Outpatient Treatment Of Patients Research Articles

Enterococcal Infective Endocarditis – Post discharge treatment with continuous benzylpenicillin and ceftriaxone: A retrospective cohort study

BackgroundEnterococcal Infective Endocarditis (EIE) is usually treated with the combination of penicillin/ampicillin with gentamicin or ampicillin with ceftriaxone. To enable prolonged outpatient treatment, a combination of benzylpenicillin and ceftriaxone has been suggested. This study aimed to describe the incidence and characteristics of EIE and to determine the outcome of EIE cases treated with benzylpenicillin and ceftriaxone. MethodsThis was a retrospective single-center study including all patients diagnosed with infective endocarditis (IE) during 2016–2021, comparing EIE with IE caused by other pathogens. We described the outpatient treatment of patients with EIE, comparing those treated of benzylpenicillin - ceftriaxone with other regimes. ResultsAmong 222 patients with IE, 44 (20%) were diagnosed with EIE. Those were older, had a male predominance (p = 0.035), and were more disabled (p = 0.004). The incidence of EIE reached 30% towards the last year, becoming the leading etiology. Twenty-six patients received outpatient treatment, five of whom were discharged with benzylpenicillin and ceftriaxone. Adding patients from this cohort to the scarce data available, revealed similar recurrence and mortality rates compared to other treatment regimes. ConclusionsEIE is becoming a more frequent cause of IE, involving older, more disabled patients with male predominance. Our experience and existing literature suggest that the combination of benzylpenicillin and ceftriaxone is as safe as more conventional regimes, although further research is needed.

The effectiveness of essential oils in the treatment of acute viral rhinosinusitis

Introduction. Acute respiratory viral infections are the most widespread diseases, accounting for up to 90% of all infectious pathology, which supports the relevance of optimizing the treatment of acute viral rhinosinusitis.Aim. Evaluate the dynamics of clinical symptoms of acute viral rhinosinusitis, which arose as part of an acute respiratory infection, when supplementing therapy with the drug Respero Myrtol (Pol-Boskamp GmbH and Co.KG, Germany), the active ingredient of which is myrtol standardized 120 mg in 1 capsule.Materials and methods. The dynamics of clinical symptoms of 20 cases of acute viral rhinosinusitis in comparison groups was analyzed. Traditional treatment of patients included taking propionic acid derivatives, ascorbic acid, intranasal use of decongestants and irrigation of the nasal cavity with isotonic saline solutions. Patients who have received traditional treatment are defined as a “standard therapy group”. To assess the effectiveness of therapy using standardized myrtol, 20 cases of acute viral rhinosinusitis against the background of acute respiratory viral infections with a similar severity were analyzed, in which patients received outpatient therapy with Respero Myrtol 2 capsules 3 times a day for 7 days in addition to the above treatment (the “myrtol therapy” group). The dynamics of the disease assessed: the number of days of disability before recovery, the period of normalization of body temperature in feverish patients, the need for vasoconstrictive intranasal agents after the seventh day of therapy, the period of complete relief of pain syndrome, the period of normalization of night sleep, the number of cases of bacterial superinfection and the need for systemic antibacterial therapy.The results. In the observed patients, the quality of sleep was restored faster, the pain syndrome was stopped earlier, less often there was a need for systemic antibiotics and prolonged use of intranasal decongestants. The disease proceeded with fewer days of disability.Conclusion. The study results have been shown to report the clinical efficacy of Respero Myrtol essential oils in the outpatient treatment of patients with acute rhinosinusitis.

