most common cancer in males worldwide. The incidence of prostate cancer generally increases with age and men with family history of prostate cancer have an increased risk of getting prostate cancer. The incidence varies across the world, where developed countries have a higher incidence as compared to developing countries. It is well known that early detection of certain grades of prostate cancer leads to a higher remission rate. Starting the screening for prostate cancer at the age of 40 for specific population provides the only way to reduce mortality from prostate cancer. A cross sectional hospital study was conducted using Consecutive sampling of eligible patients in the Urology Outpatient Department (OPD) of a tertiary care hospital in Kathmandu. A total of 378 patients attending Urology OPD were included in the study. A structured questionnaire which was sectioned into sociodemographic characteristics, knowledge of prostate cancer and its screening practices was administered to all the participants. Male more than 60 years of age attending Urology OPD were more (33.3%) followed by age group less than 40 years of age (28.6%). The majority of the patients visiting Urology UPD were from Province 3 (73.0%) and Province 1 (11.1%). Most of these patients were literate (34.9%) but the education level of college or higher were less (17.7%). When knowledge of prostate cancer among the participants were assessed, 55.6% participants replied that they have heard about the prostate cancer and among them, the majority of the participants (28.6%) had heard it from media like TV, radio and internet. The most common symptoms chosen by patients were hematuria (80.2%) and weight loss (72.0%). When asked about the prevention and cure of prostate cancer, 61.1% and 78.6% of them did not know about the prevention and its cure respectively. When knowledge on screening of prostate cancer was assessed, more than half of the participants were found to be aware of screening test and among them 94.4% chose blood test, Serum Prostate Specific Antigen (PSA) as the screening test. Majority of the patients (61.4%) had chosen the age for screening as &lt;40 years and many more (91.3%) wanted to go for screening. Overall, 55.6% had heard about prostate cancer and 30.7% did not know any symptoms of prostate cancer. This study identifies some deficits in knowledge of prostate cancer and screening among participants which can be addressed to increase the knowledge related to prostate cancer. It is thus important that these participants and other men be educated more on these important domains of prostate cancer.

Minority and Lower Socioeconomic Status Patients Receive Ankle Fracture Care at Higher Cost Sites

Category: Ankle; Trauma Introduction/ Purpose: Socioeconomic disparities exist in the delivery of orthopedic care. Inequitable outcomes based on socioeconomic status (SES), including income, race, and geography, have been studied in association with outcomes following lower extremity trauma care. As orthopedic surgical care shifts increasingly towards providing care in hospital outpatient departments (HOPD) and freestanding ambulatory surgery centers (ASC), there is an opportunity to address socioeconomic disparities. We aimed to assess the association between patient SES and the outpatient facility type (HOPD versus ASC) where ankle fracture care was performed. We hypothesize: (1) White patients are more likely to receive care at ASCs, (2) Minority and lower income patients are more likely to receive care at HOPDs, and (3) Total charges for care are higher for minority and lower income patients. Methods: Data in patients ≥16 years old was sourced from the State Inpatient Database and Healthcare Utilization Project State Ambulatory Surgery Database (SASD) (for Florida, North Carolina, and Wisconsin) from 2016-2019. These 3 states were selected because their SASDs include a variable defining the location of service as a hospital outpatient department (HOPD) or ASC. Cases were identified using CPT codes converted to ICD-10 procedural codes for ankle fracture open reduction and internal fixation (ORIF). 85,749 cases were included: 50,411 (59%) inpatient, 28,536 (33%) HOPD, and 6,802 (8%) ASC, representing approximately 20% of inpatient and 11.5% of outpatient cases performed in the United States. Patient and facility characteristics were abstracted. Appropriate statistical analyses were conducted to describe and compare differences between facility type and patient characteristics. Results: Significant race and income disparities exist in outpatient ankle fracture care by facility type. Most patients receiving care were White (71%). Of the patients who received care at an HOPD, 32% were Black compared to 6% at ASCs (OR 0.795, CI 0.728-0.869). Of patients receiving care at an HOPD, 27% were other minorities compared to 9% at ASC (OR 1.213, CI 1.213- 1.309). More patients at HOPDs were in the lowest income level (26%) compared to ASC (18%). Factors found to associated with higher charges for surgery included patient being of minority race, patient of lower income level, and surgery performed at HOPD versus ASC. Conclusion: Ankle fractures treated at ASCs were more likely to be White and of higher income. These socioeconomic and racial/ethnic disparities are also associated with receiving care with higher total charges. These data indicate inequitable access to ankle fracture care performed at ASC facilities. More attention to social determinants of health is critical in the context of ankle fracture care to address potential inequitable outcomes and higher cost of care.

