Outpatient Room Research Articles

Abstract No. 516 Trends in percutaneous extremity venography among radiologists and other specialties

Evaluate utilization trends in percutaneous extremity venography among radiologist and nonradiologist providers. The nationwide Medicare Part B fee-for-service databases for 2010to 2018 were used to obtain percutaneous extremity venography volumes. Two procedure codes were used to identify extremity venography procedures, including both unilateral and bilateral procedures. Procedure volumes were aggregated based on physician specialty, specifically as radiologists, cardiologists, vascular surgeons, general surgeons, or other providers. Procedures were stratified based on place of service, including inpatient, hospital outpatient departments, office, emergency room, and other. The additional codes for transcatheter and percutaneous mechanical thrombectomy were not included to avoid potentially duplicating procedures. From 2010 to 2018, the total number of percutaneous extremity venography procedures declined (-39%) but began to plateau in 2017 to 2018 (-10%) (Table). More procedures were performed in the hospital outpatient department or office setting (N = 263,991; 58% of total volume) compared to inpatient (N = 183,386; 40%). Radiologists performed the majority of these procedures (N = 164,580; 36% of the total volume), followed by cardiologists (N = 138,949; 31%) and vascular surgeons (N = 75,431; 17%). However, radiologists saw the greatest decline in procedure volumes (25,907 to 13,108; -49%), compared with cardiologists (20,514 to 12,629; -35%) and vascular surgeons (9684 to 7921; -18%). The volume of percutaneous extremity venography procedures performed in the Medicare population declined from 2010 to 2018, most likely related to more stringent patient selection. Radiologists performed the majority of procedures but were closely followed by cardiologists.Tabled 1Total Number of Submitted Services per Year for Percutaneous Extremity Venography201068,426201160,395201252,906201350,002201448,057201545,926201644,417201742,001201841,598Total453,728 Open table in a new tab

The effect and prediction of diurnal temperature range in high altitude area on outpatient and emergency room admissions for cardiovascular diseases.

Diurnal temperature range (DTR) is a meteorological indicator closely associated with global climate change. Thus, we aim to explore the effects of DTR on the outpatient and emergency room (O&ER) admissions for cardiovascular diseases (CVDs), and related predictive research. The O&ER admissions data for CVDs from three general hospitals in Jinchang of Gansu Province were collected from 2013 to 2016. A generalized additive model (GAM) with Poisson regression was employed to analyze the effect of DTR on the O&ER admissions for all cardiovascular diseases, hypertension, ischemic heart disease (IHD) and stoke. GAM was also used to preform predictive research of the effect of DTR on the O&ER admissions for CVDs. There were similar positive linear relationships between DTR and the O&ER visits with the four cardiovascular diseases. And the cumulative lag effects were higher than thesingle lag effects. A 1°C increase in DTR corresponded to a 1.30% (0.99-1.62%) increase in O&ER admissions for all cardiovascular diseases. Males and elderly were more sensitivity to DTR. The estimates in non-heating season were higher than in heating season. The trial prediction accuracy rate of CVDs based on DTR was between 59.32 and 74.40%. DTR has significantly positive association with O&ER admissions for CVDs, which can be used as a prediction index of the admissions of O&ER with CVDs.

Pengaruh Penerapan Pelayanan Prima Terhadap Kepuasan Pasien Rawat Jalan di RSUD Labuang Baji Makassar

The number of outpatient visits at Labuang Baji Hospital, Makassar decreased from 2017 as many as 47.773 patients to 45.591 patients where the decrease in the number of outpatient visits was indicated to be related to the excellent service provided by the hospital. This study aims to analyze the effect of the application of excellent service on the satisfaction of outpatients at the Labuang Baji Hospital, Makassar. This type of research is a quantitative study using a cross sectional study design. This research was conducted in the outpatient room of the Labuang Baji Hospital, Makassar. The total sample was 397 outpatients. Data were collected using a questionnaire tool. Data were analyzed using the chi square test at α <5%. The results showed that there was an effect of excellent service from the Attitude with a value of p=0,007, Attention with a value of p=0,001, Action with a value of p=0,003, Ability with a value of p=0,001, Appearance with a value of p=0,000, and Accountability with a value of p=0,000 on outpatient satisfaction at Labuang Baji Hospital, Makassar. It is expected that the Labuang Baji Hospital, Makassar will pay attention and maintain the items of Attitude, Attention, Action, Ability, Appearance, and Accountability because it is scientifically proven affect to outpatient satisfaction.

