Characteristics Of Outpatients Research Articles

SOCIO-DEMOGRAPHIC AND CLINICAL PREDICTORS OF FAILURE TO ACHIEVE THE TARGET LEVEL OF BLOOD PRESSURE IN OUTPATIENTS WITH ISOLATED ARTERIAL HYPERTENSION AND IN COMBINATION WITH CARDIOVASCULAR COMORBIDITY

The problem of achieving the target level of blood pressure (TBP) is extremely relevant today, as arterial hypertension (AH) is the leading modifiable risk factor for cardiovascular complications.The aim of the study is to investigate the relationships between achievement/failure of TBP and socio-demographic and clinical characteristics in outpatients with isolated AH and in combination with cardiovascular comorbidity and to determine probable predictors of failure to achieve TBP.Material and methods. The study was carried out on the basis of the municipal non-profit enterprise “Gulsk outpatient clinic for general practice of family medicine” of the Strievsky village council, the village of Striyevo, Zvyagelsky district, Zhytomyr region The study involved 140 patients with AH, divided into three groups: isolated AH (n=60), AH+coronary heart disease (CHD) (n=35), AH+CHD+chronic heart failure (HF) (n=45). Patients were considered to have achieved the TBP if their office BP was <140/90 mm Hg when measured twice with an interval of 1 month.Results. The absence of statistically significant changes according to achievement/failure of TBP between outpatients with isolated AH and AH with cardiovascular comorbidity (χ2=3.37; p=0.185) was revealed, while in the group with isolated AH 65.00%, in the group with AH + CHD – 45.71%, in the group of AH + CHD + HF – 57.78% of people did not reach the TBP. Analyzing the relationships between the achievement/failure of TBP and age, gender, social status and modifiable risk factors (smoking, alcohol abuse and salt abuse), statistically significant differences were found only in relation to salt abuse in outpatients with AH and cardiovascular comorbidity (in the group of AH + CHD 100.00%, and in the group AH + CHD + HF 96.15% of people who abuse salt did not reach the TBP). The results of the logistic regression analysis showed that the female gender is by 4.1 times more likely to be associated with failure to achieve TBP compared to the male gender in the group with isolated AH, by 3.5 times – in the group of AH+CHD, by 3.4 times – in the group of AH+CHD+HF; salt abuse increases the risk of not reaching the TBP in the group with isolated AH by 19.4 times; by 20.8 times – in the group of AH + CHD; by 21.1times – in the group of AH + CHD + HF. Analyzing the relationship between achievement/failure of TBP and clinical characteristics of outpatients with isolated AH, the duration of the disease in persons who did not reach TBP is 2.0 times longer than the catamnesis of persons who reached TBP (p<0.001); the degree and stage of arterial hypertension significantly affects achievement/failure of TBP (χ2=22.27; p<0.001 and χ2=7.66; p=0.022, respectively). The results of the logistic regression analysis show that an increase in BP (in particular, each subsequent degree of AH) is more often associated with failure to achieve TBP both in patients with isolated AH and in patients with AH and cardiovascular comorbidity: by 2.7 times in the group with isolated AH; by 2.8 times in the group of AH + CHD; by 3.0 times – in the group of AH+CHD+HF.Conclusions. Female gender, salt abuse, and the degree of AH are statistically significant factors associated with an increased risk of not reaching the target blood pressure level both in outpatients with isolated AH and in patients with AH combined with cardiovascular comorbidity.

The efficacy and safety of ginger (Zingiber officinale) rhizome extract in outpatients with COVID-19: A randomized double-blind placebo-control clinical trial.

Ginger, a potent antiviral, anti-inflammatory, and antioxidant remedy, is a potential therapeutic option for COVID-19. However, there was not enough clinical evidence about ginger and COVID-19. We evaluated the efficacy and safety of ginger on clinical and paraclinical features in outpatients with COVID-19. In this randomized controlled trial, the outpatients with confirmed COVID-19 were randomly assigned in a 1:1 ratio to receive ginger (1000 mg 3 times a day for 7 days) or placebo. The primary outcome was viral clearance after the end of the intervention. Oxygen saturation (SPO2), body temperature, respiratory rate (RR), hospital admission, and the incidence of adverse events were also assessed. A total of 84 patients (42 in the ginger and 42 in the control groups) were randomized. The viral clearance was not statistically improved in the ginger group (41.6%) compared to the placebo group (42.8%). The findings indicated that SPO2, body temperature, and RR had no significant difference between the groups at the end of the intervention. The imaging finding indicated pulmonary infiltrate significantly reduced on the 7th day of the intervention in the ginger group. The percentage of patients with SPO2 <96% in the ginger group decreased over the study compared to the placebo group. Moreover, the need for hospital admission and the incidence of adverse drug events were not different between the groups over the follow-up period. Ginger had no significant impact on the clinical and paraclinical parameters of patients. However, this intervention demonstrated a safe profile of adverse events and reduced pulmonary infiltrate. The trial was registered as IRCT20200506047323N1.

