Follow-up Of Chronic Diseases Research Articles

The content of patients' emotional expressions during follow-up consultations for chronic diseases.

In this article, we seek to extract the themes that patients share when they express negative emotions in the context of follow-up consultation of chronic illness. We are mainly interested in patients with chronic illnesses, as these pathologies have a significant emotional overload leading to a significant deterioration of the patient's quality of life. Our corpus included audio recordings of 12 chronic disease follow-up consultations conducted by physicians practicing in neurology, nutrition, internal medicine and infectiology. The 12 patients participating suffer from various chronic diseases: Parkinson's, HIV, diabetes, etc. We performed thematic content analyses on the emotional sequences in order to extract the themes underlying these emotional expressions. The 10 themes we have extracted are related to physical aspects, psychological aspects, the healthcare system and/or the healthcare provider, prognostic elements, social life, family life, aspects of professional life, issues of daily life, treatments and finally, aspects related to objectives and disease progress. Our results show that follow-up consultations for chronic illnesses are consultations during which patients express emotions for different purposes. These emotional expressions concern particular themes that are not found in other forms of medical consultations. We will compare these results in the discussion part of this article.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Design and evaluation of an intelligent physical examination system in improving the satisfaction of patients with chronic disease

Backgroundand Purpose: Enhancing patient satisfaction remains crucial for healthcare quality. The utilization of artificial intelligence (AI) in the Internet of Health Things (loHT) can streamline the medical examination process. Most Traditional Chinese Medicine (TCM) examinations are non-invasive and contribute significantly to patient satisfaction. Our aim was to establish an intelligent physical examination system that amalgamates TCM and Western medicine and to conduct a preliminary investigation into its effectiveness in enhancing the satisfaction of patients with chronic diseases. Materials and methodsExperts from clinical departments, the equipment department, and the software development department were invited to participate in group discussions to determine the design principles and organizational structure of the intelligent physical examination system. This system integrates TCM and Western medicine. We compared the satisfaction levels of patients examined using the intelligent physical examination system with those examined using the traditional medical examination system. ResultsAn intelligent physical examination system, combining TCM and Western medicine, was developed. A total of 106 patients were finally enrolled (intelligent group vs. control group) to evaluate satisfaction. There were no statistically significant differences between the intelligent group and the control group in age, gender, education, or income level. We identified significant differences in five aspects of satisfaction: 1) the physical examination environment; 2) the attitude and responsiveness of doctors; 3) the attitude and responsiveness of nurses; 4) the effectiveness of obtaining results; and 5) the information regarding physical examination and medical advice (p < 0.05). Furthermore, these differences remained statistically significant even after adjusting for age, gender, education, and income level. ConclusionsThe intelligent physical examination system effectively capitalized on the advantages of combining AI with the integration of TCM and Western medicine, substantially optimizing the medical examination process. In comparison to the traditional physical examination system, the intelligent system significantly enhanced patient satisfaction. Future improvements could involve integrating chronic disease follow-up technology into the system.

Covid-19 Pandemic and Diabetes - Pandemic Effects on Blood Glucose Regulation

Background: COVID-19 (Novel Coronavirus Disease) pandemic has led to quarantines and restrictions sometimes partly and sometimes throughout the country in Turkey and as well as many other countries. Many people remained inactive since they could not go out, and follow-up of chronic diseases has become difficult because of the inability to access hospital due to the pandemic. Aim: In this study we aimed to investigate the effects of COVID-19 pandemic, which occasionally causes lockdown and partial quarantine implementations, on blood glucose regulation in patients with Type 2 Diabetes Mellitus (DM). Study Design: Single-center, Retrospective, Observational study Methods: The laboratory findings of type 2 DM patients who had been followed-up by our clinic for at least 2 years before the pandemic and who also came for control after the 3-months nationwide lockdown in Turkey (June 2020). Data were obtained from the hospital information system and examined. The values before pandemic and after lockdown were compared. Results: The study included a total of 169 patients. Of the participants 49.7% were female and 50.3% were male. The mean age was 57.7 years in female patients and 54.8 years in male patients. Triglyceride level was significantly increased after the lockdown compared to before the pandemic in all patients (p&lt;0.005). The levels of Fasting Blood Glucose (FBG) and glycated Hemoglobin (HbA1c) were significantly lower after the lockdown in the patients aged over 65 years, while these values were increased in the other age group, but the difference was not statistically significant. Conclusion: COVID-19 pandemic led to statistically insignificant disruption in glucose regulation especially in young type 2 DM patients, while glucose regulation improved in the elderly population under quarantine conditions. Our study was conducted in a short-term and limited population and therefore, further studies with larger populations are needed.

