Quality of Life Assessment by SF-36 among the Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) patients have substantial functional disability which poses a significant impact on the quality of life (QoL). So, this study aims to assess the QoL of RA patients by the Short Form Health Survey-36 (SF-36) questionnaire. Total sixty-two (62) rheumatoid arthritis patients were included in this cross-sectional observational study and were performed in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2018 to September 2019 according to selection criteria. A Bengali validated version of Medical Outcomes Study-36: Item Short Form Health Survey (SF-36) questionnaire was used to assess QoL. Among the sixty-two (62) patients, mean age was 44.18±12.14 years with female preponderance (77.4%). About one-fifth of the patients (19.4%, n=12) were illiterate and the majority (71.0%, n=44) were housewives. Amongst all, 53.2% (n=33) had monthly family income >20,000 taka. Forty percent (n=25) had a disease duration of 1 to 5 years. According to Disease Activity Score Sheet 28 (DAS-28), 36(58.1%) patients had moderate disease activity and 26(41.9%) patients had high disease activity. Among the 8 domains, the mental health domain had the highest score (42.77±13.78) and the role physical domain had the lowest (35.89±15.43). Male, literate patients with higher income had relatively better QoL. Patients with prolonged disease, high disease activity and irregular taking of Disease Modifying Anti-Rheumatic Drugs (DMARDs) had poor quality of life. A significant negative correlation was present between SF-36 scores and the DAS-28 scores (r = -0.803, p<0.001). Rheumatoid arthritis had a relatively poor quality of life regarding both physical and mental health components, but the physical health component was predominantly affected.

99 Perfecting the Proforma – A Full-Cycle Audit on The Quality of Documentation of The Hand Trauma Proforma At the Regional Plastic Surgery Department

Aim

We aimed to assess the quality of record-keeping of the departments hand trauma proforma, identify areas of improvement, and to implement and assess the quality of an updated proforma.

Method

Data from 101 parameters was collected for 20 patients undergoing surgery for an upper limb injury in November 2019. An updated proforma was implemented and a further 20 patients were analysed in February 2020. All fields were compared between two audit cycles and comments were collected.

Results

The overall completion rate increased. Documentation of the responsible consultant increased to 100%, along with an increase in documenting of hobbies and injury mechanism. X-ray findings (55% to 85%) and antibiotic plan (35% to 80%) increased. Implementation of a free text box resulted in written descriptions of injury to compliment sketches. In the operation note, documentation of anaesthetic type used increased, along with tourniquet use and time. There was clearer documentation of the injury, findings, and procedure, with greater use of diagrams to illustrate the repair. There was a drop in the recording of post-op plans (100% to 85%), post-op antibiotics (90% to 75%), and follow-up plan (95% to 60%). Clinicians commented to increase the size of the free-text box and hand diagram on the operative page to facilitate easier drawings.

Conclusions

The Hand Trauma Proforma has made good progress from its original version but requires further adjustments to ensure complete data input. It sets a high standard for data collection and presents itself as a useful tool for units across the United Kingdom.

Paan without tobacco: an independent risk factor for oral cancer

Oral cancer is the second most common cancer in women and the third most common in men in Pakistan. Tobacco is smoked and chewed extensively in Pakistan. Paan is a quid of piper betel leaf that contains areca nut, lime, condiment, sweeteners, and sometimes tobacco, which is also used extensively. We did this study to clarify the independent association of paan and oral cancer. Between July 1996 and March 1998, we recruited biopsy-proven, primary cases of oral squamous-cell carcinoma, from 3 tertiary teaching centers in Karachi, Pakistan, and controls pair-matched for age, gender, hospital and time of occurrence, excluding persons with a past or present history of any malignancy. There were 79 cases and 149 controls. Approximately 68% of the cases were men, 49 years old on average, the youngest being 22 years old and the eldest 80. People with oral submucous fibrosis were 19.1 times more likely to develop oral cancer than those without it, after adjusting for other risk factors. People using paan without tobacco were 9.9 times, those using paan with tobacco 8.4 times, more likely to develop oral cancer as compared with non-users, after adjustment for other covariates. This study identifies an independent effect of paan without tobacco in the causation of oral cancer. Its findings may be of significance in South Asian communities where paan is used, and among health-care providers who treat persons from South Asia.