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Duval GT, Raud E, Gohier H, Dramé M, Tabue-Teguo M, Annweiler C. Orthostatic hypotension and cognitive impairment: Systematic review and meta-analysis of longitudinal studies. Maturitas 2024; 185:107866. [PMID: 38604094 DOI: 10.1016/j.maturitas.2023.107866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 04/13/2024]
Abstract
The association between cognitive disorders and orthostatic hypotension (OH) has been empirically explored, but the results have been divergent, casting doubt on the presence and direction of the association. The objective of this meta-analysis was to systematically review and quantitatively synthesize the association of OH and cognitive function, specifically mean score on the Mini-Mental State Examination (MMSE), cognitive impairment and incident dementia. A Medline search was conducted in May 2022 with no date limit, using the MeSH terms "orthostatic hypotension" OR "orthostatic intolerance" OR "hypotension" combined with the Mesh terms "cognitive dysfunction" OR "Alzheimer disease" OR "dementia" OR "cognition disorder" OR "neurocognitive disorder" OR "cognition" OR "neuropsychological test". Of the 746 selected studies, 15 longitudinal studies met the selection criteria, of which i) 5 studies were eligible for meta-analysis of mean MMSE score comparison, ii) 5 studies for the association of OH and cognitive impairment, and iii) 6 studies for the association between OH and incident dementia. The pooled effect size in fixed-effects meta-analysis was: i) -0.25 (-0.42; -0.07) for the mean MMSE score, which indicates that the MMSE score was lower for those with OH; ii) OR (95 % CI) = 1.278 (1.162; 1.405), P < 0.0001, indicating a 28 % greater risk of cognitive impairment for those with OH at baseline; and iii) HR (95 % CI) = 1.267 (1.156; 1.388), P < 0.0001, indicating a 27 % greater risk of incident dementia for those with OH at baseline. Patients with OH had a lower MMSE score and higher risk of cognitive impairment and incident dementia in this meta-analysis of longitudinal studies. This study confirmed the presence of an association between OH and cognitive disorders in older adults.
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Affiliation(s)
- Guillaume T Duval
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
| | - Eve Raud
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Hugo Gohier
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Moustapha Dramé
- University of the French West Indies, EpiCliV Research Unit, Fort-de-France, Martinique; University Hospitals of Martinique, Department of Clinical Research and Innovation, Fort-de-France, Martinique
| | - Maturin Tabue-Teguo
- Department of Geriatrics, University Hospital of Martinique, Fort-de-France, Martinique
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, St. Joseph's Health Care London, Gait and Brain Lab, Lawson Health Research Institute, the University of Western Ontario, London, ON, Canada; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Starmans NLP, Wolters FJ, Leeuwis AE, Bron EE, de Bresser J, Brunner-La Rocca HP, Staals J, Muller M, Biessels GJ, Kappelle LJ. Orthostatic hypotension, cognition and structural brain imaging in hemodynamically impaired patients. J Neurol Sci 2024; 461:123026. [PMID: 38723328 DOI: 10.1016/j.jns.2024.123026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Orthostatic hypotension (OH) is associated with an increased risk of dementia, potentially attributable to cerebral hypoperfusion. We investigated which patterns and characteristics of OH are related to cognition or to potentially underlying structural brain injury in hemodynamically impaired patients and healthy reference participants. METHODS Participants with carotid occlusive disease or heart failure, and reference participants from the Heart-Brain Connection Study underwent OH measurements, neuropsychological assessment and brain MRI. We analyzed the association between OH, global cognitive functioning, white matter hyperintensity (WMH) volume and brain parenchymal fraction with linear regression. We stratified by participant group, severity and duration of OH, chronotropic incompetence and presence of orthostatic symptoms. RESULTS Of 337 participants (mean age 67.3 ± 8.8 years, 118 (35.0%) women), 113 (33.5%) had OH. Overall, presence of OH was not associated with cognitive functioning (β: -0.12 [-0.24-0.00]), but we did observe worse cognitive functioning in those with severe OH (≥ 30/15 mmHg; β: -0.18 [-0.34 to -0.02]) and clinically manifest OH (β: -0.30 [-0.52 to -0.08]). These associations did not differ significantly by OH duration or chronotropic incompetence, and were similar between patient groups and reference participants. Similarly, both severe OH and clinically manifest OH were associated with a lower brain parenchymal fraction, and severe OH also with a somewhat higher WMH volume. CONCLUSIONS Severe OH and clinically manifest OH are associated with worse cognitive functioning. This supports the notion that specific patterns and characteristics of OH determine its impact on brain health.