Morbidity among Arab-Israeli and Palestinian Hajj Pilgrims: A Prospective Study.

Thousands of Palestinian and Arab-Israeli pilgrims travel to Mecca each year to complete their pilgrimage. To the best of our knowledge, no previous studies have characterized the infectious and noninfectious morbidity among Arab-Israeli or Palestinian Hajj pilgrims. Thus, we designed and conducted an observational questionnaire-based study to prospectively investigate the occurrence of health problems among these Hajjis who traveled to complete their Pilgrimage during 2019 Hajj season. For the purpose of the study, questionnaires were distributed to Hajj pilgrims at three different time occasions-before travel, inquiring on demographics and medical comorbidities; and 1 and 4 weeks after returning recording any health problems encountered during or after travel. Initial recruitment included 111 Hajjis. The mean age of responders was 49.5 (±9.1) years, with a Male:Female ratio of 1.3:1. The mean travel duration was 18.7 (13-36) days. Altogether, 66.3% of the pilgrims reported at least one health problem during and after the trip, of which 38.6% sought medical attention. Five (4.8%) hajjis were hospitalized, including life-threatening conditions. Cough was the most common complaint (53.8%), and 11.5% also reported fever. Pretravel counseling was associated with reduced outpatient and emergency room visits. We therefore concluded that a high rate of morbidity was reported among this cohort of Hajj pilgrims with a morbidity spectrum similar to pilgrims from other countries. Pretravel consultation with the purpose of educating the pilgrims on the health risks of Hajj may help reduce the morbidity for future Hajj seasons.

Comorbidities and Age Are Associated With Persistent COVID-19 PCR Positivity.

ObjectivesThe impact of demographics and comorbidities on the duration of COVID-19 nasopharyngeal swab PCR positivity remains unclear. The objective of our analysis is to determine the impact of age, intensive care unit (ICU) admission, comorbidities, and ethnicity on the duration of COVID-19 PCR positivity among hospitalized patients in a large group of hospital.MethodWe studied 530 patients from a large hospital system and time to SARS-CoV-2 virus RNA PCR negativity at any-time during hospitalization or following discharge from the hospital was the primary endpoint. We included patients 18 years or older who tested positive for COVID-19 during an inpatient, outpatient, or emergency room visit between February 1, 2020, and April 14, 2020.ResultsOverall, 315 (59.4%) of our patient population continued to have a positive SARS-CoV-2 virus RNA PCR 4 weeks after the initial positive test. We found that age>70 years, chronic kidney disease, hypertension, hyperlipidemia, obesity, or coronary artery disease are associated with persistent PCR positivity for more than 4 weeks after initial diagnosis.ConclusionAge, and the presence of co-morbidities should be taken into consideration when interpreting a positive COVID PCR test.

Healthcare spending and utilization for pediatric Irritable Bowel Syndrome in a commercially insured population.

Pediatric Irritable Bowel Syndrome (IBS) is common and can be associated with disabling gastrointestinal symptoms. Comprehensive data regarding utilization and cost of pediatric IBS are lacking. Our aim was to determine the annual all-cause spending and healthcare utilization in pediatric IBS. Cross-sectional cohort study using a national claims database of commercially insured individuals. 932,592 members, age 8-18years, were included. Members were selected based on PheWas codes and continuous enrollment in 2014. Linear and binomial regression models were used to calculate healthcare spending and compare comorbidities between IBS subjects and controls. 1215 members with claims for IBS (68.4% female) and 931,377 controls (55.7% female) were included. Mean age was 15.03±2.83 (median 16) years in the IBS group and 13.14±3.12 (median 13) years in controls. Mental health and chronic pain comorbidities were more prevalent in the IBS cohort. Healthcare spending: The mean annual all-cause incremental spending of members with IBS was $6,364.60 compared to controls when adjusting for age and gender. Healthcare utilization: Members with IBS had increased healthcare utilization including higher rates of inpatient, outpatient, and emergency room visits, and higher rates of health service utilization including medical care, radiology/laboratory services, surgery, anesthesia, mental health, and physical therapy. General pediatrics was more frequently consulted by controls. All subspecialty consultations, with the exception of dental medicine and endocrinology, were sought more frequently by IBS patients. Patients with IBS incur significant annual spending through increased healthcare utilization.

