Number Of Clinic Appointments Research Articles

A national evaluation of QbTest to support ADHD assessment: a real-world, mixed methods approach.

QbTest is a commercially available, computerised test of attention, impulsivity, and activity designed to assist with the diagnosis of attention deficit hyperactivity disorder (ADHD). Health Innovation East Midlands (formerly East Midlands AHSN), led the implementation of the QbTest on behalf of the 15 Health Innovation Networks across Child and Adolescent Mental Health services (CAMHS) and Paediatric sites in England between April 2020 and March 2023. We evaluate the impact of this programme on diagnostic assessment at participating sites. A mixed-methods approach was used including: case-note data collected on 10-30 cases per site pre and post QbTest implementation; interviews with healthcare staff working with QbTest; and surveys to explore perspectives of healthcare staff and patients/carers. Case-note data was descriptively analysed to compare time to diagnosis (number of appointments and days) pre/post QbTest implementation. Survey data was analysed descriptively. Qualitative interview data was explored using thematic analysis. Case-note data was provided by 20 sites across England. Comparison of mean values pre- and post-QbTest implementation identified a decrease of 0.37 (11.5%) in number of appointments to reach a diagnostic decision, a 55-day (12.5%) increase in days from initial referral to diagnosis, and a 12-day (10.3%) increase in days to reach a diagnostic decision. Exploratory analyses indicated greater benefit for Paediatric services over CAMHS, in terms of a decrease in days from referral to diagnosis and number of appointments to diagnosis. Interviews with healthcare staff (n=21) revealed that the QbTest was perceived to support a faster, more efficient diagnostic process. Survey data (n=65 healthcare staff, n=22 patients/carers) identified that the QbTest helped patients understand their symptoms and the diagnostic decision. Although some logistical issues (e.g., room requirements) and patient issues (e.g., sensory sensitivity) were identified, healthcare staff considered that QbTest was easily incorporated into the ADHD assessment pathway. The national implementation of QbTest in ADHD clinics resulted in a small reduction in the number of clinical appointments needed to reach a diagnostic decision, with greatest benefit demonstrated in Paediatric sites. Data were impacted by COVID-19 therefore, further evaluation is warranted.

Recent Advances In Complete Dentures – A Narrative Review On Digital Complete Denture Clinical Workflows

Complete dentures are one of the most challenging prosthetic treatments to be performed throughout history. It has undergone transformation during the last decade tremendously with introduction of digital dentistry. The efforts are being focused at reducing the duration and number of clinical appointments, making the process more predictable and repeatable. The milled pre-polymerized PMMA has superior physical and mechanical properties, better biological properties and polishability. It is necessary to understand the clinical workflow of the digital dentures to be able to apply them clinically, giving patients the best possible outcome.

Home Medication Management and Practices among Post-stroke Patients: A Cross-sectional Study in a University-based Primary Care Clinic in Malaysia

Effective medication management practice (MMP) improves compliance of chronic conditions management and reduces medication error for better clinical outcomes. This is important for stroke survivors with multiple comorbidities and post-stroke complications. This study aimed to determine appropriateness of home MMP and its associated factors among post stroke patients. This was a cross-sectional, single-centre study involving 120 stroke patients of a primary care medical centre in Kuala Lumpur between January and March 2021. The assessment of MMP appropriateness relied on scores obtained through a set of questions administered via face-to-face, online or telephone interview. The mean age of participants was 65.1 (SD 11.7) years. 55.8% of participants had inappropriate home MMP; where the majority did not update their medication list (86.3%), did not memorise the medication’s name (75%), and did not return the leftover medication to the pharmacy (63.3%). Female gender (AOR: 2.74, 95% CI: 1.18-6.35, p-value: 0.019), household income (> RM4850) (AOR: 2.82, 95% CI: 1.03-7.69, p-value: 0.043), and number of clinic appointments (>2) (AOR: 5.27, 95% CI: 1.44-19.24, p-value: 0.012) were significantly correlated with better home MMP. The MMP among post-stroke patients was poor. Better home MMP were associated with female gender, higher socioeconomic status, and more frequent clinic appointments. Concerted health education should be provided, particularly focusing on medication management to improve home MMP in post-stroke patients and ultimately improving their overall health outcomes.

Perceived Stressful Life Events and Suicide Risk in Adolescence: The Mediating Role of Perceived Family Functioning.

