Development of a Quality Assessment Tool for Outpatient Infusion Clinics: A Literature Review and Pilot Survey.

This study aimed to develop a quality assessment tool for outpatient infusion clinics, as a lack of literature exists on the subject. The authors conducted a literature review targeting studies since 2016 to identify variables that affect patient satisfaction in outpatient infusion clinics. Due to the limited number of relevant studies found, the authors shadowed 2 infusion clinic nurses to capture additional determinants of outpatient infusion clinic quality. A total of 72 variables relevant to an outpatient infusion quality assessment tool were listed. From this list of variables, a pilot survey was conducted at an outpatient rheumatology infusion clinic to assess patient satisfaction with 16 variables of interest. The pilot survey (N = 43) revealed that patients were relatively dissatisfied with walking to clinics, lack of access to public transit, lack of parking and/or free parking, lack of privacy, and flexible scheduling and/or cancellation policies. These findings demonstrate how the assessment tool may highlight specific areas of concern at an infusion clinic to identify targets for future quality improvement initiatives. Therefore, the tool presented has the potential to improve the quality of care provided to patients attending infusion facilities.

The attitudes and beliefs of Pakistani medical practitioners about depression: a cross-sectional study in Lahore using the Revised Depression Attitude Questionnaire (R-DAQ).

BACKGROUND: Mental disorders such as depression are common and rank as major contributors to the global burden of disease. Condition recognition and subsequent management of depression is variable and influenced by the attitudes and beliefs of clinicians as well as those of patients. Most studies examining health professionals' attitudes have been conducted in Western nations; this study explores beliefs and attitudes about depression among doctors working in Lahore, Pakistan. METHODS: A cross-sectional survey conducted in 2015 used a questionnaire concerning demographics, education in psychiatry, beliefs about depression causes, and attitudes about depression using the Revised Depression Attitude Questionnaire (R-DAQ). A convenience sample of 700 non-psychiatrist medical practitioners based in six hospitals in Lahore was approached to participate in the survey. RESULTS: Six hundred and one (86 %) of the doctors approached consented to participate; almost all respondents (99 %) endorsed one of various biopsychosocial causes of depression (38 to 79 % for particular causes), and 37 % (between 13 and 19 % for particular causes) noted that supernatural forces could be responsible. Supernatural causes were more commonly held by female doctors, those working in rural settings, and those with greater psychiatry specialist education. Attitudes to depression were mostly less confident or optimistic and less inclined to a generalist perspective than those of clinicians in the UK or European nations, and deterministic perspectives that depression is a natural part of aging or due to personal failings were particularly common. However, there was substantial confidence in the efficacy of antidepressants and psychological therapy. More confident and therapeutically optimistic views and a more generalist perspective about depression management were associated with a rejection of supernatural explanations of the origin of depression. CONCLUSIONS: Non-psychiatrist medical practitioners in Pakistan hold a range of views about the causes of depression, with supernatural explanations held by more than a third. Depression attitudes appear less positive than among UK and European clinicians, with the notions that depression is due to a lack of stamina and will-power and a natural part of growing old being especially commonly held; more positive attitudes appear to be associated with a rejection of supernatural explanatory models of depression.

Radical hysterectomy in the elderly.

BACKGROUND: The considerable increase in life expectancy on one hand and an increase in cervical cancer among Iranian patients on the other, brings out the importance of investigating whether radical surgery can be performed safely and effectively on patients above 60 years of age. METHODS: In a study of historical cohort, all 22 patients 60 years and above who have undergone a Wertheim radical hysterectomy for cervical cancer from 1999 to 2005 were compared with 128 matched cases under 60 years of age who had undergone a Wertheim hysterectomy during the same calendar year. All patients were analyzed for preexisting medical comorbidities, length of postoperative stay, morbidity, and postoperative mortality. RESULTS: There was no operative mortality in either group, morbidity (minor, p = 0.91; major, p = 0.89) were statistically not different in the two groups despite the patient's above 60 years having significantly higher comorbidity prior to surgery than the younger cohort (minor, P < 0.05; major, P < 0.05). The mean postoperative hospital stay was significantly longer in the older patients (5 days vs. 3 days, P < 0.001). CONCLUSION: Wertheim Radical hysterectomy is a safe surgical procedure in the selected population of patients 60 years and over. No differences in operative mortality or morbidity were found when compared to a cohort of patient's aged 60 years or younger.