Clinical impacts of compulsory outpatient treatment in patients with psychiatric disorders: an observational study

BACKGROUND: Compulsory treatment is frequently applied in psychiatry practice, but it is still a controversial issue. This study aimed to investigate the effectiveness of compulsory outpatient treatment decisions in patients with psychiatric disorders.METHODS: A total of 141 patients who had compulsory outpatient treatment decisions were enrolled. To evaluate the clinical effectiveness of the compulsory outpatient treatment decisions, the number of admissions to the psychiatric emergency service, the number of hospitalization, and the total length of hospital stay of the patients 12 months before and after the compulsory treatment decision were compared.RESULTS: The patients with schizophrenia, bipolar disorder, and schizoaffective disorder showed a significant reduction in the number of emergency service admission 12 months after the compulsory outpatient treatment decision. However, the reduction in the number of hospitalization and total hospital stays was only significant in patients with schizophrenia and bipolar disorder. The duration of the compulsory outpatient treatment decision and frequency of compulsory outpatient follow-up visits did not have any effect on the emergency service admissions and hospitalization profiles.CONCLUSIONS: Compulsory outpatient treatment could be effective to reduce hospital readmissions particularly in patients with schizophrenia and bipolar disorder whose continuous treatment is important to prevent relapses.

Efficacy and Safety of Fluvoxamine as Outpatient Treatment for Patients With Covid-19: A Systematic Review and Meta-analysis of Clinical Trials

Fluvoxamine may be beneficial for the management of coronavirus disease 2019 (Covid-19) because of its effect on the sigma-1 receptor. Available evidence from randomized clinical trials (RCTs) has shown conflicting results. This study sought to analyze the efficacy and safety of fluvoxamine as an outpatient treatment for Covid-19. Using specific keywords, we comprehensively go through the potential articles on PubMed, Scopus, Europe PMC, and ClinicalTrials.gov sources until February 1, 2023. We collected all published clinical trials on fluvoxamine and Covid-19. We were using Review Manager 5.4 to conduct statistical analysis. We include a total of 6 trials. Our pooled analysis revealed that fluvoxamine did not offer any significant benefit when compared with placebo in reducing the risk of clinical deterioration (risk ratio [RR] = 0.83; 95% CI: 0.65-1.06, P = 0.14, I2 = 29%), and hospitalization (RR = 0.80; 95% CI: 0.62-1.04, P = 0.09, I2 = 0%) of Covid-19 outpatients. The serious adverse events did not differ significantly between the 2 groups. This study indicates that although safe, fluvoxamine was not effective for outpatient treatment of Covid-19. Until more evidence can be obtained from larger RCTs, our study did not encourage the use of fluvoxamine as routine management for patients with Covid-19.

Rates of Complications and Readmissions: In-Patient vs Outpatient ORIF of Calcaneus Fractures

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneus fractures are common injuries to the hindfoot. The safety of in-patient versus outpatient treatment in patients with calcaneus fractures remains unclear. The aim of the present study was to assess differences in wound complications and readmissions in operative calcaneus fractures treated with open reduction and internal fixation (ORIF) in an in- patient versus outpatient setting. Methods: Patients undergoing ORIF for calcaneus fractures from 2012 to 2020 were reviewed. Inclusion criteria were age greater than 18 years and an operative calcaneus fracture treated with the sinus tarsi approach (STA). Exclusion criteria consisted of a minimum of three months follow-up, open calcaneal fractures or fracture dislocations, inpatients with polytrauma, and patients without a preoperative computed tomography (CT) scan. A total of 113 patients met inclusion criteria with 24 (21%) managed inpatient and 89 (79%) managed as outpatient. The primary outcomes were deep infection defined as return to the operating room for debridement with positive cultures and readmissions. Secondary outcomes included implant related pain and unplanned return to the operating room. Results: Inpatients had a higher percentage of ASA classification 3&4 patients (58.3% vs 29.2%, p=0.008). Outpatients had a longer delay in days between injury and definitive fixation (mean 8 (8.9 SD, 0-31 range) vs. 14 (12.4 SD, 0-91 range) days, p=0.009). There were no statistically significant differences in the incidence of deep infections (8.3% vs. 4.5%, p=.606), implant related pain (8.3% vs. 15.7%, p=.516), return to the operating room (16.7% vs. 15.7%, p=1.0) or readmissions (4.2% vs. 3.4%, p=1.0) between inpatient and outpatient groups including in binary logistic regression models (p>.3 for all). In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting. Conclusion: In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting.

Integrated hepatitis C treatment is associated with improved retention and success in outpatient treatment for opioid use disorder at a private clinic.