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Affiliation(s)
- Naomi L P Starmans
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Anna E Leeuwis
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
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Vidal-Petiot E, Pathak A, Azulay JP, Pavy-Le Traon A, Hanon O. Orthostatic hypotension: Review and expert position statement. Rev Neurol (Paris) 2024; 180:53-64. [PMID: 38123372 DOI: 10.1016/j.neurol.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20mmHg or a drop in diastolic blood pressure of at least 10mmHg within 3minutes of standing. It is a common disorder, especially in high-risk populations such as elderly subjects and patients with neurological diseases, and is associated with markedly increased morbidity and mortality. Its management can be challenging, particularly in cases where supine hypertension is associated with severe orthostatic hypotension. Education of the patient, non-pharmacological measures, and drug adaptation are the cornerstones of treatment. Pharmacological treatment should be individualized according to the severity, underlying cause, 24-hour blood pressure profile, and associated coexisting conditions. First-line therapies are midodrine and fludrocortisone, which may need to be combined for optimal care of severe cases.
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Affiliation(s)
- E Vidal-Petiot
- Service de physiologie, ESH Excellence Center, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France; INSERM U1148, Université Paris-Cité and Université Sorbonne Paris Nord, LVTS, 75018 Paris, France.
| | - A Pathak
- Service de cardiologie, ESH Excellence Center, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98000 Monaco, France
| | - J-P Azulay
- Service de neurologie et pathologie du mouvement, hôpital de la Timone, 13385 Marseille cedex 05, France
| | - A Pavy-Le Traon
- Service de neurologie, CHU de Toulouse, 31059 Toulouse cedex, France; UMR 1297, institut des maladies métaboliques et cardiovasculaires, Toulouse, France
| | - O Hanon
- Service de gériatrie, université Paris-Cité, EA4468, hôpital Broca, AP-HP, 75013 Paris, France
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4
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Almutairi A, Alrebdi M, Kalevaru CS, Jahan S. Three years versus four years Saudi Board Family Medicine program: Graduates' academic performance, perceptions, burnout, and satisfaction with professional life. J Family Med Prim Care 2023; 12:2786-2796. [PMID: 38186826 PMCID: PMC10771212 DOI: 10.4103/jfmpc.jfmpc_917_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 01/09/2024] Open
Abstract
Background The specialty of family medicine, established in Saudi Arabia in the 1980s, has rapidly progressed in healthcare settings and is increasingly utilized by the population as well as recent MBBS graduates. Universally, there is ambiguity in the duration, curriculum, and assessment methods used in family medicine specialization programs. Methodology A cross-sectional study was conducted among 183 fresh graduates from a 3-year and 4-year residency program. Data were collected using electronic forms, which were subsequently transferred to Microsoft Excel. Following appropriate coding, the data were transferred to SPSS for analysis. The dataset was then cleaned, and statistical tests, such as Chi-square and independent t-tests, were used to draw inferences. Results Males (50.3%) and females (49.7%) had almost equal distribution in the study. Overall, 67.6% of respondents had passed the final exam; the pass percentage was 69.3% for the 3-year residency program and 66.4% for the 4-year program. The overall mean score for perceived achievement of SaudiMED-FM 2020 competencies was 23.06 ± 5.52 out of a total score of 30. On comparing the 3-year versus 4-year residency program, there was no statistically significant difference between perceived competency scores and professional satisfaction scores. Among the study participants, 19 (10.4%) had 'serious burnout', and 22 (12%) had 'extremely serious burnout'. Professional satisfaction was significantly associated with burnout (P = 0.006). Conclusions Based on the study results, there was no significant difference regarding academic performance, perceived competencies, and professional satisfaction among the graduates of the 3-year versus 4-year residency program. Approximately more than half of the graduates had suffered from burnout which was reported more by the females and those with financial issues. The majority of the respondents suggested improvements in clinical rotation and assessment methods.