Costs of shoulder and elbow procedures are significantly reduced in ambulatory surgery centers compared to hospital outpatient departments.

Recent literature has shown the advantages of outpatient surgery for many shoulder and elbow procedures, including cost savings with equivalent safety in appropriately selected patients. Two common settings for outpatient surgeries are ambulatory surgery centers (ASCs), which function as independent financial and administrative entities, or hospital outpatient departments (HOPDs), which are owned and operated by hospital systems. The purpose of this study was to compare shoulder and elbow surgery costs between ASCs and HOPDs. Publicly available data from 2022 provided by the Centers for Medicare & Medicaid Services (CMS) was accessed via the Medicare Procedure Price Lookup Tool. Current Procedural Terminology (CPT) codes were used to identify shoulder and elbow procedures approved for the outpatient setting by CMS. Procedures were grouped into arthroscopy, fracture, or miscellaneous. Total costs, facility fees, Medicare payments, patient payment (costs not covered by Medicare), and surgeon's fees were extracted. Descriptive statistics were used to calculate means and standard deviations. Cost differences were analyzed using Mann-Whitney U tests. Fifty-seven CPT codes were identified. Arthroscopy procedures (n=16) at ASCs had significantly lower total costs ($2667±$989 vs. $4899±$1917; P=.009), facility fees ($1974±$819 vs. $4206±$1753; P=.008), Medicare payments ($2133±$791 vs. $3919±$1534; P=.009), and patient payments ($533±$198 vs. $979±$383; P=.009) compared with HOPDs. Fracture procedures (n=10) at ASCs had lower total costs ($7680±$3123 vs. $11,335±$3830; P=.049), facility fees ($6851±$3033 vs. $10,507±$3733; P=.047), and Medicare payments ($6143±$2499 vs. $9724±$3676; P=.049) compared with HOPDs, although patient payments were not significantly different ($1535±$625 vs. $1610±$160; P=.449). Miscellaneous procedures (n=31) at ASCs had lower total costs ($4202±$2234 vs. $6985±$2917; P<.001), facility fees ($3348±$2059 vs. $6132±$2736; P<.001), Medicare payments ($3361±$1787 vs. $5675±$2635; P<.001), and patient payments ($840±$447 vs. $1309±$350; P<.001) compared with HOPDs. The combined cohort (n=57) at ASCs had lower total costs ($4381±$2703 vs. $7163±$3534; P<.001), facility fees ($3577±$2570 vs. $6539.1±$3391; P<.001), Medicare payments ($3504±$2162 vs. $5892±$3206; P<.001), and patient payments ($875±$540 vs. $1269±$393; P<.001) compared with HOPDs. Shoulder and elbow procedures performed at HOPDs for Medicare recipients were found to have average total cost increase of 164% compared with those performed at ASCs (184% savings for arthroscopy, 148% for fracture, and 166% for miscellaneous). ASC use conferred lower facility fees, patient payments, and Medicare payments. Policy efforts to incentivize migration of surgeries to ASCs may translate into substantial health care cost savings.

The Differential Effect of COVID on Total Joint Arthroplasty Between Hospital and Ambulatory Surgery Centers/Hospital Outpatient Departments: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis.

