Bibliographies thématiques / Outpatient management

Littérature scientifique sur le sujet « Outpatient management »

Auteur : Grafiati
Publié le 10 mars 2023

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Articles de revues sur le sujet "Outpatient management"

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Cockcroft, Donald W., et Sanjay Kalra. « OUTPATIENT ASTHMA MANAGEMENT ». Medical Clinics of North America 80, no 4 (juillet 1996) : 701–18. http://dx.doi.org/10.1016/s0025-7125(05)70464-8.

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Warner, Petra M., Tammy L. Coffee et Charles J. Yowler. « Outpatient Burn Management ». Surgical Clinics of North America 94, no 4 (août 2014) : 879–92. http://dx.doi.org/10.1016/j.suc.2014.05.009.

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Burt, Vivien K., Pamela Summit et Joel Yager. « Outpatient Management Teams ». Academic Psychiatry 16, no 1 (mars 1992) : 24–28. http://dx.doi.org/10.1007/bf03341491.

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Elting, Linda S., Charles Lu, Carmelita P. Escalante, Sharon H. Giordano, Jonathan C. Trent, Catherine Cooksley, Elenir B. C. Avritscher et al. « Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia ». Journal of Clinical Oncology 26, no 4 (1 février 2008) : 606–11. http://dx.doi.org/10.1200/jco.2007.13.8222.

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Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.
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Schussman, Lee C., et Lawrence J. Lutz. « Outpatient Management of Hemorrhoids ». Primary Care : Clinics in Office Practice 13, no 3 (septembre 1986) : 527–41. http://dx.doi.org/10.1016/s0095-4543(21)01575-x.

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Menna, Cecilia, Mohsen Ibrahim, Camilla Poggi, Camilla Vanni, Giulio Maurizi, Antonio D’Andrilli, Anna Maria Ciccone, Federico Venuta, Erino Angelo Rendina et Claudio Andreetti. « Outpatient chest tube management ». Journal of Xiangya Medicine 3 (avril 2018) : 12. http://dx.doi.org/10.21037/jxym.2018.03.03.

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Klassen, Terry P., et Peter C. Rowe. « Outpatient management of croup ». Current Opinion in Pediatrics 8, no 5 (octobre 1996) : 449–52. http://dx.doi.org/10.1097/00008480-199610000-00005.

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Nelson, Harold S. « Outpatient Management of Asthma ». Primary Care Case Reviews 1, no 1 (mars 1998) : 3–11. http://dx.doi.org/10.1097/00129300-199801010-00002.

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Ponn, Ronald B., Howard J. Silverman et John A. Federico. « Outpatient Chest Tube Management ». Annals of Thoracic Surgery 64, no 5 (novembre 1997) : 1437–40. http://dx.doi.org/10.1016/s0003-4975(97)00853-9.

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White, Anthony. « Outpatient management of pyelonephritis ». Annals of Emergency Medicine 21, no 1 (janvier 1992) : 111. http://dx.doi.org/10.1016/s0196-0644(05)82272-3.

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Thèses sur le sujet "Outpatient management"

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Jacobson, Eva. « Pain management in outpatient knee arthroscopy / ». Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-642-5/.

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Anyiam, Helen. « Educating Staff Members in an Outpatient Clinic on Hypertension Management ». Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930842.

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An educational module on hypertension was created in response to the recurring pattern of patient visits with hypertension and an observed knowledge gap among nursing staff in an outpatient clinic located in the southern United States. The educational module was patterned after Joint National Committee-8 and American College of Cardiology guidelines involving patient lifestyle modification and provided clinic staff with information on hypertension diagnosis and self-management for use in patient education. The module was reviewed by a panel of 3 experts who approved it for appropriateness and clarity of content and made one minor recommendation for revision. The education materials were modified to meet the panel’s recommendations and subsequently presented to 5 nursing staff members. Pre- and postmodule questionnaires were provided to the staff to determine the extent of their learning from the education program. Pretest results indicated that staff lacked information on the guidelines for treatment of hypertension. Posttest results indicated that all 5 participants found the module information useful for staff to use in educating patients on self-management of hypertension. Providing nursing staff with current evidence-based practice guidelines can increase staff nurse knowledge on hypertension management. Educating nursing staff has the potential to effect positive social change by empowering staff and patients to improve health care outcomes by enabling staff to coach patients on hypertension management using up-to-date evidence-based practice guidelines.