Diyabet ve hipertansiyon hastalarında kronik hastalığa bağlı stigma düzeyinin değerlendirilmesi

Introduction and Aim: The two most common chronic diseases in primary care chronic disease follow-up are diabetes (DM) and hypertension (HT). The aim of this study is to evaluate the level of chronic disease stigma, perceived social support and depression in DM and HT patients, and to examine their effects on treatment regulation. Materials and Methods: A single-center, descriptive study was conducted with randomly selected 50 DM and 50 HT patients who applied to a Family Health Center between September and December 2020. Patients with DM were divided into regulated and non-regulated groups according to HbA1c level, and HT patients according to target cytolic/diastolic arterial pressure.The level of stigmatization with the Expected Stigma Scale in Chronic Diseases (CIASS), psychological health status with the Patient Health Questionnaire-9 Scale (PHQ-9), and perceived social support status with the Multidimensional Scale of Perceived Social Support (MSPSS) were questioned face-to-face. SPSS program was used in the analysis of the data. Results: One hundred patients with a mean age of 56.4±11.4 years and a diagnosis period of 10.4±7.2 years were included in the study. Stigma levels of patients with unregulated DM (38.0%) and unregulated HT (14%) were compared. DM patients had higher total expected stigma score of chronic diseases (p=0.001), related to work life (p&lt;0.001) and healthcare workers (p=0.007). In the linear regression analysis, it was determined that the current depression level of the patient is the determinant of the level of stigma in chronic diseases in both HT patients (F = 4.073, p=0.012, R² = 0.21) and DM patients (F = 3.154, p =0.012, R² = 0.30). Discussion and conclusion: The level of chronic disease stigma was found to be higher in DM patients than in HT patients, and the rate of treatment regulation was lower. The role of depression level, expected stigma level from work environment and healthcare professionals were pointed out in the regulation of DM.

Frailty and Related Factors in Elderly Patients with Chronic Kidney Disease

Introduction: Chronic kidney disease and frailty are two crucial clinical conditions increasing in prevalence globally. Both lead to severe complications that increase mortality and morbidity in patients. Conditions that may potentiate frailty in chronic kidney disease patients may complicate the follow-up of chronic disease and complicate long-term survival in this patient group. In this study, we aimed to evaluate frailty and related factors in chronic kidney disease patients over 65 years of age who were on dialysis and who were not. Materials and Methods: This cross-sectional study was carried out in geriatric chronic kidney disease patients followed in nephrology outpatient clinics or undergoing routine hemodialysis. Frailty was assessed using a scoring scale. Laboratory findings and their relationship with demographic and epidemiological data were investigated. Results: One hundred eighty-eight patients aged 65 and over were included in our study. Of the patients, 92 were female, and 96 were male. The mean age was 72.86 years. We found frailty in 82 patients (43.6%). Female gender, over 75 years old, under dialysis treatment, low-income status, and low education level were parameters significantly associated with frailty. In the regression analysis, we found that economic status and dialysis were variables that independently affected frailty in chronic kidney disease patients. Conclusions: In our study, the frequency of frailty was found to be high. Practical management and early assessment of frailty seem rational with the basic nephrological approach in patients with chronic kidney disease. Considering the high mortality rate among frail patients, we think these patients should be followed up more closely. Keywords: Frailty; Aged; Renal Insufficiency, Chronic.

Determinants of hypertension among diabetes patients attending selected comprehensive specialized hospitals of the Amhara Region, Ethiopia: An unmatched case-control study.