Coronavirus disease (COVID) created unprecedented challenges, especially for high-volume elective subspecialties like total joint arthroplasty. Limited inpatient capacity and resource conservation led to new outpatient selection criteria and site of service changes. As a Michigan Arthroplasty Registry Quality Collaborative Initiative quality project, demographic changes, complications, and differential effects on inpatient vs outpatient centers pre- and post-COVID were analyzed. The registry identified all total joint arthroplasty at hospitals and ASCs/HOPDs between 07/2019-12/2019 and 07/2020-12/2020. These intervals represented pre-COVID and post-COVID elective surgery shutdowns. Case volumes, demographics, and 90-day complications were compared. Comparing 2020 to 2019, hospital volumes decreased (-9% total hip arthroplasty [THA],-17% total knee arthroplasty [TKA]), and ambulatory surgery center (ASC)/hospital outpatient department (HOPD) increased (+84% THA,+125% TKA). Entering 2020, ASC/HOPD patients were older (P= .0031, P < .0001: THA, TKA), had more American Society of Anesthesiologists score 3-4 (P= .0105, P= .0021), fewer attended joint class (P < .0001, P < .0001), and more hips were women (P= .023). Hospital patients had higher preoperative pain scores (P= .0117, P < .0001; THA, TKA), less joint education attendance (P < .0001, P < .0001), younger TKAs (P= .0169), and more American Society of Anesthesiologists score 3-4 (0.0009). After propensity matching, there were no significant differences between site of service for 90-day fractures, deep vein thromboses or pulmonary embolisms, infection, or hip dislocations. Hospital THAs had higher readmissions (P= .0003) and TKAs had higher 30-day emergency department visits (P= .005). ASC/HOPD patients were prescribed higher oral morphine equivalents (P < .0001, P < .0001; THA, TKA). COVID's elective surgery shutdown caused a dramatic site of service shift. Traditional preoperative education was negatively impacted, and older and sicker patients became outpatients. But short-term complications were not increased in ASCs/HOPDs. These site of service and associated patient demographic changes may be safely sustained.

Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

A comparison of the characteristics of adult medicine patients seeking telemedicine consultations versus in-person consultations in a Philippine public hospital

Background Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital. Methods This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation. Results Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults. Conclusions The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care.

Hospital-physician Integration and Value-based Payment: Early Results From MIPS.

Hospital-physician integration is often justified as a driver of clinical quality improvement due to joint resources covering a broad spectrum of care. Value-based programs, such as the Medicare Merit-Based Incentive Payment System (MIPS), are intended to tie financial incentives to clinical quality, which may confer an advantage on such integrated practices. We assessed the relationship between hospital-physician integration and MIPS performance by comparing hospital-integrated practices and independent practices. This was a cross-sectional study using data from the Quality Payment Program for the performance year 2020. Physician practices with a valid MIPS composite score in performance year 2020. Hospital integration was based on whether at least 75% of a practice's physicians either billed most of their services using hospital outpatient department codes or billed through a hospital tax identifier. The primary outcome was the MIPS quality category score, and the secondary outcomes were the specific quality measures reported by practice groups. Of the 20 most frequently reported measures, 14 were common in both groups. No difference was observed in the quality category score between hospital-integrated practices and independent practices in either unadjusted comparisons or after adjusting for practice characteristics, including practice size, geography, specialty mix, and case mix. In the secondary outcome models for specific quality measures, hospital-integrated practices achieved higher scores on most overlap measures but not all. The findings on quality category score suggest that hospital integration does not confer much advantage in the context of MIPS quality performance.

Drug utilization study of anti-diabetic drugs in patients attending medicine outpatient department at a tertiary care hospital in Western Maharashtra