Symptoms of depression among outpatients with suspected COVID-19 in metropolitan Local Government Areas of Kaduna State, Nigeria.

The novel SARS-CoV-2 virus that causes Coronavirus disease (COVID-19) has redefined global health and response to Acute Respiratory Infection (ARI). The outbreak of a cluster of influenza-like illnesses in Wuhan, China, has morphed into a pandemic in the last quarter of 2019, stretching from South East Asia to Europe, The Americas, Africa, and the Australian subcontinent. We evaluated the prevalence of depression among outpatients diagnosed with ARI. We utilized a cross-sectional, observational design and investigated the prevalence of symptoms of depression among outpatients with ARI and described the characteristics of outpatients with ARI in Kaduna State. The prevalence of symptoms of depression was 19.6% for respondents with symptoms of ARI and 14.4% for those without symptoms of ARI. On no risk of depression, we had a higher proportion of the respondents without symptoms of ARI (86%) than those with symptoms of depression (80%) (M = 318.4, SD = 29.62 case, and M = 344.0, SD = 14.2 control, r = 0.88, CI = 13.5 to 6.5, P = 0.000952). Likewise, in the category with mild risk of depression, respondents without symptoms of ARI were fewer (10%) than those with symptoms of depression (15%) (M = 58.4, SD = 26.0 case, and M = 42.1, SD = 12.7 control, r = 0.86, CI = 11.8 to 5.8, P = 0.0136. There was no significant difference between respondents with symptoms of ARI and without symptoms of ARI in the categories of moderate (M = 13.6, SD = 5.1 case, and M = 11.6, SD = 4.6 control, r = 0.87, CI = 2.3 to 2.1, P = 0.178) and high (M = 5.6, SD = 2.5 case, and M = 4.4, SD = 3.2 control, r = 0.61, CI = 1.2 to 1.5, P = 0.174) risk of depression. Symptoms of depression were commoner among respondents who presented with symptoms of Acute Respiratory Infection (ARI) at the Outpatient Department (OPD). However, further explanatory research is needed to establish causality.

Relationships and Activities. The study is supported by OOO AstraZeneca Phar­maceuticals.

Heart failure (HF) is a global health problem. Despite advances in the development of effective treatments for patients with heart failure, morbidity and mortality from remain high, and the prognosis is poor. However, there is potential to improve outcomes in HF patients with current disease-modifying therapy. Planning needs and resources, assessing the effectiveness of care for HF patients in clinical practice requires high-quality epidemiological data. Previously performed Russian observational studies of HF were characterized by relatively small sample sizes, inclusion of patients in only one or a few regions, strict selection criteria, single-stage design, or short follow-up. The rationale and design of the all-Russian prospective observational multicenter registry study "PRIORITET-CHF", which included 20000 patients with HF throughout the Russian Federation, is presented. The main aims of the study are to (1) describe baseline clinical and demographic characteristics in outpatients with HF in the Russian Federation and (2) characterize routine therapy and evaluate the compliance of treatment for HF with reduced ejection fraction with current clinical guidelines.