BackgroundDirect acting antiretrovirals (DAA) are effective for individuals who are infected with chronic hepatitis C virus (HCV), yet many people go without access to these lifesaving treatments.Materials and methodsWe conducted a non-randomized study evaluating treatment data for patients in outpatient treatment for opioid use disorder (OUD) at a private clinic. Patients who were HCV-positive, had been in OUD treatment for at least 4 weeks, and engaged in integrated HCV treatment with DAA (co-located within their treatment for OUD) were compared to patients with HCV who only received OUD treatment. We evaluated HCV cure; OUD medication adherence, treatment utilization and retention; and illicit substance use for those engaged in treatment between 9/2016 and 1/2018.ResultsSeventy-four patients completed integrated HCV-OUD treatment with DAA, with 87.8% achieving cure. Of the 66 who completed treatment and were subsequently evaluated for sustained viral response 98.5% were cured. Patients who received integrated HCV and OUD treatment in our clinic, stayed in OUD treatment longer, demonstrated higher OUD medication adherence, and used less opioids or cocaine compared to HCV-infected patients (n = 572) being treated only for OUD.DiscussionWe have reported on a reproducible intervention that lends itself to outpatient OUD treatment. Analyses demonstrate the potential positive impact HCV treatment has on OUD recovery, including reduction in opioid and cocaine use and increased retention in careConclusionCo-locating HCV treatment with existing OUD treatment is feasible, effective, and demonstrates positive outcomes for the treatment of both conditions.

Evaluation of Clinical Outcomes of Intravenous Drug Use-Related Infective Endocarditis in Buprenorphine-Treated Patients.

Intravenous drug use (IVDU) is an independent risk factor for infective endocarditis (IE). IVDU-related IE is associated with poor clinical outcomes, such as infection-related and drug abuse-related readmissions and mortality. Critical interventions to treat addiction, such as medication for opioid use disorder (MOUD) with buprenorphine, may prevent these unfavorable outcomes. This study aimed to establish the effectiveness of buprenorphine prescriptions at hospital discharge for patients admitted for IVDU-related IE. A single center, retrospective cohort study evaluated the effectiveness of discharge prescriptions of buprenorphine in adult patients (≥18 years of age) with OUD and IVDU-related IE. Outcomes of 30-day readmissions, 180-day readmissions, and mortality were compared to a cohort of patients who were not prescribed buprenorphine at hospital discharge. The primary endpoint of all cause 30-day readmission was lower in patients who received buprenorphine (n=11/122, 9%) at hospital discharge for IVDU-related IE compared to those who did not (n=9/48, 19%), although not statistically significant (unadjusted OR 0.429, 95% CI 0.165-1.138, p=0.082). After accounting for intensive care admission, infusion unit admission, and psychiatry consultation, the odds of all cause 30-day readmission were statistically lower in patients prescribed buprenorphine (adjusted OR 0.337, 95% CI 0.125-0.909, p=0.029). Additionally, significantly more patients prescribed buprenorphine at discharge followed-up in an outpatient treatment program, 57% and 15% respectively (p<0.001). Incidence of readmission at 180 days and mortality was similar between the two cohorts. This study demonstrated that buprenorphine prescriptions at hospital discharge in patients with OUD admitted for IVDU-related IE were effective at decreasing readmission rates at 30 days and increasing outpatient treatment follow-up. Therefore, it is imperative that an emphasis on addiction-focused interventions, such as initiating buprenorphine, be considered in this patient population at hospital discharge to decrease hospital readmissions and engage patients in outpatient treatment for OUD. This study is the first to evaluate the effects of MOUD on readmission rates for patients hospitalized with IVDU-related IE and contributes to the growing body of evidence to support addiction-focused interventions for this unique patient population.

Avoidant and borderline personality disorder patients during the first Covid-19 wave in Norway – a survey-based comparison of therapy changes and patients’ accommodations

Background Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020. Objectives To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients’ reactions to these changes. Methods The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis. Results All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group. Conclusion After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.