To oversew or not to oversew in robotic sleeve gastrectomy: a case against oversewing the staple line.

The benefits of oversewing the staple lines during laparoscopic sleeve gastrectomy have been controversial. No study examined the benefit of oversewing the staple lines in robotic sleeve gastrectomy (RSG). This retrospective study aims to examine the difference in immediate postoperative complications, readmissions, reoperations, and emergency room visits between RSG patients with and without oversewn staple lines at a single, large-volume, bariatric center. A retrospective chart review was conducted on 623 patients who underwent RSG between November 1, 2017, and November 1, 2019. Of these, 316 had their staple line oversewn between November 1, 2017, and November 12, 2018, and 307 did not have their staple line oversewn between November 13, 2018, and November 1, 2019. A total of 623 patients underwent RSG, of which 50.7% (n = 316) had their staple line oversewn. The mean length of hospital stay was similar between the two groups. However, the mean operative time was significantly longer in the "oversew" group than "no oversew" group by 7.4 minutes (p < 0.001). Readmission, reoperation, and intervention rates during the 30-day postoperative period were similar between the two groups. However, the percentage of patients requiring outpatient emergency room visits during the 30 days after RSG was significantly higher in the "oversew" group than that of the "no oversew" group. No significant difference in major complications was found between RSG patients with and without oversewn staple lines. Oversewing of the staple line may be associated with increased emergency room visits.

Addressing Antibiotic Overuse in the Outpatient Setting: Lessons From Behavioral Economics

Addressing Antibiotic Overuse in the Outpatient Setting: Lessons From Behavioral Economics

Outcomes of an aseptic technique for Kirschner wire percutaneous pinning in the hand and wrist.

Kirschner wires (K-wires) have been shown to effectively stabilize fractures of the hand and wrist, but are associated with high infection rates, which may limit its use. Previous literature has attributed the risk of infection to many different aspects of a fixation technique. However, we introduce an approach to percutaneous K-wire pinning to mitigate the risk of infection. Patients undergoing K-wire fixation procedures of the hand and wrist were retrospectively queried. All cases were performed under the same principles of our technique. None of the K-wires were buried, nor bent and were covered with betadine-soaked alcohol pads as pin site dressings. Pins were removed in an outpatient procedure room up to 12 weeks postoperatively and were then assessed for signs of superficial or deep infection. 90 patients were included in this study across a variety of K-wire fixation operations in the hand and wrist. No patients presented with any signs of infection or other complications necessitating postoperative antibiotics, early pin removal, or reoperation. The specific guidelines of our technique resulted in no cases of pin site infection, despite a largely underserved patient population. Our low incidence of infection was maintained without the use of prophylactic antibiotics and in patients with long periods of fixation. While the high infection rates in previous literature have often been associated with wires left exposed, the principles of our technique allow for K-wire fixations to be performed percutaneously without burying the wires. This may allow for improved cost and time efficiency, without compromising patient safety.