The coexistence of diabetes mellitus and hypertension is a worldwide public health problem causing significant morbidity, mortality, and decreased quality of life. Despite the increasing burden of hypertension among patients with DM, data on determinants of hypertension among patients with DM in the Amhara region of Ethiopia is scarce. Hence, this study identified determinants of hypertension among people with diabetes attending chronic disease follow-up clinics in the Amhara region of comprehensive specialized hospitals in Ethiopia. An institutional-based unmatched case-control study was conducted among 470 individuals with diabetes in the Amhara region's comprehensive specialized hospitals (Debre Berhan, Felege Hiwot, and Dessie Comprehensive specialized hospital). A multistage sampling technique was used to select participants for this study. We collected the data using standard questionnaires (short form of international physical activity questionnaire, Morisky medication adherence scale, patient health questionnaire, perceived dietary adherence scale, Oslo social support questionnaire, and alcohol use disorder identification test), physical measurements, and data extraction checklists. A multivariable binary logistic regression was fitted to identify determinants of hypertension, and we presented the findings using an adjusted odds ratio (AOR) with a 95% confidence interval (CI). 235 cases and 235 controls participated in this study. The median (IQR) age for the cases was 60 (52-66 = 14), and the mean age (± SD) for the controls was 51.72 (± 12.51). The significant determinants of hypertension with AOR [95% CI] were a lower level of physical activity: 1.82 [1.00, 3.31], depression: 2.00 [1.24, 3.21], family history of hypertension: 2.13 [1.34, 3.37], not having diabetic health education: 1.87 [1.18, 2.96], a longer duration of diabetes: 1.99 [1.05, 3.79], and poor glycemic control: 1.57 [1.01, 2.45]. In this study, determinants that increase the risk of hypertension among people with diabetes mellitus were older age, physical inactivity, depression, family history of hypertension, not having diabetic health education, a longer duration of diabetes, and poor glycemic control.

Mortality, Causes of Death, and Predictors of Death among Patients On and Off Opioid Agonist Treatment: Results from a 19-Year Cohort Study

Background: Mortality is increased among people with opioid use disorder but reduced while on opioid agonist treatment (OAT). However, the impact of patient and treatment characteristics on mortality and causes of death is insufficiently studied. Objectives: The objective of this study was to explore mortality and causes of death and examine the impact of patient and treatment characteristics on mortality in an OAT cohort with high retention in treatment. Methods: Design: longitudinal cohort study. Setting: Norway. Observation period: time from OAT start as of 1998 until death or end of 2016, 2,508 person-years (PY) in total. Sample: 200 persons starting OAT 1998–2007. Data sources: hospital records, interviews, the Norwegian Cause of Death Registry, Statistics Norway. Results: Retention: 86.4% of the observation period was on OAT, 9.0% off, 4.6% unknown OAT status. All-cause crude mortality rate per 100 PY during the whole observation period was 1.64 (95% CI: 1.19–2.20), for deaths of somatic cause 0.88 (0.56–1.31), for drug-induced deaths 0.44 (0.23–0.76), and traumatic deaths 0.24 (0.10–0.50). Off-versus-on-OAT all-cause mortality ratio was 2.31 (1.00–4.85). On OAT, 58% of the deaths were of somatic cause and 21% drug-induced; off OAT, 38% of somatic cause and 50% drug-induced. Increasing baseline age and rate of somatic hospital treatment episodes were independently associated with increased all-cause mortality risk, while increasing rate of in-patient psychiatric treatment episodes was associated with reduced risk. Increasing duration of nicotine and cannabis use and alcohol dependence as well as increasing severity of polydrug use were associated with increased all-cause and somatic mortality adjusted for age and sex. Conclusion: The long observation period made it possible to demonstrate the importance of long-term retention in OAT to reduce mortality. Further, the preponderance of somatic and reduction of drug-induced causes of death during OAT underlines the need for follow-up of chronic diseases and health-promoting lifestyle changes. These findings add to the knowledge about long-term OAT effects, not least in ageing OAT populations.

A Glance Into Healthcare Delivery During COVID-19 Pandemic: A Survey Among Turkish Medical Doctors.

