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BackgroundA recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment.ObjectiveThis study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non–dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment.Design and participants/settingThe ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non–dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23).Main outcome measuresStatements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale.Statistical analysis performedOne-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings.ResultsThirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants’ understanding of core responsibilities of dietitians in ED treatment and dietitians “drifting” from delivering evidence-based components of dietetic treatment.ConclusionsResults of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with individuals with lived experience.  相似文献   
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目的:探讨音乐干预对门诊肌内注射患儿心理状态和治疗配合度的影响。方法:将130例门诊肌内注射患儿按照随机数字表法分为观察组和对照组各65例,观察组注射时给予音乐干预,对照组注射时无任何背景音乐;比较两组干预后疼痛情况[采用Wong-Baker面部表情量表],比较两组干预前后心理状态[采用儿童焦虑性情绪障碍筛查表(SCARED)和儿童抑郁障碍自评量表(DSRSC)],比较两组哭闹时间及治疗配合度。结果:观察组Wong-Baker量表评分低于对照组(P<0.05),哭闹时间短于对照组(P<0.05);干预后,两组SCARED、DSRSC评分均低于干预前(P<0.05),且观察组低于对照组(P<0.05);观察组治疗配合度高于对照组(P<0.05)。结论:音乐干预能减轻门诊肌内注射患儿疼痛感,缩短哭闹时间,缓解不良情绪,提高患儿治疗配合度。  相似文献   
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ObjectiveMotivating older adults to follow up with an outpatient clinician after discharge from emergency departments (ED) is beneficial yet challenging. We aimed to answer whether psychological needs for motivation and discrete emotions observed by care transition coaches would predict this behavioral outcome.MethodsCommunity-dwelling older adults following ED discharge were recruited from three EDs in two U.S. states. We examined home visit notes documented by coaches (N = 725). Retrospective chart reviews of medical records tracked participants’ health care utilization for 30 days.ResultsObserved knowledge-based competence predicted higher likelihood of outpatient follow-up within 30 days, while observed sadness predicted a lower likelihood of follow-up within seven days following discharge. Moreover, participants who demonstrated happiness were marginally more likely to have an in-person follow-up within seven days, and those who demonstrated knowledge-based competence were more likely to have an electronic follow-up within 30 days.ConclusionsKnowledge-based competence and emotions, as observed and documented in coach notes, can predict older adults’ subsequent outpatient follow-up following their ED-discharge.Practice implicationsIntervention programs might encourage coaches to check knowledge-based competence and to observe emotions in addition to delivering the content. Coaches could also customize strategies for patients with different recommended timeframes of follow-up.  相似文献   
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BackgroundTo enable services to be provided at a distance during the COVID-19 pandemic, outpatient pharmacy services in Australia underwent near-immediate reform by moving to telehealth, including telephone and video consults.ObjectiveTo investigate how telehealth was used in a metropolitan outpatient pharmacy setting before and after the start of the COVID-19 restrictions and the various influences on the uptake of phone and video modalities.MethodsA multi-methods approach was used including: (1) quantifying administrative activity data between July 2019 to December 2020 and, (2) semi-structured interviews