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White, Denise L. « Operational Planning and Scheduling in the Outpatient Clinic Environment ». University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1276527552.

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Okonofua, Modupe Mary. « Depression Management in Outpatient Settings : A Systematic Review of the Literature ». ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5392.

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Depression is a mental illness that requires prompt identification and treatment due to grave consequences if untreated. Depression can affect a person's level of functioning, lead to worsening health conditions, comorbid substance abuse, and suicide. Despite these facts, the current state of nursing practice includes an inadequate diagnosis of patients with depression, lack of guidelines for the use of assessment tools and diagnostic tests to identify depression, and insufficient information concerning the accuracy of depression assessment tools. This systematic literature review examined 6 depression assessment tools in regard to their accuracy as identified by specificity, sensitivity, reliability, and validity. This project also examined the pros and cons, demographics, and healthcare settings that use these depression inventory tools. This project used the Orlando nursing process theory as a theoretical framework. Based on the review of 10 articles selected, evidence showed that the Hamilton depression rating scale has the highest sensitivity (93%) and specificity (97%) rates. The implications for positive social change include the opportunity for clinicians to use the findings of this project in their selection of depression assessment tools in healthcare settings. Other researchers can use this project as a valuable resource for management of major depressive disorders.
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Leung, Tai-tei Betty, et 梁帶娣. « Evidence-based guideline on nanocrystalline silver (ACTICOAT) therapy for outpatient burn management ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658268X.

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Cruze, Erin Michelle. « An Exploratory Study of Toxicology Screening Policies in Outpatient Pain Clinics ». The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1338232409.

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Marshall, Adam Ryan. « Improving outpatient non-oncology infusion through centralization and scheduling heuristics ». Thesis, Massachusetts Institute of Technology, 2016. http://hdl.handle.net/1721.1/104307.

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Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
Thesis: S.M. in Engineering Systems, Massachusetts Institute of Technology, Department of Mechanical Engineering, 2016. In conjunction with the Leaders for Global Operations Program at MIT.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 117-119).
The use of highly effective intravenously infused specialty drugs has increased significantly over the past two decades as they have led to dramatic improvements in patients' quality-of- life. At Massachusetts General Hospital, these drugs are administered in ten independent outpatient clinics. While some clinics only need to offer sporadic treatments and have low utilization of resources, other clinics find patient access is severely limited due to high utilization, poor scheduling practices, and inadequate staffing. This thesis describes methods to increase patient access to infusion while improving resource utilization. Underlying this improvement is a specially developed scheduling algorithm that smooths chair utilization while permitting flexible, multi-day scheduling. By employing the new scheduling algorithm, the recommended centralized infusion unit will be able to provide more expedient care, offer emergent appointments, avoid unnecessary hospital infusion admissions, and make more efficient use of clinical resources. Adding only two days of flexibility to appointments reduces resource requirements by up to 57%. Also, the day-to-day variability in patient volume is stabilized. Finally, the centralization of administrative resources ensures efficient prior authorization processing, leading to significant financial savings.
by Adam Ryan Marshall.
M.B.A.
S.M. in Engineering Systems
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Zurovac, Dejan. « Malaria outpatient management in government health facilities in Kenya : an evaluation of current practices ». Thesis, Open University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422003.

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Nguyen, Lisa L. « Pacific Psychiatric Group| A Business Plan For a Direct Pay Outpatient Psychiatric Practice ». Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10604226.

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The demand for psychiatry is driven by the amount of patients that require mental health services. In the United States, there is a growing need for mental health services. One in every 5 adults in America suffers from some type of mental illness; 1 in every 20 has a serious mental illness. In 2014, 60% of adults living with a mental illness did not receive treatment for it. The amendment of the Mental Health Parity and Addiction Equity Act by the Patient Protection and Affordable Care Act has expanded access to mental health services. However, although the accessibility to psychiatric services has increased, a shortage of psychiatrists has resulted in long wait times, creating challenges to meet the demand. Pacific Psychiatric Group is a direct pay, outpatient practice that offers mental health services at competitive, fixed cash rates. Insurance will not be accepted. The burden of overhead dealing with the bureaucracy and administration of insurance will be eliminated, which helps to keep costs low and allows providers to focus on the patient. Pacific Psychiatric Group’s mission is to alleviate accessibility challenges and provide timely, high quality, personalized, patient-focused mental health services. This proposed business plan will demonstrate how Pacific Psychiatric Group plans to improve accessibility, transparency, and quality of psychiatric services in an effort to reduce the number of untreated individuals.