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Affiliation(s)
- Abdulaziz Almutairi
- Trainer, Family Medicine Academy, Qassim Health Cluster, Buraidah, Saudi Arabia
| | - Muath Alrebdi
- Trainer, Family Medicine Academy, Qassim Health Cluster, Buraidah, Saudi Arabia
| | | | - Saulat Jahan
- Trainer, Family Medicine Academy, Qassim Health Cluster, Buraidah, Saudi Arabia
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ShahAli S, Shahabi S, Etemadi M, Hedayati M, Anne BC, Mojgani P, Behzadifar M, Lankarani KB. Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research. Heliyon 2023; 9:e20736. [PMID: 37860510 PMCID: PMC10582494 DOI: 10.1016/j.heliyon.2023.e20736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.
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Affiliation(s)
- Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manal Etemadi
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Maryam Hedayati
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Barth Cornelia Anne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Dublin, Ireland
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Pande BS, Patel AR, Patil AJ, Patel S, Shaikh MU. Quality in neonatal mortality audits: Results of pilot study from district of Dhule, Maharashtra. J Family Med Prim Care 2023; 12:2032-2035. [PMID: 38024895 PMCID: PMC10657104 DOI: 10.4103/jfmpc.jfmpc_178_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction As per WHO guidelines, it is important to have quality among mortality audit documents to improve outcome in health services. Objective To assess quality of facility-based neonatal mortality audits implementation. Methodology Mixed-method descriptive analysis was conducted. Totally, 96 death review documents were reviewed. The 25 healthcare workers were interviewed in depth. Observation analysis done for audit meetings using WHO modified checklist for quality in audit toolkit. Results The observation of audit meetings highlighted that almost half of the members were not communicated regarding vision of audit and framework of audit and review meetings. In quantitative analysis, it was found that secondary care hospitals were not having accuracy and consistency in audit documentation. Conclusion The quality of neonatal death audit was poor due to challenges faced by the hospitals in creating an enabling atmosphere, which can be overcome by sharing the vision of audit with the whole staff of the hospital. A standard operating procedure for audit committee to be adopted to implement action plans. Commitment, investment, and intentional leadership from everyone, including all healthcare workers, can make these ambitious goals attainable.
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Affiliation(s)
| | | | | | - Shraddha Patel
- Community Medicine Departments, ACPM Medical College, Dhule, Maharashtra, India
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Noghabi FA, Yousefi M, Golalipour E, Zarei A, Yousefi H, Sadeghi T. Lived experience caring for a child with Covid-19 disease: A phenomenological study. Heliyon 2023; 9:e18481. [PMID: 37533988 PMCID: PMC10392080 DOI: 10.1016/j.heliyon.2023.e18481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Caregivers of COVID-19 patients, including mothers with an infected child, are affected by adverse physical and psychological effects. Since mothers perform an important role in caring for a child with Covid-19, explaining their challenges and experiences positively affects the health conditions of children and society, in general. Aim This study aimed to explain mothers' experiences with children diagnosed with COVID-19, who were referred to Bandar Abbas Children's Hospital. Method The present study was qualitative and used the Van-Manen method. The statistical population included 13 mothers with children hospitalized for coronary heart disease and COVID-19, who were selected by purposive sampling. Semi-structured interviews were implemented to collect data until saturation. Data analysis was performed using MAXQDA 10 software. Lincoln and Guba's criteria were used to evaluate the data's accuracy and strength. Results The mean age of mothers participating in the study was 37.92 ± 4.87. On the other hand, the mean age of children was 5.15 ± 2.07 years. Three main themes and 13 sub-themes were extracted from the data analysis. The main themes were "Inability to Caring", "Mental and Physical drain" and "Conflict of Roles and Responsibilities". In this study, when a child develops COVID-19 disease, the mother experiences a series of negative emotions, which lead to feelings of helplessness and inability to care for the child. Conclusion Mental and physical manifestations strains were the most important issues that the mothers experienced. The majority of the participants need psychological support to cope with the disease. Therefore, it is recommended to make a proper design to psychologically and socially support these mothers, while alleviating the physical manifestations of their children's disease.