873 Risk of unplanned healthcare utilization in postpartum period for women with hypertensive disorders of pregnancy

The objective of this study was to determine which factors are associated with unplanned postpartum healthcare utilization, including hospital readmission and unplanned outpatient and emergency room visits, in patients with hypertensive disorders of pregnancy (HDP). This was a case-control study of patients with HDP delivering at a single academic institution from 2014 through 2018. The diagnosis of HDP included chronic hypertension, gestational hypertension, preeclampsia and superimposed preeclampsia. Using univariable and multivariable analysis, demographic and clinical characteristics were compared between patients who had unplanned healthcare utilization, defined as readmission to the hospital, emergency room visit or unplanned outpatient encounter in the first 6 weeks postpartum, and those patients who did not. Of the 1042 patients included in this analysis, 151 (14.5%) had unplanned postpartum healthcare utilization. In multivariable logistic regression, mild range blood pressure on day of discharge after delivery compared with normal range blood pressures (aOR 1.71, 95% CI 1.14-2.58) and HDP with severe features (aOR 3.65, 95% CI 1.64-8.12) were associated with higher odds of unplanned postpartum healthcare utilization. In contrast, chronic hypertension (aOR 0.52, 95% CI 0.31-0.89) and receipt of magnesium sulfate intrapartum or immediately postpartum (aOR 0.22, 95% CI 0.10-0.49) were associated with lower odds of unplanned postpartum healthcare utilization (Table). Among postpartum patients with HDP, severe disease features and mild range blood pressures prior to discharge were associated with higher odds of unplanned healthcare utilization in the first 6 weeks postpartum, while chronic hypertension and receipt of magnesium sulfate were associated with lower odds.

An assessment of outpatient clinic room ventilation systems and possible relationship to disease transmission

BackgroundWith healthcare shifting to the outpatient setting, this study examined whether outpatient clinics operating in business occupancy settings were conducting procedures in rooms with ventilation rates above, at, or below thresholds defined in the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers/American Society for Health Care Engineering Standard 170 for Ventilation in Health Care Facilities and whether lower ventilation rates and building characteristics increase the risk of disease transmission.MethodsVentilation rates were measured in 105 outpatient clinic rooms categorized by services rendered. Building characteristics were evaluated as determinants of ventilation rates, and risk of disease transmission was estimated using the Gammaitoni-Nucci model.ResultsWhen compared to Standard 170, 10% of clinic rooms assessed did not meet the minimum requirement for general exam rooms, 39% did not meet the requirement for treatment rooms, 83% did not meet the requirement for aerosol-generating procedures, and 88% did not meet the requirement for procedure rooms or minor surgical procedures.ConclusionsLower than standard air changes per hour were observed and could lead to an increased risk of spread of diseases when conducting advanced procedures and evaluating persons of interest for emerging infectious diseases. These findings are pertinent during the SARS-CoV-2 pandemic, as working guidelines are established for the healthcare community.

Containment of procedure-associated aerosols by an extractor tent: effect on nebulized drug particle dispersal

BackgroundSeveral medical procedures involving the respiratory tract are considered as ‘aerosol-generating procedures’. Aerosols from these procedures may be inhaled by bystanders, and there are consequent concerns regarding the transmission of infection or, specific to nebulized therapy, secondary drug exposure.AimTo assess the efficacy of a proprietary high-efficiency-particulate-air-filtering extractor tent on reducing the aerosol dispersal of nebulized bronchodilator drugs.MethodsThe study was conducted in an unoccupied outpatient room at St. James's Hospital, Dublin, Ireland. A novel real-time, fluorescent particle counter, the Wideband Integrated Bioaerosol Sensor (WIBS), monitored room air continuously for 3 h. Baseline airborne particle count and count during nebulization of bronchodilator drug solutions were recorded.FindingsNebulization within the tent prevented any increase over background level. Nebulization directly into room air resulted in mean fluorescent particle counts of 4.75 x 105/m3 and 4.21 x 105/m3 for Ventolin and Ipramol, respectively, representing more than 400-fold increases over mean background level. More than 99.3% of drug particles were <2 μm in diameter and therefore small enough to enter the lower respiratory tract.ConclusionThe extractor tent was completely effective for the prevention of airborne spread of drug particles of respirable size from nebulized therapy. This suggests that extractor tents of this type would be efficacious for the prevention of airborne infection from aerosol-generating procedures during the COVID-19 pandemic.

Response of L V Prasad Eye Institute to COVID-19 outbreak in India: experience at its tertiary eye care centre and adoption to its Eye Health Pyramid.