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Phillips, Martha A. « Improving the Transition of Care for Psychiatric Patients Moving from Inpatient to Outpatient Psychiatric Healthcare Settings ». Thesis, University of Louisiana at Lafayette, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=10815412.

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Abstract The aim of this quality improvement (QI) project was to explore whether the implementation of an enhanced telephone reminder system improved the rate of attendance at initial follow-up appointment and medication adherence. A total of 86 patients, discharged from inpatient psychiatric units with a follow-up within 7 days of discharge, were eligible to receive the enhanced telephone contact reminder and follow-up text. A preliminary retrospective chart review was conducted to collect historical data on medication and attendance adherence. A prospective interventional design was used to implement the QI project. Patients received telephone contact within 24-72 hours of discharge and text message reminder strategies. A medication adherence assessment was completed at telephone contact and at initial follow-up appointment. An analysis of the data examined the impact of the TCM strategy on patient?s rate of adherence to medication and initial follow-up appointments. Descriptive analysis assessed the frequency of medication adherence in retrospective and implementation data. Inferential statistics analyzed factors of association such as prior clinic services and rate of attendance at follow-up appointment. In the retrospective chart review (n=57), data revealed a 28% attendance rate and an 81% medication adherence at the follow-up appointment, with no statistical difference in a 145 history of prior series on attendance. Implementation data on medication adherence at telephone contact and at first follow-up appointment revealed a 61.5% medication adherence rate at telephone contact and 80% adherence rate at first follow-up appointment. The predictor value of a prior history of service on attendance at first follow-up appointment revealed no statistically significant difference. The project, however, resulted in clinically significant benefits that promoted individual patients? medication-taking behaviors and decisions to attend follow-up appointments, and improved clinical practices at the BHC.

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Livres sur le sujet "Outpatient management"

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Outpatient management of depression. Caldo, OK : Professional Communications, Inc., 1994.

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Masci, Joseph R. Outpatient management of HIV infection. 4e éd. New York : Informa Healthcare, 2011.

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R, Masci Joseph, dir. Outpatient management of HIV infection. 2e éd. St. Louis : Mosby, 1996.

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Outpatient management of HIV infection. 3e éd. Boca Raton : CRC Press, 2001.

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1948-, Glass Richard, dir. Coloproctology : Diagnosis and outpatient management. Berlin : Springer-Verlag, 1985.

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N, Nathanson Susan, et Lerman Dan, dir. Outpatient cancer centers : Implementation and management. Chicago : American Hospital Pub., 1988.

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Clinical Resource Efficiency Support Team. A short guide to outpatient management. [Belfast] : CREST, 1991.

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1941-, Gantz Nelson Murray, et Brown Richard B, dir. Infections in outpatient practice : Recognition and management. New York : Plenum Medical Book Co., 1988.

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Regan, Donovan Michelle, et Matson Theodore A, dir. Outpatient case management : Strategies for a new reality. Chicago, Ill : American Hospital Pub., 1994.

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Avis, Mark. Patient satisfaction and the management of outpatient consultation. Nottingham : Department of Nursing and Midwifery Studies, University of Nottingham, 1995.

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Chapitres de livres sur le sujet "Outpatient management"

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Yowler, Charles J., et Tammy L. Coffee. « Outpatient Burn Management ». Dans Handbook of Burns Volume 1, 435–42. Cham : Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-18940-2_33.

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Lu, Marvin Louis Roy, et Hakeem Ayinde. « Device Management ». Dans Handbook of Outpatient Cardiology, 441–52. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-88953-1_26.

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Goldberg, Daniel, et David T. Harrington. « Outpatient Management of Burns ». Dans Burn Care for General Surgeons and General Practitioners, 165–70. Cham : Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-29161-1_12.

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Yousefzai, Rayan, et Marcus Urey. « Outpatient Management of LVAD ». Dans Case-Based Device Therapy for Heart Failure, 93–110. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-70038-6_6.

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Brown, Richard B. « Management of Infectious Diarrhea ». Dans Infections in Outpatient Practice, 155–71. Boston, MA : Springer US, 1988. http://dx.doi.org/10.1007/978-1-4899-0780-6_13.

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Brown, Richard B. « Management of Pneumonia in Outpatients ». Dans Infections in Outpatient Practice, 89–100. Boston, MA : Springer US, 1988. http://dx.doi.org/10.1007/978-1-4899-0780-6_7.