Suicidal behavior is a serious public health problem and a major cause of death among adolescents. Three categories of major risk factors have been identified: psychological factors, stressful life events, and personality traits. Severe and objective stressful life events (SLEs), such as childhood mistreatment or abuse, have been clearly associated with higher rates of suicide risk. However, the relationship between suicide risk and adolescents' perceptions of the SLE impact is not as clear. This paper studies the relationship between SLE impact perception and suicide risk and the possible mediating role of perceived family functioning in this relationship. The need for longer-term or more intense psychological or psychiatric treatment in relation to SLE impact perception is also addressed. One hundred forty-seven adolescents aged 11-17 were consecutively recruited from the Child and Adolescent Mental Health Outpatient Services Department of a general hospital in Madrid, Spain. Self-informed questionnaires were used to assess suicide risk, SLEs, and family functioning. In addition, the clinical records of the participants were consulted to collect information about their treatment histories, including the number of appointments and the duration of follow-up. SLE impact perception correlates significantly with suicide risk, the number of clinical appointments, the duration of treatment, and the perceived level of family functioning. The mediation model of the family functioning perception variable in the relationship between SLE impact perception and suicide risk is significant. The linear regression model of SLE impact perception and family functioning perception on suicide risk is also significant, accounting for 25.7% of the variance. Beyond the clear and proven effect of serious and objective SLEs, the perceived impact of SLEs reported by adolescents is related to an increased risk of suicide and more intense psychological and/or psychiatric follow-up. This relationship is mediated by the perceived level of family functioning. Adolescents' perceptions of their life experiences and perceived family support may be key determinants of suicide risk prevention.

1200 Polytrauma Clinic in a Major Trauma Centre in the UK – a Novel Approach for Polytrauma Patients

Abstract Introduction The UK major trauma network was successfully implemented in 2012. However, rehabilitation has mainly been described in military veterans. In our unit a multidisciplinary polytrauma clinic attended by an Advanced Physiotherapist, Rehabilitation Medicine Consultant and a Trauma and Orthopaedic Consultant was established to manage these patients after discharge. Method This observational study assessed the polytrauma rehabilitation clinic at a single UK Major Trauma Centre. Eligible patients had 2 or more significant limb injuries +/- pelvic fracture. A retrospective review between 1st July 2016 to 31st July 2021 was performed. Electronic records were assessed for mechanism of injury, number of injuries requiring surgery, length of inpatient stay, number of clinic appointments, diagnosis of post-traumatic amnesia and re-admission. Results Of a total of 87 patients, 68% sustained injuries following road traffic collisions. Mean number of injuries per patient was 5.9 SD+/- 2.6, mean operations performed per patient 4.3 SD+/- 4. Patients had a mean of 1.4 SD+/- 0.6 reviews per year in the clinic, with 1.5 +/- 0.6 years of follow-up. 14% of patients had post-traumatic amnesia. Re-admission was required for 24 patients, of which 21 (87.5%) were planned. Conclusions The polytrauma clinic introduced a multi-disciplinary approach to the aftercare of this patient population, whilst reducing their appointment burden. This study found patients required 1-2 appointments per year, demonstrating a cost-effective approach to follow up. The streamlining of required interventions in a timely manner is supported by the fact that over 70% of patients did not require further admissions for treatment.

A biologically oriented preparation technique (BOPT) for immediate posterior implant placement, immediate provisionalization, and definitive implant crown fabrication: A complete digital workflow.

Immediate implants and immediate alveolar sealing have been a widely utilized treatment with high predictability and biological advantages. The improvement in technology has made it possible to simplify clinical processes. The aim of the present report was to describe the complete digital workflow of the Biologically oriented preparation technique for immediate posterior implant, immediate provisionalization and fabrication of definitive implant crowns. The surgical process and prosthetic management to preserve the gingival contours of the extracted natural tooth during immediate implant placement and provisionalization are described. Additionally, during the same clinical intervention, the definitive intraoral digital implant scans for capturing the implant position, peri-implant tissue contours, adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured for the fabrication of the definitive crown. Based on the technique described, the immediate implant placement and provisionalization in the posterior area provides biological and clinical advantages, reducing the number of abutment-implant disconnections and the number of clinical appointments, as well as increases patient comfort. The present article describes a technique for an immediate implant placement and provisionalization in the posterior region for maintaining the gingival architecture of the extracted tooth. During the same appointment, the implant position, peri-implant tissue contours, and adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured by using an intraoral scanner and used for the fabrication of the definitive crown. This technique aims to reduce the number of abutment-implant disconnections and clinical appointments.

