Clinical Consultation Research Articles

The Experiences and Unmet Supportive Care Needs of Partners of Men Diagnosed With Prostate Cancer: A Meta-aggregation Systematic Review.

Partners of men diagnosed with prostate cancer face their own emotional struggles as they navigate additional caregiver responsibilities while concurrently adjusting to the diagnosis and coping with greater illness uncertainty for their loved one. This qualitative systematic review examined the unmet supportive care needs of partners affected by prostate cancer. A meta-aggregation was conducted. Four electronic databases were searched using key words. The methodology followed the Joanna Briggs Institute for qualitative evidence synthesis. The review process followed a registered priori review protocol and was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Data extraction and quality assessment were conducted in parallel. Twenty-one publications were included. A total of 239 findings and 32 categories were synthesized into 7 domains of unmet needs as experienced by partners. The domains of needs expressed by the participants included interpersonal/intimacy, physical/daily living, healthcare service, family-related, psychological/emotional needs, and spiritual and social needs. There are gaps in clinical service support, despite routine clinical consultation with healthcare professionals. Partners may diminish their social networks to protect their husband at the cost to their own self-preservation and well-being. Cancer organizations, policy makers, healthcare care professionals, and researchers are slowly making progress to acknowledge the unique support needs of partners affected by cancer. Healthcare professionals should encourage partners to be included in models of prehabilitation to access timely support to address informational, intimacy, spiritual, and daily living needs support.

Nomogram developed with APOA5 genetic variant rs662799 and clinical characteristics predicting risk of essential hypertension in a Chinese population.

The apolipoprotein A5 (APOA5) gene has been identified as a key regulatory factor in triglyceride (TG) metabolism and plasma lipid levels. Genetic polymorphisms of APOA5 have been linked to an elevated risk of atherosclerosis, metabolic syndrome, stroke, and coronary artery disease. The rs662799 variant is a single nucleotide polymorphism (SNP) that occurs at a specific position within the APOA5 gene. However, the association between rs662799 polymorphism and essential hypertension (EHT) remains unclear. The study aimed to comprehensively examine the potential correlation between the rs662799 polymorphism and the susceptibility to EHT in a Chinese population using a systematic analysis. In a case study conducted at the First Affiliated Hospital of Xinjiang Medical University between Jan 2019 and Dec 2021, we examined a total of 700 cases of EHT along with 700 corresponding controls. The serum concentrations of various lipid parameters were measured by enzymatic method, while the genotyping of the SNP was performed using the improved multiplex ligation detection reaction (iMLDR) method. The independent risk factors of EHT were identified from multivariable logistic regression analysis. The nomogram prediction model that incorporated the APOA5 genetic variations and clinical variables was constructed. In addition, receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were conducted to determine the performance of the nomogram model. The optimal threshold was calculated based on Youden index. Our study revealed a higher prevalence of the G allele of the rs662799 variant in individuals diagnosed with EHT compared to the control group. Logistic regression analysis indicated that with the adjustment of other confounders, the observed difference between the two groups remained statistically significant [odds ratio (OR) =1.519; 95% confidence interval (CI): 1.203-1.917; P<0.001]. Based on 8 independent risk factors including APOA5 rs662799 G allele, age, body mass index (BMI), smoking, diabetes, education, low-density lipoprotein cholesterol (LDL-C), and TG, we constructed a novel risk evaluation nomogram of EHT. The area under the ROC curve of the nomogram was 0.722 (95% CI: 0.693-0.752; P<0.001) and 0.747 (95% CI: 0.690-0.804; P<0.001) for the training and validation set, respectively. Furthermore, the Hosmer-Lemeshow test indicated excellent calibration performance, yielding P values of 0.969 for the training set and 0.761 for the validation set. In our study, the rs662799 variant of the APOA5 gene was significantly associated with susceptibility to EHT. A nomogram for the early prediction of EHT in in the Chinese population was successfully constructed and validated. The nomogram can provide a visual assessment of the risk of EHT for clinical consultation.

