By the year 1990, it is projected that 50 per cent of all surgery in the United States will be performed on an outpatient basis. Both surgeons and anesthesiologists must understand patient and procedure prerequisites for outpatient surgery. The surgeon, prior to scheduling the operation, must evaluate the patient as to acceptability and provide that patient with complete information about the proposed outpatient experience. Anesthesia techniques (premedication, intravenous, inhalational, regional) must be modified and adapted to accomplish early patient ambulation and discharge to home on the same day as surgery. Patients must meet established clinical criteria prior to discharge and must be examined by a physician at the time these criteria have been met. The physician's clinical judgment is the single most important factor in determining the patient's home readiness.
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J Med Internet Res
January 2025
Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Background: Sepsis, a critical global health challenge, accounted for approximately 20% of worldwide deaths in 2017. Although the Sequential Organ Failure Assessment (SOFA) score standardizes the diagnosis of organ dysfunction, early sepsis detection remains challenging due to its insidious symptoms. Current diagnostic methods, including clinical assessments and laboratory tests, frequently lack the speed and specificity needed for timely intervention, particularly in vulnerable populations such as older adults, intensive care unit (ICU) patients, and those with compromised immune systems.
View Article and Find Full Text PDFJ Med Internet Res
January 2025
Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, US.
Background: Most cancer survivors have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association's Life's Simple 7 cardiovascular health (CVH) metrics to promote CVH assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors.
View Article and Find Full Text PDFPrim Care Companion CNS Disord
January 2025
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
View Article and Find Full Text PDFJ Med Internet Res
January 2025
Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, US.
Background: Virtual patients (VPs) are computer screen-based simulations of patient-clinician encounters. VP use is limited by cost and low scalability.
Objective: Show proof-of-concept that VPs powered by large language models (LLMs) generate authentic dialogs, accurate representations of patient preferences, and personalized feedback on clinical performance; and explore LLMs for rating dialog and feedback quality.
PLoS One
January 2025
Department of Neurology, University of Virginia, Charlottesville, Virginia, United States of America.
We examine the efficacy of the Individualized Coordination and Empowerment for Care Partners of Persons with Dementia (ICECaP), an intervention that involves one-on-one individualized support from a dementia care coordinator for a dementia care partner, compared to an active control group. At least once monthly contact is made from a dementia care coordinator to the dementia care partner by telephone, video conferencing, email, or in-person support at clinical visits for the person with dementia. In this pilot randomized unblinded control trial of ICECaP, n = 61 (n = 90 randomized) care partners completed 12-months of the ICECaP intervention and n = 69 (n = 92 randomized) care partners received routine clinical support (controls) in an outpatient memory care clinic at an academic medical center, from which the participants were recruited.
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