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Sengupta A, Pettigrew S, Jenkins CR. Telemedicine in specialist outpatient care during COVID-19: a qualitative study. Intern Med J 2024; 54:54-61. [PMID: 37926924 DOI: 10.1111/imj.16288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND COVID-19 accelerated healthcare changes, introducing various telehealth services. Work is needed to determine the suitability of telemedicine in the post-pandemic era. AIMS To explore perceptions and experiences of telemedicine among patients and providers (clinicians and health administrators) who were involved in telemedicine appointments in hospital outpatient clinics in 2020-2022. DESIGN, SETTING AND PARTICIPANTS Qualitative study: semi-structured interviews were conducted with 37 participants (16 patients and 21 providers) in various hospital specialist outpatient clinics in a New South Wales local health district. RESULTS Patients were generally satisfied with telemedicine consultations, especially during COVID restrictions, because of the convenience of accessing care from home and minimising the risk of COVID exposure. However, patients considered that the inability to receive a physical examination was a significant disadvantage of telemedicine. Providers had ambivalent perceptions and expressed concerns about mis- and under-diagnoses because of the inability to conduct physical examinations. They considered telemedicine suitable for review appointments but noted an associated increased workload and stressed the need for sustainable funding models (Medicare items). Both patients and providers recognised the need for education/training and better integration of telemedicine platforms into existing infrastructure to facilitate an optimal hybrid model of care. CONCLUSION Despite expressing some concerns over its limitations, patients valued telemedicine for its convenience and for meeting their needs during the pandemic. While acknowledging that patients experienced some benefits from telemedicine, clinicians expressed concerns about potential missed diagnoses, uncertain clinical outcomes and lack of administrative and technological infrastructure. The ultimate test of telemedicine will be its impact on clinical outcomes versus longstanding models of in-person care.
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Affiliation(s)
- Agnivo Sengupta
- Respiratory Program, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- Health Promotion and Behaviour Change, The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Christine R Jenkins
- Respiratory Program, The George Institute for Global Health, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Alawadhi A, Palin V, van Staa T. The impact of the COVID-19 pandemic on rates and predictors of missed hospital appointments in multiple outpatient clinics of The Royal Hospital, Sultanate of Oman: a retrospective study. BMC Health Serv Res 2023; 23:1438. [PMID: 38115022 PMCID: PMC10729569 DOI: 10.1186/s12913-023-10395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman. METHODS A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments. RESULTS A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments. CONCLUSION The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments.
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Affiliation(s)
- Ahmed Alawadhi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, The Univeristy of Manchester, St Marys Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Eze CO, Okoro FC, Okorie M. Sleep Health amongst Patients Attending Adult Neurology Clinic in Abakaliki, Nigeria. West Afr J Med 2023; 40:1192-1198. [PMID: 38096460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Sleep health indicates how well an individual or population sleeps. Good sleep health is characterized by subjective satisfaction, sustained alertness during waking hours, appropriate timing, high efficiency, and adequate duration. Poor sleep health is associated with many short-term and long-term health consequences. There are limited data on the pattern of sleep health in Nigeria. Against this backdrop, we embarked on this study to determine the Pattern of Sleep Health among patients attending the Adult Neurology clinic in a Federal Teaching Hospital, in Abakaliki, Nigeria. METHODS This is a cross-sectional observational hospital-based study undertaken at the Adult Neurology clinic of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from July to September 2022. RESULTS Out of the 267 patients recruited for the study, 19% had good sleep health with SATED scores of 8 to 10 while 81% had poor sleep health. The absence of alcohol abuse, cigarette smoking, and neurological diagnosis were statistically associated with poor sleep health with no sex and age predilection. The mean sleep duration was 7.5± 1.5 hours (male = 7.6 hours, female = 7.3 hours, 18- 64 years= 7.4 hours, ≥ 65 years =7.9 hours). Timing of sleep (mean= 0.97) was the least rated while sleep satisfaction (mean= 1.54) was the best-rated sleep dimension. CONCLUSION Sleep health is very poor amongst patients attending the adult Neurology clinic at Abakaliki Nigeria and it is associated with smoking, absence of alcohol abuse, and neurological diagnosis. CONTEXTE La santé du sommeil indique à quel point un individu ou une population dort. Une bonne santé du sommeil se caractérise par une satisfaction subjective, une vigilance soutenue pendant les heures d'éveil, un timing approprié, une efficacité élevée et une durée adéquate. Une mauvaise santé du sommeil est associée à de nombreuses conséquences sanitaires à court et à long terme. Il existe des données limitées sur le schéma de santé du sommeil au Nigéria. Dans ce contexte, nous avons entrepris cette étude pour déterminer le schéma de santé du sommeil parmi les patients fréquentant la clinique de neurologie pour adultes dans un hôpital d'enseignement fédéral à Abakaliki, Nigeria. MÉTHODES Il s'agissait d'une étude observationnelle transversale réalisée à la clinique de neurologie pour adultes de l'hôpital universitaire fédéral Alex Ekwueme àAbakaliki, Nigeria, de juillet à septembre 2022. RÉSULTATS Sur les 267 patients recrutés pour l'étude, 19 % avaient une bonne santé du sommeil avec des scores SATED de 8 à 10, tandis que 81 % avaient une mauvaise santé du sommeil. L'absence d'abus d'alcool, de tabagisme et de diagnostic neurologique était statistiquement associée à une mauvaise santé du sommeil, sans prédilection pour le sexe et l'âge. La durée moyenne du sommeil était de 7,5 ± 1,5 heures (homme = 7,6 heures, femme = 7,3 heures, 18-64 ans = 7,4 heures, ≥ 65 ans = 7,9 heures). Le timing du sommeil (moyenne = 0,97) était la dimension la moins bien notée, tandis que la satisfaction du sommeil (moyenne = 1,54) était la dimension la mieux notée. CONCLUSION La santé du sommeil est très mauvaise chez les patients fréquentant la clinique de neurologie pour adultes à Abakaliki, au Nigéria, et elle est associée au tabagisme, à l'absence d'abus d'alcool et au diagnostic neurologique. Mots-clés :Santé du sommeil, Clinique de neurologie,Abakaliki, Nigeria.
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Affiliation(s)
- C O Eze
- Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria. E-mail: , ; Tel: 2347033432117
| | - F C Okoro
- Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria. E-mail: , ; Tel: 2347033432117
| | - M Okorie
- Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Nigeria. E-mail: , ; Tel: 2347033432117
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Agarwal MA, Opotowsky A. The Long and Winding Road to Adults With Congenital Heart Disease Clinic: Examining Adult Congenital Clinic Nonattendance. Am J Cardiol 2023; 203:515-517. [PMID: 37544798 DOI: 10.1016/j.amjcard.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Manyoo A Agarwal
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Alexander Opotowsky
- Cincinnati Children's Hospital, Heart Institute, Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Radeck VMM, Helbig H, Barth T, Gamulescu A, Maerker D, Wolf A. Are Retinal Detachments Becoming More Frequent? Data from 2 University Eye Clinics and Literature Review. Klin Monbl Augenheilkd 2023; 240:1046-1051. [PMID: 37353213 DOI: 10.1055/a-2116-9565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
There have been marked increases in the numbers of patients with retinal detachments at individual centres in recent years and this is supported by the subjective impression of many experts. We therefore surveyed the literature on changes in the incidence of retinal detachments worldwide. This revealed quite significant methodological differences between the studies, so that it was difficult to achieve a conclusive comparison of the development of the incidence of retinal detachment. Despite these limitations, all data from recent studies suggest an increase in the number of retinal detachments. The incidence of retinal detachment in the western world currently seems to be more than 20 cases per 100,000 person-years, which is significantly higher than described in earlier decades. It can be assumed that an increase in the number of individuals with myopia, a demographic increase in patients of the typical age group for retinal detachment and an increasing number of cataract surgeries, especially in younger patients, are responsible for the rising incidence of retinal detachment.
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Affiliation(s)
| | - Horst Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Teresa Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Andreea Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - David Maerker
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Deutschland
| | - Armin Wolf
- Augenklinik, Universitätsklinikum Ulm, Deutschland
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Parke DW, Williams GA. Pass-Through Payments, Cost, and Convenience in Hospital Outpatient Departments and Ambulatory Surgical Centers. JAMA Ophthalmol 2023; 141:851-852. [PMID: 37535383 DOI: 10.1001/jamaophthalmol.2023.3424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- David W Parke
- American Academy of Ophthalmology, San Francisco, California
| | - George A Williams
- American Academy of Ophthalmology, San Francisco, California
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
- Beaumont Eye Institute, Royal Oak, Michigan
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Doucette C, Milano MT, Kamen C. Patient Perceptions of Sexual Orientation and Gender Identity Data Collection in an Outpatient Radiation Oncology Setting. Int J Radiat Oncol Biol Phys 2023; 116:68-78. [PMID: 36549346 DOI: 10.1016/j.ijrobp.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sexual and gender minority patients with cancer experience significant health disparities requiring tailored care. Collecting sexual orientation and gender identity (SOGI) data in the electronic medical record (EMR) could allow care to be tailored and is in line with radiation oncology's mission to better serve diverse patients. This article describes a systematic method for collecting SOGI data for all patients starting radiation treatment in a department of radiation oncology (DRO). METHODS AND MATERIALS During a 3-month experimental period, DRO staff administered a demographic questionnaire and attitude survey to new adult patients. SOGI demographic data, entered into the EMR by nursing staff, were extracted and analyzed for all patients from the experimental period and from the 3 months prior (control period). Descriptive and categorical data completion rates were compared between the experimental and control periods using independent-samples t tests and Pearson χ2 tests. RESULTS A total of 788 patients were included in this analysis: 368 in the control period and 420 in the experimental period. Of the 420 patients enrolled in the experimental period, 267 (63.6%) were offered a survey, of whom 211 (79.0%) completed the survey. There were higher rates of sexual orientation responses entered into the EMR for the experimental group compared with the control group (56.9% vs 27.1%; P <.001), with the highest response rates for patients who completed a survey (82.9%). Ten patients (2.9%) identified as gay or lesbian and 100% identified as cisgender. The majority of patients were not upset by the form, with only 11 patients (5.2%) stating that any specific question caused them distress. CONCLUSIONS Collecting SOGI data via a demographic form is feasible in an outpatient DRO. This approach was well received by the majority of patients and could lead to provision of higher-quality, tailored care.
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Affiliation(s)
| | | | - Charles Kamen
- Surgery, University of Rochester Medical Center, Rochester, New York.
