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This concise handbook provides an update on topics in general pediatrics for general pediatricians in practice. It focuses on ambulatory pediatrics and includes topics dealing with newborns, children, and adolescents. The general format covers common topics in general pediatrics with a brief definition, brief epidemiology, brief review of symptomatology, brief discussion of approach to the topic, and then provides an emphasis on management of the condition/disorder being reviewed.

Little is known about recent trends in physician reporting of sleep apnea during outpatient practice visits. To assess trends in the frequency of adult outpatient visits for sleep apnea in the United States, the clinicians who provided those visits, and the characteristics of patients reported to have sleep apnea; and to assess whether the reporting of a diagnosis of sleep apnea varies across regions of the country as a function of body weight and insurance status. We reviewed annual stratified samples of patients identified as having sleep apnea during physician office visits in the U.S. National Ambulatory Medical Care Survey database, and during visits to hospital outpatient practices in the U.S. National Hospital Ambulatory Medical Care Survey database, between 1993 and 2010. The aggregate data set included records of 838,000 ambulatory practice visits. During this 17-year period, survey reports of a diagnosis of sleep apnea increased 14.6- fold, from 420,000 to 6.37 million per year (P = 0.0002). Thirty-three percent were reported by primary care providers, 17% by pulmonologists, and 10% by otolaryngologists. Over the period of observation, reports of a diagnosis of sleep apnea by \"other groups\" increased considerably (P < 0.001). The per capita rate of sleep apnea diagnoses per 1,000 persons per year differed across regions of the United States (P < 0.0001). Regions that reported a higher rate of sleep apnea appeared to be influenced by obesity (P < 0.001) and health insurance status (P < 0.005). Diagnoses of sleep apnea during outpatient visits to hospital-based and non-hospital-based practices in the United States were much more frequent in 2010 than in 1993, as reported by outpatient practice clinicians participating in national surveys. Although the majority of diagnoses of sleep apnea were reported by primary care providers, pulmonologists, and otolaryngologists (60%), there was a substantial increase in reports of sleep apnea by clinicians practicing other specialties during the study period. Reporting of a diagnosis of sleep apnea varied by obesity prevalence and health insurance status across U.S. geographic regions.

Background The prevalence of reflux disease is increasing. Health-care utilization including physician visits for this disorder is lacking. Our purpose was to analyze the trend in physician visits for GERD from the period 1995-2006 using the National Ambulatory Medical Care Survey. We also sought to determine health-care utilization for GERD indirectly by assessing prescription trends for proton-pump inhibitors and H2 receptor blockers during the period. Methods The National Ambulatory Medical Care Survey is a survey of approximately 3,000 office-based physicians that uses a three-stage probability sampling procedure to allow extrapolation to the US population. All visits between 1995 and 2006 for symptoms and/or diagnoses compatible with GERD were combined into a single categorical variable. Weighted data was utilized for descriptive and inferential statistical analysis. Results After weighting, there were N = 321,513 adult ambulatory care encounters for all diagnoses. Visits for reflux increased throughout the examined period. Using logistic regression, visits for reflux were associated with female gender, age over 40, and calcium channel blocker use. Proton-pump inhibitor use increased substantially during the study period while H2 blocker use declined. Family practitioners and internists saw the majority of reflux patients. Conclusions The frequency of ambulatory visits in the United States for gastroesophageal reflux disease increased significantly between 1995 and 2006. The use of PPI therapy is increasing even more substantially. Older age, female gender, and use of calcium channel blockers were associated with a higher frequency of GERD visits. Health-care utilization for this disorder is increasing perhaps due to our ever-increasing epidemic of obesity.

A practical, hands-on resource for physicians in all specialties,Medical Teaching in Ambulatory Care is a guide on training medical students and residents in settings such as private practices and hospital clinics.

To estimate and evaluate the sensitivity and specificity of providers' diagnosis codes and medication lists to identify outpatient visits by patients with diabetes. We used data from the 2006 to 2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We assessed the sensitivity and specificity of providers' diagnoses and medication lists to identify patients with diabetes, using the checkbox for diabetes as the gold standard. We then examined differences in sensitivity by patients' characteristics using multivariate logistic regression models. The checkbox identified 12,647 outpatient visits by adults with diabetes among the 70,352 visits used for this analysis. The sensitivity and specificity of providers' diagnoses or listed diabetes medications were 72.3% (95% CI: 70.8% to 73.8%) and 99.2% (99.1% to 99.4%), respectively. Diabetic patients ≥75years of age, women, non-Hispanics, and those with private insurance or Medicare were more likely to be missed by providers' diagnoses and medication lists. Diabetic patients who had more diagnosis codes and medications recorded, had glucose or hemoglobin A1c measured, or made office- rather than hospital-outpatient visits were less likely to be missed. Providers' diagnosis codes and medication lists fail to identify approximately one quarter of outpatient visits by patients with diabetes.