Organization of the activities of the infectious diseases hospital for the treatment of a new coronavirus infection (COVID-19) at a large construction site

Relevance. The emergence of a large number of cases of a new coronavirus infection (COVID-19) required the formation of a new system of medical care and, above all, the creation of infectious hospitals for the treatment of patients with COVID-19.Intention. Analysis of the organization of the work of a temporary infectious diseases hospital for the treatment of COVID-19 in workers involved in the construction of the Amur Gas Processing Plant (AGPP). Methodology. The object of the study was a temporary infectious diseases hospital organized for the diagnosis and treatment of COVID-19 in workers mobilized for the construction of AGPP. During the study period from March 2020 to April 2022, the total number of employees participating in construction work daily at AGPP ranged from 17,759 to 39,437 people. Construction personnel worked on a rotational basis, the duration of the shift was from 2 to 6 months. Along with citizens of the Russian Federation, citizens of foreign countries from near and far abroad worked on the site. All shift workers lived in hostels on the territory of temporary construction camps, ate in common canteens. Development of the organizational and staff structure, completeness of medical equipment, medicines and property, evaluation of the effectiveness of the temporary infectious hospital performed using the methods of historical analysis and comparison, system and logical analysis, and expert evaluations. Results and Discussion. The results of a retrospective analysis of the measures for the construction and organization of the work of the temporary infectious disease hospital at the AGPP site presented. The hospital built based on a quickly erected building of block-modular type, passed sanitary-epidemiological examination and licensing in 45 days. The hospital has two departments with 44 beds each for the treatment of patients with COVID-19 (88 beds in total), an intensive care unit with 6 beds, two isolation wards with 2 beds each, a clinical and diagnostic laboratory that allows conducting studies by polymerase chain reaction (PCR) methods and immunofluorescence assay (ELISA), as well as the full range of general clinical laboratory tests, computed tomography unit, vaccination unit, medical gas supply station. The organizational and staffing structure and the number of medical personnel changed dynamically, depending on the epidemiological situation and the arising tasks of medical support of AGPP workers; at maximum staffing the hospital had 22 doctors, 1 pharmacist, 45 nurses, 30 paramedics and support personnel. From July 12, 2020 to April 10, 2022, inpatient treatment received 2622 people in the hospital’s infectious disease departments, and 198 people in the intensive care unit. Outpatient treatment provided to 4127 workers, of which 462 hospitalized for inpatient treatment and 3665 discharged to work upon recovery. There are 17,893 lung examinations including 12,582 primary and 5311 repeated (control) examinations performed and 6547 viral pneumonias detected in the computed tomography unit. The clinical and diagnostic laboratory performed 302,695 tests by PCR, 14,037 tests to IgM and IgG levels by ELISA, 9065 general clinical hematological and biochemical tests, 7832 coagulograms, and 20,782 tests to evaluate specific markers of inflammatory response characteristic for COVID-19. Medical personnel of the hospital carried out a mass vaccination against influenza for 42620 workers of AGPP, vaccination against COVID-19 with the first component of the “Sputnik” vaccine was given to 13678 workers, the second component – to 12,598 workers, the “Sputnik Lite” vaccine – to 19,214 workers. Conclusion. The construction of a temporary infectious diseases hospital on the basis of quickly erected building, its equipping with modern medical equipment and medicines, staffing with highly qualified medical personnel made it possible to organize laboratory and instrumental diagnostics of COVID-19, inpatient and outpatient treatment of patients, as well as vaccination for shift workers of all contractors involved in the implementation of the AGPP project.

Primary care disease management for venous leg ulceration\u2014study protocol for the Ulcus Cruris Care [UCC] randomized controlled trial (DRKS00026126)

BackgroundVenous leg ulcers (VLU) have a prevalence of 1–2% in developed countries, and affected patients are severely and long-term impaired in daily activities, work, and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case management. The main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants, and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention.MethodsThe UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the visual analog scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query, and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation.DiscussionThe UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life, and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered.Trial registrationThe trial protocol (version 1 as of July 19, 2021) has been registered in the German Clinical Trials Register on August 30, 2021 (DRKS00026126).

Can scoring systems be used for the triage of COVID-19 patients?