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Affiliation(s)
- Fariba Asadi Noghabi
- Mother and Child Welfare Research Center, Department of Nursing, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohsen Yousefi
- School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Elnaz Golalipour
- School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Aref Zarei
- Department of Nursing, School of Nursing and Midwifery, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar, Abbas, Iran
| | - Hadi Yousefi
- Department of social medicine,faculty of medicine, Hormozgan University of Medical Sciences, Bandar,Abbas, Iran
| | - Tahereh Sadeghi
- Clinical Research Development Unit of Akbar Hospital, Department of Pediatrics, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Cuspidi C, Gherbesi E, Tadic M. Diabetes and orthostatic hypotension: are all patients created equal? J Hypertens 2023; 41:1217-1218. [PMID: 37259781 DOI: 10.1097/hjh.0000000000003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital 'Dr Dragisa Misovic-Dedinje', Belgrade, Serbia
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Komaikul J, Ruangdachsuwan S, Wanlayaporn D, Palabodeewat S, Punyahathaikul S, Churod T, Choonong R, Kitisripanya T. Effect of andrographolide and deep eutectic solvent extracts of Andrographis paniculata on human coronavirus organ culture 43 (HCoV-OC43). PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 112:154708. [PMID: 36805485 PMCID: PMC9905047 DOI: 10.1016/j.phymed.2023.154708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/19/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Andrographis paniculata (Burm. f.) Nees has demonstrated potential for treating infections caused by coronaviruses. However, no antiviral activity of andrographolide or A. paniculata extracts against human coronavirus organ culture 43 (HCoV-OC43) has been reported. PURPOSE This study aimed to evaluate the anti-HCoV-OC43 effect of andrographolide and A. paniculata as well as the correlation between andrographolide concentration and the anti-HCoV-OC43 activity of A. paniculata extracts. METHODS This study evaluated and compared the in vitro anti-HCoV-OC43 activities of various A. paniculata extracts and andrographolide. To obtain A. paniculata extracts with different concentrations of andrographolide and its components, methanol and deep eutectic solvents (DES) were used to extract the aerial parts of A. paniculata. Andrographolide content was determined using UV-HPLC, and antiviral activity was assessed in HCT-8 colon cells. RESULTS The methanol and five acidic DES (containing malic acid or citric acid) extracts of A. paniculata exerted anti-HCoV-OC43 activity. Antiviral activity had a moderately strong positive linear relationship (r = 0.7938) with andrographolide content. Although the methanol extract contained the highest andrographolide content (2.34 mg/ml), its anti-HCoV-OC43 activity was lower than that of the DES extracts containing lower andrographolide concentrations (0.92-1.46 mg/ml). CONCLUSION Methanol and the five acidic DES extracts of A. paniculata exhibited anti-HCoV-OC43 activity. However, the in vitro antiviral activity of A. paniculata extracts did not have a very strong positive linear relationship (r < 0.8) with andrographolide concentration in the extract. As a result, when comparing A. paniculata extracts, the anti-HCoV-OC43 test could provide a different result from the andrographolide concentration determination.