State scope of practice restrictions and nurse practitioner practice in nursing homes: 2012-2019.

Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.

Application of Science and Technology in Intellectual Property Rights Process Patent

This research aims to analyze, explain and understand the application of science and technology to intellectual property rights in process patents and to analyze, explain and understand legal protection for process patents. The type of research used is empirical legal research because it is motivated by the idea that law cannot be separated from people's lives in the form of values and attitudes/behavior, but law can be studied from its empirical aspect, namely how the law is in reality in people's lives. The results of this research reveal that the application of IPTEKS and Intellectual Property Rights in the patent process means that Indonesian society as a society does not respect Intellectual Property Rights. The reality in society still shows that there are many violations of Patent Rights and it is suspected that they have reached a dangerous level and can damage the order of life in society in general, especially creativity to give birth to new discoveries. Meanwhile, legal protection for process patents developed by indigenous Papuans according to the Patent Law is granted on the basis of an application. And until December 2021, through the Trade and Small and Medium Industry IPR Consultation Clinic, the Papua Province Industry and Trade Service, several inventions regarding traditional medicines have been registered at the Patent Office in Jakarta. The form of legal protection can be seen from the application of Law Number 13 of 2016 concerning Patents

Quality balanced scorecard for the outpatient clinic

The quality audit system for healthcare in various countries is based on the quality of medical services, the satisfaction of the patient and his relatives, as well as the quality of medical documentation. At the same time, quality indicators of healthcare facilities include criteria of the social and economic efficiency. Often these groups of indicators are considered by researchers separately from each other, and the literature available does not show balanced approaches to combining indicators from different groups within one process, which served as the basis for this work.Aim. The article is devoted to identifying the specifics of quality balanced scorecard for outpatient clinic using the example of the results of preventive examination for children in the first year of life.Material and methods. The study of quality indicators of the outpatient clinic was carried out from 2019 to 2023. The base of the study was the Clinical Consultative and Diagnostic Clinic № 27 in Novosibirsk. The study of the Clinic development was carried out from 2012 to 2023. The work used data from a social and expert survey of managers (20122018), as well as comparative modeling, general logical methods and techniques.Results. The longest multi-level and complex medical service is the process of preventive examination of children in the first year of life. Therefore, using his example, a quality balanced scorecard for the outpatient clinic was developed. At the first stage, medical quality criteria were determined. Patients were interviewed and quality criteria important for the patients' parents were determined. The complexity, multi-stage nature and short time frame for providing medical services determined the criteria for the economic efficiency. At the second stage, criteria for the management effectiveness and criteria for quality monitoring were developed, which allow department heads to track key performance indicators, as well as build coordinated work between various departments. At the third stage, the quality criteria were developed, which, on the one hand, reflect the clinic work, and, on the other hand, are not redundant and can be used to assess the effectiveness of the organization as a whole.Conclusion. The study showed that to increase the sustainability of the clinic development, effective monitoring based on key performance indicators is necessary. The classical approach to determining the effectiveness of medical facilities is based on general performance indicators to the quality criteria of individual processes, which does not allow identifying violations in individual medical and auxiliary processes, and, accordingly, does not allow identifying ways to solve them. It also does not indicate the level of violation. The use of a process and system approach in developing quality criteria allows developing a quality balanced scorecard with respect to the criteria of various groups, which ultimately reflects the effectiveness of processes as a whole, provides an understanding of cause-and-effect relationships and identifies the root cause of destabilization.

NLP-Assisted Differential Diagnosis of Chronic Obstructive Pulmonary Disease Exacerbation.