Background: Studies on antidiabetic drug utilization are important for the optimization of drug therapy and rational prescription of drugs. The aim of the present study was to understand the trends in prescription pattern of oral anti-diabetic drugs among type 2 diabetes mellitus (T2DM) patients attending medicine outpatient department of tertiary care hospital of Western Maharashtra. Methods: A prospective observational study was conducted at Medicine OPD of Government Medical College and Hospital, Miraj. All adult patients (≥18 years) diagnosed with T2DM and willing to give informed consent to participate in the study, were enrolled. The study was approved by Institutional Ethics Committee. The data was computed using MS excel and results were expressed as counts and percentages. Results: Out of 72 T2DM patients enrolled, male population (58.33%) had higher prevalence than females (41.67%). Biguanides (63.16%) were the most commonly prescribed class of oral antidiabetic drugs followed by sulfonylureas (35.09%). Metformin (63.16%) was the most commonly prescribed oral antidiabetic drug followed by glimepiride (30.70%). Combination of oral antidiabetic drugs (OADs) were prescribed in 52.78% and 47.22% patients were prescribed single drug. ‘Metformin and glimepiride’ was the most commonly prescribed combination. Conclusions: In a chronic disease like diabetes mellitus, constant follow up for successful management is a must. It also demands active participation by the patients. Continuing education for the clinicians to keep themselves abreast of the latest development will also contribute in the effective management of diabetes mellitus and rational prescription of antidiabetic drugs.

Translation and validation of the Sindhi version of the general medication adherence scale in patients with chronic diseases.

Background: There is no medication adherence scale available in Sindhi language currently. Hence, the Sindhi speaking population will either use a translator or provide their medical history in another language for documentation of medical conditions. This poses a challenge in monitoring and evaluating adherence to medications within this linguistic community. Aim: The aim of this study was to translate and validate the Sindhi version of the General Medication Adherence Scale (GMAS-S) in patients with chronic diseases. Methods: This was a cross-sectional study of 4 months duration and was conducted in out-patient department of a university affiliated hospital in Karachi, Pakistan. All adults with chronic diseases, who were on long-term medications, and able to read and understand Sindhi language were invited. Convenience sampling was employed and a questionnaire consisting of demographic questions and the Sindhi version of GMAS was used. The translation of the scale was carried out. Confirmatory factor analysis (CFA) was conducted, and a structural equation model (SEM) was developed. Fit indices, namely, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were reported. Reliability was assessed using Cronbach's alpha (α), intraclass correlation coefficient (ICC), corrected item-to-total correlation (ITC) and item deletion. Data were analysed through IBM SPSS version 23 and IBM AMOS version 25. The study obtained ethical clearance. Results: A total of 150 responses were analysed. The reliability of the Sindhi version of GMAS was (α) = 0.696. The intraclass correlation coefficient (ICC) was reported at 0.696 (95% CI: 0.618-0.763). The values for the fit indices were as follows: χ2/df = 1.84, GFI = 0.918, TLI = 0.920, CFI = 0.942, AGFI = 0.864, and RMSEA = 0.075. All values except AGFI were in the acceptable ranges and indicated good fitness. Most participants (80.7%) appeared non-adherent to their medications. Conclusion: The results of the study demonstrate that the Sindhi version of the GMAS is a valid and reliable scale to measure adherence in Sindhi speaking persons with chronic diseases.

The Prevalence of Elder Abuse and its Association with Frailty in Elderly Patients at the Outpatient Department of a Super-Tertiary Care Hospital in Northern Thailand.

Background and Objectives: The global population is undergoing rapid aging, resulting in an increase in geriatric syndromes and hidden health issues such as elder abuse. However, the prevalence of elder abuse varies across different settings. The objective of this study is to determine the prevalence and factors associated with elder abuse at the outpatient department of a super-tertiary care hospital in northern Thailand. Materials and Methods: This cross-sectional study involved 210 elderly patients who visited Maharaj Nakorn Chiang Mai Hospital between May and August 2022. The participants completed several assessments, including the Mini-Cog, Thai Geriatric Depression Scale-6, Core Symptom Index-15, FRAIL scale, Barthel Activities of Daily Living, Interview Guideline for Screening for Elder Abuse, and Diagnostic Criteria for Elder Abuse. Fisher's exact test was used to examine the association between the factors and elder abuse. Results: The Screening for Elder Abuse yielded noteworthy results, with 15.7% of the elderly patients having experienced psychological abuse. However, only a smaller subset of study participants, comprising five individuals or 2.38%, met the diagnostic criteria for elder abuse. Furthermore, statistical analysis revealed no significant correlation between elder abuse and the other factors examined in the study. Conclusions: As a result, it is crucial for hospitals to consider preventive measures and implement routine screening protocols.