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Affiliation(s)
- Jukrapun Komaikul
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Sasiporn Ruangdachsuwan
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Duangnapa Wanlayaporn
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Somnuek Palabodeewat
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Surat Punyahathaikul
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Theeraporn Churod
- Center for Vaccine Development, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | | | - Tharita Kitisripanya
- Department of Pharmacognosy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
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10
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Bhanu C, Petersen I, Orlu M, Davis D, Walters K. Incidence of postural hypotension recorded in UK general practice: an electronic health records study. Br J Gen Pract 2023; 73:e9-e15. [PMID: 36253110 PMCID: PMC9591019 DOI: 10.3399/bjgp.2022.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Postural hypotension is a common condition associated with adverse outcomes in older adults. General practice plays an important role in identification of the condition. AIM To examine the incidence of postural hypotension between 2008 and 2018 in general practice and how trends vary by age, sex, year, and social deprivation. DESIGN AND SETTING Retrospective cohort study using electronic health records from the IQVIA Medical Research Data (IMRD) between 2008 and 2018. METHOD Patients were included if they were aged ≥50 years. Incident postural hypotension was identified as a new (first) recording of a postural hypotension code. Recording of incident postural hypotension was estimated per 10 000 person-years at risk (PYAR) according to age, sex, year, and social deprivation. Incident rate ratios were estimated by multivariable Poisson regression. RESULTS Of 2 911 260 patients, 24 973 had an electronic record indicating a new diagnosis of postural hypotension between 2008 and 2018. This was equivalent to 17.9 cases per 10 000 PYAR in males (95% confidence interval [CI] = 17.6 to 18.2) and 16.2 cases per 10 000 PYAR in females (95% CI = 15.9 to 16.5). A significant age-sex interaction was identified. Recorded postural hypotension rate increased with age and social deprivation, and reduced between 2008 and 2018. The rate was higher in males compared with females, particularly in older age groups (>80 years). CONCLUSION To the authors' knowledge, this is the first study to quantify incident recorded postural hypotension in general practice. The rate is lower than expected compared with studies in screened older populations. Potential barriers to identification include underreporting, underdetection owing to lack of time and/or poorly standardised methods of measurement, and poor coding. Future research should investigate current practice and approaches for increased detection such as education, practical methods of screening, and standardised measurement of postural blood pressure.
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Affiliation(s)
- Cini Bhanu
- Research Department of Primary Care and Population Health, University College London, London
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London
| | - Mine Orlu
- UCL School of Pharmacy, University College London, London
| | - Daniel Davis
- MRC Unit for Lifelong Health & Ageing, University College London, London
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London
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Clark CE. Hypertension and hypotension: getting the balance right. Br J Gen Pract 2023; 73:6-7. [PMID: 36543552 PMCID: PMC9799343 DOI: 10.3399/bjgp23x731493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, Faculty of Health and Life Sciences, University of Exeter Medical School, Exeter
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12
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Alharbi S, Flemban AF, Kabrah SM, Khogeer AA, Alahmdi H, Mansour AA, Qari AK, Alqasimi GJ, Almasoudi LS, Alotaibi RS, Alskhairi RF, AlHarbi RA. The Association between Colorectal Cancer and Colonoscopic Conditions in Saudi Patients: A 10-Year Cross-Sectional-Retrospective Study. Ethiop J Health Sci 2022; 32:1157-1166. [PMID: 36475247 PMCID: PMC9692146 DOI: 10.4314/ejhs.v32i6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022] Open
Abstract
Background In Saudi Arabia, colorectal cancer (CRC) is the most common cancer in males and the third most common cancer in females. The current gold standard for colorectal cancer diagnosis is colonoscopy. Several concerns regarding the balance of ordering colonoscopy procedures for patients presenting with signs and symptoms. There are also several concerns regarding over-ordering the procedure when unnecessary. The current study aimed to evaluate the association between colorectal cancer and colonoscopic conditions in Saudi patients. Methods A 10-year cross-sectional study was conducted at Alnoor Specialty Hospital, Makkah, over the last ten years. Colonoscopy reports of patients were evaluated to identify the colonoscopy manifestations associated with mass, polyps, and bleeding. Results The current study evaluated 2158 cases admitted to the hospital for colonoscopic diagnosis. Results indicated that most of the patients were males (55.4%). Additionally, results showed a significant statistical association between tumor and bleeding, polyp, and hemorrhage. Moreover, it highlighted the association between polyps and bleeding, inflammation, and diverticulosis. Conclusion CRC screening in Saudi Arabia is comprehensive; however, there are a few areas for improvement, including standardization of colorectal cancer pathology reporting to improve the health system's quality. Also, the current study identified conditions that are significantly associated with reported colon polyps and tumors, which could aid in stratifying patients selected for screening via colonoscopy.