Chronic Obstructive Pulmonary Disease (COPD) frequently coincides with other comorbidities such as congestive heart failure, hypertension, coronary artery disease, or atrial fibrillation. The exhibition of overlapping sets of symptoms associated with these conditions prevents early identification of an acute exacerbation upon admission to a hospital. Early identification of the underlying cause of exacerbation allows timely prescription of an optimal treatment plan as well as allows avoiding unnecessary clinical tests and specialist consultations. The aim of this study was to develop a predictive model for early identification of COPD exacerbation by using the clinical notes generated within 24 hours of admission to the hospital. The study cohort included patients with a prior diagnosis of COPD. Four predictive models have been developed, among which the support vector machine showed the best performance based on the resulting 80% F1 score.

N01 “Just Live with it”- Exploring patients’ experience of using IBD-F scale in clinical practice – A mixed methods study using focus groups and cross-sectional questionnaires

Abstract Background Inflammatory bowel disease (IBD) related fatigue is one of the most common, yet debilitating symptoms reported by patients with IBD. The causes for the issue are not fully understood, and patients and clinicians alike struggle to communicate about this topic in consultations. In 2014, the IBD-F scale was created to assist this communication, and this study aimed to explore its role in the experiences of patients assessing and managing their IBD fatigue with Health Care Professionals (HCP’s). Methods A mixed methods study was conducted consisting of an online survey and 3 online patient focus groups. The survey was advertised through patient charities and explored individual fatigue assessment and management. 24 patients from across the UK were recruited to participate in the online focus groups, providing 243 minutes of discussion. This data was recorded, transcribed, and anonymised before being coded by two independent researchers. Results The online survey received 426 responses. 272 (64%) respondents reported fatigue levels between 7-10 on a scale of 0-10. When the medical assessment of their fatigue was explored, only 41(10%) respondents reported a medical assessment of the fatigue, 27 (6%) reported being offered support or advice, and 5 (1%) reported that the fatigue had been reassessed. 162 (38%) respondents said they would use the IBD-F on a regular basis and wanted this information to be shared with their medical teams, and 136 (32%) requested the results be attached to their clinical record. The topics arising from the patient focus groups support the notion that fatigue is both overwhelming, and underserved. The main findings are collated into three main themes or “desires”, constructed to represent the patient’s call to HCP's; 1) The desire to “Give up”, 2) The desire to be heard, 3) The desire to change their situation. All groups reported a desire to improve clinical and public education around IBD fatigue and introduce communication tools like the IBD-F into clinical consultations and medical notes. Conclusion This mixed methods exploration highlights a significant, perceived gap in clinical provision for patients experiencing IBD related fatigue. IBD patients are reporting a sense of alienation and abandonment from HCP’s, but also a resounding desire to utilise their voices to educate their medical teams and a willingness to take advantage of additional resources to help improve education, communication and treatment of this symptom. Further research is needed to explore this phenomenon from the HCP’s perspective, and to explore the practical implications of the suggested changes to IBD fatigue education, assessment, and management within these clinical settings. Figure 1:

The Impact of Clinical Ethics Consultations on Physicians in aLatin American Context.

Clinical bioethics plays a significant role in hospital settings through bioethics consultations, which focus on providing ongoing assistance in complex situations within the doctor-patient dynamic. These consultations entail regular interaction between physicians and clinical bioethicists. This situation prompts an exploration into how bioethics consultations affect physicians. The current research aims to understand the influence of bioethics consultations on physicians' bioethical knowledge by analyzing the lexical content in their patients' medical records. Medical records are a synthesis carried out by physicians, often reflecting collaborative efforts, and capturing verbal statements indicative of thought processes suggestive of learning. The study is a sequential mixed-methods design with a retrospective descriptive approach, comparing medical records from the early years of the Department of Humanism and Bioethics' operation (2013-2015) to the more recent ones (2019). Technical bioethical terminology such as "therapeutic effort limitation," "futility," "beneficence," and "respect for autonomy" is more prevalent in recent medical records. This trend may stem from the positive impact of bioethics consultations conducted by the Department, with haptic communication serving as a particularly effective form of interaction with others during experiences of moral distress. This appears to be characteristic of cultures like those in Latin America.