To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India. Our responses are based on the principles of social distancing, hand hygiene, respiratory etiquettes, surface disinfection protocol, and rational use of appropriate personal protective equipment (PPE). We describe our response in terms of administrative controls, clinical protocols, staff protection, environmental controls, and social distancing measures. We also discuss our communication strategies and monitoring systems, to ensure compliance to protocols. Administrative control is mainly related to formation of task force and its functions. Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient, Inpatient and Operating Room. Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home, and use of PPE. Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital. In addition, there are systems for communication as well as monitoring compliance to protocols. We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel, and their patients across the world.

Relationship of socio-demographics, comorbidities, symptoms and healthcare access with early COVID-19 presentation and disease severity

BackgroundCOVID-19 studies are primarily from the inpatient setting, skewing towards severe disease. Race and comorbidities predict hospitalization, however, ambulatory presentation of milder COVID-19 disease and characteristics associated with progression to severe disease is not well-understood.MethodsWe conducted a retrospective chart review including all COVID-19 positive cases from Stanford Health Care (SHC) in March 2020 to assess demographics, comorbidities and symptoms in relationship to: 1) their access point of testing (outpatient, inpatient, and emergency room (ER)) and 2) development of severe disease.ResultsTwo hundred fifty-seven patients tested positive: 127 (49%), 96 (37%), and 34 (13%) at outpatient, ER and inpatient, respectively. Overall, 61% were age < 55; age > 75 was rarer in outpatient setting (11%) than ER (14%) or inpatient (24%). Most patients presented with cough (86%), fever/chills (76%), or fatigue (63%). 65% of inpatients reported shortness of breath compared to 30–32% of outpatients and ER patients. Ethnic/minority patients had a significantly higher risk of developing severe disease (Asian OR = 4.8 [1.6–14.2], Hispanic OR = 3.6 [1.1–11.9]). Medicare-insured patients were marginally more likely (OR = 4.0 [0.9–17.8]). Other factors associated with developing severe disease included kidney disease (OR = 6.1 [1.0–38.1]), cardiovascular disease (OR = 4.7 [1.0–22.1], shortness of breath (OR = 5.4 [2.3–12.6]) and GI symptoms (OR = 3.3 [1.4–7.7]; hypertension without concomitant CVD or kidney disease was marginally significant (OR = 2.3 [0.8–6.5]).ConclusionsEarly widespread symptomatic testing for COVID-19 in Silicon Valley included many less severely ill patients. Thorough manual review of symptomatology reconfirms the heterogeneity of COVID-19 symptoms, and challenges in using clinical characteristics to predict decline. We re-demonstrate that socio-demographics are consistently associated with severity.

Association of Gamma-GT Serum and Nerve Conduction Velocity of Nervus Peroneus Motor Vehicles on Diabetic Polyneuropathy Patients

Background and Objectives: Diabetic Polyneuropathy is one of the common complications of diabetesmellitus (DM) and can lead to foot ulcers or amputation. The pathophysiology of Diabetic Polyneuropathyincludes several factors such as metabolic, vascular, autoimmune, oxidative stress and neurohormonalgrowth-factor deficiency. The recent studies have suggested the use of serum gammaglutamyl transferase(GGT) as an early marker of oxidative stress. Therefore, we investigated whether serum GGT may be usefulin predicting Diabetic Polyneuropathy.Methods: The study was conducted in patients with diabetic polyneuropathy who meet the criteria forinclusion and exclusion in neurological outpatient clinic and EMG room departments of NeurologyDr.Soetomo General Hospital Surabaya consecutively started in June 2014 to April 2015.Result: We obtained 20 study subjects (8 subjects with increased serum levels of gamma GT and 12 subjectswith normal serum levels of gamma GT). There was statistically no significant between serum levels ofgamma GT with motoric nerve conduction velocity (NCV) of peroneal nerve (p = 0.582 ; Odds ratio 0.600).Conclusion: There was no relationship between elevated levels of serum gamma GT with decreased motornerve conductivity velocity peroneal nerve in patients with diabetic polyneuropathy.