The coronavirus 2019 (COVID-19) pandemic had an enormous impact on healthcare delivery globally. We conducted a cross-sectional online survey in Turkey to evaluate the impact of COVID-19 on healthcare services in Turkey. A 35-item anonymized online survey was completed by HCPs (medical doctors, MD) who continued their clinical practice during the COVID-19 pandemic in Turkey, regardless of their specialties or degrees. Overall, 209 HCPs participated in the study. Forty-two percent of the participants stated that their current workload intensity has been increased compared with the pre-pandemic era. More than half of the participants (54.6%) were using telemedicine services during their clinical practice, however, the effectiveness of telemedicine for first-time patients and follow-up patients was rated as low. The majority of participants (59.3%) reported that during the peak period of the pandemic, they encountered only a small variety of cases, other than COVID-19. Fifty-two percent of the participants agreed that they occasionally had patients who received misdiagnosis in the first admission due to the suspicion of a possible COVID-19 infection predominating the diagnostic process (eg., not excluding COVID-19 even though the PCR test is negative). For the distribution of possible late-diagnosed diseases, 25.8% of HCPs selected chest diseases, followed by infectious diseases, heart diseases, and cancer. In general, participants agreed that there was an increase in the negligence in the follow-up of various diseases and/or complication rates due to COVID-19 pandemic. Sixty percent of the HCPs agreed that HCPs are being much more rigorous to diagnose/treating COVID-19 than other important diseases. Fifty-seven percent of the participants stated that the diagnosis and follow-up of chronic diseases are affected, while 57.9% of the HCPs stated that some diseases that show similar signs and symptoms as COVID-19 are not diagnosed correctly during COVID-19 pandemic. Findings from this study emphasize that COVID-19 pandemic has significantly caused delayed diagnoses and interruption in the management of chronic diseases, and also increased the risk of missing out the diagnosis of non-COVID-19 diseases. The study genuinely aims to yield the floor to a permanent improvement in post-pandemic clinical management and it also shows the need for a focused approach in distinct areas of medical care. Policymaking is required to drive changes to better support HCPs in Turkey.

Narrative Descriptive Reports on Public Health Impact of Conflict among War-Affected Zones at Amhara Region, 2022

Introduction: Armed conflicts result in the interruption of clinical services, public health services, and other health-related programs and damage to the health facilities and their infrastructures. Objective: This study aimed to assess the impact of conflict on public health within the war-affected zones of the Amhara region. Method: a descriptive cross-sectional study was conducted in the Amhara region. Document review and interview administered questionnaires were employed for collecting the data during the study period. Result: Based on this assessment; more than 51% of health facilities and their infrastructures were damaged and looted. About 10,333 patients on chronic disease follow-up had interrupted their treatment and follow-up for more than three to six months. And also, more than 29632 civilians died in the conflict-sourced war. Maternal and child health services have been interrupted for more than70, 000 pregnant &amp; lactating mothers. 1035 unwanted pregnancies and 934 sexual gender-based violence (SGBV) have been occurred due to the conflict. Conclusion: About 51% of health facilities in the region were damaged; following this essential health services such as chronic follow non-communicable and chronic infectious disease, maternal health services, and child health services have been interrupted in the affected zones. This had led to the occurrence of maternal mortality of 233 &amp;child mortality of 166 among those who lived in the affected area. Therefore, it needs Rapid strengthening of mobile health services, and the reestablishment of health facilities buildings and their infrastructures to reduce future morbidity and mortality

The Impact of the COVID-19 Pandemic on Alzheimer's Disease and Other Dementias.

Introduction: Numerous countries went into lockdown to contain the COVID-19 outbreak, which has impeded follow-up of chronic diseases, such as cognitive impairment (CI). Cognitive and neuropsychiatric changes during the COVID-19 pandemic are neglected in China, which is the world's whistleblower. To investigate the cognitive and neuropsychologic changes in CI, as well as the proportions of rapid cognitive decline (RCD) before and during the COVID-19 pandemic to provide clinical evidence for CI intervention during a public health emergency.Methods: We performed a descriptive and retrospective study based on medical records from the memory clinic of Tianjin Dementia Institute collected through face-to-face evaluations. Information of 205 patients with CI, including patients with mild cognitive impairment and dementia, of whom 131 with Alzheimer's disease (AD) were analyzed and compared to a control group before the COVID-19 pandemic.Results: Among the 205 CI patients, the scores on the Chinese Mini Mental State Examination (C-MMSE), the Montreal Cognitive Assessment (MoCA), activities of daily living (ADLs), and the global Neuropsychiatric Inventory (NPI) were significantly different at the baseline and follow-up evaluations (p < 0.05) after 14.07 (±2.87) months. The same findings were recorded among AD patients, and they exhibited more sleep disturbances at the follow-up than at baseline (32.8 vs. 20.6%, p = 0.035). When compared to the control group, slightly worse performance of cognitive, −1.00 (−4.00, 1.00) from the C-MMSE, −1.00 (−2.00, 0.00) on the MoCA, 1.00 (0.00, 9.00) on ADLs and neuropsychological 0.00 (−1.00, 3.50) on the global NPI profile, at the follow-up were presented, particularly for delusion, agitation, irritability, and appetite disturbances (p < 0.05). Twenty-five (19.1%) AD patients and 48 (36.6%) controls suffered RCD during the COVID-19 pandemic. Moreover, AD patients during the COVID-19 pandemic were 0.408 times (95% confidence interval: 0.232–0.716) less likely to suffer RCD than the control.Conclusion: Confinement might ease the cognitive and neuropsychiatric deterioration of AD patients compared to those not in crisis and help prevent RCD in AD patients.