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Wakslak, Menachem, et David T. Huang. « Syncope, Work Up and Management ». Dans Manual of Outpatient Cardiology, 373–90. London : Springer London, 2011. http://dx.doi.org/10.1007/978-0-85729-944-4_14.

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Gamlen, Hannah. « Ambulatory and Outpatient Procedures ». Dans Nursing Management of Women’s Health, 235–46. Cham : Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-16115-6_12.

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Brown, Richard B. « Outpatient Management of Acquired Immunodeficiency Syndrome ». Dans Infections in Outpatient Practice, 49–64. Boston, MA : Springer US, 1988. http://dx.doi.org/10.1007/978-1-4899-0780-6_4.

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Sawan, Mariem A., et Michael McDaniel. « Post-myocardial Infarction Evaluation and Management ». Dans Handbook of Outpatient Cardiology, 235–47. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-88953-1_14.

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Actes de conférences sur le sujet "Outpatient management"

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Vijayakumar, Bavithra, Chris Davies et Matthew Gibson. « Outpatient management of PE ». Dans ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.pa1454.

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Castillo Acosta, Sara, José Carlos Castillo Acosta et Jorge L. Freixinet Gilart. « Outpatient management of persistent air leak ». Dans ERS International Congress 2019 abstracts. European Respiratory Society, 2019. http://dx.doi.org/10.1183/13993003.congress-2019.pa1078.

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Knowlman, T., et R. Carroll. « Barriers to outpatient management of pulmonary embolism ». Dans ERS International Congress 2022 abstracts. European Respiratory Society, 2022. http://dx.doi.org/10.1183/13993003.congress-2022.1792.

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Liu, Yang, Na Geng et Yanhong Zhu. « MDP-based outpatient scheduling for multiple examinations ». Dans 2015 IEEE International Conference on Industrial Engineering and Engineering Management (IEEM). IEEE, 2015. http://dx.doi.org/10.1109/ieem.2015.7385860.

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Choi, Byoung K., Donghun Kang, Joohoe Kong, Hyeonsik Kim, Arwa A. Jamjoom, Aisha M. Mogbil et Thoria A. Alghamdi. « Simulation-based operation management of outpatient departments in university hospitals ». Dans 2013 Winter Simulation Conference - (WSC 2013). IEEE, 2013. http://dx.doi.org/10.1109/wsc.2013.6721604.

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Woolnough, Kerry, et Saskia Jones-Perrott. « Outpatient Management Of PE & ; The Need For Service Development ». Dans American Thoracic Society 2010 International Conference, May 14-19, 2010 • New Orleans. American Thoracic Society, 2010. http://dx.doi.org/10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a1913.

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Yang, Limeng, et Feng Liang. « Inventory control of outpatient appointment based on revenue management theory ». Dans 2017 14th International Conference on Service Systems and Service Management (ICSSSM). IEEE, 2017. http://dx.doi.org/10.1109/icsssm.2017.7996263.

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Bernatchou, Maryam, Fatima Ouzayd, Adil Bellabdaoui et Mohammed Hamdaoui. « Towards a simulation model of an outpatient chemotherapy unit ». Dans 2017 International Colloquium on Logistics and Supply Chain Management (LOGISTIQUA). IEEE, 2017. http://dx.doi.org/10.1109/logistiqua.2017.7962894.

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Yue Fan et Qiying Hu. « Minimizing total cost in outpatient scheduling with unpunctual arrivals ». Dans 2016 13th International Conference on Service Systems and Service Management (ICSSSM). IEEE, 2016. http://dx.doi.org/10.1109/icsssm.2016.7538429.

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Toyoda, Shuichi, Noboru Niki et Hiromu Nishitani. « FUJI-Scheduler : Outpatient-Test-Order-Management Function for Order Entry System ». Dans Conference Proceedings. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 2006. http://dx.doi.org/10.1109/iembs.2006.259367.

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Rapports d'organisations sur le sujet "Outpatient management"

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McDonagh, Marian, Andrea C. Skelly, Amy Hermesch, Ellen Tilden, Erika D. Brodt, Tracy Dana, Shaun Ramirez et al. Cervical Ripening in the Outpatient Setting. Agency for Healthcare Research and Quality (AHRQ), mars 2021. http://dx.doi.org/10.23970/ahrqepccer238.