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Affiliation(s)
- Samah Alharbi
- Physiology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Arwa F Flemban
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Saeed M Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Asim A Khogeer
- Research Department, The Strategic Planning Administration, General Directorate of Health Affairs Makkah Region, Ministry of Health, Makkah, Kingdom of Saudi Arabia, Medical Genetics Unit, Maternity & Children Hospital, Makkah Healthcare Cluster, Ministry of Health, Makkah, Kingdom of Saudi Arabia
| | - Hanaa Alahmdi
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ahmed Abu Mansour
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Adwa K Qari
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ghadi J Alqasimi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Lama S Almasoudi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Rahaf S Alotaibi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Raneem F Alskhairi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Rozan A AlHarbi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
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13
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Masoli JAH, Mensah E, Rajkumar C. Age and ageing cardiovascular collection: blood pressure, coronary heart disease and heart failure. Age Ageing 2022; 51:6657798. [PMID: 35934320 DOI: 10.1093/ageing/afac179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Indexed: 01/25/2023] Open
Abstract
As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care.
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Affiliation(s)
- Jane A H Masoli
- Healthcare for Older People, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.,Institute of Biomedical and Clinical Science, University of Exeter, Exeter UK
| | - Ekow Mensah
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK.,Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
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14
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Keshavarzi MH, Safaie S, Faghihi SAA, Zare S. Barriers of physician-patient relationships in professionalism: A qualitative study. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2022; 10:199-206. [PMID: 35910520 PMCID: PMC9309164 DOI: 10.30476/jamp.2022.94010.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Undoubtedly, there are several obstacles in the path of medical professionalism. This study examines these obstacles in the relationship between physician and patient. Therefore, this study was conducted to explore the barriers of physician-patient relationships in professionalism based on physician experiences. METHODS It was a qualitative study with a conventional content analysis approach. Our participants were 14 patients and 11 physicians. The sampling method was purposive, and data was collected through semi-structured interviews and field notes. Interviews continued until data saturation. RESULTS Findings of the study regarding barriers of patient-physician relationship were classified into five main categories: misperception of the physician's identity, unprofessional behavior of the physician, physician's sense of self-superiority, patients' cultural differences, and lack of supportive services in the health care system. CONCLUSION The results of this study showed that the communication challenges between physician and patient were not limited to the physicians' education. Part of these challenges depends on the patients and their culture. Another part of these challenges is directly related to the medical and management system structure.
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Affiliation(s)
- Mohammad Hasan Keshavarzi
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
| | | | - Seyed Ali Akbar Faghihi
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
| | - Soolmaz Zare
- Clinical Education Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz Iran
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15
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Idiaquez Rios JF, Lovblom LE, Perkins BA, Bril V. Orthostatic blood pressure changes and diabetes duration. J Diabetes Complications 2022; 36:108169. [PMID: 35307262 DOI: 10.1016/j.jdiacomp.2022.108169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED To determine the prevalence and the associated clinical characteristics of orthostatic hypotension and orthostatic hypertension in patients with diabetic sensorimotor polyneuropathy (DSP). METHODS A single-center retrospective cross-sectional study was conducted on 200 DSP patients who had 3-minute orthostatic measures as part of the standard clinic evaluation. We measured the heart rate (HR) and blood pressure (BP) supine and again after 3 min of standing. RESULTS The prevalence of orthostatic hypotension was 19.5% and that of orthostatic hypertension was 23%. Subjects with orthostatic hypotension had significantly longer diabetes duration than subjects who were normotensive and those with orthostatic hypertension. Quantitatively, BP changes from supine to standing correlated with diabetes duration (R = 0.306; P = 0.0582) and age (R = 0.434; P = 0.006) in subjects with orthostatic hypotension. CONCLUSIONS Orthostatic hypertension and orthostatic hypotension are frequent in patients with DSP. Orthostatic hypertension is associated with shorter diabetes duration than orthostatic hypotension.
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Affiliation(s)
- Juan F Idiaquez Rios
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases University Health Network, University of Toronto, Canada
| | - Leif Erik Lovblom
- Division of Endocrinology, Department of Medicine, Leadership Sinai Centre for Diabetes, Sinai Health System, University of Toronto, Toronto, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology, Department of Medicine, Leadership Sinai Centre for Diabetes, Sinai Health System, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen & Martin Prosserman Centre for Neuromuscular Diseases University Health Network, University of Toronto, Canada.