Characteristics of Outpatients with Mild Chronic Diseases Who Use Tertiary General Hospitals and General Hospitals

Characteristics of Outpatients with Mild Chronic Diseases Who Use Tertiary General Hospitals and General Hospitals

Investigation of Reflux Characteristics in Outpatients of Otorhinolaryngology-Head and Neck Surgery by Age and Gender in the Chinese Population

To investigate the characteristics of patients with reflux diseases in the otorhinolaryngology-head and neck surgery clinics through the Reflux Symptom Scale-12 (RSS-12) and the Gastroesophageal Reflux Disease Questionnaire (GERD-Q). All included patients completed the RSS-12 and GERD-Q scales and were considered to have LPR with an RSS-12 score >11 and GERD with a GERD-Q score >7. Data were analyzed according to genders (male and female) and age (18-40, 41-60, and >60 years). A total of 977 patients were included. the mean RSS-12 and GERD-Q score were 11.32±21.34 and 6.31±1.21, and the positive rate of LPR and GERD were 28.76% and 8.90%, respectively. Males had a higher positive rate of LPR and GERD than females, and there were more males with LPR who also had GERD. Among those with both LPR and GERD, males had significantly higher ear-nose-throat (ENT) symptom scores such as hoarseness and excess throat mucus than females. However, females had significantly higher scores of gastrointestinal (GI) symptoms, mainly indigestion and abdominal pain, and elder patients (>60 years) had higher scores of ENT, GI, respiratory symptoms, as well as the impact of symptoms on quality of life than the young patients (18-40, and 41-60 years). Patients in the otorhinolaryngology-head and neck surgery clinics have different reflux characteristics by gender and age in the Chinese population. Males had more severe ENT-related symptoms of distress, while females had more complaints of GI symptoms. Older patients had higher scores for ENT, GI and respiratory symptoms.

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China.

BackgroundWorkflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.MethodsIn a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.ResultsThe number of patients was the significant independent predictor of the number of interruptions (p < 0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (X2 = 16.988, p = 0.049).ConclusionThe findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

Characteristics of outpatients with functional somatic syndromes at a university hospital's general medicine clinic.

BackgroundThe term medically unexplained symptoms (MUS) is unhelpful for both patients and physicians, and more acceptable illness categories are needed as substitutes for MUS. While some potential substitutes are characterized by excessive psychological burden related to somatic symptoms, “functional somatic syndromes” (FSS) is a category that focuses on physical dysfunction and emphasizes similarities among individual syndromes. Examples of FSS include irritable bowel syndrome, functional dyspepsia, and fibromyalgia syndrome. This study aimed to distinguish FSS from MUS and compare the somatic and psychobehavioral characteristics of FSS with those of other diseases.MethodsThis study included 1975 first‐visit outpatients at a Japanese university hospital's general medicine clinic. According to their first‐listed diagnosis, they were classified as having FSS, acute infection, organic disease (OD), psychiatric disorder, and unknown condition (UC). The somatic symptom burden and health‐related quality of life (HRQoL) were assessed using the Somatic Symptom Scale‐8 and EuroQol‐5 Dimension, respectively; the involvement of psychobehavioral factors affecting somatic symptoms was also evaluated.ResultsOverall, 33% of patients were included in the FSS category, and 93% of the supposed MUS (FSS and UC) were diagnosed with FSS. Compared with OD, FSS showed more severe somatic symptom burden, similar reduced HRQoL, and higher involvement of psychobehavioral factors.ConclusionIt can be useful to improve FSS diagnostic skills for the reduction of MUS misdiagnosis. Psychobehavioral factors might be less associated with MUS (in the narrow sense of the term) than FSS.

Clinical-Epidemiological Characteristics in Outpatients with Mild to Moderate Covid-19, in the South of Mexico City

Background: Regional information on the characteristics of patients with mild and moderate intensity SARS-CoV-2 “COVID-19” coronavirus disease is needed to better understand the pandemic Objective: The objective of this study was to report the epidemiological clinical characteristics of outpatients with mild to moderate intensity COVID-19 that was carried out by Telemedicine in a first contact clinic, specializing in infectious diseases, in the South from Mexico City from March 10, 2020 to January 31, 2021. Material and Methods: This is a prospective, cross-sectional, observational, single-center study of a series of patients with clinical data of upper and lower respiratory tract infection and a positive CRP for SARS-CoV-2, who requested telemedicine consultation from a first contact clinic with a specialty in infectious diseases, attended from March 10, 2020 to January 31, 2021, The information was analyzed in a statistical package using SPSS 23.0. Results: 66patients who met the established criteria for diagnosis were attended to. In January 2021, the highest number of patients was treated; they requested medical attention, 6.5 days (range from 1 to 12 days) after having started with the disease. The median age was 48 years (range 10 to 80 ) years), 53% were female, 26% had type 2 diabetes mellitus, 23% with arterial hypertension, 7% previous pulmonary disease, 4% suffered from hypothyroidism, 24% positive smoking, 21% positive alcoholism, 39% had obesity , 17% were allergic. The clinical characteristics, the most prevalent was cough in 76%, followed by headache in 73% and myalgia in 71%. Conclusions: Patients with comorbidities, whether they are men or women in the fifth decade of life, are important for the evolution, especially when they are carriers of immunosenescence in the cases of those older than 60 years, or the immune system is immunocompromised as it is the case of patients with DM2 and even more so when they have more than one comorbidity that persists, they have a pro- inflammatory state and attenuation of the innate immune response.