Gastro-oesophageal reflux disease increases healthcare use and medical costs in patients with bronchiectasis: a Korean nationwide population-based study.

Background:Gastro-oesophageal reflux disease (GORD) is not only a common aetiology but also accompanying comorbidity of non-cystic fibrosis bronchiectasis (bronchiectasis). However, the association between GORD and the disease burden of bronchiectasis has not been well evaluated. Our study aimed to evaluate whether GORD is associated with increased healthcare use and medical costs in patients with bronchiectasis.Methods:We analyzed the data from 44,119 patients with bronchiectasis using a large representative Korean population-based claim database between 2009 and 2017. We compared the healthcare use [outpatient department (OPD) visits and emergency room (ER) visits/hospitalizations] and medical costs in patients with bronchiectasis according to the presence or absence of GORD.Results:The prevalence of GORD in patients with bronchiectasis tended to increase during the study period, especially in the 50s and older population. GORD was associated with increased use of all investigated healthcare resources in patients with bronchiectasis. Healthcare use including OPD visits (mean 47.6/person/year versus 30.0/person/year), ER visits/hospitalizations (mean 1.7/person/year versus 1.1/person/year), and medical costs (mean 3564.5 Euro/person/year versus 2198.7 Euro/person/year) were significantly higher in bronchiectasis patients with GORD than in those without GORD (p < 0.001 for all). In multivariable analysis, bronchiectasis patients with GORD showed 1.44-fold (95% confidence interval = 1.37–1.50) and 1.26-fold (95% confidence interval = 1.19–1.33) increased all-cause and respiratory-related ER visits/hospitalizations relative to those without GORD, respectively. After adjusting for potential confounders, the estimated total medical costs (mean 4337.3 versus 3397.4 Euro/person/year) and respiratory disease-related medical costs (mean 920.7 versus 720.2 Euro/person/year) were significantly higher in bronchiectasis patients with GORD than in those without GORD (p < 0.001 for both).Conclusion:In patients with bronchiectasis, GORD was associated with increased healthcare use and medical costs. Strategies to reduce the disease burden associated with GORD are needed in patients with bronchiectasis.

Efficacy of Ascitic Fluid Dipstick Leukocyte Esterase Activity in Early Diagnosis of Spontaneous Bacterial Peritonitis

Introduction: Spontaneously occurring ascitic fluid infections {Spontaneous Bacterial Peritonitis (SBP)} are the most common and recurring complications in patients with decompensated cirrhosis with ascitis. Unlike other infections, ascitic fluid infections usually present with non specific symptoms and may be asymptomatic in a large number of patients. They not only accelerate hepatic decompensation, but may also lead to, or exacerbate other complications like hepatic encephalopathy, hematemesis, renal failure and death. The existing protocol of diagnosis of SBP includes ascitic fluid total and differential leukocyte counts, and ascitic fluid cultures, by inoculating the ascitic fluid in blood culture vials, which are not only cumbersome, but also costly, time consuming and cannot be followed in all patients presenting for outpatient treatment for therapeutic peracentesis. Aim: To evaluate the efficacy of testing ascitic fluid pH, protein and Leucocyte Esterase (LERS) activity, by using Siemens Multistix 10SG Reagent Strips (SMRS) for early screening of patients for SBP. Materials and Methods: The observational study was conducted at SGRR Institute of Medical and Health Sciences Dehradun, Uttarakhand, India, from January 2018 to March 2019. The study included 329 patients with cirrhosis and ascites presenting in either the Outpatient Department (OPD) or Emergency Room for therapeutic paracentesis or with cirrhotic complications were evaluated for SBP using SMRS for ascitic fluid pH, Leukocyte Esterase (LERS) activity and ascitic fluid protein, for early detection of SBP. The standard diagnostic criteria i.e., ascitic fluid Polymorphonuclear Counts (PNM) more than 250 cells/mm3, by Chamber Counting Method or positive ascitic fluid culture after 48 hours incubation were used as gold standard for diagnosis of SBP. Chi-square test was applied to find out significant association between independent and dependent variables. A p-value of &lt;0.05 was considered significant. Results: Among total 329 patients with cirrhotic ascitic, 81 were diagnosed to have SBP. At a cut-off of 2+, SMRS correctly detected SBP in 77/81 patients, was negative in 4/81 patients and falsely positive in 7/248 NSBP patients, thereby having a sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 95%, 97.33%, 98.96% and 96.69%. At a cut-off of 3+, SMRS was able to detect SBP in 53/81 patients, and was falsely positive in 1/248 patients, thereby, although decreasing the sensitivity to 64%, but improving the specificity and PPV to 99.6% and 98.11%, respectively. Conclusion: During diagnostic paracentesis, ascitic fluid LERS activity using SMRS are highly sensitive markers for early detection of SBP, especially in the presence of fever, vomiting and shock.