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Objectives. To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient setting (vs. inpatient, vs. other outpatient intervention) and of fetal surveillance when a prostaglandin is used for cervical ripening. Data sources. Electronic databases (Ovid® MEDLINE®, Embase®, CINAHL®, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) to July 2020; reference lists; and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) and cohort studies of cervical ripening comparing prostaglandins and mechanical methods in outpatient versus inpatient settings; one outpatient method versus another (including placebo or expectant management); and different methods/protocols for fetal surveillance in cervical ripening using prostaglandins. When data from similar study designs, populations, and outcomes were available, random effects using profile likelihood meta-analyses were conducted. Inconsistency (using I2) and small sample size bias (publication bias, if ≥10 studies) were assessed. Strength of evidence (SOE) was assessed. All review methods followed Agency for Healthcare Research and Quality Evidence-based Practice Center methods guidance. Results. We included 30 RCTs and 10 cohort studies (73% fair quality) involving 9,618 women. The evidence is most applicable to women aged 25 to 30 years with singleton, vertex presentation and low-risk pregnancies. No studies on fetal surveillance were found. The frequency of cesarean delivery (2 RCTs, 4 cohort studies) or suspected neonatal sepsis (2 RCTs) was not significantly different using outpatient versus inpatient dinoprostone for cervical ripening (SOE: low). In comparisons of outpatient versus inpatient single-balloon catheters (3 RCTs, 2 cohort studies), differences between groups on cesarean delivery, birth trauma (e.g., cephalohematoma), and uterine infection were small and not statistically significant (SOE: low), and while shoulder dystocia occurred less frequently in the outpatient group (1 RCT; 3% vs. 11%), the difference was not statistically significant (SOE: low). In comparing outpatient catheters and inpatient dinoprostone (1 double-balloon and 1 single-balloon RCT), the difference between groups for both cesarean delivery and postpartum hemorrhage was small and not statistically significant (SOE: low). Evidence on other outcomes in these comparisons and for misoprostol, double-balloon catheters, and hygroscopic dilators was insufficient to draw conclusions. In head to head comparisons in the outpatient setting, the frequency of cesarean delivery was not significantly different between 2.5 mg and 5 mg dinoprostone gel, or latex and silicone single-balloon catheters (1 RCT each, SOE: low). Differences between prostaglandins and placebo for cervical ripening were small and not significantly different for cesarean delivery (12 RCTs), shoulder dystocia (3 RCTs), or uterine infection (7 RCTs) (SOE: low). These findings did not change according to the specific prostaglandin, route of administration, study quality, or gestational age. Small, nonsignificant differences in the frequency of cesarean delivery (6 RCTs) and uterine infection (3 RCTs) were also found between dinoprostone and either membrane sweeping or expectant management (SOE: low). These findings did not change according to the specific prostaglandin or study quality. Evidence on other comparisons (e.g., single-balloon catheter vs. dinoprostone) or other outcomes was insufficient. For all comparisons, there was insufficient evidence on other important outcomes such as perinatal mortality and time from admission to vaginal birth. Limitations of the evidence include the quantity, quality, and sample sizes of trials for specific interventions, particularly rare harm outcomes. Conclusions. In women with low-risk pregnancies, the risk of cesarean delivery and fetal, neonatal, or maternal harms using either dinoprostone or single-balloon catheters was not significantly different for cervical ripening in the outpatient versus inpatient setting, and similar when compared with placebo, expectant management, or membrane sweeping in the outpatient setting. This evidence is low strength, and future studies are needed to confirm these findings.
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Quak, Evert-jan. Lessons Learned from Community-based Management of Acute Malnutrition (CMAM) Programmes that Operate in Fragile or Conflict Affected Settings. Institute of Development Studies (IDS), septembre 2021. http://dx.doi.org/10.19088/k4d.2021.133.

