Analysis on the current situation of outpatient management in 56 tertiary medical institutions in Anhui Province / 中华医院管理杂志

Objective:To comprehensively understand the current situation of outpatient management in tertiary medical institutions in Anhui Province under the COVID-19 epidemic, and to provide empirical reference for effective prevention and control of the epidemic.Methods:In December 2020, a stratified cluster sampling method was used to investigate and score the current situation of outpatient management in 56 tertiary medical institutions in Anhui Province. The survey content included four dimensions: appointment and triage setting and management, fever clinic setting and management, nosocomial infection prevention and control management, and medical resource storage management. The scoring results were divided into three grades, namely " good" (total score≥90 points), " acceptable" (85≤total score<90 points)and " inadequate" (total score<85 points). SPSS 21.0 software was used for data statistical analysis. Independent sample t-test was used to compare the outpatient setting and management scores of medical institutions, and the proportion of assessment grades was used chi-square inspection.Results:The outpatient setting and management of 56 tertiary medical institutions in Anhui Province were evaluated as good in 36, acceptable in 6 and inadequate in 14. The outpatient setting and management score was(81.55±24.94), including(16.53±2.66)in " appointment and triage setting and management" , (47.62±19.60) in " fever clinic setting and management" , (8.69±1.44)in " nosocomial infection prevention and control management" , and (8.75±3.02) in " medical resource storage management" . The total scores and four dimension scores of 39 general hospitals were higher than those of 17 specialized hospitals, and the differences were significant( P<0.05). Conclusions:The overall situation of outpatient epidemic prevention and control management in tertiary medical institutions in Anhui Province is good, but the construction and control of specialized hospitals need to be further strengthened.

The pregnancy outcomes in women with gestational diabetes mellitus in one-day outpatient management with or without nutrition specialist involvement: a propensity score matching study / 中华临床营养杂志

Objective:Objective To explore the special role of nutrition specialists in the one-day-care clinic of gestational diabetes mellitus (GDM), and provide a basis for strengthening the standardized construction of one-day-care clinic.Methods:It was a retrospective observation study that the pregnant women who participated in the one-day-care clinic of GDM in our hospital without nutrition specialists in November and December 2017 were divided into control group (177 cases), and who participated in the one-day-care clinic of GDM in our hospital with nutrition specialists in January and February 2018 were divided into observation group (307 cases). The differences of pregnancy outcomes between the two groups were compared after the propensity score matching.Results:176 pairs of patients were successfully matched with a 1:1 propensity score. The incidence of macrosomia in pregnant women with GDM in the observation group (2.8%) was significantly lower than that in the control group (8.5%) ( P=0.036). There were no significant differences in the weight gain during pregnancy, the gestational week of delivery and the incidences of insulin use, hypertension during pregnancy, preeclampsia, cesarean section, premature infants, premature rupture of membranes, umbilical cord around the neck, and fetal distress between the two groups ( P>0.05). Conclusion:Nutrition specialists are indispensable in the multidisciplinary cooperation of one-day-care clinic of GDM, and they play a key role in considerably lowering the prevalence of macrosomia in GDM pregnant women.

Exploration on the construction of outpatient intra-hospital hierarchical diagnosis and treatment system / 中华医院管理杂志

Reasonable intra-hospital hierarchical diagnosis and treatment system will effectively guide the patients to see a doctor on demand and improve the efficiency of medical services. Beijing Tongren Hospital, Capital Medical University, has explored the intra-hospital hierarchical diagnosis and treatment system depending on different situatioins such as for new patients, subsequent visit patient, and the same patients with different clinical stage. Through establishing a series of intra-hospital hierarchical diagnosis and treatment modes, such as the well-known expert team, the outpatient service for specialized diseases, the multidisciplinary outpatient service for complex diseases, the nursing service, and the pharmaceutical care service, the outpatients could be oriented by specialties and disciplines and graded by the complexity in diagnosis and treatment of diseases. Relying on the appointment methods such as referral and revisit to open up the information channel, it can optimize the time cost and economic cost of patients, reflect the functional positioning of the tertiary hospitals, and improve patients′ sense of medical access and happiness.