Designing an Independent Kit as an Early Detection Tool for Covid-19 Symptoms

COVID-19 disease is one of the leading causes of mortality over the world. Continuous passive monitoring of subjects using mobile sensors can help detect disease, estimate severity, track progression over time, and predict adverse exacerbation events. The high demand for point-of-care devices for the convenient detection and follow-up of chronic diseases is posing demands to the development of novel low-cost sensors. Over the world the COVID-19 disease is one of the most worldwide spread diseases. Now a day’s doctors/nurse is in a COVID-19 relief, they need to cover their body for safety. Producing such datasets requires devices that can withstand real-world use and yet are unobtrusive enough to yield high doctors adherence. In this system, we describe a set of necessary characteristics for a device to address these issues, informed by stakeholders in pulmonary health monitoring and produce required mixture of oxygen air to doctor/nurses while working in the covid-19 isolation ward. There in, the app displays real-time and summary data such as respiration rate, heart rate, SPO2 respiratory rate, body temperature, cough, &amp; PPG values detected. Each wearable device contains a 4.5AH lithium ion battery rated at approximately 1,600 hours (over 60 days) of active use when worn on-body and paired with a smart phone.

Bir aile hekimliği biriminde düzenlenen ilaç raporlarının değerlendirilmesi

Amaç: Bu çalışmada bir aile hekimliği biriminde dört yıldan uzun süre çalışan bir aile hekimliği uzmanının düzenlediği ilaç raporlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Retrospektif arşiv incelemesinin yapıldığı bu çalışma Samsun iline bağlı Asarcık ilçesinde bir aile sağlığı merkezine bağlı birimde gerçekleştirilmiştir. Ağustos 2015- Ekim 2019 tarihleri arasında ilgili birimde düzenlenen ilaç raporlarının sahipleri örneklemi oluşturmaktadır. Bulgular: İlaç raporu yenilenen veya ilk defa düzenlenen 446 kişinin 623 adet raporu incelenmiştir. Yaş ortalaması 61,81±16,24 olup, hasta başına ortalama 2,19 kez rapor düzenlenmiştir. Hastaların %79,37’ine (n=354) en az bir adet antihipertansif ilaç raporu düzenlenmiştir, %14,57’sine (n= 65) ise en az bir adet oral antidiyabetik ilaç raporu düzenlenmiştir. Antihipertansif ilaçlardan en sık diüretikler (n= 225, %50,45), oral antidiyabetik ilaçlardan en sık metformin (n= 54, %12,11) raporlanmıştır. Kalp damar sistemi kısmında değerlendirilen ilaçlar rapor başına 1,55±1,10 kez ile en sık raporlananlardır. Yaş ile kalp damar sistemi rahatsızlıklarında kullanılan ilaç sayısı pozitif yönlü ve zayıf bir korelasyon göstermiştir (p&amp;lt; 0,001 , r= 0,266). Sonuç: Birinci basamak uzmanının kronik hastalıklarının medikal izleminde düzenlediği raporlarla etkin rol aldığı görülmüştür. Bu yüzden, düzenlenebilen ilaç raporu çeşitliliğinin artması faydalı olabilir.

Effects of removing a fee-for-service incentive on specialist chronic disease services: a time-series analysis.