Effectiveness of a Telerehabilitation Evidence-Based Tablet App for Rehabilitation in Traumatic Bone and Soft Tissue Injuries of the Hand, Wrist, and Fingers

ObjectiveTo assess whether feedback-guided exercises performed on a tablet touchscreen improve clinical recovery and reduce health care usage more than the conventional home exercise program prescribed on paper in patients with bone and soft tissue injuries of the wrist, hand, and/or fingers treated by public health services. DesignA multicenter assessor-blinded, parallel, 2-group controlled trial. SettingTrauma and rehabilitation services of 4 hospitals. ParticipantsSix hundred sixty-three patients with limited functional ability due to bone and soft tissue injuries of the wrist, hand, and/or fingers (N=663). InterventionsThe experimental group received a home exercise program using a tablet-based application with feedback, monitoring, and progression; the control group received an evidence-based home exercise program on paper. Main Outcome MeasuresThe primary outcome was functional ability through Patient Rated Wrist Evaluation for wrist conditions and the short version of Disabilities of the Arm, Shoulder and Hand for all other hand pathologies. Secondary outcomes included dexterity, pain intensity, grip strength, and health care usage (number of patients referred to rehabilitation service and number of clinical appointments). ResultsThe experimental group showed a significant improvement on the Patient Rated Wrist Evaluation (P=.001) and the short version of Disabilities of the Arm, Shoulder and Hand (P=.001) with medium effect sizes (η2=0.066-0.067) when compared with the control group. Regarding health care usage, the experimental group presented a reduction of 41% in the rate of referrals to face-to-face rehabilitation service consultations, a reduction of rehabilitation consultations (mean difference=−1.64; 95% confidence interval, −2.64 to −0.65) and physiotherapy sessions (mean difference=−8.52, 95% confidence interval, −16.92 to −0.65) compared to the control group. ConclusionsIn patients with bone and soft tissue injuries of the wrist, hand, and/or fingers, prescribing feedback-guided exercises performed on a tablet touchscreen was more effective for improving patients’ functional ability and reduced the number of patients referred to rehabilitation consultation and number of clinical appointments.

1145 Achilles Tendon Rupture Management: Improving Our Pathway

Abstract Background Achilles tendon ruptures are the most common tendon injury which affect predominantly middle age males. The yearly incidence is 31/100,000, with a rising incidence due to an increasingly active older generation1. Conservative versus operative management options shows no significant difference in rates of re-rupture or length of rehabilitation2. Delays in imaging have been found to delay definitive treatment and led to multiple attendances in the outpatient clinic. Method A retrospective analysis was performed patients diagnosed with an Achilles tendon rupture from September 2016 to February 2017 throughout the East Kent Trust. Patients were identified via clinical coding of ED attendance. Following implementation of the pathway in October 2018, a second retrospective analysis of patients identified between October 2018 and March 2019 was performed. Patients with re-ruptures or < 16 years old were excluded from the study. Results Following introduction of the pathway, there has been a 100% increase in the number of ultrasound scans performed, with the rupture gap size documented in 50% of these. The time to decision for conservatively managed patients dropped from 8 to 2 days. The number of clinic appointments also dropped from 3 to 2 with the management of patients predominantly in the plaster room. Conclusions The pathway has streamlined the process for patients following their injury. The majority of patients are seen by a senior clinician within 72 hours and a treatment plan clarified. The use of surgical care practitioner led clinics have allowed continuity of care for these patients and swift escalation when required.

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial.

In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength. In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. ACTRN12619000344190.

Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation

ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of...

Custom Nasal Septum Prosthesis Fabricated from a 3D-Printed Working Model: A Clinical Report.

This clinical report describes the treatment of a 47-year-old female patient with a nasal septum perforation. The treatment used a 2-piece magnetic custom prosthesis fabricated from a 3D-printed model. By using an existing medical CT scan to generate the printed working model, the number of clinical appointments was reduced. The workflow expanded the purpose of the radiologic images from simply diagnostic to include the prosthetic aspect of treatment.

What is the right number of clinic appointments?: Visit frequency and the accountable care organization.

What is the right number of clinic appointments?: Visit frequency and the accountable care organization.

Acceptability and Receipt of Preventive Care for Chronic-Disease Health Risk Behaviors Reported by Clients of Community Mental Health Services.

Compared with the general population, people with a mental illness have a greater prevalence of behaviors that contribute to higher chronic disease rates. Mental health clinical guidelines recommend preventive care to address such behaviors; however, little information is available about whether clients consider preventive care acceptable or about the prevalence of such care in mental health services. This article describes acceptability and receipt of assessment, advice, and referral for smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and physical inactivity, as reported by community mental health service clients. The association between preventive care, diagnosis, and number of clinical appointments was examined. A cross-sectional telephone interview was conducted with clients (N=558) of community mental health services in Australia. Although preventive care was highly acceptable to clients (86%-97%), receipt of preventive care was low. Client receipt of risk assessment ranged from 26% (assessment of fruit or vegetable intake) to 76% (assessment of alcohol consumption). The proportion of clients at risk of and assessed for unhealthy behavior who then received brief advice ranged from 69% (fruit or vegetable intake) to 85% (physical activity), whereas only 38% (alcohol consumption) to 49% (smoking) received any referral. A greater number of mental health appointments were associated with higher prevalence of preventive care, as were diagnoses of diabetes or respiratory conditions and not having a schizophrenia diagnosis. Practice change strategies are required to increase the delivery of routine preventive care within mental health services if clients are to benefit from clinical guidelines.