Whether to send COVID-19 patients home with quarantine measures or to hospitalize and treat them on an inpatient basis is a very important decision in the treatment of COVID-19 patients. This study aimed to introduce a scoring system that will enable making decisions on inpatient or outpatient treatment of patients by scoring their symptoms, clinical, radiological, and laboratory results during the initial assessment. Data of patients over 18 years of age, examined for COVID-19 between March 11, 2020, and May 31, 2020, and who had a positive PCR result, and their radiological (computed tomography reports) and blood test (complete blood count, blood gas and laboratory results) results were recorded to develop our scoring system. A comparison of COVID-19 patients, who received outpatient and inpatient treatments by age variable, revealed a significant result (P < 0.001). The comparison of laboratory results showed a significant difference between both groups (P < 0.001). The comparison of the groups by the presence of comorbidity also revealed a significant result (P < 0.001). According to the scoring system that we developed (Cebeci score), a score of 5 points and above had a specificity of 81% and a sensitivity of 88% for indicating the probability of receiving inpatient treatment. We believe that the scoring system we developed will be a simple, practical, and leading guide for physicians to avoid dilemmas regarding the issue of whether to quarantine patients at home or to hospitalize them in order to use medical resources effectively.

Outpatient treatment of patients with COVID-19: Normative documents and/or clinical thinking

The legal framework for the provision of medical care, its evaluation and control of quality in Russia requires the attending physician to strictly comply with the provisions of regulatory documents. At the same time, clinical practice shows that the recommended algorithms for the provision of care do not allow in all situations to provide medical care of adequate quality. Analysis of the clinical example shows that in the era of the COVID-19 pandemic, in addition to compliance with the established rules, a thorough assessment of a specific clinical situation in the dynamics of development is necessary and timely correction of treatment and diagnostic measures, including those in excess of the established requirements, are required. The methods of remote monitoring of the patients condition need to be improved, since in their current form they do not provide an objective assessment of the patients condition. Face-to-face examinations of patients with COVID-19 receiving medical care at home should be carried out at least every 72 hours, regardless of the result of the remote assessment. The absence of the effect of therapy within three days may be an indication for transferring the patient to a higher level of medical care.

["iFightDepression" in inpatient treatment : Evaluation of aweb-based, therapist-guided self-management program on aspecialized ward for affective disorders].

HintergrundE‑Mental-Health (EMH) spielt im ambulanten Versorgungssetting depressiver Störungen zunehmend eine Rolle. Ziel dieser Studie war die Implementierung und Evaluierung der Anwendbarkeit und des Nutzens des onlinebasierten Selbstmanagementprogramms „iFightDepression“ (iFD) als Zusatzangebot im Rahmen einer leitliniengerechten Behandlung auf einer Spezialstation für affektive Störungen.MethodikEs wurden insgesamt 78 stationäre PatientInnen mit einer unipolaren Depression unterschiedlichen Schweregrades (ICD-10 F32.0‑3, F33.0-3) oder einer Dysthymie (F34) rekrutiert. Die Interventionsdauer mit dem iFD-Tool belief sich vom Zeitpunkt der stationären Aufnahme bis zur Entlassung und wurde vom Stationspersonal begleitet. Die Erhebung der Symptomschwere sowie von Parametern zur Behandlungserwartung und Therapievorerfahrung erfolgte online vor der Intervention (T0), die Interventionszufriedenheit wurde unmittelbar vor der stationären Entlassung (T1) mittels eines Paper-pencil-Fragebogens erfasst.ErgebnisseVon den 78 Teilnehmenden loggten sich 42 mindestens einmal in das iFD-Tool ein. Es zeigten sich moderat hohe Erwartungswerte sowie leicht überdurchschnittliche Zufriedenheitswerte bezüglich der Behandlung. 67 % der aktiven NutzerInnen gaben an, das iFD-Tool poststationär weiter nutzen zu wollen. Wesentliche Gründe gegen die Nutzung waren eine kurze Aufenthaltsdauer, eine schwere depressive Symptomatik und fehlende Medienkompetenz.DiskussionEine Implementierung des iFD-Tools im stationären Setting ist prinzipiell machbar und führte zu positiven Rückmeldungen seitens der NutzerInnen. Auch konnten sich die meisten aktiv an der Studie Teilnehmenden eine weitere Nutzung des iFD-Tools nach der Entlassung gut vorstellen. Allerdings weisen die insgesamt geringen Nutzungs- (42/78, 54 %) und Komplettierungsraten auf Nutzungsbarrieren hin, deren Überwindung entsprechende Anpassungen der Intervention speziell für den stationären Einsatz erforderlich machen.