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Babayoff O, Shehory O, Geller S, Shitrit-Niselbaum C, Weiss-Meilik A, Sprecher E. Improving Hospital Outpatient Clinics Appointment Schedules by Prediction Models. J Med Syst 2022; 47:5. [PMID: 36585996 DOI: 10.1007/s10916-022-01902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
Patient no-shows and suboptimal patient appointment length scheduling reduce clinical efficiency and impair the clinic's quality of service. The main objective of this study is to improve appointment scheduling in hospital outpatient clinics. We developed generic supervised machine learning models to predict patient no-shows and patient's length of appointment (LOA). We performed a retrospective study using more than 100,000 records of patient appointments in a hospital outpatient clinic. Several machine learning algorithms were used for the development of our prediction models. We trained our models on a dataset that contained patients', physicians', and appointments' characteristics. Our feature set combines both unstudied features and features adopted from previous studies. In addition, we identified the influential features for predicting LOA and no-show. Our LOA model's performance was 6.92 in terms of MAE, and our no-show model's performance was 92.1% in terms of F-score. We compared our models' performance to the performance of previous research models by applying their methods to our dataset; our models demonstrated better performance. We show that the major effector of such differences is the use of our novel features. To evaluate the effect of our prediction results on the quality of schedules produced by appointment systems (AS), we developed an interface layer between our prediction models and the AS, where prediction results comprise the AS input. Using our prediction models, there was an 80% improvement in the daily cumulative patient waiting time and a 33% reduction in the daily cumulative physician idle time.
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Affiliation(s)
| | - Onn Shehory
- Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Shamir Geller
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Shitrit-Niselbaum
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Launer J. John Launer: When outpatient appointments are put on hold. BMJ 2022; 379:o2479. [PMID: 36261153 DOI: 10.1136/bmj.o2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Deghan Manshadi S, Dehghan K, Robertson DI, Reimer C, Zevin B. Safety and outcomes of performing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy at an ambulatory site of a tertiary care hospital in Ontario. Can J Surg 2022; 65:E38-E44. [PMID: 35042719 PMCID: PMC8900739 DOI: 10.1503/cjs.007120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: In Ontario, bariatric surgery is publicly funded and is performed only in accredited tertiary care hospitals. The purpose of our study was to report on the safety and outcomes of performing bariatric surgery at an ambulatory site of a tertiary care hospital in southern Ontario. Methods: We conducted a retrospective cohort study of all adult (age ≥ 18 yr) patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at the ambulatory site of our tertiary care hospital between September 2016 and August 2018. The 2 sites are 1.4 km apart. Patient demographic characteristics, duration of surgery, intraoperative and 90-day postoperative complications, number of transfers and readmission to the tertiary care hospital, and emergency department visits were collected. Results: A total of 314 patients (285 women [90.8%] and 29 men [9.2%] with a mean age of 41.8 yr [standard deviation (SD) 8.9 yr]) underwent surgery: LRYGB in 295 cases (93.9%) and LSG in 19 (6.0%). The mean body mass index was 45.3 (SD 5.1), the median American Society of Anesthesiologists score was 3 (range 2–4), and the median Edmonton Obesity Staging System score was 2 (range 0–4). The mean operative time was 119.8 (SD 23.1) minutes for LRYGB and 96.2 (SD 22.0) minutes for LSG, and the mean length of stay was 2.1 (SD 0.6) days and 2.1 (SD 0.2) days, respectively. Thirteen patients (4.1%) required transfer to the tertiary care hospital for a postoperative complication. Of 312 patients, 29 (9.3%) presented to emergency department within 90 days after surgery, and 8 (2.6%) required readmission to hospital; no deaths were reported. Conclusion: The findings suggest that LRYGB and LSG can be performed safely at an ambulatory site of a tertiary care hospital. However, caution should be exercised in performing these procedures at an ambulatory site without a tertiary care hospital affiliation, as patients may require urgent transfer for a serious postoperative complication.
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Affiliation(s)
- Shaidah Deghan Manshadi
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Kooroush Dehghan
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - David I Robertson
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Cara Reimer
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
| | - Boris Zevin
- From the Division of General Surgery, Department of Surgery, Queen's University, Kingston, Ont. (Deghan Manshadi, Robertson, Zevin); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Dehghan); and the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ont. (Reimer)
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Nikrad E, Kanaan RA. How Positive Are Conversion Disorder Diagnoses?: Patterns of Referral to a Functional Neurology Clinic. J Nerv Ment Dis 2021; 209:743-746. [PMID: 34048413 DOI: 10.1097/nmd.0000000000001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria for conversion disorder have replaced the criterion of evidence of a "psychogenic" etiology with a criterion that patients must be "positively" diagnosed on the basis of their neurological assessment. We retrospectively studied referrals to a specialist functional neurology clinic to see how commonly the new criteria were met since DSM-5's introduction. Positive signs were reported in a quarter of referrals (26.5%), which was associated with diagnosticians' confidence (p = 0.001) and with the clinic confirming the diagnosis (p = 0.01). Our clinic found positive signs in 28.6% of the referrals. In 13 (13.3%) patients, the new criterion was not met. In conclusion, positive signs are diagnostically helpful but are only reported in a minority of assessments. A significant group of those currently believed to have conversion disorder would not meet the revised diagnostic criteria based on this.
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Affiliation(s)
- Ehsan Nikrad
- Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, VIC, Australia
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RICCARDI NICCOLÒ, RODARI PAOLA, DURANTI SILVIA, VILLA SIMONE, ASSANTE LUCAROSARIO, CASTELLOTTI PAOLA, FERRARESE MAURIZIO, MARTINI MARIANO, ZUPPINI TERESA, TESSARI ROBERTO, CALZA CRISTINA, CODECASA LUIGI, BESOZZI GIORGIO, ANGHEBEN ANDREA. How to improve TB outpatient service in a TB low-endemic country during SARS-CoV-2 pandemic. J Prev Med Hyg 2021; 62:E50-E52. [PMID: 34622084 PMCID: PMC8452285 DOI: 10.15167/2421-4248/jpmh2021.62.1s3.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/17/2021] [Indexed: 11/05/2022]
Abstract
Despite notable progresses in the recent decades, tuberculosis (TB) continues to remain a public health concern even in Europe. TB prevention and care should be people-centred, improving ambulatory models across countries, in order to expand access to diagnosis and treatment for both TB infection and disease. Even more, during emergencies such as the current pandemic, when seeking of TB care has been replaced by the fear of coronavirus disease 2019 (COVID-19), TB patient’s care is fundamental. In this short communication, we document how was possible to implement a TB outpatient service meanwhile a local outbreak of SARS-CoV-2 transmission was ongoing.
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Affiliation(s)
- NICCOLÒ RICCARDI
- StopTB Italia, Milan, Italy
- Department of Infectious, Tropical Diseases & Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - PAOLA RODARI
- Department of Infectious, Tropical Diseases & Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - SILVIA DURANTI
- StopTB Italia, Milan, Italy
- Department of Infectious, Tropical Diseases & Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - SIMONE VILLA
- StopTB Italia, Milan, Italy
- Centre for Multidisciplinary Research in Health Science, University of Milan, Italy
| | - LUCA ROSARIO ASSANTE
- Division of Pulmonology and Thoracic Endoscopy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy
| | - PAOLA CASTELLOTTI
- StopTB Italia, Milan, Italy
- Regional TB Reference Centre, Istituto Villa Marelli, Niguarda Hospital, Milan, Italy
| | - MAURIZIO FERRARESE
- StopTB Italia, Milan, Italy
- Regional TB Reference Centre, Istituto Villa Marelli, Niguarda Hospital, Milan, Italy
| | - MARIANO MARTINI
- StopTB Italia, Milan, Italy
- Department of Health Sciences, University of Genoa, Italy
- Correspondence: Mariano Martini, Department of Health Sciences, University of Genoa, largo R. Benzi 10 Pad. 3, 16132 Genoa, Italy - Tel./Fax: 010.353.85.02 - E-mail: /
| | - TERESA ZUPPINI
- Service of Hospital Pharmacy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - ROBERTO TESSARI
- Service of Hospital Pharmacy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - CRISTINA CALZA
- Service of Hospital Pharmacy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - LUIGI CODECASA
- StopTB Italia, Milan, Italy
- Regional TB Reference Centre, Istituto Villa Marelli, Niguarda Hospital, Milan, Italy
| | | | - ANDREA ANGHEBEN
- Department of Infectious, Tropical Diseases & Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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13
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Hsieh YP, Yen CF, Wu CF, Wang PW. Nonattendance at Scheduled Appointments in Outpatient Clinics Due to COVID-19 and Related Factors in Taiwan: A Health Belief Model Approach. Int J Environ Res Public Health 2021; 18:4445. [PMID: 33922171 PMCID: PMC8122706 DOI: 10.3390/ijerph18094445] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
During the COVID-19 pandemic, the number of hospital visits and attendance at scheduled appointments have dropped significantly. We used the health belief model (in three dimensions) to examine the determinants of non-attendance of scheduled appointments in outpatient clinics due to the COVID-19 pandemic. Participants in Taiwan (n = 1954) completed an online survey from 10 April 10 to 23 April 2020, which assessed how people perceived and responded to the outbreak of a fast-spreading infectious disease. We performed both univariate and multivariate logistic regression to examine the roles of cognitive, affective, and behavioral health belief constructs in nonattendance at scheduled appointments. The results indicated that individuals who perceived high confidence in coping with COVID-19 were less likely to miss or cancel their doctor's appointments, whereas individuals who reported high anxiety and practiced more preventive health behaviors, including avoiding crowded places, washing hands more often, and wearing a mask more often, were more likely to miss or cancel their appointments due to the COVID-19 pandemic. Non-heterosexual participants had a lower rate of nonattendance at scheduled appointments compared with heterosexual ones. The study results increase our understanding of the patients' cognitive health beliefs, psychological distress, and health behaviors when assessing adherence to medical appointments during a pandemic.
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Affiliation(s)
- Yi-Ping Hsieh
- Department of Social Work, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chia-Fen Wu
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
| | - Peng-Wei Wang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (C.-F.Y.); (C.-F.W.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
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14
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Nouchi A, Chastang J, Miyara M, Lejeune J, Soares A, Ibanez G, Saadoun D, Morélot-Panzini C, Similowski T, Amoura Z, Boddaert J, Caumes E, Bleibtreu A, Lorenzo A, Tubach F, Pourcher V. Prevalence of hyposmia and hypogeusia in 390 COVID-19 hospitalized patients and outpatients: a cross-sectional study. Eur J Clin Microbiol Infect Dis 2021; 40:691-697. [PMID: 33033955 PMCID: PMC7543958 DOI: 10.1007/s10096-020-04056-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Anecdotal evidence rapidly accumulated during March 2020 from sites around the world that sudden hyposmia and hypogeusia are significant symptoms associated with the SARS-CoV-2 pandemic. Our objective was to describe the prevalence of hyposmia and hypogeusia and compare it in hospitalized and non-hospitalized COVID-19 patients to evaluate an association of these symptoms with disease severity. We performed a cross-sectional survey during 5 consecutive days in March 2020, within a tertiary referral center, associated outpatient clinic, and two primary care outpatient facilities in Paris. All SARS-CoV-2-positive patients hospitalized during the study period and able to be interviewed (n = 198), hospital outpatients seen during the previous month (n = 129), and all COVID-19-highly suspect patients in two primary health centers (n = 63) were included. Hospitalized patients were significantly more often male (64 vs 40%) and older (66 vs 43 years old in median) and had significantly more comorbidities than outpatients. Hyposmia and hypogeusia were reported by 33% of patients and occurred significantly less frequently in hospitalized patients (12% and 13%, respectively) than in the health centers' outpatients (33% and 43%, respectively) and in the hospital outpatients (65% and 60%, respectively). Hyposmia and hypogeusia appeared more frequently after other COVID-19 symptoms. Patients with hyposmia and/or hypogeusia were significantly younger and had significantly less respiratory severity criteria than patients without these symptoms. Olfactory and gustatory dysfunction occurs frequently in COVID-19, especially in young, non-severe patients. These symptoms might be a useful tool for initial diagnostic work-up in patients with suspected COVID-19.