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This rapid review synthesises the literature on how community-based management of acute malnutrition (CMAM) programmes could be adapted in settings of conflict and fragility. It identifies multiple factors affecting the quality and effectiveness of CMAM services including the health system, community engagement and linkages with other programmes, including education, sanitation, and early childhood development. Family MUAC (Mid-Upper Arm Circumference) is a useful tool to increase community participation and detect early cases of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) more effectively and less likely to require inpatient care. The literature does not say a lot about m-Health solutions (using mobile devises and applications) in data collection and surveillance systems. Many of the above-mentioned issues are relevant for CMAM programmes in settings of non-emergency, emergency, conflict and fragility. However, there are special circumstance in conflict and fragile settings that need adaptation and simplification of the standard protocols. Because of a broken or partly broken health system in settings of conflict and fragility, local governments are not able to fund access to adequate inpatient and outpatient treatment centres. NGOs and humanitarian agencies are often able to set up stand-alone outpatient therapeutic programmes or mobile centres in the most affected regions. The training of community health volunteers (CHVs) is important and implementing Family MUAC. Importantly, research shows that: Low literacy of CHVs is not a problem to achieve good nutritional outcomes as long as protocols are simplified. Combined/simplified protocols are not inferior to standard protocols. However, due to complexities and low funding, treatment is focused on SAM and availability for children with MAM is far less prioritised, until they deteriorate to SAM. There is widespread confusion about combined/simplified protocol terminology and content, because there is no coherence at the global level.
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Totten, Annette, Dana M. Womack, Marian S. McDonagh, Cynthia Davis-O’Reilly, Jessica C. Griffin, Ian Blazina, Sara Grusing et Nancy Elder. Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication. Agency for Healthcare Research and Quality, décembre 2022. http://dx.doi.org/10.23970/ahrqepccer254.

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Objectives. To assess the use, effectiveness, and implementation of telehealth-supported provider-to-provider communication and collaboration for the provision of healthcare services to rural populations and to inform a scientific workshop convened by the National Institutes of Health Office of Disease Prevention on October 12–14, 2021. Data sources. We conducted a comprehensive literature search of Ovid MEDLINE®, CINAHL®, Embase®, and Cochrane CENTRAL. We searched for articles published from January 1, 2015, to October 12, 2021, to identify data on use of rural provider-to-provider telehealth (Key Question 1) and the same databases for articles published January 1, 2010, to October 12, 2021, for studies of effectiveness and implementation (Key Questions 2 and 3) and to identify methodological weaknesses in the research (Key Question 4). Additional sources were identified through reference lists, stakeholder suggestions, and responses to a Federal Register notice. Review methods. Our methods followed the Agency for Healthcare Research and Quality Methods Guide (available at https://effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview) and the PRISMA reporting guidelines. We used predefined criteria and dual review of abstracts and full-text articles to identify research results on (1) regional or national use, (2) effectiveness, (3) barriers and facilitators to implementation, and (4) methodological weakness in studies of provider-to-provider telehealth for rural populations. We assessed the risk of bias of the effectiveness studies using criteria specific to the different study designs and evaluated strength of evidence (SOE) for studies of similar telehealth interventions with similar outcomes. We categorized barriers and facilitators to implementation using the Consolidated Framework for Implementation Research (CFIR) and summarized methodological weaknesses of studies. Results. We included 166 studies reported in 179 publications. Studies on the degree of uptake of provider-to-provider telehealth were limited to specific clinical uses (pharmacy, psychiatry, emergency care, and stroke management) in seven studies using national or regional surveys and claims data. They reported variability across States and regions, but increasing uptake over time. Ninety-seven studies (20 trials and 77 observational studies) evaluated the effectiveness of provider-to-provider telehealth in rural settings, finding that there may be similar rates of transfers and lengths of stay with telehealth for inpatient consultations; similar mortality rates for remote intensive care unit care; similar clinical outcomes and transfer rates for neonates; improvements in medication adherence and treatment response in outpatient care for depression; improvements in some clinical monitoring measures for diabetes with endocrinology or pharmacy outpatient consultations; similar mortality or time to treatment when used to support emergency assessment and management of stroke, heart attack, or chest pain at rural hospitals; and similar rates of appropriate versus inappropriate transfers of critical care and trauma patients with specialist telehealth consultations for rural emergency departments (SOE: low). Studies of telehealth for education and mentoring of rural healthcare providers may result in intended changes in provider behavior and increases in provider knowledge, confidence, and self-efficacy (SOE: low). Patient outcomes were not frequently reported for telehealth provider education, but two studies reported improvement (SOE: low). Evidence for telehealth interventions for other clinical uses and outcomes was insufficient. We identified 67 program evaluations and qualitative studies that identified barriers and facilitators to rural provider-to-provider telehealth. Success was linked to well-functioning technology; sufficient resources, including time, staff, leadership, and equipment; and adequate payment or reimbursement. Some considerations may be unique to implementation of provider-to-provider telehealth in rural areas. These include the need for consultants to better understand the rural context; regional initiatives that pool resources among rural organizations that may not be able to support telehealth individually; and programs that can support care for infrequent as well as frequent clinical situations in rural practices. An assessment of methodological weaknesses found that studies were limited by less rigorous study designs, small sample sizes, and lack of analyses that address risks for bias. A key weakness was that studies did not assess or attempt to adjust for the risk that temporal changes may impact the results in studies that compared outcomes before and after telehealth implementation. Conclusions. While the evidence base is limited, what is available suggests that telehealth supporting provider-to-provider communications and collaboration may be beneficial. Telehealth studies report better patient outcomes in some clinical scenarios (e.g., outpatient care for depression or diabetes, education/mentoring) where telehealth interventions increase access to expertise and high-quality care. In other applications (e.g., inpatient care, emergency care), telehealth results in patient outcomes that are similar to usual care, which may be interpreted as a benefit when the purpose of telehealth is to make equivalent services available locally to rural residents. Most barriers to implementation are common to practice change efforts. Methodological weaknesses stem from weaker study designs, such as before-after studies, and small numbers of participants. The rapid increase in the use of telehealth in response to the Coronavirus disease 2019 (COVID-19) pandemic is likely to produce more data and offer opportunities for more rigorous studies.
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Chou, Roger, Jesse Wagner, Azrah Y. Ahmed, Ian Blazina, Erika Brodt, David I. Buckley, Tamara P. Cheney et al. Treatments for Acute Pain : A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), décembre 2020. http://dx.doi.org/10.23970/ahrqepccer240.