with key stakeholders (n = 34).ResultsActivity data: Between July 2019 to December 2020 16,377 outpatient pharmacy consults were provided. Of these, 13,543 (83%) were provided in-person, 2,608 (16%) by telephone and 226 (1.4%) by video consult. COVID-19 impacted how these services were provided with telephone activity more than four-times higher in April 2020 than March 2020 and slight increases in video consults. Pharmacists have heavily favoured using the telephone despite the recommendation that video consults be used as the primary mode of contact and that telephone only be used when a video consult was not possible. As soon as COVID-19 restrictions eased, clinicians gradually returned to in-person appointments, maintaining some use of telephone and very limited use of video consult. Semi-structured interviews: Whilst clinicians recognised the potential benefits of video consults, challenges to routine use included the additional administrative and planning work required pre-consult, perceptions that patients were unable to use the technology, and the belief that in-person care was ‘better’ and that the telephone was easier.ConclusionOrganisational strategies that encouraged the use of video over telephone (e.g. through financial incentives) did not appear to influence clinicians’ choice of care modality. Implementation studies are required to co-develop solutions to embed telehealth options into outpatient pharmacy settings that provide the best experience for both patients and clinicians.  相似文献   
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目的 分析中国不同地区中老年居民门诊服务利用现状及其影响因素。方法 基于2018年CHARLS第四次调查,将中国28个省份划分为东中西部三个地区,依据安德森模型对19 136例中老年居民门诊服务利用的影响因素采用二分类多水平Logistic回归模型进行探讨。结果 我国中老年居民慢性病患病率为44.7%,其中,西部地区慢性病患病率最高(47.3%),四周就诊率最高(18.2%); 不同地区中老年居民门诊服务利用的影响因素有所不同,东部地区,女性(男性OR=0.782,95%CI:0.675~0.905)、文化水平较高(OR=1.853,95%CI:1.197~2.869)、丧偶者(OR=1.317,95%CI:1.081~1.605)四周就诊的可能性增加; 在中部地区,参加城镇职工医保(OR=2.094,95%CI:1.123~3.903)或新农合(OR=1.952,95%CI:1.069~3.563)、轻度失能(OR=1.440,95%CI:1.099~1.885)的居民四周就诊的可能性增加; 在西部地区,女性四周就诊的可能性高于男性(OR=0.718,95%CI:0.628~0.821); 三个地区均显示自评健康状况越差、慢性病患者四周就诊的可能性更高(P<0.05)。结论 我国不同地区中老年居民门诊服务利用的影响因素有所不同,自评健康状况和慢性病是三个地区四周就诊率相同的影响因素因此,在配置门诊医疗资源时,应针对不同地区的中老年人群特点进行合理倾斜。  相似文献   
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摘 要 目的:分析生殖医学中心门诊超说明书用药情况,为临床合理用药提供参考,并进一步规范临床超说明书用药行为。 方法: 采用回顾性调查法,抽取2018年1~12月生殖医学中心门诊处方中所有超说明书用药处方,根据药品说明书,对超说明书用药处方进行统计分析,查阅相关指南、文献等对其用药合理性进行分析评价。 结果: 超说明书用药类型包括超适应证用药、超剂量用药和超给药途径用药。黄体酮注射液、左卡尼汀口服液、雌二醇/雌二醇地屈孕酮片等均有相关国内外指南推荐,循证医学证据级别较高,其超说明书用药较合理;羟乙基淀粉200/0.5氯化钠注射液、戊酸雌二醇片、辅酶Q10片等其有效等级有效性具有争议;硒酵母片、维生素E胶丸未见相关文献、指南、国内外权威医学专著等报道,属于经验用药。 结论: 某院生殖医学中心门诊超说明书用药的现象广泛存在,虽然多数有循证医学证据支持,但也存在不合理用药现象。医院应重视超说明书用药情况,并建立相关管理制度予以规范,临床医师应当谨慎用药,药师应当严谨审方发药,从而降低超说明书用药带来的执业风险,促进医院合理用药水平。  相似文献   
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目的了解中国人民解放军联勤保障部队第九九一医院门诊药房近年退药情况,分析退药的原因,提出管理对策。方法收集中国人民解放军联勤保障部队第九九一医院2017年1-12月退药处方641张,从门诊药房退药原因、退药种类和退药剂型等方面分析导致退药的因素。结果门诊退药主要原因是药品不良反应,占全部退药的54.29%;抗菌药物是退药种类最多的药品,在退药剂型中最多的为粉针剂型。结论医院应加强对退药管理的制度化和规范化,提高合理用药水平,减少退药情况发生。  相似文献   
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目的探讨沟通技巧在产科门诊分诊中的应用价值。方法选取2018年1-12月期间收入该院治疗的98名待产妇,均分为对照组(n=49)、观察组(n=49),对照组实施常规门诊分诊管理,观察组在对照组的基础上加以沟通技巧,对比两组护理效果以及不良事件的发生情况。结果实施管理前,两组护理质量、服务态度、沟通能力比较,差异无统计学意义(P>0.05)。实施管理后,观察组患者的护理质量评分(85.74±7.87)分、服务态度(86.58±7.89)分、沟通能力(87.9±7.96)分,均好于对照组护理质量评分(76.58±8.58)分、服务态度(75.87±8.47)分、沟通能力(76.81±8.25)分,差异有统计学意义(P<0.05)。且护理纠纷事件、漏诊事件、误诊事件的总发生几率为2.04%显著低于对照组护理纠纷事件、漏诊事件、误诊事件的总发生几率18.36%,差异有统计学意义(P<0.05)。结论沟通技巧的实施,可提高产科门诊分诊质量,降低不良事件的发生风险,值得临床应用与推广。  相似文献   
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