Clinical Features of Outpatients with Fecal Impaction

Clinical Features of Outpatients with Fecal Impaction

Prevalence and Clinical Features Associated with Unrecognized Bipolar Disorder among Outpatients with Depressive Disorder in Thailand

Objective: To determine the prevalence of unrecognized bipolar disorder and explore the clinical features of outpatients with depressive disorder associated with bipolar disorder. Materials and Methods: The present study was a cross-sectional study. One hundred six volunteer participants, diagnosed with depressive disorder at Naresuan University Hospital, Buddhachinaraj Phitsanulok Hospital, and Phichit Hospital participated in this study. Psychiatrists interviewed the participants to collect basic data and clinical characteristics to determine unrecognized bipolar disorder using the Thai version of the Mini International Neuropsychiatric Interview (MINI). Results: The results showed that the prevalence of unrecognized bipolar disorder was 18.9%. When multivariable logistic regression was used, it was found that there were two statistically significant factors associated with unrecognized bipolar disorder. These factors were a history of self-harm or suicide attempts (AOR 4.40, 95% CI 1.24 to 15.60), and atypical depression seen with overeating and hypersomnia (AOR 11.73, 95% CI 2.32 to 59.35). Conclusion: There are several misdiagnoses of patients with bipolar disorder because the patients are usually in a depressive state when they decide to consult a doctor. Therefore, doctors should further probe especially in patients with atypical depression, history of self-harm or attempted suicide. Keywords: Bipolar depression; Bipolar disorder; Diagnosis; Epidemiology; Prevalence

ASSESSMENT OF THE USE OF DRUG TREATMENT OF DYSLIPIDEMIA AT MILITARY HOSPITAL 105

Dyslipidemia characteristics of outpatients with dyslipidemia for the first time, characteristics of drug use, and effectiveness in controlling dyslipidemia indexes after 3 months of treatment at Military Hospital 105 were studied. A crosssectional, retrospective descriptive study was investigated on adult outpatients who were diagnosed with dyslipidemia for the first time, examined and treated as outpatients at the hospital, and monitored for effectiveness in blood lipid control for 3 months after starting treatment. The decision to use the drug at the start of the study and the achievement of treatment goals at the time points were analyzed based on the ESC\EAS 2019 guidelines for treating DL. The majority of patients were aged &gt; 45 years (80.5%), the most common group of patients was aged 46 - 59 (43.7%). The number of patients with comorbidities accounted for 62.8%. 87% of patients had mixed dyslipidemia, 54.8% of patients were in the group with high and very high cardiovascular risk. 93.5% of patients needed to start treatment with drugs based on LDL-C index at the time of treatment initiation. The majority of patients used monotherapy regimens, in which, Statins were used the most in the study sample with the rate of 95.3% in the initial treatment regimen. 70.4% of patients had an inappropriate decision to initiate treatment, of which the most common was the decision to use statins with insufficient dosage in patients (45.1%). Only 28% of patients reached their LDL-C goal after 3 months of treatment. From the high percentage of patients who did not reach the treatment goal in the study sample, it is necessary to consider using stronger statin therapy, higher dose statin, or using another treatment regimen for patients.

