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Office Visit (office + visit)
Selected AbstractsBuilding the Powerful 10-Minute Office Visit: Part II.THE LARYNGOSCOPE, Issue 1 2001Beginning a Critical Literature Review Abstract Objective This is the second part in a series of sequential Tutorials in Clinical Research. The objective of this tutorial is to introduce methods of searching the vast stores of information now available, to review some of the computer resources available, to reintroduce the concept of an a priori design for the search, and to reveal the need for assessment of the clinical importance and validity of each pertinent article found. Study Design Tutorial. Methods An open working group has been formed with the specific aim of surveying and translating the large volume of complex information on research design and statistics into easily understood, useable, and non-threatening tutorials for the busy practitioner. The hypotheses under which this work is conducted are highly intelligent, but extremely busy, surgeons are interested in evidence-based medicine and will increase personal participation in critical reading of the literature, pending an expanded familiarity with clinical research design and statistics. Results Available resources for literature searching, methods of quick personal overviews, and quick question-specific reviews are discussed. Additionally, the methods, with examples, of beginning a critical literature review are presented. Conclusions Rapid, personal, critical literature review requires succinct formulation of the question, efficient search for the best available evidence, and critical appraisal of the pertinent individual articles to determine if sufficient evidence exists to support a clinical contention. [source] Hydrophilic Polymers with Potassium Salt and Microporous Polysaccharides for Use as Hemostatic AgentsDERMATOLOGIC SURGERY, Issue 12 2007JULIA HO MD BACKGROUND Postoperative bleeding can lead to complications such as hematoma, infection, dehiscence, and an unscheduled office visit. Topical hemostatic agents can be used to aid in hemostasis. OBJECTIVE The objective is to familiarize physicians with topical hemostatic agents,hydrophilic polymers with potassium salts (Urgent QR powder) and microporous polysaccharide hemispheres (Bleed-X). METHODS Two hemostatic agents, microporous polysaccharide hemospheres and hydrophilic polymers with potassium salt, are discussed. The literature is reviewed. RESULTS Numerous types of hemostatic agents exist. Topical hemostatic agents are safe, cost-effective, and efficient. CONCLUSION Microporous polysaccharide hemospheres and hydrophilic polymers with potassium salts can be an adjunct to hemostasis after cautery and ligation. Patients can apply hemostatic agents if they experience any bleeding leading to decreased office visits. Hemostatic agents used intraoperatively shorten bleeding time and enable the physician to use less cautery. Using hemostatic agents can lead to fewer hematomas, infections, and office visits. [source] Utilization and Expenditures on Chiropractic Care in the United States from 1997 to 2006HEALTH SERVICES RESEARCH, Issue 3 2010Matthew A. Davis Objective. To investigate national utilization and expenditures on chiropractic care between 1997 and 2006. Data Source. The nationally representative Medical Expenditure Panel Survey (MEPS). Study Design. We performed descriptive analyses and generated national estimates from data obtained from U.S. adult (,18 years) MEPS respondents who reported having visited a chiropractor (annual sample size between 789 and 1,082). For each year, we examined the estimated total national expenditure, the total number of U.S. adults who received chiropractic care, the total number of ambulatory visits to U.S. chiropractors, and the inflation-adjusted charges and expenditures per U.S. adult chiropractic patient. Principal Findings. The total number of U.S. adults who visited a chiropractor increased 57 percent from 7.7 million in 2000 to 12.1 million in 2003. From 1997 to 2006, the inflation-adjusted national expenditures on chiropractic care increased 56 percent from U.S.$3.8 billion to U.S.$5.9 billion. Inflation-adjusted total mean expenditures per patient and expenditures per office visit remained unchanged. Conclusion. The large increase in U.S. adult expenditures on chiropractic care between 1997 and 2006 was due to a 57 percent increase in the total number of U.S. adult chiropractic patients that occurred from 2000 to 2003. From 2003 to 2006, the total number of U.S. adult chiropractic patients has remained stable. [source] Caught in the Act?HEALTH SERVICES RESEARCH, Issue 6 2006Consequences of Physician Detection of Unannounced Standardized Patients, Predictors, Prevalence Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression. Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004. Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request). Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory. Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p<.05). Physicians more frequently referred SPs to mental health professionals when visits aroused high suspicion (p<.05). Conclusions. Trained actors portrayed patient roles conveying mood disorders at low levels of detection. There was some evidence for differential treatment of detected standardized patients by physicians with regard to referrals but not antidepressant prescribing or follow-up recommendations. Systematic assessment of detection is recommended when SPs are used in studies of clinical process and quality of care. [source] Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom ScoreINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2002Murat Bozlu Abstract Objectives: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self-administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated. Methods: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I-PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t -tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician-assisted and self-administered scores among the different educational groups were further compared using a one-way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level. Results: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups. Conclusion: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient. [source] Open Heart Surgery in Patients 85 Years and OlderJOURNAL OF CARDIAC SURGERY, Issue 1 2004Wellington J. Davis III M.D. Several reports have documented acceptable morbidity and mortality in patients 80 years and older. The results from surgical patients 85 years and older were analyzed. Methods: The records of 89 consecutive patients 85 years and older having cardiac operations between June 1993 and May 1999 were retrospectively reviewed. For purposes of statistical analysis follow-up was considered as a minimum of one office visit to the surgeon, cardiologist, or internist at least 1 month postoperatively. Results: Eighty-seven patients underwent coronary artery grafting and two patients had mitral valve replacement. Follow-up was 100% complete. The operative mortality rate was 12.3%; probability of in-hospital death