Physician payment models are known to affect the nature and volume of services provided. Our objective was to study the effects of removing a financial incentive, the fee-for-service premium, on the provision of chronic disease follow-up services by internal medicine, cardiology, nephrology and gastroenterology specialists. We collected linked administrative health care data for the period 1 April 2013 to 31 March 2017 from databases held at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada. We conducted a time-series analysis before and after the removal of the fee-for-service premium on 1 April 2015. The primary outcome was total monthly visits for chronic disease follow-up services. Secondary outcomes were monthly visits for total follow-up services and new patient consultations. We compared internal medicine, cardiology, nephrology and gastroenterology specialists practising during the study timeframe with respirology, hematology, endocrinology, rheumatology and infectious diseases specialists who remained eligible to claim the premium. We chose this comparison group as these are all subspecialties of internal medicine, providing similar services. The number of chronic disease follow-up visits decreased significantly after removal of the premium, but there was no decrease in total follow-up visits. There was also a significant downward trend in new patient consultations. No changes were observed in the comparison group. The decrease in volume of chronic disease follow-up visits can be explained by diagnostic criteria being met less often, rather than an actual reduction in services provided. Potential effects on patient outcomes require further exploration.

Determination of Beck Depression Inventory Scores of the Patients in a Hemodialysis Center: Evaluation with a Holistic Approach

Aim/ Background: The holistic approach in medicine refers to addressing an individual as a whole. Family physicians should be familiar with psychological as well as physical problems of their hemodialysis patients. This study aims to measure depressive mood levels of patients in a hemodialysis center, and to investigate the potential risk factors with a holistic approach. Method: This study was conducted on patients receiving treatment at a private hemodialysis center. During the hemodialysis session, the patients’s blood samples were taken, and serum phosphorus, creatinine, albumin, and hematocrit levels were measured. A semi-structured questionnaire form was used to investigate the sociodemographic characteristics and the Beck Depression Inventory (BDI) was used to determine depressive mood level of the patients. Results: This study was conducted on a sample of 88 patients (33 female, 55 male). The mean BDI scores were 16.7±9.8, and when the cut-off point of BDl was taken as 15, the rate of depressive mood was %56.8 for hemodialysis patients. We evaluated the duration of illness, family structure, educational level, having non-renal comorbid disease, employment status, economic status, and also blood creatinine, albumin, phosphorus, and hematocrit levels. The mean BDI score was significantly lower in patients who lived in simple nuclear families with fewer than six individuals at home. Conclusion: The holistic approach is essential, especially in chronic disease follow-up in primary healthcare. Family support and psychological evaluation with a holistic approach are vital for hemodialysis patients.

The impact of COVID-19 on ophthalmology practice in Egypt

Background: The emergence of coronavirus disease 2019 (COVID-19) affected medical practice all over the world including ophthalmology, especially elective procedures. Objectives: Evaluation of the effect of COVID-19 on ophthalmology practice in Egypt. Method: A cross-sectional study was done using an internet-based questionnaire including Egyptian ophthalmologists. Results: A total of 1257 participants completed the questionnaires. A majority of the responders (79.9%) were working in private ophthalmic organisations. Out of (79.9%) responders, (57.5%) were seeing patients at the time of the survey. The majority of patients seen (32%) and operations done (21.1%) were both emergency and electives. Most of the responders (82%) did not try to use telemedicine. The majority of the participants (81.5%) thought that the lockdown had a detrimental effect on the progression and follow-up of chronic diseases (e.g. glaucoma). Conclusion: COVID-19 affects elective ophthalmology practice; we need to activate the role of telemedicine according to ethics.

Telemedicine approach for psoriasis management, time for application? A systematic review of published studies.

Psoriasis is a common chronic inflammatory skin condition. It has a chronic course with multiple evolving relapses and patients require long-term treatment and follow-up. Teledermatology was introduced for diagnosis, treatment and follow-up of chronic diseases. Thus, we performed a systematic review for collecting the evidence regarding the efficacy of telemedicine in psoriasis management. Out of 287 records, we included seven studies (four of which were randomized controlled trials). We found that telemedicine alone or combined with usual care had the same or higher efficacy of psoriasis management compared to usual care or control group. We recommend further studies for assessing the pros and cons of this intervention which can replace conventional strategies especially in pandemic times.

The role of the first level of health care in the approach to Chagas disease in a non-endemic country.