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16
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Moulaei K, Shanbehzadeh M, Bahaadinbeigy K, Kazemi-Arpanahi H. Survey of the patients' perspectives and preferences in adopting telepharmacy versus in-person visits to the pharmacy: a feasibility study during the COVID-19 pandemic. BMC Med Inform Decis Mak 2022; 22:99. [PMID: 35418072 PMCID: PMC9005615 DOI: 10.1186/s12911-022-01834-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/30/2022] [Indexed: 12/26/2022] Open
Abstract
Background Following the coronavirus disease 2019 (COVID-19) pandemic, the health authorities recommended the implementation of strict social distancing and complete lockdown regulations to reduce disease spread. The pharmacists quickly adopted telemedicine (telepharmacy) as a solution against this crisis, but awareness about this technology is lacking. Therefore, the purpose of this research was to explore the patients' perspectives and preferences regarding telepharmacy instead of traditional in-person visits. Methods An electronic questionnaire was designed and sent to 313 patients who were eligible for the study (from March to April 2021). The questionnaire used five-point Likert scales to inquire about motivations for adopting telepharmacy and in-person visits, their perceived advantages and disadvantages, and the declining factors of telepharmacy. Finally, the results were descriptively analyzed using SPSS 22. Results Of all 313 respondents, a total of 241 (77%) preferred appointments via telepharmacy while 72 (23%) preferred in-person services. There was a significant difference between the selection percentage of telepharmacy and in-person services (chi-square 91.42; p < 0.0001). Preference bout the telepharmacy system versus in-person visits to the pharmacy was associated with factors such as "reducing the incidence of contagious disease" (4.41; ± 0.78), "spending less time receiving pharmaceutical services” (4.24; ± 0.86)), and “traveling a shorter distance for receiving pharmaceutical services" (4.25; ± 0.86). "Reducing costs" (90.87%), "saving time" (89.21%), and "reducing the incidence of contagious disease" (87.13%) were the most important reasons for choosing telepharmacy services. Also, “face-to-face communication with the pharmacist” (25%), “low internet bandwidth” (25%), and “reduction of patients' anxiety and the increase of their peace of mind” (23.61%) were the most important reasons for choosing in-person visits. Conclusion Survey data indicate that most participants are likely to prefer the use of telepharmacy, especially during crises such as the current COVID-19 pandemic. Telepharmacy can be applied as an important means and a crucial service to lessen the load on healthcare organizations and expand drug supply shelters in pharmacies. However, there are still substantial hurdles to overcome in order to successfully implement the telemedicine platform as part of mainstream practice.
Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01834-5.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. .,Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran.
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17
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Sasidharan A, Ambatipudi S. A community-based cross-sectional survey of orthostatic hypotension among elderly from south India. Indian Heart J 2022; 74:478-483. [PMID: 36403667 PMCID: PMC9773280 DOI: 10.1016/j.ihj.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. METHODS A community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. RESULTS The prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR = 1.97 [95%CI = 1.05, 3.72]). Increase in number of co-morbidities (ORadj = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (ORadj = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (ORadj = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (ORadj = 4.81 [95%CI = 1.57, 14.77]), hypertension (ORadj = 4.97 [95%CI = 1.01, 24.46]) and cognitive impairment (ORadj = 5.01 [95%CI = 1.40, 18.51]) were at a higher odds of having OH. CONCLUSIONS OH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.
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Affiliation(s)
- Akhil Sasidharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Thiruvananthapuram, 695011, India,Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, 600077, India
| | - Srikant Ambatipudi
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Thiruvananthapuram, 695011, India,Corresponding author. Achutha Menon Centre for Health Science Studies. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical college, Thiruvanathapuram, 695011, India.