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Affiliation(s)
- Agathe Nouchi
- Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France.
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Universitaire APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Julie Chastang
- Département de Médecine Générale, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Makoto Miyara
- INSERM UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Julie Lejeune
- INSERM UMR-S-1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Unité de Recherche Clinique Pitié, CIC-1422, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - André Soares
- Département de Médecine Générale, Sorbonne Université, Paris, France
| | - Gladys Ibanez
- Département de Médecine Générale, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - David Saadoun
- INSERM, UMR-S-959, Immunology-Immunopathology- Immunotherapy (I3), Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Capucine Morélot-Panzini
- INSERM, UMR-S-1158, Service de Pneumologie et Réanimation Médicale (Département R3S), Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Thomas Similowski
- INSERM, UMR-S-1158, Service de Pneumologie et Réanimation Médicale (Département R3S), Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Inserm UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Service de Médecine Interne 2, Groupe Hospitalier Universitaire APHP, Sorbonne-Université, site Pitié-Salpêtrière, Paris, France
| | - Jacques Boddaert
- Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- INSERM UMR-S 1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Service de Gériatrie, Groupe Hospitalier Universitaire APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Caumes
- Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Universitaire APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Alexandre Bleibtreu
- Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Universitaire APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Lorenzo
- Département de Médecine Générale, Sorbonne Université, Paris, France
| | - Florence Tubach
- INSERM UMR-S-1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Unité de Recherche Clinique Pitié, CIC-1422, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Valérie Pourcher
- Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Universitaire APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
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15
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Jiang Y, Wei J, Fritzsche K, Toussaint AC, Li T, Cao J, Zhang L, Zhang Y, Chen H, Wu H, Ma X, Li W, Ren J, Lu W, Leonhart R. Assessment of the structured clinical interview (SCID) for DSM-5 for somatic symptom disorder in general hospital outpatient clinics in China. BMC Psychiatry 2021; 21:144. [PMID: 33691663 PMCID: PMC7944631 DOI: 10.1186/s12888-021-03126-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is still unknown whether the "Somatic symptom disorders (SSD) and related disorders" module of the Structured Clinical Interview for DSM-5, research version (SCID-5-RV), is valid in China. This study aimed to assess the SCID-5-RV for SSD in general hospital outpatient clinics in China. METHODS This multicentre cross-sectional study was conducted in the outpatient clinics of nine tertiary hospitals in Beijing, Jincheng, Shanghai, Wuhan, and Chengdu between May 2016 and March 2017. The "SSD and related disorders" module of the SCID-5-RV was translated, reversed-translated, revised, and used by trained clinical researchers to make a diagnosis of SSD. Several standardized questionnaires measuring somatic symptom severity, emotional distress, and quality of life were compared with the SCID-5-RV. RESULTS A total of 699 patients were recruited, and 236 were diagnosed with SSD. Of these patients, 46 had mild SSD, 78 had moderate SSD, 100 had severe SSD, and 12 were excluded due to incomplete data. The SCID-5-RV for SSD was highly correlated with somatic symptom severity, emotional distress, and quality of life (all P < 0.001) and could distinguish nonsevere forms of SSD from severe ones. CONCLUSIONS This study suggests that SCID-5-RV for SSD can distinguish SSD from non-SSD patients and severe cases from nonsevere cases. It has good discriminative validity and reflects the DSM-5 diagnostic approach that emphasizes excessive emotional, thinking, and behavioural responses related to symptoms.
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Affiliation(s)
- Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Anne Christin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoyin Zhang
- Department of Psychosomatic Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Chen
- Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wentian Li
- Department of Clinic Psychology, Wuhan Mental Health Center, Wuhan, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, Jincheng, China
| | - Wei Lu
- Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, Beijing, China
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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16
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Højager A, Tingsgaard JK, Andersen D, Søholm H, Taskiran M, Bock TG, Schoos MM. Silent atrial fibrillation detected by home-monitoring: Cardiovascular disease and stroke prevention in patients with diabetes. J Diabetes Complications 2020; 34:107711. [PMID: 32900590 DOI: 10.1016/j.jdiacomp.2020.107711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with silent and undiagnosed paroxysmal atrial fibrillation and flutter (AF) have increased risk of ischemic stroke. Patients with diabetes have a higher risk of both AF and ischemic stroke compared to patients without diabetes. Our aim was to investigate the prevalence of silent AF in patients with diabetes in an outpatient cohort and to identify the possible risk factors associated with AF. RESEARCH DESIGN AND METHODS This prospective observational study was performed in the outpatient diabetes clinic at a single University Hospital. We included 217 patients with type 1 or type 2 diabetes with at least one additional risk factor from the CHA2DS2VASc Score for Stroke Risk Assessment in Atrial Fibrillation. The primary outcome was prevalence of AF, with a duration of at least 30 s, recorded by a seven-day home-monitor, external loop recorder (ELR) in comparison to a standard resting ECG. Seventeen patients were excluded due to premature removal of the device. RESULTS In the final cohort of 200 patients the majority were male (58.5%) with a mean age of 66 ± 0.7 years. The mean BMI was 29 ± 6 and patients had a mean diabetes history of 23 ± 14 years with the majority diagnosed with type 2 diabetes (59%). Comorbidity was common with hypertension in 86%, and dyslipidemia in 80%. The total prevalence of silent AF [n = 20 (10%)] or flutter [n = 1 (0.5%)] was 10.5% using the ELR compared to a 0.0% detection-rate in the standard ECG method (p < 0.001). Higher age, male gender, albuminuria, and elevated systolic blood pressure were associated with AF in univariate analyses, but only age [OR 1.14 (95% CI = 1.00-2.04) (p = 0.048)], male gender [OR 4.9 (95% CI = 1.30-18.65) (p = 0.019)] and albuminuria [OR 2.7 (95% CI =1.08-6.98) (p = 0.034) were independently associated with AF. Mean CHA2DS2VASc Score was ≥2 (4.1, SD ± 1.6), and patients with AF were referred to further cardiac evaluation. CONCLUSION Undiagnosed, silent AF is common in high-risk cohort with a long history of diabetes followed in a University Hospital outpatient clinic. Non-invasive monitoring with ELR enhances detection of AF and identifies candidates for early anticoagulation treatment with the possible effect of stroke prevention.
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Affiliation(s)
- Anna Højager
- Department of Medicine, Zealand University Hospital, Denmark.
| | | | - Ditte Andersen
- Department of Medicine, Zealand University Hospital, Denmark
| | - Helle Søholm
- Department of Cardiology, Zealand University Hospital, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | | | | | - Mikkel M Schoos
- Department of Cardiology, Zealand University Hospital, Denmark
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17
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Baek YJ, Lee T, Cho Y, Hyun JH, Kim MH, Sohn Y, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yeom JS, Lee J, Choi JY. A mathematical model of COVID-19 transmission in a tertiary hospital and assessment of the effects of different intervention strategies. PLoS One 2020; 15:e0241169. [PMID: 33104736 PMCID: PMC7588052 DOI: 10.1371/journal.pone.0241169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/10/2020] [Indexed: 01/08/2023] Open
Abstract
Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of coronavirus disease (COVID-19). This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients, early testing of suspected infected people, and personal protective equipment for both medical staff and visitors were evaluated. The model suggested that the early testing (within eight hours) of infected cases and monitoring the quarantine ward for newly hospitalized patients are effective measures for decreasing the incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. This model suggests that under the assumed conditions, some effective measures have a great influence on the incidence of COVID-19 within a hospital. The implementation of the preventive measures could reduce the size of a hospital outbreak.
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Affiliation(s)
- Yae Jee Baek
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taeyong Lee
- Department of Mathematics, Yonsei University, Seoul, Republic of Korea
| | - Yunsuk Cho
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hoon Hyun
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yujin Sohn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeehyun Lee
- Department of Mathematics, Yonsei University, Seoul, Republic of Korea
- Department of Computational Science and Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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SHEN M, TONG L, FU C, DONG S, WANG T, ZHU G, XU H. [Application of three-in-one intelligent screening in outpatient department of children's hospital during COVID-19 epidemic]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:656-661. [PMID: 32959548 PMCID: PMC8800817 DOI: 10.3785/j.issn.1008-9292.2020.08.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/20/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital. METHODS We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups. RESULTS The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s (t=13.182, P<0.01). The triage coincidence rate of the intelligent pre-inspection model was 98%, which was similar to that of traditional model (97%, χ2=0.251, P>0.05). CONCLUSIONS The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
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Affiliation(s)
| | | | | | | | | | | | - Hongzhen XU
- 徐红贞(1966-), 女, 学士, 主任护师, 硕士生导师, 主要从事儿科护理管理; E-mail:
;
https://orcid.org/0000-0002-5793-3464
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19
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Bo A, Jensen NH, Bro F, Nicolaisen SK, Maindal HT. Higher patient assessed quality of chronic care is associated with lower diabetes distress among adults with early-onset type 2 diabetes: Cross-sectional survey results from the Danish DD2-study. Prim Care Diabetes 2020; 14:522-528. [PMID: 32169500 DOI: 10.1016/j.pcd.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/11/2019] [Accepted: 02/18/2020] [Indexed: 01/09/2023]
Abstract
AIM Among adults aged 20-45 years with type 2 diabetes mellitus, we examined the perceived quality of chronic care, and its associations with (i) sociodemographic and clinical characteristics, and (ii) diabetes distress. METHODS In total, 216/460 (47%) completed a self-administered survey assessing sociodemographic characteristics, patient assessed chronic illness care (PACIC-20, scale of 1-5) and diabetes distress (PAID-20, scale of 0-100), and 197 had full quality of care data for assessment. We obtained clinical data from national registers and used linear and logistic regression models to examine associations. RESULTS The mean (SD) PACIC score was 2.6 (0.9) (score range 1-5). Lower PACIC scores were associated with female sex and current unemployment, and with receiving diabetes care in general practice compared with hospital outpatient clinics [mean difference: -0.4 (95% confidence interval (CI) (-0.7 to -0.2)]. People with upper quartile PACIC scores were less likely to report high diabetes distress compared with people with lower quartile PACIC scores [odds Ratio 0.3 95%CI (0.1-0.8)]. CONCLUSION Higher quality of care was associated with lower diabetes distress among adults with early onset type 2 diabetes mellitus, but respondents reported less than optimal quality in several core areas of chronic care.
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Affiliation(s)
- Anne Bo
- Aarhus University, Department of Public Health, Bartholins allé 2, 8000, Aarhus C, Denmark.
| | - Nanna Husted Jensen
- Aarhus University, Department of Public Health, Bartholins allé 2, 8000, Aarhus C, Denmark
| | - Flemming Bro
- Aarhus University, Department of Public Health, Bartholins allé 2, 8000, Aarhus C, Denmark
| | - Sia Kromann Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Helle Terkildsen Maindal
- Aarhus University, Department of Public Health, Bartholins allé 2, 8000, Aarhus C, Denmark; Steno Diabetes Centre Copenhagen, Health Promotion, Niels Steensens Vej 2, 2820, Gentofte, Denmark.