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Objectives. To evaluate the effectiveness and comparative effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic therapy in patients with specific types of acute pain, including effects on pain, function, quality of life, adverse events, and long-term use of opioids. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to August 2020, reference lists, and a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) of outpatient therapies for eight acute pain conditions: low back pain, neck pain, other musculoskeletal pain, neuropathic pain, postoperative pain following discharge, dental pain (surgical or nonsurgical), pain due to kidney stones, and pain due to sickle cell disease. Meta-analyses were conducted on pharmacologic therapy for dental pain and kidney stone pain, and likelihood of repeat or rescue medication use and adverse events. The magnitude of effects was classified as small, moderate, or large using previously defined criteria, and strength of evidence was assessed. Results. One hundred eighty-three RCTs on the comparative effectiveness of therapies for acute pain were included. Opioid therapy was probably less effective than nonsteroidal anti-inflammatory drugs (NSAIDs) for surgical dental pain and kidney stones, and might be similarly effective as NSAIDs for low back pain. Opioids and NSAIDs were more effective than acetaminophen for surgical dental pain, but opioids were less effective than acetaminophen for kidney stone pain. For postoperative pain, opioids were associated with increased likelihood of repeat or rescue analgesic use, but effects on pain intensity were inconsistent. Being prescribed an opioid for acute low back pain or postoperative pain was associated with increased likelihood of use of opioids at long-term followup versus not being prescribed, based on observational studies. Heat therapy was probably effective for acute low back pain, spinal manipulation might be effective for acute back pain with radiculopathy, acupressure might be effective for acute musculoskeletal pain, an opioid might be effective for acute neuropathic pain, massage might be effective for some types of postoperative pain, and a cervical collar or exercise might be effective for acute neck pain with radiculopathy. Most studies had methodological limitations. Effect sizes were primarily small to moderate for pain, the most commonly evaluated outcome. Opioids were associated with increased risk of short-term adverse events versus NSAIDs or acetaminophen, including any adverse event, nausea, dizziness, and somnolence. Serious adverse events were uncommon for all interventions, but studies were not designed to assess risk of overdose, opioid use disorder, or long-term harms. Evidence on how benefits or harms varied in subgroups was lacking. Conclusions. Opioid therapy was associated with decreased or similar effectiveness as an NSAID for some acute pain conditions, but with increased risk of short-term adverse events. Evidence on nonpharmacological therapies was limited, but heat therapy, spinal manipulation, massage, acupuncture, acupressure, a cervical collar, and exercise were effective for specific acute pain conditions. Research is needed to determine the comparative effectiveness of therapies for sickle cell pain, acute neuropathic pain, neck pain, and management of postoperative pain following discharge; effects of therapies for acute pain on non-pain outcomes; effects of therapies on long-term outcomes, including long-term opioid use; and how benefits and harms of therapies vary in subgroups.
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