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18
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White AEC, Hood-Medland EA, Kravitz RL, Henry SG. Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy. J Gen Intern Med 2022; 37:78-86. [PMID: 34159543 PMCID: PMC8738805 DOI: 10.1007/s11606-021-06917-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/05/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. OBJECTIVE This study creates a novel measure, "visit linearity," to assess visit organization and examines whether visits that require less shifting back and forth between topics are associated with better patient and physician visit experiences. It also explores whether visit linearity differs depending on the following: (1) whether or not pain is a major topic of the visit and (2) whether or not pain is the first topic raised. DESIGN This study analyzed 41 video-recorded visits using inductive, qualitative analysis informed by conversation analysis. We used linear regression to evaluate associations between visit organization and post-visit measures of participant experience. PARTICIPANTS Patients were established adult patients planning to discuss pain management during routine primary care. Physicians were internal or family medicine residents. MAIN MEASURES Visit linearity, total topics, return topics, topic shifts, time per topic, visit duration, pain main topic, pain first topic, patient experience, and physician difficulty. KEY RESULTS Visits had a mean of 8.1 total topics (standard deviation (SD)=3.46), 14.5 topic shifts (SD=6.28), and 1.9 topic shifts per topic (SD=0.62). Less linear visits (higher topic shifts to topic ratio) were associated with greater physician visit difficulty (β=7.28, p<0.001) and worse patient experience (β= -0.62, p=0.03). Visit linearity was not significantly impacted by pain as a major or first topic raised. CONCLUSIONS In primary care visits for patients with chronic pain taking opioids, more linear visits were associated with better physician and patient experience. Frequent topic shifts may be disruptive. If confirmed in future research, this finding implies that reducing shifts between topics could help decrease mutual frustration related to discussions about pain.
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Affiliation(s)
- Anne Elizabeth Clark White
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Richard L. Kravitz
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
| | - Stephen G. Henry
- Department of Internal Medicine, University of California Davis, Sacramento, CA USA
- University of California Davis Center for Healthcare Policy and Research, Sacramento, CA USA
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19
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Getu AA, Abuhay DA, Goshu BT. Orthostatic Hypotension in Male Hypertensive Patients: A Cross-Sectional Study at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. Integr Blood Press Control 2021; 14:133-139. [PMID: 34675649 PMCID: PMC8502017 DOI: 10.2147/ibpc.s331467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Orthostatic hypotension (OH) is defined as a fall in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg within 3 minutes of standing. OH incidence is increased with hypertension, and management of these patients may pose challenges, as treatment of one can worsen the other. Objective This study aimed to determine the prevalence of OH and its associated factors among male hypertensive patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. Methods A hospital-based cross-sectional design was employed. Seated BP was measured twice and the average of the two taken. After BP had been stabilized for 5 minutes, SBP within 3 minutes of standing was measured twice and the minimum of the two taken. A drop of ≥20 mmHg in SBP within 3 minutes of standing was taken as OH. All male hypertensive patients who were able to attain a standing position were included. Sociodemographic, anthropometric, and clinical status of the patients were taken using structured interviewer-administered questionnaires. Data were entered and analyzed using SPSS 21. Both bivariate and multivariate logistic regression analysis were done. P≤0.05 was considered statistically significant. Results The median age of study participants was 57 (25–96) years. The prevalence of OH was 17.6%. Uncontrolled hypertension (adjusted OR 2.08, 95% CI 1.125–3.872) and duration of hypertension ≥5 years (adjusted OR 2.04, 95% CI 1.069–3.895) were significantly associated with OH in hypertensive patients. Conclusion The prevalence of OH among male hypertensive patients was high. Hypertensive patients whose BP was uncontrolled and having had hypertension ≥5 years were risk factors of OH.
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Affiliation(s)
- Ayechew Adera Getu
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Deribew Abebaw Abuhay
- Department of Physiology, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Bahiru Tenaw Goshu
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
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20
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Buoite Stella A, Furlanis G, Frezza NA, Valentinotti R, Ajcevic M, Manganotti P. Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study. J Neurol 2021; 269:587-596. [PMID: 34386903 PMCID: PMC8359764 DOI: 10.1007/s00415-021-10735-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9-31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.
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Affiliation(s)
- Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Nicolò Arjuna Frezza
- School of Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Romina Valentinotti
- Infectious Diseases, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
| | - Milos Ajcevic
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy
- Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio 10, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.
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