The impact of gender and the social determinants of health on the clinical course of people living with HIV in Myanmar: an observational study

BackgroundThere is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is incompletely defined in many countries. This study was performed to gain a greater understanding of the non-clinical determinants of prognosis of PLHIV in Myanmar.MethodsSelected demographic, behavioural and socioeconomic characteristics of outpatients at two specialist HIV hospitals and one general hospital in Yangon, Myanmar were correlated with their subsequent clinical course; a poor outcome was defined as death, hospitalisation, loss to follow-up or a detectable viral load at 6 months of follow-up.Results221 consecutive individuals with advanced HIV commencing anti-retroviral therapy (ART) were enrolled in the study; their median CD4 T-cell count was 92 (44–158) cells/mm3, 138 (62.4%) were male. Socioeconomic disadvantage was common: the median (interquartile range (IQR) monthly per-capita income in the cohort was US$48 (31–77); 153 (69.9%) had not completed high school. However, in a multivariate analysis that considered demographic, behavioural, clinical factors and social determinants of health, male gender was the only predictor of a poor outcome: odds ratio (95% confidence interval): 2.33 (1.26–4.32, p = 0.007). All eight of the deaths and hospitalisations in the cohort occurred in males (p = 0.03).ConclusionsMen starting ART in Myanmar have a poorer prognosis than women. Expanded implementation of gender-specific management strategies is likely to be necessary to improve outcomes.

Is it important to maintain the reverse remodeling?

Abstract Background Consistent advances in Heart Failure (HF) treatment have generated a new phenotype: reverse remodelling (RR). These patients have better outcomes than those who don't achieve the RR, however little is known about the long-term remodelling maintenance and its predictors or about a new worsening on ejection fraction (EF). Purpose To analyze the difference between patients who maintain the RR, those who can not maintain it and those who have not improved. Methods Observational study that analyzed features in outpatients with HF and initial EF lower than 40%, an intermediary EF, and last EF in 2014, 2015 and 2016, with a minimal interval of 6 months. Patients were divided into 3 groups: Negative RR (NRR - All EF &amp;lt;40%); non-maintained RR (NMRR – 2nd EF &amp;gt;40% and 3rd EF&amp;lt;40%) and Maintained RR (MRR – 2nd and 3rd EF &amp;gt;40%). Comparisons were made by Kruskal-Wallis test and the survival was analyzed by Kaplan Meyer and Log-Rank tests. Results 1762 medical records were analyzed and 1484 were included. 993 patients had NRR, 201 patients had NMRR and 290 patients had MRR. The initial EF was lower in the NRR group. In the first 3 years, the groups NMRR and MRR improve the EF by 16.4% (±1.2) and 18.1% (±1.1), respectively. During the next 3 years, the NMRR group lost this improvement (−16.1% ±1.1), while the MRR group maintained it (0.7% ±1.4). The MRR group had more hypertension (0.75±0.05) as comorbidity, while the NMRR had more myocardial infarction (0.39±0.07) and myocardial revascularization (0.17±0.05). Chagasic and alcoholic aetiologies predominated in the NRR group (0.05±0.01 and 0.19±0.02) and these patients had less valvar cause (0.04±0.01). The NMRR group had more ischemic aetiology (0.41±0.07), and the MRR had more hypertensive (0.22±0.05). General survival was different between the three groups (p&amp;lt;0.001) major in MRR, NMRR and NRR group, respectively. Survival after the last EF also was significantly different between the groups (p&amp;lt;0.001) with the same pattern. Conclusion Achieving RR is important, but maintaining it can bring better outcomes and prognosis. Therefore, it is important to identify factors and therapeutic goals for the RR maintenance. Figure 1 Funding Acknowledgement Type of funding source: None

