Outpatient clinics

Assessments are both initial and ongoing. An initial assessment is made based on objective and subjective data collected when the patient is first seen in a hospital, outpatient clinic, health care provider s office, or other type of health care facility. The initial assessment usually is more thorough and provides a database (sometimes called baseline) from which later data can be compared and decisions made The initial assessment provides information that is analyzed to identify... 

A patient who is a recent immigrant to the United Spates is seen in the outpatient clinic for a severe upper respiratory infection. The primary health care provider prescribes a cephalosporin and asks you to give the patient instructions for taking the drug. You note that the patient appears to underhand very little English. Discuss how you would solve this problem. Determine what information you would include in a teaching plan... 

When taking the drug history of Mr. Woods, a patient in the outpatient clinic, you note that he has been taking... 

Ms. Carson is seen in the outpatient clinic for a severe respiratory infection and is prescribed ciprofloxacin. Discuss what you would include in the teaching plan for this patient. 

On a visit to an outpatient clinic, Ms. Cain tells you that die takes aspirin daily for the minor aches and pains die experiences. Determine what you might want to discuss with Ms. Cam to explore her use of this drug. Discuss what you might incorporate into the teaching plan to increase her knowledge of the drug and to prevent any complications. 

Each time the patient visits the outpatient clinic, the nurse evaluates the patient s response to therapy and looks for any signs that drug dependency might again be a problem. 

Mr. Johnson, age 78 years, has glaucoma and is prescribed the pilocarpine ocular system. On a visit to the outpatient clinic, Mr. Johnson tells you that he is having problems retaining the ocular system. You notice that his right eye is very red and inflamed. Determine how you can investigate this problem further with Mr. Johnson. Provide suggestions that will help Mr. Johnson to retain the system. 

The ongoing assessment usually occurs when the patient comes to an outpatient clinic for follow-up... 

Mr. Parker is at an outpatient clinic for a follow-up visit. He has been taking quinidine for several months for a cardiac arrhythmia. Analyze what assessments you would make on Mr. Parker to determine the effectiveness of quinidine therapy. Discuss what questions you would adz to determine the presence of any adverse reactions. 

Ms. Baxter, age 37years, has been taking insulin for the past 6 years for type 1 diabetes mellitus. An assessment at the outpatient clinic reveals a blood... 

A patient calls the outpatient clinic and says that she missed one day s dose of her birth control pills. Which of tiie following statements would be most appropriate for the nurse to make to the patient ... 

In contrast to chlordiazepoxide and diazepam, lorazepam and oxazepam are not metabolized into active compounds in the liver. Instead, they are excreted by the kidneys following glucuronidation. This is important because many alcohol-dependent patients have compromised liver function. Therefore, when treatment is initiated before the results of blood tests for liver function are known, as is often the case in outpatient clinics, lorazepam and oxazepam may be preferred. Patients with liver disease may still be treated with diazepam and chlordiazepoxide, but at lower doses. This can be accommodated with the loading technique, although hourly dosing with 5 mg of diazepam or 25 mg of chlordiazepoxide may be sufficient. 

In 1975, the first commercial entity was formed to provide multicenter, outpatient clinical trial contracting services in the United States. This was the beginning of the modern Contract Research Organization (CRO) industry. It is now composed of thousands of domesfic and infernafional firms involved in medical producf evaluations in humans. The total annual expense globally for clinical trials and related functions necessary for commercial, governmenf, and academic therapeutic product development is estimated at US 50 billion, of which about US 15 billion is outsourced to the contract services market. 

Site management organizations provide physician investigators, qualified patients, and support personnel for inpatient and outpatient clinical trials for single site or multicenter clinical trials. These firms provide services to sponsors and CROs. They are included in the CRO industry revenue totals, and unlike CROs they incorporate per pahent grant funds in their revenues. 

A central IRB is an "outside" or "independent" IRB. The central IRB serves to review research for non-IRB institutions, private practices, or outpatient clinical trials. Investigators conducting research in a noninshtutional setting often choose to use an established central IRB rather than forming their own. In addition, many hospitals and other instituhons are choosing to eliminate their internal IRBs and outsource this function. The benefits of the decision to outsource include ... 

Based on the work of Jarvis and coworkers, who measured cotinine levels in individuals attending outpatient clinics in the United Kingdom in the early 1980s,... 

Parents brought their 3-year-old boy to the outpatient clinic because of a facial rash. Today the patient was one of several children sent home from day care because of similar rashes. Physical examination revealed a normal, healthy boy with discrete erythematous papular eruptions on his cheeks. There were no vesicles or bullae. The rash was covered with a honey crust, suggesting impetigo. Which of the following treatments would be most appropriate ... 

Zimet, S., Farley, G., and Zimet, G. (1994a) Home behaviors of children in three settings an outpatient clinic, a day hospital and an inpatient hospital. J Am Acad Child Adolesc Psychiatry 33 56-59. 

In a retrospective chart review of 352 adult patients treated in an outpatient clinic with SSRI medications, 171 patients who had supervised discontinuation of their medication were compared to those who stayed on medication (Coupland et ah, 1996). The most common withdrawal symptom was, again, dizziness, but paresthesias, asthenia, nausea, visual disturbances, and headache were also common. Movement-induced exacerbation of symptoms were associated with discontinuation of paroxetine (16.0%) and fluvoxamine (7.0%). It seems prudent to recommend gradual titra-... 

Retrospective clinical review of fluoxetine treatment in an outpatient clinic (38)... 

Rates of polypharmacy appear to vary from setting to setting. For example, Kaplan and associates (1994) surveyed two public, university-affiliated outpatient clinics, one in New York and one in Ohio, discovering that the proportion of children who received multiple concurrent psychotropic medications differed between the two clinics. In Ohio, 22% of all medicated youths (ages 2 to 19 years) were treated with multiple psychotropic medications, while only 11 % of those medicated... 

A survey on the use of antidepressive agents by an entire country s child and adolescent psychiatric services was recently conducted in Denmark (5 million inhabitants) by sending a questionnaire to all child and adolescent psychiatric departments and specialists with private practices. The response rate from all in- and outpatient clinics as well as from specialists with their own practice was 93.5%. Thirty-two departments and specialists received the survey and 30 were returned. Practitioners were asked to go through their files and report the number of children on medication and the indications for the treatment. Altogether, approximately 5000 children and adolescents were in psychiatric care (out of approximately 1 million children and adolescents in the age group 0-19 years). Of these, 400 (8%) were treated with an antidepressant on the date of the survey (February 8). 

The Concise Guides Series from American Psychiatric Publishing, Inc., provides, in an accessible format, practical information for psychiatrists, psychiatry residents, and medical students working in a variety of treatment settings, such as inpatient psychiatry units, outpatient clinics, consultation-liaison services, and private offices. The Concise Guides are meant to complement the more detailed information to be found in lengthier psychiatry texts. 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

Bellack et al. (1981) reported on a comparative study involving 72 women with non-psychotic unipolar depression, of whom 60% came from a psychiatric outpatient clinic and 40% answered advertisements for treatment in the press and radio. They were aged 20 60 years with a mean age of 36 years. The patients were divided into the following treatment groups at random ... 

Jolley AG, Hirsch SR, McRink A, et ai. Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients clinical outcome at one year. BrMed J 1989 298 985-990. 

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