Tertiary level management of overweight and obese children and adolescents—Does intensive dietetic intervention using a moderate protein intake have a positive impact on weight control in children?

Aims: To review weight loss outcomes (change in BMI z score) in a tertiary (dietetic) clinical practice, to determine if number of appointments or time between appointments is associated with outcome, to determine gender or age differences in outcome, to determine correlation between level of obesity and attrition rate and to review clinical practice dependent upon outcome. Methods: A retrospective audit with analysis of patient data collected June 2005—September 2009. Data included: Anthropometry, biochemistry, comorbidities and referral source on 210 patients (52% females). Patients attended for assessment and education on a structured moderate-protein diet. Reviews are scheduled monthly for up to 5 visits. Results: Significant reduction in BMI z score for boys at all appointments (p < 0.001). Significant reduction in BMI z score for girls by the fifth appointment (p = 0.036). Significant reduction in pre-adolescent BMI z scores at all appointments (p < 0.001). High attrition rate (50%) after the first appointment but 20% still returning for the fifth appointment. Changes in BMI z score ranging from −0.28 to −0.13. No correlation between changes in BMI z score and duration or number of clinic appointments. Conclusions: Tertiary level dietary treatment of childhood obesity using a structured moderate protein intake and regular reviews has a positive influence on childhood obesity. These findings will assist in service improvement and development of best practice guidelines for treatment of childhood obesity in a tertiary clinic setting. Funding source: None.

Impact of the '2 week wait' directive for suspected cancer on service provision in a symptomatic breast clinic.

The '2 week wait' directive (Health Service Circular (HSC) 1998/242) guaranteeing that 'everyone with suspected breast cancer will be able to see a specialist within two weeks of their general practitioner (GP) deciding they need to be seen urgently' is a unique audited approach to access for the British National Health Service, the effects of which have been assessed in a non-academic symptomatic breast clinic. New GP referrals (n = 607) were reviewed prospectively in two comparable 3-month intervals, beginning 1 April 1998 and 1 April 1999, to determine the probability of a breast cancer diagnosis from the referral letter and the effects of the directive on waiting times for appointments and utilization of clinics. The urgency of referral was not specified in 53 per cent of GP referrals. For the 'urgent' cases (25 per cent of all new referrals) the probability of a final diagnosis of breast cancer was 0.19. The breast specialists prospectively achieved a rate of 0.26 from 99 per cent of the same referral letters. 'Urgent' referrals did not wait significantly longer in 1999 (median 9 versus 10 days) but waiting times for new appointments overall increased (13 versus 16 days; P < 0.01), and this was greatest for 'routine' [14] versus 21 days; P < 0.001). These changes were caused by an increase in the number of clinic appointments, due to significant increases in median number of visits to diagnosis or discharge and clinic non-attendance in 1999, resulting in overbooking. Telephonic communications were associated with faster median access times (fax 8 days; telephone 2 days), relative to mailed [19] days) (P < 0.01). Breast specialists were better overall at assessing the probability of a breast cancer diagnosis. The waiting time for 'urgent' appointments was unchanged following HSC 1998/242, but there was an increased wait for other patients, especially those assessed as having a lower probability of cancer.

The Association Between Appointment-Keeping and Birth Outcome in a Prenatal Care Program for High-Risk Women

ABSTRACT Objective: To examine possible associations between appointment keeping and birth outcome among a sample of low-income high-risk pregnant women enrolled in a prenatal care program. Method: Perinatal outcome measures were evaluated for high-risk program patients who delivered between January 1, 1994 and June 30, 1994. Of these, perinatal outcomes of women who attended thirteen or more clinic appointments (n = 27) were compared to those of women who attended four or fewer appointments (n = 28). Each comparison group comprised roughly 25% of the total group of 119 patients who delivered during this time frame. Results: Program participants who attended the higher number of clinic appointments delivered infants with significantly greater gestational ages and higher birth weights than did the comparison group. Apgar scores averaged higher for participants who attended more visits than for the comparison group. Conclusions: These more favorable birth outcomes support prenatal care services provided to high-risk patients.