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20
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Tan WY, Ng GC, Mah YY, Law MC, Wong CS. Outpatient Management of Patients in Singapore's National Centre for Infectious Diseases Special Precautions Area Clinic in the COVID-19 Pandemic. Ann Acad Med Singap 2020; 49:690-693. [PMID: 33241259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Wilnard Yt Tan
- Department of Medicine, Tan Tock Seng Hospital, Singapore
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21
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Kuder MM, Lennox MG, Li M, Lang DM, Pien L. Skin testing and oral amoxicillin challenge in the outpatient allergy and clinical immunology clinic in pregnant women with penicillin allergy. Ann Allergy Asthma Immunol 2020; 125:646-651. [PMID: 32798617 DOI: 10.1016/j.anai.2020.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Penicillin allergy is frequently reported. In pregnant women, reported penicillin allergy is associated with negative health outcomes and suboptimal group B streptococcal prophylaxis. For individuals having penicillin allergy, skin testing followed by an observed oral challenge is recommended. Previous data indicate a low risk of adverse reaction with skin testing in pregnant women, but the subsequent oral challenge was not routinely pursued. OBJECTIVE To determine whether skin testing followed by the outpatient oral challenge is tolerated by pregnant women. METHODS We conducted a retrospective review of all pregnant women who underwent penicillin allergy evaluation at an outpatient allergy and clinical immunology clinic. The patients underwent oral amoxicillin challenges based on the discretion of the allergy provider. We evaluated the index reaction history, skin test results, oral challenge results, and subsequent antibiotic exposure. RESULTS A total of 46 pregnant women underwent skin testing without adverse reactions, of whom 44 patients (95.6%) received negative results. A total of 18 women (39%) completed an oral challenge without adverse reactions. Patients challenged vs not challenged did not differ in patient age, gestational age, latency since index reaction, or reaction history risk level. Notably, 28 women received intrapartum antibiotics. There was no difference in intrapartum antibiotic administration between those who did or who did not complete an in-office oral challenge (P = .90). CONCLUSION Penicillin skin testing and oral challenge in pregnant women can safely be performed in the outpatient setting. There was no difference in the intrapartum antibiotic use between women who were and those who were not challenged. Further research is needed to determine the utility of oral challenge in pregnant patients.
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Affiliation(s)
- Margaret M Kuder
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Maria G Lennox
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manshi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lily Pien
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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22
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Mbwete GW, Kilonzo KG, Shao ER, Chamba NG. Suboptimal Blood Pressure Control, Associated Factors, and Choice of Antihypertensive Drugs among Type 2 Diabetic Patients at KCMC, Tanzania. J Diabetes Res 2020; 2020:4376251. [PMID: 32775461 PMCID: PMC7391100 DOI: 10.1155/2020/4376251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypertension (HTN) can be present in up to two-thirds of patients living with diabetes mellitus (DM). It is a risk factor for the development of diabetes as well as complications like coronary artery disease (CAD), nephropathy, retinopathy, and neuropathy. Hypertension is treatable, and the degree to which it is controlled determines the risk of development of cardiovascular diseases and other complications in a given individual patient. Even though antihypertensive drugs are available and issued to hypertensive diabetic patients, the rate of control of HTN is often inadequate. The aim of this study was to assess the prevalence of suboptimal blood pressure (BP) control, its associated factors, and the choice of antihypertensive drugs among type 2 DM patients at Kilimanjaro Christian Medical Centre (KCMC). METHODS A hospital-based cross-sectional study was conducted at the KCMC diabetes clinic from October 2018 to March 2019 among type 2 DM patients with HTN based on the inclusion criteria. Data were collected using structured questionnaires, and written informed consent was obtained. Suboptimal BP was defined as BP levels ≥ 140/90 mmHg according to the American Diabetes Association guideline published in 2018. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 25. Chi-square analysis was done to identify the independent predictors of BP control, and a p value of <0.05 was considered to be statistically significant. RESULTS The data of 161 participants was analysed; the mean age was 63.9 ± 20.2 years, with the majority being females (67.1%). Despite all participants being on different classes of antihypertensives, 57.8% had suboptimal BP control. Among the participants with good BP control, 52.7% were on angiotensin-converting enzyme inhibitors (ACE-I). Poor diabetes control was observed in 50.1% participants as indicated by elevated glycated haemoglobin. CONCLUSION This study demonstrated that BP control in type 2 DM patients was suboptimal in more than half of the participants. The study showed that the use of ACE-I or angiotensin II receptor blockers (ARBs) in the majority of DM patients has a good impact in the control of blood pressure. The early initiation of ACE-I or ARBs among the diabetic patients will improve the optimal BP control.
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Affiliation(s)
- Gabriel W. Mbwete
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kajiru G. Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elichilia R. Shao
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nyasatu G. Chamba
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Liu L, Gu J, Shao F, Liang X, Yue L, Cheng Q, Zhang L. Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study. JMIR Mhealth Uhealth 2020; 8:e19417. [PMID: 32568722 PMCID: PMC7337960 DOI: 10.2196/19417] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/02/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. OBJECTIVE The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. METHODS Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. RESULTS Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. CONCLUSIONS Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.
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Affiliation(s)
- Luwen Liu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianqin Gu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Fengmin Shao
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xinliang Liang
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lixia Yue
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qiaomei Cheng
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lianzhong Zhang
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Marshall MR, Vandal AC, de Zoysa JR, Gabriel RS, Haloob IA, Hood CJ, Irvine JH, Matheson PJ, McGregor DOR, Rabindranath KS, Schollum JBW, Semple DJ, Xie Z, Ma TM, Sisk R, Dunlop JL. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial. J Am Soc Nephrol 2020; 31:1078-1091. [PMID: 32188697 PMCID: PMC7217404 DOI: 10.1681/asn.2019090877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and mortality. There is a global trend to lower dialysate sodium with the goal of reducing fluid overload. METHODS To investigate whether lower dialysate sodium during hemodialysis reduces left ventricular mass, we conducted a randomized trial in which patients received either low-sodium dialysate (135 mM) or conventional dialysate (140 mM) for 12 months. We included participants who were aged >18 years old, had a predialysis serum sodium ≥135 mM, and were receiving hemodialysis at home or a self-care satellite facility. Exclusion criteria included hemodialysis frequency >3.5 times per week and use of sodium profiling or hemodiafiltration. The main outcome was left ventricular mass index by cardiac magnetic resonance imaging. RESULTS The 99 participants had a median age of 51 years old; 67 were men, 31 had diabetes mellitus, and 59 had left ventricular hypertrophy. Over 12 months of follow-up, relative to control, a dialysate sodium concentration of 135 mmol/L did not change the left ventricular mass index, despite significant reductions at 6 and 12 months in interdialytic weight gain, in extracellular fluid volume, and in plasma B-type natriuretic peptide concentration (ratio of intervention to control). The intervention increased intradialytic hypotension (odds ratio [OR], 7.5; 95% confidence interval [95% CI], 1.1 to 49.8 at 6 months and OR, 3.6; 95% CI, 0.5 to 28.8 at 12 months). Five participants in the intervention arm could not complete the trial because of hypotension. We found no effect on health-related quality of life measures, perceived thirst or xerostomia, or dietary sodium intake. CONCLUSIONS Dialysate sodium of 135 mmol/L did not reduce left ventricular mass relative to control, despite improving fluid status. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The Australian New Zealand Clinical Trials Registry, ACTRN12611000975998.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd., Singapore
| | - Alain C Vandal
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Janak R de Zoysa
- Department of Renal Medicine, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
- Waitemata Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruvin S Gabriel
- Department of Cardiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Imad A Haloob
- Department of Renal Medicine, Bathurst Base Hospital, New South Wales, Bathurst, Australia
| | - Christopher J Hood
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - John H Irvine
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Philip J Matheson
- Department of Nephrology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - David O R McGregor
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Kannaiyan S Rabindranath
- Department of Nephrology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - John B W Schollum
- Nephrology Service, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - David J Semple
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Zhengxiu Xie
- Middlemore Clinical Trials, Auckland, New Zealand; and
| | - Tian Min Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
| | - Rose Sisk
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanna L Dunlop
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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25
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Daly B, Michaelis LC, Sprandio JD, Kapke JT, Narra RK, Malosh E, Zervoudakis A, Holland J, Zablocki M. From Theory to Practice: Implementation of Strategies to Reduce Acute Care Visits in Patients With Cancer. Am Soc Clin Oncol Educ Book 2020; 40:85-94. [PMID: 32421450 DOI: 10.1200/edbk_281139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patients with cancer frequently seek acute care as a result of complications of their disease and adverse effects of treatment. This acute care comes at high cost to the health care system and often results in suboptimal outcomes for patients and their caregivers. The Department of Health and Human Services has identified this as a gap in our care of patients with cancer and has called for quality-improvement efforts to reduce this acute care. We highlight the efforts of three centers-a community practice, an academic practice, and a cancer center-to reduce acute care for their patients. We describe the foundational principles, the practice innovation and implementation strategy, the initial results, and the lessons learned from these interventions. Each of the described interventions sought to integrate evidence-based best practices for reducing unplanned acute care. The first, a telephone triage system, led to 82% of calls being managed at home and only 2% being directed to an emergency department (ED) or hospital. The second, a 24-hour continuity clinic, led to a 26% reduction in ED utilization for patients with cancer. The third, a digital symptom monitoring and management program for high-risk patients on active treatment, led to a 17% reduction in ED presentations. There is a need for innovative care delivery models to improve the management of symptoms for patients with cancer. Future research is needed to determine the elements of these models with the greatest impact and how successful models can be scaled to other institutions.
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Affiliation(s)
- Bobby Daly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laura C Michaelis
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - John D Sprandio
- Consultants in Medical Oncology and Hematology, Broomall, PA
- University of Wisconsin Cancer Center at ProHealth Care, Waukesha, WI
| | - Jonathan T Kapke
- University of Wisconsin Cancer Center at ProHealth Care, Waukesha, WI
| | - Ravi Kishore Narra
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth Malosh
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Alice Zervoudakis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessie Holland
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Melissa Zablocki
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
OBJECTIVE To evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK. DESIGN Retrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns. SETTING Primary and secondary care sectors in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management. RESULTS Diagnosis was incomplete in 63% of patients' records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients' wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients' records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively. CONCLUSIONS Due to incomplete documentation in the patients' records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients' records, integration of care between different providers, wound healing rates and reducing infection.