Nurses' clinical competence is a significant concern in all healthcare settings due to the necessity of delivering high-quality patient care. Understanding and addressing the factors related to competence are crucial for promoting nurses' clinical competence and ultimately improving patient outcomes. Producing and maintaining a skilled nursing workforce is essential to protect communities. This study aimed to assess the level of self-evaluated clinical competence and its correlation with demographic and occupational variables among registered nurses employed at selected outpatient clinics in Egypt. The study utilized a descriptive cross-sectional design with a self-administered, two-part questionnaire that assessed participants' demographic and occupational variables as well as perceived clinical competence in various healthcare settings. It took place at outpatient clinics of two governmental hospitals and five primary healthcare centers in Mansoura City, Egypt between January, and June 2023. A purposive sample of 450 nurses took part in this study. The average score of nurses' clinical competence was 155.3±7.2 out of 230, indicating a \"moderate level\". In terms of professional behaviors and general performance, the average score for clinical competence was 48.4±3.6 and 40.7±4.1 respectively. Additionally, the average score for clinical competence regarding core and advanced nursing skills were 43.4±3.0 and 22.8±1.5 respectively. Among the domains of clinical competence, the highest average score was associated with \"professional behaviors\" as it forms the backbone of nursing practice. There was a highly significant relationship between the average score of clinical competence and the participant's age, sex, level of education, and years of clinical work experience (P<0.001). Nurses perceived their level of clinical competence as moderate. To enhance nurses' clinical competence, future studies and interventions should focus on promoting supportive work environments, providing ongoing education and training in advanced nursing skills, and the fostering development of critical thinking skills in nurses.

Nurses' clinical competence is a significant concern in all healthcare settings due to the necessity of delivering high-quality patient care. Understanding and addressing the factors related to competence are crucial for promoting nurses' clinical competence and ultimately improving patient outcomes. Producing and maintaining a skilled nursing workforce is essential to protect communities. This study aimed to assess the level of self-evaluated clinical competence and its correlation with demographic and occupational variables among registered nurses employed at selected outpatient clinics in Egypt. The study utilized a descriptive cross-sectional design with a self-administered, two-part questionnaire that assessed participants' demographic and occupational variables as well as perceived clinical competence in various healthcare settings. It took place at outpatient clinics of two governmental hospitals and five primary healthcare centers in Mansoura City, Egypt between January, and June 2023. A purposive sample of 450 nurses took part in this study. The average score of nurses' clinical competence was 155.3±7.2 out of 230, indicating a \"moderate level\". In terms of professional behaviors and general performance, the average score for clinical competence was 48.4±3.6 and 40.7±4.1 respectively. Additionally, the average score for clinical competence regarding core and advanced nursing skills were 43.4±3.0 and 22.8±1.5 respectively. Among the domains of clinical competence, the highest average score was associated with \"professional behaviors\" as it forms the backbone of nursing practice. There was a highly significant relationship between the average score of clinical competence and the participant's age, sex, level of education, and years of clinical work experience (P<0.001). Nurses perceived their level of clinical competence as moderate. To enhance nurses' clinical competence, future studies and interventions should focus on promoting supportive work environments, providing ongoing education and training in advanced nursing skills, and the fostering development of critical thinking skills in nurses.

This handy pocket guide features a \"how to\" approach to common problems that require immediate attention in an ambulatory care setting. The book emphasizes the ability to handle urgent and emergent care situations quickly and efficiently with a focus on low-tech procedures and skills. Descriptions are concise and provide basic procedures with the necessary skills. More than 200 illustrations supplement the text. Plus, a \"Practical Tips\" section for easy learning.

Motivational interviewing provides a framework and tools to promote patient-centered engagement and change. This article focuses on motivational interviewing at the clinical care level, with emphasis on the motivational interviewing spirit and its four elements: partnership, acceptance, compassion, and empowerment.