Methadone vs. Buprenorphine for In-Hospital Initiation: Which Is Better for Outpatient Care Retention in Patients with Opioid Use Disorder?

Currently, few hospitals provide medications for opioid use disorder (MOUD) to admitted patients with opioid use disorder (OUD). Data are needed to inform whether the choice of medication during hospitalization influences probability of retention in outpatient OUD treatment. This was a retrospective cohort analysis of patients who received a medical toxicology consult for OUD. Medical records were reviewed to determine if patients received MOUD and were referred to Engaging Patients in Care Coordination (EPICC), a service that connects hospitalized patients with OUD to outpatient care. Patients were stratified by the last form of MOUD they received in the hospital (methadone verses buprenorphine); retention in outpatient treatment was measured at 2weeks, 30days, and 12weeks. The log-rank test was used to determine the difference in probabilities of retention in the methadone and buprenorphine groups. An event was defined as drop-out from outpatient treatment. Of 267 total patients with medical toxicology consults for OUD, 155 received MOUD and referral to EPICC. One hundred six patients received buprenorphine and 46 received methadone. Three additional patients were excluded. The rate of retention in outpatient treatment for patients who received buprenorphine was 37%, 26%, and 13% and for patients who received methadone was 43%, 39%, and 35% at 2weeks, 30days, and 12weeks, respectively. Methadone was associated with a statistically significant increased probability of retention in outpatient treatment as compared to buprenorphine (P < 0.01). Despite the limitations of this retrospective study, in hospitalized patients who received MOUD, the probability of retention in outpatient treatment was higher in patients receiving methadone compared to buprenorphine.

Main Causes of Skin Traumas and Damage in Patients with COVID-19

COVID-19 can affect multiple organs including heart and blood vessels, kidneys, gut, and brain. This study aimed to assess all aspects of skin traumas and damages in COVID-19. The main causes of skin trauma in COVID-19 and its consequences can be examined in four parts, including cutaneous manifestations that appear during COVID-19, drug reactions that occur during hospitalization or outpatient treatment of patients, skin damages caused by over-washing or rinsing with inappropriate detergents, or inappropriate use of personal protective equipment (mask, gloves,.), and changes the duration of COVID-19 in patients with autoimmune, chronic and inflammatory underlying skin diseases. The rate of skin manifestations in patients with COVID-19 in the range of 1.8%-20.4%, including vascular lesions (petechiae, purpura, livedo reticularis, pernio, and chilblain lesions), urticaria and maculopapular rash, and other less common skin manifestations such as erythema multiforme, pityriasis rosea, suite syndrome. These skin manifestations were commonly seen in men aged 45-89 years. The most lesions distribution ( 69.4%) was in the body, but in 19% of cases, lesions were observed in the hands and feet. Patients with COVID-19 receive multiple viral treatments, antibiotics, and various anti-inflammatory drugs. Receiving these drugs has led to cutaneous manifestations in some patients. Medical staff is prone to various traumatic skin conditions, due to the long-term use of personal protective equipment. These conditions include itching, redness, skin irritation, contact dermatitis, and worsening of underlying diseases. The effects of COVID-19 on the skin system can be serious and long-lasting. Adequate treatment and supportive therapy can prevent the long-lasting consequences and disability of the patient.

Methadone: applications in pediatric anesthesiology and critical care medicine.

Like morphine, methadone is a pure agonist at the µ opioid receptor. However, in distinction to morphine which has an elimination half-life of 2-3h, methadone has an elimination half-life of 24-36h. In addition to its effects at the µ opioid receptor, methadone is an antagonist at the N-methyl-D-aspartate (NMDA) receptor and also inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine, in the central nervous system. Given its long half-life and high oral bioavailability, methadone has had a primary role in the outpatient treatment of patients with a history of opioid abuse or addiction. However, its unique pharmacology and cellular effects make it a valuable agent in the treatment of both acute and chronic pain of various etiologies. The following manuscript reviews the pharmacologic properties of methadone and discusses its clinical applications in the practice of pediatric anesthesiology and pediatric critical care medicine.