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Affiliation(s)
- Julian F Guest
- Catalyst Consultants, Rickmansworth, UK
- King's College London, London, UK
| | | | - Jacky Edwards
- Burns Nurse Consultant, Burn Centre, Manchester University NHS Foundation Trust, Manchester, UK
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de Gouveia Belinelo P, Nielsen A, Goddard B, Platt L, Da Silva Sena CR, Robinson PD, Whitehead B, Hilton J, Gulliver T, Roddick L, Pearce K, Murphy VE, Gibson PG, Collison A, Mattes J. Clinical and lung function outcomes in a cohort of children with severe asthma. BMC Pulm Med 2020; 20:66. [PMID: 32188435 PMCID: PMC7081619 DOI: 10.1186/s12890-020-1101-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uncontrolled severe asthma in children is burdensome and challenging to manage. This study aims to describe outcomes in children with uncontrolled severe asthma managed in a nurse-led severe asthma clinic (SAC). METHODS This retrospective analysis uses data collected from children referred by a paediatric respiratory specialist to a nurse-led SAC for uncontrolled severe asthma between 2014 and 2019. The pre-clinical assessments included a home visit to assess modifiable factors that could be addressed to improve control. A comprehensive lung function analysis was conducted at each visit. Interventions were personalised and included biologic agents. Statistical analysis was performed using nonparametric, two-tailed Mann-Whitney U-test, the parametric Student's t-test, or analysis of variance (ANOVA) as appropriate. RESULTS Twenty-three children with a median age of 12 years were seen once, and 16 were followed up. Compared to a non-asthmatic (NA) and asthmatic (A) age-matched cohort, children with severe asthma (SA) had a lower FEV1, and FVC% predicted before and after bronchodilator inhalation, and a higher mean Lung Clearance Index [LCI] (10.5 [SA] versus 7.3 [NA] versus 7.6 [A], p = 0.003). Almost 80% of children with SA had an abnormal LCI, and 48% had a reduced FEV1% at the first SAC visit. Asthma control and FEV1% predicted significantly improved at a follow-up visit, while LCI remained abnormal in the majority of children (83%). CONCLUSION Over time, many children with severe asthma showed improved clinical outcomes and lung function while lung ventilation inhomogeneities persisted. Future appropriately controlled studies are required to determine if a nurse-led multidisciplinary SAC is associated with better outcomes.
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Affiliation(s)
- Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Aleisha Nielsen
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Bernadette Goddard
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Lauren Platt
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Carla Rebeca Da Silva Sena
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Bruce Whitehead
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Jodi Hilton
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Tanya Gulliver
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Laurence Roddick
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Kasey Pearce
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
- Respiratory & Sleep Medicine Department, John Hunter Hospital, Newcastle, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Lookout Road, New Lambton, 2305, Australia.
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, Australia.
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Vellore VR, Grando MA, Duncan B, Kaufman DR, Furniss SK, Doebbeling BN, Poterack KA, Miksch T, Helmers RA. Process Mining and Ethnography Study of Medication Reconciliation Tasks. AMIA Annu Symp Proc 2020; 2019:1167-1176. [PMID: 32308914 PMCID: PMC7153070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We studied the medication reconciliation (MedRec) task through analysis of computer logs and ethnographic data. Time spent by healthcare providers performing MedRec was compared between two different EHR systems used at four different regional perioperative settings. Only one of the EHRs used at two settings generated computer logs that supported automatic discovery of the MedRec task. At those two settings, 53 providers generated 383 MedRec instances. Findings from the computer logs were validated with ethnographic data, leading to the identification and removal of 47 outliers. Without outliers, one of the settings had slightly smaller mean (SD) time in seconds 67.3 (40.2) compared with the other, 92.1 (25). The difference in time metrics was statistically significant (p<.001). Reusability of an existing task-based analytic method allowed for rapid study of EHR-based workflow and task.
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Affiliation(s)
| | - M Adela Grando
- Biomedical Informatics, College of Health Solutions, Arizona State University, AZ, US
| | - Benjamin Duncan
- Biomedical Informatics, College of Health Solutions, Arizona State University, AZ, US
| | - David R Kaufman
- Biomedical Informatics, College of Health Solutions, Arizona State University, AZ, US
| | - Stephanie K Furniss
- Biomedical Informatics, College of Health Solutions, Arizona State University, AZ, US
- Kern Center Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Bradley N Doebbeling
- Biomedical Informatics, College of Health Solutions, Arizona State University, AZ, US
- Science of Healthcare Delivery, Arizona State University, AZ, US
| | - Karl A Poterack
- Kern Center Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
- Department of Anesthesiology, Mayo Clinic, AZ, US
| | - Timothy Miksch
- Kern Center Informatics and Knowledge Management, Mayo Clinic, Rochester, MN, US
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Shiozawa T, Yamaguchi S, Matsunaga A, Sawada U, Fujii C. Development of the Interpersonal Processes of Care Survey-Japanese version. Neuropsychopharmacol Rep 2020; 40:107-112. [PMID: 32022453 PMCID: PMC7292220 DOI: 10.1002/npr2.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/06/2019] [Accepted: 12/26/2019] [Indexed: 11/18/2022] Open
Abstract
AIMS In the past two decades, there has been growing interest in patient-doctor communication in psychiatry, and several treatment options have been established. This study aimed to develop the Interpersonal Processes of Care Survey-Japanese version (IPC-J), which measures multidimensional communication and the relationship between doctors and patients in Japanese psychiatry. METHOD We conducted a cross-sectional questionnaire survey at one psychiatric hospital and two psychiatric clinics in Japan and investigated the factor validity, convergent validity, internal consistency, and test-retest reliability of the IPC-J. RESULT Overall, 148 eligible patients participated in the study and were included in the analyses. Data from 16 participants were used to examine test-retest reliability. An exploratory factor analysis using 23 items from the IPC scale was performed to clarify the factor structure in a Japanese psychiatric setting. The final IPC-J contained 22 items and a two-factor structural model. High internal consistency (α > .8) and moderate test-retest reliability (interclass correlation > .65) were observed. Regarding convergent validity, the factor 1 "Doctor's communication-related attitudes and skills" was significantly correlated with service satisfaction, empowerment, and medication adherence, whereas the factor 2 "Consideration for the patient's to promote own treatment decisions" was correlated with service satisfaction and medication adherence. CONCLUSION The IPC-J appears to be a useful tool for assessing patient views on interpersonal communication with doctors in a Japanese psychiatric setting. While the analysis suggested utilizing an IPC-J with 22 items, the full IPC-J can be used in cross-cultural studies.
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Affiliation(s)
- Takuma Shiozawa
- Department of Nursing SciencesGraduate School of Human Health SciencesTokyo Metropolitan UniversityTokyoJapan
- Department of Community Mental Health and LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Sosei Yamaguchi
- Department of Community Mental Health and LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Asami Matsunaga
- Department of Community Mental Health and LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | - Utako Sawada
- Department of Community Mental Health and LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
- Department of Psychiatric NursingGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Chiyo Fujii
- Department of Community Mental Health and LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
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Wang L, Timmer S, Rosenman K. Assessment of a University-Based Outpatient Asthma Education Program for Children. J Pediatr Health Care 2020; 34:128-135. [PMID: 31628006 DOI: 10.1016/j.pedhc.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/27/2019] [Accepted: 09/07/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess the effect of a pediatric asthma intervention program on reducing asthma morbidity. METHODS Study eligibility criteria included aged less than 18 years and at least two office visits for asthma in the previous year. Patients were randomly assigned to either the control or intent to intervene group. The intervention included home visits and education on the basic pathophysiology of asthma, self-management techniques, modification of asthma triggers, and proper use of asthma medications by a certified nurse educator. RESULTS Using simple randomization, 901 eligible pediatric patients with asthma were assigned; 458 to the control and 443 to the intent to intervene group. Of the 443 patients randomized to the intent to intervene group, 271 received the asthma education intervention. Most of the remaining 172 patients in the intent to intervene group did not receive the intervention owing to not having an appointment during the study period. Only 27 families allowed a home visit. After controlling for the difference in sex, children in the intent to intervene group had significantly less total clinic visits (incidence rate ratio [IRR] = 0.53, p < .01), and steroid bursts (IRR = 0.47, p < .01) than controls. DISCUSSION The implementation of a pediatric asthma education program decreased both the total clinic visits and the need for steroid bursts consistent with better asthma control. We demonstrated the benefit of a dedicated asthma educator in university-based community practice and recommend this intervention be considered a standard of care for children with asthma in all health-care settings.
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Huang Y, Zhang L, Huang X, Liu K, Yu Y, Xiao J. Potentially inappropriate medications in Chinese community-dwelling older adults. Int J Clin Pharm 2020; 42:598-603. [PMID: 32026350 DOI: 10.1007/s11096-020-00980-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Abstract
Background There is a lack of data on the prevalence of potentially inappropriate medications (PIMs) in community-dwelling older adults in China. Objective To assess the prevalence of potentially inappropriate medication in community dwelling older adults in China and to investigate risk factors associated with the use of such medication. Setting Ambulatory Care Clinic of Xiangya Hospital, Central South University. Method A cross-sectional retrospective review of prescriptions for older patients (aged ≥ 65 years) was performed using the 2019 American Geriatrics Society (AGS) Beers Criteria and the 2017 Chinese Criteria. We only assessed potentialli inappropriate medications independently from diagnosis and drug-drug interactions. Each patient was classified as PIM-user or non-PIM-user, according to whether a patient took at least one potentially inappropriate medication. Main outcome measure Prevalence of potentially inappropriate medication based on the two criteria. Results A total of 8477 medications among 1874 elderly patients were examined over the study period from January 1 to December 31, 2018. The Chinese Criteria detected significantly more PIM-users than the AGS Beers Criteria (50.6% vs 35.0%, P < 0.001), and also a higher percentage of inappropriate medication in prescribed medications (14.7% vs 8.5%, P < 0.001). Benzodiazepines, anticholinergics, antipsychotics, and insulin were the most frequently prescribed classes by both criteria. Alprazolam (47.7%) was the most frequently found inappropriate medicine based on the 2019 AGS Beers Criteria compared to clopidogrel (42.2%) based on the Chinese Criteria. The number of medications was a significant risk factor to the use of potentially inappropriate medication in both criteria. Conclusion The prevalence of the use of potentially inappropriate medication in Chinese community-dwelling older adults is high, and explicit criteria are a useful tool to evaluate the prescription of such medication in the elderly.
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Affiliation(s)
- Yamin Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lu Zhang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Xingxing Huang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Keke Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yangyong Yu
- Department of Pharmacy, The Second People's Hospital of Beihai, Beihai, 536000, Guangxi, China
| | - Jian Xiao
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Halvorson AJ, Sechriest VF, Gravely A, DeVries AS. Risk of surgical site infection after carpal tunnel release performed in an operating room versus a clinic-based procedure room within a Veterans Affairs medical center. Am J Infect Control 2020; 48:173-177. [PMID: 31627986 DOI: 10.1016/j.ajic.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Carpal tunnel release (CTR) is increasingly performed in a clinic-based procedure room (PR) environment, which is less restrictive than traditional operating rooms (ORs). It is unknown if there is an impact on surgical site infection (SSI) rates. METHODS Records of patients who underwent clean, elective CTR from October 2014 to April 2017 at a single site were identified using Current Procedural Terminology codes and charts reviewed using National Healthcare Safety Network SSI criteria. Procedure type and patient characteristics were assessed with multivariate logistic regression and costs compared using administrative data. RESULTS A total of 312 procedures were included: 221 in OR and 91 in PR. SSI rate, including revisions, was 2.88% (nonrevision rate was 2.30%). Unadjusted SSI rate was 3.2% in OR and 2.2% in PR (P = .64). After adjusting for underlying risk factors, procedure setting was not associated with risk of SSI (P = .53; odds ratio, 0.43; 95% confidence interval, 0.03-5.94). Revision CTR was a predictor of SSI (P = .02; odds ratio, 28.21; 95% confidence interval, 1.84-434.57). The mean total cost of CTR in the OR was $4,254.21 and PR was $416.93. CONCLUSIONS There was no significant difference in SSI rates for CTR performed in OR and PR environments. CTRs performed in a PR led to a 10-fold cost savings. Based on our findings of PRs as both safe and cost-effective, we recommend that more facilities explore the use of PRs for CTR.