Effectiveness of an infection control system for examining suspected infectious disease patients in emergency department and fever outpatient room during the COVID-19 pandemic

Effectiveness of an infection control system for examining suspected infectious disease patients in emergency department and fever outpatient room during the COVID-19 pandemic

Analisis Kerahasiaan Rekam Medis Berdasarkan Hak Akses Ruang Filing Rawat Jalan di RSUD Dr.Saiful Anwar Malang

Confidentiality of medical records at RSUD Dr. Saiful Anwar Malang still had several obstacles in implementation, where there were non-medical record officers who enter and exit the outpatient filing room although there was finger prints and written warnings stating that "other than medical record officers are prohibited from entering" in the outpatient filing section. The purpose of this report is to analyze the confidentiality of medical records based on the right of access to outpatient filing rooms at RSUD Dr. Saiful Anwar Malang. This report used qualitative methods, and the analysis method used is 5M management aspects (man, money, material, method, and machine) to identify the problems and look for priority causes use USG (Urgency, Seriousness, Growth) techniques. The results of this report indicate that the management aspects of man, method, material, and machine are the factors causing the lack of secrecy of the medical record based on the right of access to outpatient filing rooms at RSUD Dr. Saiful Anwar Malang. The priority cause of the problem in this report is the ignorance of officers in relation to the existing SOP / Medical Record Services Book. The priority results of the cause of the problem produce a solution, it are necessary to conduct socialization about SOP for storing medical records and Medical Record Services Book relating to the secrecy of medical records to all medical records officers, especially filing officers before being placed in their work units and evaluating every three months by monitoring the implementation of SOP /Medical Record Services Book by an outpatient filing coordinator.

A New Device for Autologous Small Volume Fat Grafting

Many techniques and devices have been developed to improve small volume fat grafting efficiency and consistency for use in the operating room and outpatient procedure room. These methods require cumbersome or messy processing to remove excess oil and fluid from adipose graft. The aim of this study was to compare the fat processing efficiency of a novel handheld device, the Push-to-Spin (P2S) system, with that of other common processing techniques and validate tissue quality after lipoaspirate processing. Human lipoaspirate samples were processed by 1 of 3 methods: cotton gauze (Telfa) rolling, centrifugation (Coleman technique), or the P2S system. Efficiency of fat processing was evaluated in terms of total processing time, fat harvest ratio, and fat processed ratio. Histologic examination and immunohistochemical staining were used to compare tissue morphology and adipocyte viability, respectively. Experimental samples were compared with unprocessed lipoaspirate controls. Lipoaspirate processing was significantly faster with the P2S device than with other techniques. All 3 methods achieved similar fat harvest and fat processing ratios. Additionally, the P2S, Telfa, and Coleman techniques yielded grafts with similar cellularity and with similar perilipin and glycerol-3-phosphate dehydrogenase 1 expression. Measured differences between experimental and control samples were statistically significant. The P2S device is an easy-to-use, efficient, and potentially cost-effective handheld device that can be used for lipoaspirate harvest, processing, and grafting in any procedural setting. The resulting adipocytes have similar morphology, viability, and function to those yielded by other techniques. This handheld technology decreases procedure time, thereby improving surgeon efficiency and patient experience.