BackgroundChagas disease has crossed South America’s borders and in recent years has spread to regions that were not previously affected. Early diagnosis and treatment of Chagas disease improves the clinical prognosis and prevents vertical transmission. Taking into account the lack of evidence of how primary care services manage Chagas disease in a non-endemic country, this study assessed Chagas disease knowledge, attitudes and practices among primary health care professionals.Methods and principal findingsBetween 2017 and 2019, eight focus groups were formed with 41 family physicians and 40 nurses from healthcare centers in Madrid, Spain, and 70 field notes were collected during non-participant observation. The family physicians and nurses showed a lack of general knowledge about Chagas disease, and they did not identify the country of origin to request the blood test. The family physicians and nurses thought that the population did not talk broadly about Chagas disease because of the stigma or shame. The role of nurses was more focused on vaccination status and chronic disease follow-up, and family physicians assumed a facilitating role to send patients to different hospital facilities. Communication between primary care professionals and the hospital is a barrier frequently experienced by family physicians.ConclusionsThe diagnosis of CD in non-endemic countries continues being an important challenge for health systems. The results obtained with the study of the knowledge, attitudes and practices at primary care through a qualitative approach allows to obtain evidence that could help to develop strategies for the screening of CD in a protocolized way in order to avoid that the diagnosis depends exclusively on the request of the patient.

Study on the effect of family doctor team service under medical association model on empowerment behavior and health status of elderly diabetic patients in community

Objective To explore the effect of family doctor team service in the medical association model on empowerment behavior and health status of elderly patients with diabetes in the community. Methods A total of 158 patients with diabetes who were diagnosed with free physical examination and were diagnosed as diabetic patients in 4 communities under the jurisdiction of Fuzhong Community Health Service Center From March 2018 to May 2018, we conveniently divided into intervention group (79 cases) and the control group (79 cases), according to whether or not to sign a family doctor. The control group was older people who did not sign up for a family doctor, the control group was given routine intervention according to the community chronic disease follow-up mode, while the intervention group gave the contracted family doctor on the basis of routine intervention, and carried out individual assessment, group management, group intervention, one-on-one guidance, and the body mass index, abdominal circumference, fasting blood glucose, HbA1c, self-management ability of the two groups were evaluated before intervention and 6 months after intervenation. Results There was no significant difference between the two groups before intervention (P >0.05). After 6 months of intervention,abdominal circumference, fasting blood glucose and HbA1c was (79.5±5.0) cm, (6.1±0.7) mmol/L, (6.3±0.6)% in the intervention group, (85.2±11.4) cm, (6.5±0.8) mmol/L, (6.8±0.7)% in the control group, and there was significant difference between the two groups (t=2.142, 3.345, 4.820, P<0.05 or 0.01); the self-empowerment ability and the self-management was (37.7±1.7), (44.3±6.8) in the intervention group, (30.1±2.5), (36.5±2.8) in the control group, and there was significant difference between the two groups (t=22.344, 9.427, P<0.01) . Conclusion The family doctor team service under the model of medical association can improve empowerment behavior of elderly diabetic patients in the community and improve their health status. Key words: Medical association; Family doctor team service; Diabetes; Empowerment behavior; Health status

Evaluation of chronic disease follow-up training of family physicians in primary care units

Abstract Background Chronic diseases are a major cause of morbidity and mortality due to late diagnosis and insufficient treatment. This study deals with the training on chronic diseases organized by the Ministry of Health in the provinces. The aim of this study was to measure the effectiveness of training programs for family physicians in a province. Methods This semi experimental study was carried out during the training held in Bingöl that is eastern city of Turkey, on 22-26 October 2018 and 19-20 December 2018. The universe of the study consisted of family physicians working in the province. Of the 90 family physicians working in the province, 75 participated in the study. The training was conducted by the researchers and (before-after) 16-question test to the participants were used. The trainings cover the sub-heading Cardiovascular Risk Assessment and Diagnosis and Treatment of Hypertension. The family physicians were divided into 7 groups and were given 7-hour training. SPSS 25 program was used to analyze the data. In the analysis of data, Wilcoxon test, Cochran’s Q test and Bayesian approach samples t test were used. Results The average number of correct before training was 7.33 (min: 2 - max: 13), after training 12.64 (min: 7- max: 16; p &amp;lt; 0.001). After the training, participants’ correct answers to 15 questions increased (p &amp;lt; 0.001). Increase rate is 71%. Bayesian factor was found to be &amp;lt; 0.001 according to the results of Bayesian approach t test. There is definite evidence against the H0 hypothesis. According to the results of this quasi-experimental study, training is very effective. Conclusions In this study, it was shown that the education of the family physicians about the chronic diseases of the Ministry of Health is effective in increasing the knowledge level of family physicians. Key messages The training of the family physicians in charge of the primary health care is important. This study showed that education is very effective accorging to the pre-training.