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Affiliation(s)
- Amanda J Halvorson
- Infectious Disease, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - V Franklin Sechriest
- Orthopaedic Surgery, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - Amy Gravely
- Research Services, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - Aaron S DeVries
- Infectious Disease, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN.
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Madziro-Ruwizhu TB, Nyagura T, Takarinda K, Jack HE, Kajawu L, Mangezi W. HIV Infection in Attendees of Psychiatric Clinics in Harare, Zimbabwe; Prevalence, Associated Factors and HIV Care Uptake. AIDS Behav 2019; 23:3471-3481. [PMID: 31444714 DOI: 10.1007/s10461-019-02633-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Determination of HIV prevalence among people with mental illness is necessary for developing integrated services for HIV and mental illness. This study determined HIV prevalence and uptake of HIV care among outpatients of psychiatric hospitals in Harare, Zimbabwe. HIV status was determined using open testing of 270 randomly selected consenting adult outpatients. HIV prevalence was 14.4% and the risk of acquiring HIV was similar to the general population of adults in Zimbabwe. Females were six times more likely to have HIV infection than males. Although a relatively high proportion of patients had been tested for HIV in the past (77.2%), fewer were recently tested (27.8%). Access to HIV care was high (94%) amongst patients previously diagnosed to be HIV positive. Tertiary mental health services should offer similar HIV care packages as other points of care and there is need for interventions that reduce the risk of HIV in women with mental disorders.
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Affiliation(s)
- Tatenda B Madziro-Ruwizhu
- Department of Psychiatry, Faculty of Medicine, Midlands State University, P Bag 9055, Gweru, Zimbabwe.
| | - Tendai Nyagura
- United States Agency for International Development (USAID), Harare, Zimbabwe
| | | | - Helen E Jack
- Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
- University of Washington, Seattle, WA, USA
| | - Lazarus Kajawu
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Walter Mangezi
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Cheong HC, Yap PSX, Chong CW, Cheok YY, Lee CYQ, Tan GMY, Sulaiman S, Hassan J, Sabet NS, Looi CY, Gupta R, Arulanandam B, AbuBakar S, Teh CSJ, Chang LY, Wong WF. Diversity of endocervical microbiota associated with genital Chlamydia trachomatis infection and infertility among women visiting obstetrics and gynecology clinics in Malaysia. PLoS One 2019; 14:e0224658. [PMID: 31738795 PMCID: PMC6860443 DOI: 10.1371/journal.pone.0224658] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022] Open
Abstract
The cervical microbiota constitutes an important protective barrier against the invasion of pathogenic microorganisms. A disruption of microbiota within the cervical milieu has been suggested to be a driving factor of sexually transmitted infections. These include Chlamydia trachomatis which frequently causes serious reproductive sequelae such as infertility in women. In this study, we profiled the cervical microbial composition of a population of 70 reproductive-age Malaysian women; among which 40 (57.1%) were diagnosed with genital C. trachomatis infection, and 30 (42.8%) without C. trachomatis infection. Our findings showed a distinct compositional difference between the cervical microbiota of C. trachomatis-infected subjects and subjects without C. trachomatis infection. Specifically, significant elevations of mostly strict and facultative anaerobes such as Streptococcus, Megasphaera, Prevotella, and Veillonella in the cervical microbiota of C. trachomatis-positive women were detected. The results from the current study highlights an interaction of C. trachomatis with the environmental microbiome in the endocervical region.
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Affiliation(s)
- Heng Choon Cheong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Polly Soo Xi Yap
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
| | - Yi Ying Cheok
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chalystha Yie Qin Lee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Grace Min Yi Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sofiah Sulaiman
- Department of Obstetrics and Gynecology, Faculty of medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jamiyah Hassan
- Department of Obstetrics and Gynecology, Faculty of medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chung Yeng Looi
- School of Bioscience, Taylor’s University, Subang Jaya, Selangor, Malaysia
- * E-mail: (WFW); (CYL)
| | - Rishein Gupta
- Center of Excellence in Infection Genomics, South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Bernard Arulanandam
- Center of Excellence in Infection Genomics, South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Sazaly AbuBakar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Tropical Infectious Disease Research and Education Center, University of Malaya, Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li Yen Chang
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Won Fen Wong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail: (WFW); (CYL)
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Spritzer PM, Marchesan LB, Santos BR, Cureau FV, Oppermann K, Reis RMD, Ferriani RA, Weiss R, Meirelles R, Candido AL, Reis FM. Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case-control study. BMJ Open 2019; 9:e029191. [PMID: 31640995 PMCID: PMC6830701 DOI: 10.1136/bmjopen-2019-029191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Brazil is a large country, with a population of mixed ethnic background and broad variation in dietary and physical activity traits across its five main regions. Because data on Brazilian women with polycystic ovary syndrome (PCOS) are still scarce, a nation-wide collaborative study was designed to determine the prevalence of metabolic and reproductive abnormalities and the presence of anxiety and depression in Brazilian women with PCOS. In addition, the study aims at describing how these characteristics are distributed across PCOS phenotypes and at detecting associations with regional demographic and lifestyle aspects, genetic variants, and epigenetic markers. METHODS AND ANALYSIS The Brazilian PCOS study is being conducted in the outpatient clinics of eight university hospitals within the public healthcare network (Unified Health System) across the country. Additional centres will be included following completion of the research ethics approval process. The sample includes women with PCOS according to Rotterdam criteria at inclusion in the study and a control group of healthy women matched by age, socioeconomic status and geographical region. Data will be collected in each centre and incorporated into a unified cloud database. Clinical, demographic, socioeconomic, psychological, metabolic, epigenetic and genotypic variables will be evaluated. The data resulting from this study will be useful to guide specific public strategies for primary and secondary prevention of metabolic and reproductive comorbidities in the PCOS population of Brazil. ETHICS AND DISSEMINATION The study protocol was approved by each local Research Ethics Committee. Written informed consent will be obtained from each participant. During data collection, analysis and publication, care will be taken to ensure confidentiality of participant information. Study results will be published in peer-reviewed journals and disseminated at international conferences. This research protocol was registered with the Research Ethics Committee of HCPA, through Plataforma Brasil. TRIAL REGISTRATION NUMBER CAAE 18082413.9.1001.5327.
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Affiliation(s)
- Poli Mara Spritzer
- Department of Physiology and Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Gynecological Endocrinology Unit, Endocrine Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Lucas B Marchesan
- Department of Physiology and Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Betânia R Santos
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe V Cureau
- Postgraduate Program in Medical Sciences: Endocrinology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karen Oppermann
- Department of Gynecology and Obstetrics, Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics Ribeirao Preto, Universidade de Sao Paulo Campus de Ribeirao Preto, Ribeirao Preto, Brazil
| | - Rui A Ferriani
- Department of Gynecology and Obstetrics Ribeirao Preto, Universidade de Sao Paulo Campus de Ribeirao Preto, Ribeirao Preto, Brazil
| | - Rita Weiss
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
| | - Ricardo Meirelles
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
| | - Ana Lucia Candido
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernando M Reis
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Khan DM, Asghar N, Ali I, Khan WA. The frequency of various diseases among patients attending Tehsil Headquarter Hospital Khwazakela, Swat. J PAK MED ASSOC 2019; 69:1369-1371. [PMID: 31511727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This hospital-based study was conducted in THQ (Tehsil Headquarter) Hospital Khwazakhela, district Swat in April 2018, to determine the incidence of various diseases among patients in general and the cases attended in the OPD (out patients department) in particular. One year of data was taken from April 2017 to March 2018, of all the patients who attended the THQ Hospital to check the frequency of individual diseases, month wise, gender wise, age wise as well as, case wise. Information on patients attending OPD with respiratory, gastro intestinal, urinary tract diseases and other communicable diseases were compiled. A total of 219,056 patients attended Civil Hospital Khwazakhela during that period, with an average of 18,254.66 patients per month. This comprised 104,349(47.63%) males and 114,707 (52.36%) females. Most patients were in the age group of 15 to 59 years which comprised a total of 109,217 (49.85%) patients. In this age group 42,713 (39.10%) were males and 66,504 (60.89%) were females. A total of 77,286 patients attended OPD having respiratory, gastro intestinal, urinary tract diseases and communicable diseases. Among these patients, about 28,115 (36.37%) had respiratory diseases, 23,045 (29.81%) had gastro intestinal diseases, 18,060 (23.36%) had urinary tract diseases and 8,066 (10.43%) had other communicable diseases. Respiratory diseases were the most common in our study. The ratio of female cases was higher than males. Most of the patients were in the age group of 15-59 years. The emerging challenges for health practitioners are to prevent respiratory diseases that pose a major healthcare burden in the region.
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Mustafa RE, Mushtaq S, Akhtar N, Yameen MA. Assessment of knowledge, attitude and practice towards hepatitis among patients visiting the hepatitis clinic in tertiary care hospital, Rawalpindi, Pakistan. J PAK MED ASSOC 2019; 69:1136-1141. [PMID: 31431767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the knowledge, attitude and practice of hepatitis B and C patients towards the disease. METHODS The cross-sectional, descriptive, questionnaire-based study was conducted at the Rawalpindi Medical University (RMU) and its allied hospitals, Rawalpindi, Pakistan, from October to December 2017, and comprised hepatitis B and C patients aged ≥18 years who were visiting the outpatient department. A structured, close-ended, 30-item questionnaire was used to collect data which was then analysed using SPSS 23. . RESULTS Of the 399 patients, 230(57.6%) were women, 103(26%) did not have any formal education, and TV, radio and the internet was the main source of information regarding hepatitis for 138(34.6%) patients. The overall mean age was 42.82}11.78 years. The sample showed poor knowledge with a mean score of 7.33}2.03, adequate attitude with a mean of 4.33}1.19, and poor practice with a mean of 2.97}1.05. Correlation was statistically significant between knowledge and practice (p<0.01). CONCLUSIONS Lack of imperative knowledge of hepatitis in patients was the main reason for negative attitude and poor practices.