Neumonía atípica y COVID-19 durante la pandemia. A propósito de casos manejados exitosamente a domicilio / Atypical pneumonia and COVID-19 during the pandemic. Regarding cases successfully managed at home / Pneumonia atípica e COVID-19 durante a pandémica. Em relação aos casos gerenciados com sucesso em casa

Resumen: Un nuevo virus emergió a finales del año pasado en Wuhan, China, lo que ocasionó una pandemia de enormes proporciones que se ha extendido por todo el planeta cobrando miles de vidas humanas. Su forma grave, la neumónica, puede alcanzar criterios de SIRPA y se asocia con una elevada mortalidad. Se discute un posible sobreuso de ventiladores mecánicos por una no del todo apropiada selección de casos en los hospitales en el contexto de un nuevo padecimiento, con una fisiopatología no bien comprendida y una alta posibilidad de lesión pulmonar asociada al ventilador, así como su eventual manejo domiciliario en casos bien seleccionados. En tiempos de pandemia, el ingreso a la UCI debe ser estrictamente sensato y razonado.

Abstract: A new virus emerged at the end of last year in Wuhan, China, causing a huge pandemic that has spread across the planet, taking thousands of human lives. Its severe form, pneumonia, can meet ARDS criteria and is associated with high mortality. A possible overuse of mechanical ventilators is discussed due to a not entirely appropriate selection of cases in hospitals in the context of a new condition with a poorly understood pathophysiology and a high possibility of ventilator-associated lung injury, as well as its eventual home management in well selected cases. In times of pandemic, admission to the ICU must be strictly sensible and reasoned.

Resumo: Um novo vírus surgiu no final do ano em Wuhan, na China, causando uma pandemia de enormes proporções que se espalhou por todo o planeta, levando milhares de vidas humanas. Sua forma grave, pneumonia, pode atender aos critérios da ARDS e está associada a alta mortalidade. Um possível uso excessivo de ventiladores mecânicos é discutido devido a uma seleção não totalmente apropriada de casos em hospitais no contexto de uma nova doença com uma fisiopatologia pouco compreendida e uma alta possibilidade de lesão pulmonar associada ao ventilador, bem como seu eventual tratamento domiciliar em casos bem selecionados. Em tempos de pandemia, a admissão na UTI deve ser estritamente sensata e fundamentada.

Setup and management of the multi-functional post for outpatients / 中华医院管理杂志

Simplified outpatient service flow and higher service efficiency can save back-and-forth trips and queuing time of outpatients and better their medical experience. The authors introduced the hospital′s experience in establishing a one-stop multi-functional outpatient service center. This center integrated such departments as outpatient office service, medical insurance office service, and registration & fee payment. Such a " multifunctional post" provided a one-stop service for the patients, hence optimizing the workflow for creating a convenient and fast outpatient service.

Medical Termination of Delayed Miscarriage: Four-Year Experience with an Outpatient Protocol / Terminação médica de gravidez inviável do 1° trimestre: quatro anos de experiência com um protocolo de tratamento em ambulatório

Abstract Purpose To evaluate the efficacy of an outpatient protocol with vaginal misoprostol to treat delayed miscarriage. Methods Retrospective analysis of prospectively collected data on women medically treated for missed abortion with an outpatient protocol. The inclusion criteria were: ultrasound-based diagnosis of missed abortion with less than 10 weeks; no heavy bleeding, infection, inflammatory bowel disease ormisoprostol allergy; nomore than 2 previous spontaneous abortions; the preference of the patient regarding the medical management. The protocol consisted of: 1) a single dose of 800 μg of misoprostol administered intravaginally at the emergency department, after which the patients were discharged home; 2) clinical and ultrasonographic evaluation 48 hours later - if the intrauterine gestational sac was still present, the application of 800 μg of vaginal misoprostol was repeated, and the patients were discharged home; 3) clinical and ultrasonography evaluation 7 days after the initiation of the protocol - if the intrauterine gestational sac was still present, surgical management was proposed. The protocol was introduced in January 2012. Every woman received oral analgesia and written general recommendations. We also gave them a paper form to be presented and filled out at each evaluation. Results Complete miscarriage with misoprostol occurred in 340 women (90.2%). Surgery was performed in 37 (9.8%) patients, representing the global failure rate of the protocol. Miscarriage was completed after the first misoprostol administration in 208 (55.2%) women, with a success rate after the second administration of 78.1% (132/169). The average age of the women with complete resolution using misoprostol was superior to the average age of those who required surgery (33.99 years versus 31.74 years; p = 0.031). Based on the ultrasonographic findings in the first evaluation, the women diagnosed with fetal loss achieved greater success rates compared with those diagnosed with empty sac (p = 0.049). Conclusions We conclude this is an effective and safe option in the majority of delayed miscarriage cases during the first trimester, reducing surgical procedures and their consequences.