Clinical profile and drug therapy of outpatients with arterial hypertension

Aim. To study clinical profile and antihypertensive treatment features in outpatients observed in ambulatory facilities.Material and methods. 140 arterial hypertension (AH) outpatients were examined, questioning and anthropometry were performed. Blood pressure (BP) was measured on both hands, then twice on the hand with larger value, the medium value was calculated. Tests results were obtained from outpatient cards.Results. The sampling included 100 (71.4%) females and 40 (28.6%) males. Median of systolic BP at first measurement was 140.0 mm Hg (130.0;150.0), mean value of three BP measurements was 138.0 mm Hg (127.0;150.0) (p&lt;0.001); median diastolic BP at first measurement was 83.0 mm Hg (80.0;90.0), mean BP value was 82.0 mm Hg (78.0;88.0) (p&lt;0.001). Grade 1 AH was identified in 11.4% of patients, Grade 2 – in 35.7%, Grade 3 in 52.9%. No target organ damage was found in 26.4% of AH patients, asymptomatic target organ damage was diagnosed in 26.4%, and 61.4% had associated clinical conditions. Cardiovascular event risk was assessed as moderate in 13.6%, high – in 24.3% and very high – in 62.1% of patients. Every third patient had myocardial hypertrophy signs; Cornell index was detected more often than Sokolov-Layon index (p=0.006). Chronic kidney disease was diagnosed in 65.1% of patients: 44.0% of them had stage C2, 13.8% – stage C3A, 6.5% – stage C3B, and 1.8% – stage C4. 97.9% of AH patients received antihypertensive treatment. Daily medication consumption was reported by 127 people, and 10 patients reported taking medication as needed. Monotherapy was prescribed in 14.3% of patients; combined treatment was performed in 83.6% people. BP target value was achieved in 59 patients (42.1%) at first measurement results and in 71 (50.7%) ones at calculated mean value (p=0.002). Indications for statin use were identified in 86.4% of patients. Statins were administered in 56.2% patients having indications and in 21.1% of subjects without indications (p=0.006). Indications for antiplatelet therapy use were identified in 56.4% of patients. Antiplatelet treatment was administered in 58.2% of patients with indications and in 23.0% of subjects without indications (p&lt;0.001).Conclusion. Glomerular filtration rate and left ventricular myocardial hypertrophy amplitude criteria calculation allow to diagnose subclinical target organ damage in outpatients at physician visit without additional costs. Compliance with the current antihypertensive therapy guidelines allows to achieve target BP in current practice. Compliance with the BP measuring rules allows to adequately assess the effectiveness of antihypertensive therapy. A significant proportion of AH outpatients have a very high cardiovascular risk, which requires lipid-lowering and antiplatelet therapy.

Adult Congenital Heart Disease Outpatient Clinic. Descriptive Analysis of A 12-Year Experience in Brazil.

ObjectiveDescription of adult congenital heart disease (CHD) outpatient characteristics has not been reported and several aspects regarding these patients require attention. We describe the 12-year experience of a Brazilian unit.MethodsThe main characteristics of 1168 patients were reviewed annotating for each patient age, gender, city of residence, main diagnosis, functional class at last examination, defect complexity and in-hospital referral pattern.ResultsIncreasing workload was documented. Among the CHD patients, 663 (57%) were between 14 and 30 years old and 920 (79%) lived in the referral region. Referrals were made by hospital cardiologists for 611 (52%) patients, while 519 (45%) were referred by pediatric cardiologists. Regarding CHD severity, 637 (55%) had a defect of mild complexity. Of the patients analyzed, 616 (53%) had undergone an intervention, mainly atrial septal defect (ASD) closure, correction of tetralogy of Fallot, ventricular septal defect (VSD) closure and relief of coarctation of the aorta (CoAo). The main diagnosis of the 552 (47%) patients not submitted to an intervention were ASD, VSD, aortic stenosis, complex CHD and pulmonary stenosis. Regarding functional class, 1016 (87%) were in class I and 280 (24%) were lost to follow-up. Seventy-three patients had died, mainly due to cardiac death.ConclusionIn a unit were complex pediatric congenital heart surgery started twenty years ago, an increasing adult CHD workload was documented. Referral came predominantly from cities around the unit, most patients had low complexity defects and were in functional class I, a significant loss of follow-up was documented, and the death of patients was mainly due to the heart defect.

Listen to the outpatient: qualitative explanatory study on medical students\u2019 recognition of outpatients\u2019 narratives in combined ambulatory clerkship and peer role-play

BackgroundUnderstanding patients’ narratives has been associated with methods of improving care that go beyond what may be regarded as a “narrow” view of scientific medicine. Medical interview training in which medical students develop understanding of the importance of patients’ narratives is receiving increased attention. However, students generally receive education on patients’ narratives that does not distinguish inpatients and outpatients. No studies exploring the characteristics of outpatients’ narratives have been reported. We developed an educational program combining ambulatory clerkship and peer role-play using actual narratives from outpatients that students had encountered during their clerkship. These narratives were used as peer role-play scenarios in which the students acted as outpatients. This study explored what and how medical students learned about the characteristics of outpatients’ narratives through this original educational program.MethodsParticipants were 70 fifth-year medical students from Nagoya University, Japan. We conducted 13 focus groups, based on a convenience sample of 11 groups in 2012, one group in 2013, and one group in 2017 (from 17 clinical groups in each year). Focus group transcripts were analyzed using the “Steps for Coding and Theorization” qualitative data analysis method. We assessed medical anthropological findings regarding narratives in a conceptual framework.ResultsPatients’ narratives as perceived by medical students were divided into four quadrants by two axes: medical versus lived content, and objective versus subjective structure. Students recognized that outpatients’ narratives mainly used a subjective structure, but were mixed and crossed each quadrant. This was described as “irreproducibility.” Students also recognized that narratives of simulated patients and inpatients were mainly limited to a medical-lived content with an objective structure. These differences in narrative characteristics were recognized through students’ previous interactions with simulated patients and inpatients.ConclusionsDespite some limitations, medical students learn about patients’ narratives in our original educational program in a way that would be difficult to achieve through training using simulated patients or inpatients.