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Affiliation(s)
- Raza E Mustafa
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | - Sana Mushtaq
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad , Pakistan
| | - Naeem Akhtar
- Department of Microbiology, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Arfat Yameen
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad , Pakistan
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Chen P, Callisaya M, Wills K, Greenaway T, Winzenberg T. Associations of health literacy with risk factors for diabetic foot disease: a cross-sectional analysis of the Southern Tasmanian Health Literacy and Foot Ulcer Development in Diabetes Mellitus Study. BMJ Open 2019; 9:e025349. [PMID: 31366636 PMCID: PMC6677956 DOI: 10.1136/bmjopen-2018-025349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Poor health literacy (HL) is associated with poorer health outcomes in diabetes but little is known about its effects on foot disease. This study was aimed to determine the associations between HL and diabetic foot disease. DESIGN This is a cross-sectional analysis of baseline data from a prospective study of foot disease. SETTING Attendees of the Royal Hobart Hospital's Diabetes outpatient clinics. PARTICIPANTS 222 people with type 1 or type 2 diabetes aged >40 years and without a history of foot disease, psychotic disorders or dementia. MEASURES Outcomes were peripheral neuropathy, peripheral arterial disease and foot deformity according to published guidelines. The exposure, HL, was measured using the short form Test of Functional Health Literacy in Adults (S-TOFHLA) and the Health Literacy Questionnaire (HLQ). Covariates included demographic characteristics, medical history, psychological measures and foot care behaviour. RESULTS Of 222 participants, 204 had adequate HL. (Mean (SD) S-TOFHLA scores were 31.9 (6.7)), mean(SD) HLQ scores were 134.4 (18.4)). In univariable but not multivariable analyses, higher S-TOFHLA scores were associated with lower overall risk for foot disease (OR 0.96, 95% CI 0.93 to 0.99) and loss of protective sensation (OR 0.95, 95% CI 0.91 to 0.995). CONCLUSIONS These data provide little support for clinically important impacts of HL on risk factors for diabetic foot disease. However, in the absence of longitudinal data, such effects cannot be ruled out. Longitudinal studies measuring incident foot disease are needed to properly judge the potential for interventions improving HL to reduce the incidence of diabetic foot disease.
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Affiliation(s)
- Pamela Chen
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Michele Callisaya
- Academic Unit, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Karen Wills
- Respiratory Research Group, Menzies Research Institute, Hobart, Tasmania, Australia
| | - Tim Greenaway
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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Yarube IU, Friday J, Alhassan AW, Saleh MIA. Cognitive Dysfunction Among Primi gravidae Attending an Ante Natal Clinic in Kano, Northwest Nigeria. Niger J Physiol Sci 2019; 34:43-48. [PMID: 31449270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
Cognitive deficits among pregnant women have been reported, though the evidence is equivocal. Cognitive dysfunction during pregnancy may have negative consequences on maternal and child health. Yet, very little is known about cognitive function of pregnant women in general and primi gravidae in particular in the area under study. This study aimed to evaluate cognitive function among primi gravidae. About 120 primi gravidae were studied in a large urban hospital in Kano. Mini-Mental State Examination (MMSE) was used to evaluate cognitive function; socio-demographic and clinical data were obtained. Data were processed using IBM SPSS statistics version 20.0. Significant values of P were those < 0.05. The median age of the primi gravidae was 20.0 (3) years; 80 % of them had secondary school education, 88.3 % were in their third trimester of pregnancy and 42.5 % did not have any medical complaints at the time of presentation. The median MMSE score of the primi gravidae was 22.00 (19.0), indicating mild cognitive impairment. Majority of the women (88.3%) had either mild (58.3%) or severe (30%) cognitive dysfunction. The cognitive dysfunction was influenced by level of education (X2 = 11.961, P = 0.003) and type of presenting complaints (X2 = 13.514, P = 0.036). There was significant association between the mild cognitive impairment and level of education (X2 = 11.426, P = 0.022). This study concluded that the primi gravidae had mild cognitive impairment; with majority (88.3%) of them having cognitive dysfunction, which was significantly associated with level of educational attainment and was influenced by the level of education and presenting complaints.
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Affiliation(s)
- Isyaku U Yarube
- Neuroscience and Pathophysiology Unit, Department of Human Physiology, Bayero University, Kano, Nigeria.
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McCulloch R, Smith A, Crosbie N, Patmore R, Rule S. Receiving treatment at a specialist centre confers an overall survival benefit for patients with mantle cell lymphoma. Br J Haematol 2019; 185:1002-1004. [PMID: 30474177 DOI: 10.1111/bjh.15696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rory McCulloch
- Department of Haematology, Derriford Hospital, Plymouth, UK
| | - Alexandra Smith
- Epidemiology & Cancer Statistics Group, University of York, York, UK
| | - Nicola Crosbie
- Department of Haematology, Derriford Hospital, Plymouth, UK
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | - Simon Rule
- Department of Haematology, Derriford Hospital, Plymouth, UK
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
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Winn LAP, Paquette KL, Donegan LRW, Wilkey CM, Ferreira KN. Enhancing adolescent SBIRT with a peer-delivered intervention: An implementation study. J Subst Abuse Treat 2019; 103:14-22. [PMID: 31229188 DOI: 10.1016/j.jsat.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Innovations in adolescent prevention and early intervention strategies are needed to curb early substance use and bring public health models to scale, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). Young adults in recovery may have an important role to play in delivering these innovations. However, clinics, schools, and community programs may face barriers when implementing new prevention and early intervention approaches in their settings. The purpose of this study is to examine the feasibility, barriers, and facilitators of Project Amp, an innovative, four-session prevention and early intervention model to enhance SBIRT for adolescents. METHODS Three school-based programs and three health clinics were selected to implement SBIRT for adolescents and refer eligible adolescents (13-17 years old, moderate risk for substance use disorder) to the study intervention. Between three and six mentors (young adults, 18-28 years old, with lived experience of substance use recovery, also known as peers), were recruited at each site and trained in core skills to deliver the intervention. Study staff communicated with each setting throughout implementation and collected quantitative and qualitative data regarding facilitators and barriers to success. The qualitative data were analyzed to identify key strategies for success when implementing Project Amp. RESULTS Across the six sites, 71 practitioners including physicians, nurses, social workers, and counselors, completed training in SBIRT and 30 mentors were hired and trained for the study. Twenty completed sessions with adolescent participants. A total of 1192 adolescents were screened using the CRAFFT. Of those screened, 139 (12%) were eligible, 51 eligible youth (37%) enrolled in the study, and 28 enrolled youth (55%) completed the intervention. Five of the six sites were successfully able to integrate the SBIRT-based Project Amp model into their workflow. Facilitators and barriers for implementation were identified related to three critical factors: recruitment, readiness, and sustainability. CONCLUSIONS The Project Amp intervention can be conducted successfully in school and healthcare settings in conjunction with SBIRT, adding capacity to expand access to screening and early intervention in a developmentally appropriate way. However, the study yielded insights into adaptations for future implementation, such as a more streamlined model and centralized staff roles such as integrated roles for young peer mentors.
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Affiliation(s)
- Laura A Pannella Winn
- C4 Innovations, 200 Reservoir Street, Suite 202, Needham, MA 02494, United States of America.
| | - Kristen L Paquette
- C4 Innovations, 200 Reservoir Street, Suite 202, Needham, MA 02494, United States of America.
| | - Laura Rose W Donegan
- C4 Innovations, 200 Reservoir Street, Suite 202, Needham, MA 02494, United States of America.
| | - Catriona M Wilkey
- C4 Innovations, 200 Reservoir Street, Suite 202, Needham, MA 02494, United States of America.
| | - Kathleen N Ferreira
- C4 Innovations, 200 Reservoir Street, Suite 202, Needham, MA 02494, United States of America.
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Cohen GA, Nocton JJ, Treat R. Comparing Board Examination Scores Between Pediatric Residents in Continuity Clinics at Different Sites. WMJ 2019; 118:35-38. [PMID: 31083832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Determine if there is a difference in medical knowledge between pediatric residents attending continuity clinic at a community-based center versus those attending an academic center, as measured by the American Board of Pediatrics In-Training Exam (in-training exam) and the American Board of Pediatrics Certification Exam (certification exam). METHODS A retrospective evaluation of in-training and certification exam scores of pediatric residents enrolled at the Medical College of Wisconsin and Children's Hospital of Wisconsin was performed. Test scores of the group of residents participating in a community-based continuity clinic were compared to those residents attending an academic center continuity clinic. RESULTS There were no statistically significant differences in mean test scores for each of the 3 years of residency training on the in-training exam or board certifying exam after graduation. In-training exam scores significantly predicted certification exam scores, and there were significant increases in the in-training exam scores throughout residency, irrespective of clinic location. CONCLUSION This study shows no difference between residents participating in a communitybased continuity clinic and those participating in an academic center continuity clinic in objective outcomes as measured by scores on the American Board of Pediatrics In-Training Exam and the American Board of Pediatrics Certifying Exam.
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Affiliation(s)
- Gary A Cohen
- Medical College of Wisconsin, Division of Neonatology, Children's Corporate Center, Wauwatosa, Wisconsin,
| | - James J Nocton
- Medical College of Wisconsin, Division of Rheumatology, Children's Corporate Center, Wauwatosa, Wisconsin
| | - Robert Treat
- Medical College of Wisconsin, Milwaukee, Wisconsin
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Jha B, Bhattarai S, Sapkota J, Sharma M, Bhatt CP. Dermatophytes in Skin, Nail and Hair among the Patients Attending Out Patient Department. J Nepal Health Res Counc 2019; 16:434-437. [PMID: 30739936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dermatophytosis are the most common types of cutaneous fungal infection seen in human and animals affecting skin, hair and nails caused by dermatophytes. The diagnosis of dermatophytes is based on the clinical observation and laboratory diagnosis by direct microscopic examination and fungal cultures. The present study is undertaken to isolate different type of dermatophytes causing fungal infection. METHODS A prospective cross-sectional study design was used in a total of 90 clinically suspected cases of dermatophytic infection attending the out patient department of Kathmandu Medical College and Teaching hospital (KMCTH). Skin scraping, hair and nail samples were collected from the patients and were processed by direct microscopy and culture using standard protocol. Dermatophytes were identified based on the microscopic arrangement of microconidia and macroconidia. RESULTS Dermatophytosis was more common in the age group of 21-40 years and was more predominant among male with male to female ratio of 1.7: 1. Among the total clinically suspected cases of dermatophytosis, 53 were positive in direct microscopy and only a total of 20 were positive by culture. Most common clinical type observed in our study was Tinea corporis(25%) followed by Tinea cruris. Trichophyton rubrum(50%) was the commonest aetiological agent in majority of clinical types followed by Trychophyton mentagrophytes(35%). CONCLUSIONS The study highlighted T. corporis followed by T. cruris and T. unguim as the most common clinical pattern of dermatophytosis with a male predominance and 21-40 years being the most affected age group. T. rubram was the most common aetiological agent causing dermatophytosis.