was 8.2%; risk-adjusted mortality rate was 3.2%. The complication rate was 31.5%. The actuarial 1-, 3-, and 5-year survivals were as follows: 75%, 67%, and 40%. Multivariate predictors of 30-day mortality were preoperative EF, less than 30% (p = 0.029) and postoperative renal failure (p = 0.0039). Conclusions: Cardiac surgery can be performed in patients 85 years and older with good results. There is an associated prolonged hospital stay for elderly patients. Consistent successful outcomes can be expected in this patient population with selective criteria identifying risk factors. (J Card Surg 2004;19:7-11) [source] Recognizing the risk of erectile dysfunction in a urology clinic practiceBJU INTERNATIONAL, Issue 7 2005David L. Rowland OBJECTIVE To determine the utility of simple patient-reported information in signalling erectile dysfunction (ED), as a challenge for the clinical urologist or related specialist is to quickly recognize risk factors for sexual dysfunction within the time constraints of an office visit. PATIENTS AND METHODS In a sample of men visiting a urology clinic, we determined the utility of simple patient-reported information in signalling ED. RESULTS Information readily obtained through a patient's self-report (that typically obtained in the office setting) can be very useful in understanding and predicting the likelihood of ED. Risk factors identified largely paralleled those identified in men generally, and included age, specific urological and non-urological somatic conditions, and tobacco use. Furthermore, knowing about even moderate levels of patient-reported psychological or relationship stress was useful in assessing the risk of ED. CONCLUSION Understanding the relationship of such risk factors to ED among men visiting a urology clinic might be particularly useful in clinical situations where the patient, for whatever reason, is reluctant to disclose an erectile problem when scheduling an appointment or even during the consultation. [source] Effects of Family Structure on Children's Use of Ambulatory Visits and Prescription MedicationsHEALTH SERVICES RESEARCH, Issue 5 2006Alex Y. Chen Objective. To examine the effects of family structure, including number of parents, number of other children, and number and type of other adults, on office visits, emergency room visits, and use of prescription medications by children. Data Source. The Household Component of the 1996,2001 Medical Expenditure Panel Survey (MEPS). Study Design. The study consisted of a nationally representative sample of children 0,17 years of age living in single-mother or two-parent families. We used negative binomial regression to model office visits and emergency room visits and logistic regression to model the likelihood of prescription medication use. Our analyses adjusted for demographic and socioeconomic characteristics as well as measures of children's health and parental education and child-rearing experience. Data Collection/Extraction Method. We combined 1996,2001 MEPS Full Year Consolidated Files and Medical Conditions Files. Principal Findings. Descriptive data showed that children in single-mother families had fewer office visits than children in two-parent families; however, the effect of number of parents in the family on children's office visits or use of prescription medications was completely explained by other explanatory variables. By contrast, children living in families with many other children had fewer total and physician office visits and a lower likelihood of using a prescription medication than children living in families with no other children even after adjusting for other explanatory variables. Children who lived with other adults in addition to their parents also had fewer office visits and a lower likelihood of using a prescription medication than children who lived only with their parents. Conclusions. Children living in families with many other children or with other adults use less ambulatory care and prescription medications than their peers. Additional research is needed to determine whether these differences in utilization affect children's health. [source] The cost of hospital-related care of patients with psoriasis in Italy based on the AISP studyJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2001AF Finzi Abstract The objective of this study was to assess the cost of caring for patients with psoriasis in Italy according to the AISP study (Associazione Italiana Studi Psoriasi or Italian Association for Studies on Psoriasis), involving 104 university and hospital centres and 7992 patients in 1994. The mean yearly cost of care for a single patient was calculated at 905 Euros. Hospitalization accounted for more than four-fifths of the costs, therapy for about one-eighth (systemic therapies were the most expensive) and office visits and day hospitals for the remainder. In our study series less than 20% of patients accounted for more than 90% of the total costs. [source] Telephone Appointment Visits for Head and Neck Surgery Follow-up Care,,THE LARYNGOSCOPE, Issue 6 2002Jeffrey Eaton MD Abstract Objectives/Hypothesis To test the hypothesis that patients with a variety of otolaryngologic diagnoses using telephone appointment visits would be equally as satisfied as patients receiving physician office visits, the study compared telephone appointment visits with physician office visits for health maintenance organization patients who needed routine follow-up care in a head and neck surgery clinic. Study Design Randomized, nonblinded cross-sectional study. Methods After their initial visit to either of two head and neck surgery clinics, new otolaryngology patients were randomly assigned into treatment and control groups. Patients in the treatment group (n = 73) received follow-up care in the form of telephone appointment visits, and patients in the control group (n = 80) received physician office visits for follow-up care. Study data were collected using telephone interviews and physician trackingforms. Results Patients receiving telephone appointment visits were significantly less satisfied with their visits than patients receiving physician office visits (,2 = 25.4, P <.005). Patients who had physician office visits were significantly more likely than were patients in the treatment group to agree "somewhat" or "strongly" that 1) the physician addressed their questions and concerns (,2 = 24.0, P <.005); 2) the physician provided personal care and attention (,2 =29.9, P <.005); and 3) the physician provided high-quality care (,2 =34.5, P <.005). Conclusions Patients who received telephone appointment visits were statistically significantly less satisfied with all aspects of their follow-up appointment than were patients who had physician office visits. The study findings indicate that telephone appointment visits may not be an ideal type of follow-up visit for all patients. Despite these findings, one third of patients in the treatment group would consider receiving a telephone appointment visit for future routine follow-up care, and 21.9% had no preference, perhaps a factor indicating willingness to receive a telephone appointment for a follow-up visit. [source] | |||||||||||||||||||