Analysis on the features of outpatients between online and offline general practice clinics

Objective To identify the features of outpatients visiting the online GP clinics and compare the data with outpatients in offline clinic visits, for reference of outlining the service boundaries of online outpatient services. Methods Data were collected from the online outpatient clinic of the First Affiliated Hospital of Zhejiang University between February 2016 and February 2017.The data usage was descriptive statistical analysis of the basic information and disease information of the patients. Results An analysis of the 715 online general practice consultations found the following proportions: diseases of the digestive system(11.3%), that of urinary system(7.7%), that of endocrine system(7.1%), that of respiratory system(6.9%)and that of circulatory system(4.6%). Among the 5 796 offline consultations, the proportions were as follows: diseases of the digestive system(27.4%), that of endocrine system(15.5%), that of respiratory system(10.2%), that of urinary system(5.8%)and that of musculoskeletal system(5.4%).563 online outpatients(78.7%)and 4 716 offline outpatients(81.4%)were diagnosed respectively, while 152 online and 1 080 offline outpatients were medically unexplained physical symptoms.The comparison of the two groups lacked significant differences. Conclusions Characteristics of online outpatients look similar to offline ones, while the former facilitates appointment-based laboratory and imaging examination, health consultation and follow-up of chronic diseases. Key words: Information services; Online hospital; Outpatient clinic; General practice; Disease management

Epidemiological characteristics of outpatients exposed to rabies in Weinan City in 2017

Objective To investigate the epidemiological characteristics of outpatients exposed to rabies and to analyze the post-exposure prophylaxis in Weinan City in 2017 in order to provide a scientific basis for the prevention of rabies. Methods Clinical data of all outpatients with exposure to rabies in Wei-nan were collected.Ecxcel 2007 was used for data entry and SPSS13.0 for Chi-square test. Results A total of 32 094 cases were reported with an annual exposure rate of 625.64/100 000 in Weinan in 2017.Animal bites mainly occurred in spring and summer, accounting for 47.47% of the total cases in 2017.There were statistically differences in exposure rate among different age groups (χ2=15.858, P=0.003). Farmers accounted for the largest proportion of the outpatients exposed to rabies (52.34%). Among 31 435 outpatients, 28 181(89.65%) received wound care and rabies vaccination.The vaccination rate of rabies immunoglobulin for patients with grade Ⅲ exposure was 46.93%. Conclusion Comprehensive measures with focuses on compulsory vaccination for domestic dogs and adoption of stray dogs should be implemented to prevent human rabies.Meanwhile, health education rabieson prevention and control should also be strengthened. Key words: Rabies; Exposure; Rabies post-exposure prophylaxis clinic

Mobile health communication: Effective reduction of patients’ travel needs to hospitals

ABSTRACTThe increasing use of mobile telephone technology is having significant implications for the study of urban travel. This is because mobile communication has brought about tremendous improvements in person-to-person connectivity. Existing literature has established the fact that the heavy traffic congestion in Lagos has adversely affected the movement of patients to the hospital. This paper examined the effectiveness of mobile telephone usage on trip reduction to healthcare centres. The Telecommuting and Travel Concept (TTC) provided the framework for the study. Using a systematic random sampling technique, a structured questionnaire focusing on socio-economic characteristics of out-patients, mobile telephone usage to seek healthcare services, travel behaviour, and eliminated trips to healthcare centres were administered on 711 out-patients. Results showed that mobile communication between patients and medical doctors predicted a significant reduction in patients’ trips to healthcare centre (r = 0.891). This study recommends that public health policy-makers should encourage mobile communication usage to further reduce the number of trips made to healthcare centres in order to increase access to healthcare services in Nigeria.