Возможности применения глюкокортикостероидов в амбулаторном лечении пациентов с COVID-19

Возможности применения глюкокортикостероидов в амбулаторном лечении пациентов с COVID-19

Improving Performance of Outpatient Queuing System: A Simulation Based Case Study

Nowadays, hospitals are facing overcrowding of patients in outpatient treatment. It caused many problems because the patient takes a long time to wait. The long waiting times would lead to patient dissatisfaction. This study aims to improve the performance of the outpatient queuing system. The simulation technique is applied to analyze the existing system. First, the system description is constructed to determine the outpatient process flow. Next, the required data is collected, and the probability distribution is then fitted. The simulation model is developed using ARENA software. The model is then verified using a run check model and validated using paired T-Test. The simulation reports are analyzed, and it obtained the problems of long waiting times of internal medicine patients and the high utilization of internal medicine Doctors. Scenarios are then suggested to improve system performance. Scenario-3 of addition one internal medicine Doctor and develop a booking system is selected as the best scenario. The scenario can reduce the average waiting time of internal medicine patients from 97.4 minutes to 8.5 minutes and internal medicine doctor utilization from 87% to 75%. This research hopes can help hospital managers continuously improve their service quality and patient satisfaction.

107 Improving Transitions of Care for Patients Initiated on Buprenorphine from the Emergency Department

Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, access to on-demand medications for OUD is still limited, in part because of the need for outpatient linkages to care. The objective of this study is to describe emergency and outpatient providers’ perception of local barriers to transitions of care for ED-initiated buprenorphine patients. Purposive sampling was used to recruit key stakeholders, who identified as physicians, addiction specialists, and hospital administrators, from 10 EDs and 11 outpatient clinics in King County, Washington. Twenty-one interviews were recorded and transcribed, and then coded by two team members in order to verify accuracy of the thematic analysis. Interview guides and coding were informed by the Consolidated Framework for Implementation Research (CFIR), which provides a structure of domains associated with effective implementation of evidence-based practice. From the 21 interviews with emergency and outpatient providers, four major barriers emerged around transitions of care for ED-initiated buprenorphine patients—stigma, X-waiver shortage, referral incoordination, and loss to follow-up. Interviewees desired a protocolized “standard of care” for the treatment of ED patients with OUD to destigmatize the condition and increase patient self-identification and mission-driven practice. Additionally, participants highlighted the need to increase program capacity through promoting X-waiver training and creating a central repository of outpatient providers in order to streamline referrals. Lastly, interviewees aspired to increase retention of patients in outpatient treatment by having low-barrier scheduling, walk-in appointments, navigation services, and care coordination. There are a number of barriers to translating evidence-based practice around the transitions of care of ED-initiated buprenorphine patients to an urban community setting. Next steps for implementation of this intervention include increasing the number of X-waivered providers, creating a central repository for streamlined referrals and follow-up, and funding navigation services.

The perception of ostomized patients with colorectal cancer regarding their quality of life

Objective: to understanding the perception of ostomized patients affected by colorectal neoplasms regarding their quality of life. Methods: qualitative research, with 15 patients in outpatient treatment. Data collected through semi-structured interviews. To organize and present data, the content analysis technique was used. Data were interpreted according to the social phenomenology of Alfred Schutz. Results: three thematic categories emerged: Quality of life: social, psychic, and spiritual influences; Personal and environmental adaptations considering the new reality; and Complications of living with an ostomy. Conclusion: patients with ostomies resulting from colorectal cancer, in general, have variations in the way they perceive their quality of life. In the physical domain, they consider the device to be vital in the treatment, but it generated, a priori, social isolation, due to embarrassment, requiring them to adapt to the new reality as to diminish its emotional impact, which frequently presents in the form of sadness and non-acceptance.