Resumo Objetivo Avaliar a eficácia de um protocolo de tratamento médico da gravidez inviável do primeiro trimestre (GI1°T) com misoprostol vaginal em regime de ambulatório. Métodos Análise retrospectiva de dados colhidos prospectivamente de grávidas tratadas com misoprostol vaginal em ambulatório. Os critérios de inclusão foram: diagnóstico de GI1°T com < 10 semanas de gestação; ausência de hemorragia abundante, infeção, doença inflamatória intestinal ou alergia ao misoprostol; 2 abortamentos anteriores; e preferência da paciente por tratamento médico. O protocolo consiste em: dia 0-aplicação demisoprostol intravaginal (800μg) no Serviço de Urgência e alta para o domicílio; dia 2-se persistência de saco gestacional intrauterino, aplicação de segunda dose de misoprostol (800μg) e alta; Dia 7-se persistência de saco gestacional intrauterino, proposto esvaziamento uterino instrumentado. O protocolo foi implementado em janeiro de 2012. Todas as grávidas receberam analgesia oral e informação por escrito com recomendações gerais. Receberam ainda um formulário a ser preenchido em cada vinda à urgência. Resultados Das 377 mulheres incluídas, observou-se abortamento completo em 340 (90,2%). As restantes 37 (9,8%) necessitaram de tratamento cirúrgico - taxa de falência global do protocolo. Em 208 (55,2%), o sucesso foi observado ao fim da 1ª dose, com uma taxa de eficácia da 2ª dose de 78,1% (132/169). A idade média das mulheres com sucesso do tratamento médico foi superior à das mulheres sem sucesso do mesmo (33,99 versus 31,74 anos; p = 0,031). O sucesso do tratamento foi maior quando o diagnóstico ecográfico inicial era de um embrião sem vitalidade comparado com os casos de ovo anembrionado (p = 0.049). Conclusões Conclui-se que esta é uma opção de tratamento eficaz e segura na maioria das situações de GI1°T, evitando a necessidade de internamento e de intervenção cirúrgica.

Design of hospital appointment registration process based on WeChat public platform / 医疗卫生装备

Objective To introduce a new appointment registration way in the outpatient department.Methods A WeChat appointment registration platform based on HIS was established with smart phone and WeChat public platform,which was gifted with the functions of online registration and payment and etc.The processes including preliminary diagnosis and return visit,cancelling appointment,treatment of appointment breaking,and the limitations during the appointment could be accomplished by the appointment registration.Results The platform realized appointment registration,information feedback and etc.Conclusion The appointment registration based on WeChat public platform contributes to satisfying the patient,enhancing medical service and distributing medical resources rationally.

Application of real-time continuous glucose monitoring in outpatient management system for type 1 diabetes mellitus / 中华内分泌代谢杂志

Objective To evaluate the effect of continuous glucose monitoring system(CGMS) in improving the current status of type 1 diabetes mellitus(T1DM) control and reducing the economic burden of the patients.Methods One hundred and fifteen patients with T1DM were randomly assigned to the CGMS group and the self-monitoring of blood glucose(SMBG) group respectively.The patients in CGMS group were on 72 h CGMS every 6 months, while SMBG group only with SMBG to guide the insulin dose adjustment.The levels of blood glucose and the statistics of the number of hypoglycemia and diabetic ketoacidosis were taken as the main observational indexes every 6 months.The chronic complication and the statistics of the number of hospitalizations and the total cost of treatment were made as the secondary observational index every 12 months.Results 2 h postprandial plasma glucose(2hPG) and mean blood glucose(MBG) in the CGMS group were lower than those in the SMBG group [(10.7±1.9 vs 11.5±2.7) mmol/L, (9.7±0.5 vs 10.6±0.7) mmol/L, P<0.05] in the clinical follow-up visit after 6 months.The per capita number of hypoglycaemia in the CGMS group was lower than that in the SMBG group[(7.9±2.6 vs 9.2±3.4) times, P<0.05].In the outpatient follow-up re-visit to the patients after 6 months, fasting plasma glucose(FPG), 2hPG, MBG, and HbA1C of the patients in the CGMS group were lower than those in the SMBG group(t=4.71~9.75, P<0.05), the per capita numbers of hypoglycemia and DKA in the CGMS group were lower than those in the SMBG group(t=3.61~4.37, P<0.05).Conclusion The application of real-time continuous glucose monitoring in T1DM outpatient management may reduce the whole-day blood glucose of the patients, decrease the incidence risk of hypoglycemia, and improve the compliance of the treatment while without increasing the economic burden of the disease.

Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study

OBJECTIVE: This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. MATERIALS AND METHODS: From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16–64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. RESULTS: Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0–5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3–13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. CONCLUSION: TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

Optimize Clinic Management with Clinical Appointment / 浙江中医药大学学报

Objective] To study the impact of outpatient appointment supposed on the management of outpatient department and whole hospital. [Methods] Survey and research the average outpatient registration volume, patients' registration waiting time and the patients' satisfaction monthly during May 2011 to May 2014 when outpatient appointment was applied, and analyze the impact of outpatient appointment supposed on the management of outpatient department and whole hospital by comparing the results 3 years ago(during April 2008 to April 2011) when outpatient appointment was not applied. [Results] The number of patients with an appointment was on the rise, the total number of outpatients increased with the increase of outpatient appointment, and patients' registration waiting time was significantly shortened with higher satisfaction. The difference had statistical significance( P<0.05). [Conclusion] By outpatient appointment services, outpatient management has been optimized, with the increase of outpatients; the hospital benefits grow, and meanwhile the patients' satisfaction is improved.

Development trend of modern hospital outpatient management system / 医疗卫生装备

In modern hospital outpatient management, patients should be paid more attention to than hospital management and economic management. Automatic and paperless management is also important. So, the software and hardware all should be updated to gain great social and economic benefit.

Antepartum Expectant Management of Placenta Previa, Inpatient Versus Outpatient / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to determine the outcome of inpatient and outpatient management of placenta previa. METHODS: Sixty women with the initial diagnosis of placenta previa at 30 to 37 weeks' gestation who required hospitalization for no or minimal vaginal bleeding were stabilized and then randomized to receive either inpatient or outpatient expectant management. Thirty inpatients were treated at bed rest with minimal ambulation, received corticosteroids until 33 weeks of gestation and underwent ultrasonographic examination at 2 week intervals to assess fetal growth and placental location. Thirty outpatients were discharged after 2 or 3 days of hospitalization, and also received corticosteroids every week until 33 weeks of gestation and underwent ultrasonographic examination at 2 weeks intervals. All subjects who reached 37 weeks' gestation with persistent placenta previa underwent cesarean section electively. RESULTS: There were no differences between inpatients and outpatients for mean age, parity, gestational age at diagnosis, gestational age at first bleeding, and number of prior cesarean sections. There were no significant differences in the maternal and neonatal outcome measures as measured by time pregnancy prolonged, transfusions, cesarean hysterectomy, gestational age at delivery, birth weight, and neonatal morbidity. Significant difference observed only in maternal total hospital stay (p<0.01) as inpatient is 29.5+/-21.4 days and outpatient is 10.1+/-7.5 days. CONCLUSION: In selected patients, outpatient management of placenta previa can be reduced maternal total hospital stay. There were no apparent differences in the maternal and neonatal outcome of the two groups.

Education of General Medicine. Postgraduate Education of General Medicin. Postgraduate Medical Education in General Internal Medicine / 医学教育

We have an outpatient department and a ward (52 beds) in the department of general internal medicine of the Second Tokyo National Hospital. During the rotation of interns for 8 weeks, interns are taught outpatient management by clinical educators one-on-one basis in the clinic, in addition to inpatient management on the wards, and series of lectures on the general internal medicine, emergency medicine and psychosocial issues. We have a residency program from PGY 3 through PGY 5, which emphasizes outpatient continuous management throughout residency. Our residents present their outpatient cases at the daily outpatient conference that all of us would attend. There are 17 graduates of our residency, many of whom are now clinical educators not only in our hospital but also in the university hospitals and teaching hospitals. Research on the way of training rotation of interns by the national hospitals group suggested superiority of the super-rotate training system of the intern. The residency of general internal medicine would become more important not only for the training of primary care physicians but for the training of clinical educators.