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Affiliation(s)
- Beena Jha
- Department of Microbiology, Kathmandu Medical College, Duwakot, Bhaktapur and Teaching Hospital, Nepal
| | - Sabina Bhattarai
- Department of Dermatology and venereology, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - Jyotshna Sapkota
- Department of Microbiology, Kathmandu Medical College, Duwakot, Bhaktapur and Teaching Hospital, Nepal
| | - Manisha Sharma
- Department of Microbiology, Kathmandu Medical College, Duwakot, Bhaktapur and Teaching Hospital, Nepal
| | - Chandra Prakash Bhatt
- Department of Microbiology, Kathmandu Medical College, Duwakot, Bhaktapur and Teaching Hospital, Nepal
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Rhee J, Meller A, Krysinska K, Gonski P, Naganathan V, Zwar N, Hayen A, Cullen J, O’Keefe JA, McDonald J, Harris-Roxas B, Caplan GA. Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e023107. [PMID: 30679290 PMCID: PMC6347867 DOI: 10.1136/bmjopen-2018-023107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. METHODS AND ANALYSIS Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6-12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient's health-related quality-of-life and quality of chronic disease care; (ii) caregiver's health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff's self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention. ETHICS AND DISSEMINATION Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks. TRIAL REGISTRATION NUMBER ACTRN12617000280303.
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Affiliation(s)
- Joel Rhee
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne Meller
- Post Acute Care Services, Prince of Wales Hospital, South Eastern Sydney, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Gonski
- Southcare, Sutherland Hospital, South Eastern Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney and Ageing and Alzheimer’s Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, University of Technology, Sydney, New South Wales, Australia
| | - John Cullen
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Julie-Ann O’Keefe
- Aged, Chronic Care & Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Julie McDonald
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Abstract
OBJECTIVES Memory clinics play an important role in enabling early dementia diagnosis and intervention. Few studies have investigated the changing patient profiles at memory clinics over time. We studied the trend of patient characteristics in a geriatric medicine-led memory clinic over 12 years to improve services and care to meet their needs. SETTING AND PARTICIPANTS Data from 2340 first-visit patients seen at a memory clinic from 2005-2017 were extracted from a registered database and analysed. DESIGN ANOVA, Pearson chi-square and non-parametric tests were used to describe and compare between patients with dementia (PWD) and patients with no dementia (PND). MEASUREMENTS Data included diagnoses of dementia and mild cognitive impairment, age, education, MMSE scores and comorbidities. RESULTS Patients averaged 77.2 ± 8.3 years of age with mean MMSE score of 16.2 ± 6.7. Those diagnosed with dementia were older (78.3 ± 7.9 years) and almost half (48.4%) had moderate or moderately severe dementia (FAST 5-6). Over time, there was a growing proportion of patients with mild cognitive impairment (MCI) and mild Alzheimer's dementia. Many PWD had co-morbidities of hypertension (65.9%), hyperlipidemia (55.1%), diabetes (33.5%) and 28.4% were frail. CONCLUSIONS The findings call for services to better diagnose and manage patients at the earlier stages of cognitive impairment and provide holistic interventions for those with frailty and other co-morbidities. The continued rise in number of patients presenting to memory clinics provides impetus to expedite integration of tertiary-based memory clinics with primary and community care providers to better support PWD and their families.
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Affiliation(s)
- X Y Chua
- Philip Yap Lin Kiat, Affiliation: Khoo Teck Puat Hospital, Department of Geriatric Medicine, Singapore, 90 Yishun Central, Singapore 768828, , Tel: 65-66022154
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Santibenchakul S, Tschann M, Carlson ADP, L Hurwitz E, Salcedo J. Promotion of Long-Acting Reversible Contraception Among Adolescents and Young Adults. J Midwifery Womens Health 2018; 64:194-200. [PMID: 30570219 DOI: 10.1111/jmwh.12934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Intrauterine devices and contraceptive implants are recommended as first-line contraceptives by health care professional societies. However, uptake among US women lags substantially behind other developed countries. Little information is available on the extent to which clinicians document discussion about long-acting reversible contraception (LARC) in this patient population. We sought to determine the frequency with which clinicians document LARC discussion with eligible women aged 14 to 25 years in a training clinic and evaluate factors associated with LARC discussion and uptake. METHODS We conducted a retrospective chart review of all visits of nonpregnant women aged 14 to 25 years seen at an obstetrics and gynecology resident physician clinic during a calendar year. A logistic regression model was used to assess demographic factors associated with LARC education and uptake. RESULTS Among 450 visits by eligible patients, LARC discussion was documented during 47.8% (215/450) of visits. Among visits with documentation of LARC counseling, 45.6% (98/215) had documentation of a LARC placement plan. Among patients who decided to initiate LARC, 40.8% (40/98) had a device placed at the same visit. LARC placement was documented during 8.9% (40/450) of visits. Clinicians documented LARC counseling for women aged 14 to 19 years more frequently than for women aged 20 to 25 years. Compared with women who did not use any method of contraception, clinicians documented LARC counseling less frequently for women who used short-term hormonal contraception. DISCUSSION Clinicians in a training clinic did not document LARC counseling for more than half of eligible patients. Every clinical visit is an opportunity to assess risk of unintended pregnancy and ensure that contraceptive needs are addressed.
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Doersch KM, Machen GL, Thai KH, Sung J, El Tayeb MM. Feasibility and clinical outcomes of ureteral stenting in the office procedural suite. Can J Urol 2018; 25:9596-9600. [PMID: 30553285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Stent placement is a common procedure for addressing obstructive uropathy. However, lack of operating room (OR) availability can substantially delay this procedure. In this study, we sought to assess the feasibility, safety, and efficacy of this procedure in a clinical setting using nitrous oxide (N2O) and local anesthesia. MATERIALS AND METHODS Patients included in this study included those who were determined to need management of urinary obstruction with a JJ ("double J") stent and had their procedure performed in the clinic procedure suite with N2O anesthesia. RESULTS We present a case series of 565 patients undergoing ureteral stent placements in a clinic operative suite with N2O. In this cohort, complications occurred after 4.1% of procedures and unplanned admissions to the hospital occurred after 2.5% of procedures. Stent placements failed in 1.0% of procedures. Failures occurred due to pain in 2/565 patients. No anesthetic complications were encountered. CONCLUSION We report the feasibility and clinical outcomes of ureteral stent placements for ureteral obstruction in a clinic setting with the use of local anesthetic or N2O anesthesia, with excellent results. A majority of patients tolerated the procedure well and only 2 of 565 had their procedures stopped due to discomfort. To our knowledge, this is the first report of the use of N2O anesthetic for conscious sedation for the placement of ureteral stents.
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Affiliation(s)
- Karen M Doersch
- MD/PhD Program, Texas A & M Health Science Center College of Medicine, Temple, Texas, USA
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Abstract
BACKGROUND Soluble forms of Toll-like receptors (sTLR) 2 and 4 exert negative regulatory control on membrane-bound receptor activation. The study estimates the sTLR2 and sTLR4's serum levels in type 2 diabetes (T2D) and evaluates their relationship with metabolic and inflammatory parameters. SUBJECTS AND METHODS Sixty three patients with T2D and 25 controls were enrolled. sTLR were assayed through ELISA. Inflammatory markers included Interleukin 6 (IL-6), high sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor α. RESULTS Analysis demonstrated lower sTLR2 level in T2D than in control subjects (1.15 ± 0.65 versus 1.44 ± 0.60 ng/ml, p = .019) while sTLR4 level remained similar (0.09 ± 0.16 versus 0.07 ± 0.12 ng/ml, p > .05) despite higher IL-6 (2.65 ± 2.46 versus 1.44 ± 0.22 pg/ml, p = .005) and hs-CRP (2.79 ± 2.89 versus 0.70 ± 0.89 mg/l, p < .001) concentrations. Neither sTLR correlated with BMI, HbA1c, plasma glucose and analysed cytokines (p > .05). CONCLUSION The sTLR2 serum level in T2D patients was reduced despite elevated inflammatory parameters.
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Affiliation(s)
- Emanuela Zaharieva
- a Clinic of Endocrinology, Department of Internal Medicine, Faculty of Medicine , University Hospital Alexandrovska, Medical University - Sofia , Sofia , Bulgaria
| | - Tsvetelina Velikova
- b Laboratory of Clinical Immunology, Department of Clinical Immunology, Faculty of Medicine , University Hospital St. Ivan Rilski, Medical University - Sofia , Sofia , Bulgaria
| | - Adelina Tsakova
- c Central Clinical Laboratory, Department of Clinical Laboratory, Faculty of Medicine , University Hospital Alexandrovska, Medical University - Sofia , Sofia , Bulgaria
| | - Zdravko Kamenov
- a Clinic of Endocrinology, Department of Internal Medicine, Faculty of Medicine , University Hospital Alexandrovska, Medical University - Sofia , Sofia , Bulgaria
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Kunzler E, Chong BF. Outcomes associated with shorter wait times at a county hospital outpatient dermatology clinic. Cutis 2018; 102:159-160. [PMID: 30372714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Elaine Kunzler
- Department of Internal Medicine, Summa Health System, Akron, Ohio, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, and Parkland Health and Hospital System, Dallas, USA
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Out M, Top WMC, Lehert P, Schalkwijk CA, Stehouwer CDA, Kooy A. Long-term treatment with metformin in type 2 diabetes and vitamin D levels: A post-hoc analysis of a randomized placebo-controlled trial. Diabetes Obes Metab 2018; 20:1951-1956. [PMID: 29667290 DOI: 10.1111/dom.13327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/03/2018] [Accepted: 04/13/2018] [Indexed: 01/02/2023]
Abstract
AIMS To study the effects of metformin, as compared to placebo, on serum levels of vitamin D (25-hydroxyvitamin D [25(OH)D]) in patients with advanced type 2 diabetes. MATERIALS AND METHODS In the HOME trial, a randomized placebo-controlled trial, 390 insulin-treated patients with type 2 diabetes were treated with 850 mg metformin or placebo thrice daily for 52 months. In a post-hoc analysis, we examined changes in the combined levels of 25(OH)D2 and 25(OH)D3 at 4 and 16 months during the study. RESULTS Mean combined 25(OH)D at baseline was 68.2 nmoL/L (95% confidence interval [CI]: 65.5-71.1). In mixed model analysis, metformin, as compared to placebo, had no effect on 25(OH)D levels during 16 months (coefficient: 1.002 per month, multiplicative model; 95% CI: 0.998-1.006, P = .30). Metformin was associated with a small increase of 25(OH)D2 (coefficient: 1.012 per month; 95% CI: 1.003-1.021, P = .008). However, 25(OH)D2 is only a very small fraction (3%) of 25(OH)D. Seasonal variation had the biggest impact on 25(OH)D levels. Vitamin B12 levels were not associated with the levels of 25(OH)D. CONCLUSION Metformin had no effect on serum 25(OH)D during 16 months in the setting of a clinical randomized controlled trial in patients with type 2 diabetes. Our results show that metformin doesn't lead to vitamin D deficiency.
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Affiliation(s)
- Mattijs Out
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Wiebe M C Top
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
| | - Philippe Lehert
- Department of Statistics, Faculty of Economics, Facultés Universitaires Catholiques de Mons, Louvain Academy, Mons, Belgium
| | - Casper A Schalkwijk
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Adriaan Kooy
- Department of Internal Medicine, Bethesda Hospital Hoogeveen - Care Group Treant, Hoogeveen, The Netherlands
- Bethesda Diabetes Research Center Hoogeveen, Hoogeveen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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