Point-of-care testing and antibiotics prescribing in out-of-hours general practice: a register-based study in Denmark

BackgroundPoint-of-care testing may reduce diagnostic uncertainty in case of suspicion of bacterial infection, thereby contributing to prudent antibiotic prescribing. We aimed to study variations in the use of point-of-care tests (C-reactive protein test, rapid streptococcal antigen detection test, and urine dipstick) among general practitioners (GPs) and the potential association between point-of-care testing and antibiotic prescribing in out-of-hours general practice.MethodsWe conducted a population-based observational register-based study, based on patient contacts with out-of-hours general practice in the Central Denmark Region in 2014–2017. The tendency of GPs to use point-of-care testing was calculated, and the association between the use of point-of-care testing and antibiotic prescribing was evaluated with the use of binomial regression.ResultsOut-of-hours general practice conducted 794,220 clinic consultations from 2014 to 2017, of which 16.1% resulted in an antibiotic prescription. The GP variation in the use of point-of-care testing was largest for C-reactive protein tests, with an observed variation (p90/p10 ratio) of 3.0; this means that the GPs in the 90th percentile used C-reactive protein tests three times as often as the GPs in the 10th percentile. The observed variation was 2.1 for rapid streptococcal antigen detection tests and 1.9 for urine dipsticks. The GPs who tended to use more point-of-care tests prescribed significantly more antibiotics than the GPs who tended to use fewer point-of-care tests. The GPs in the upper quintile of the tendency to use C-reactive protein test prescribed 22% more antibiotics than the GPs in the lowest quintile (21% for rapid streptococcal antigen detection tests and 8% for urine dipsticks). Up through the quintiles, this effect exhibited a positive linear dose–response correlation.ConclusionThe GPs varied in use of point-of-care testing. The GPs who tended to perform more point-of-care testing prescribed more antibiotics compared with the GPs who tended to perform fewer of these tests.

Nomogram for predicting major bleeding after off-pump coronary artery bypass grafting

ObjectiveThe purpose of this investigation is to develop a novel nomogram for predicting major bleeding following off-pump coronary artery bypass grafting (CABG).MethodsBetween January 2012 and December 2022, 541 patients who underwent off-pump isolated primary CABG were included in a retrospective analysis. The primary outcome measure after off-pump CABG was major bleeding. Based on the outcomes of a multivariate analysis, nomograms were constructed. Using receiver operating characteristic analysis and calibration, the predictive accuracy of the nomograms was assessed. Using decision curve analysis (DCA), the clinical benefit of the nomograms was determined.ResultsWe categorized 399 and 142 patients in the “no major bleeding group” and “major bleeding group”, respectively. Age (odds ratio (OR) 1.038; 95% confidence interval (CI) 1.009–1.068; p = 0.009), body mass index (OR 0.913; 95% CI 0.849–0.982; p = 0.014), hemoglobin (OR 0.958; 95% CI 0.945–0.971; p < 0.001), sodium (OR 0.873; 95% CI 0.807–0.945; p = 0.001), blood urea nitrogen (OR 1.198; 95% CI 1.073–1.338; p = 0.001), and operation time (OR 1.012; 95% CI 1.008–1.017; p < 0.001) were independent predictors for major bleeding after off-pump CABG. The model based on independent predictors exhibited excellent discrimination and calibration, with good agreement between actual and nomogram-estimated probabilities of generalization. DCA demonstrated that nomogram-assisted decisions have a greater positive benefit than treating all patients or none.ConclusionsThe plotted nomogram accurately predicted major bleeding outcomes following off-pump CABG and may therefore contribute to clinical decision-making, patient treatment, and consultation services.

Reimagining rural clinical education from lessons learnt during COVID.

Securing access to sufficient and focussed learning experiences is a perennial challenge for medical trainees. This challenge was accentuated during the COVID-19 pandemic lockdowns and with physical isolation processes that decreased in-person patient presentations and a shift to telehealth consultations. This situation has prompted the need to optimise the available experiences and educational responses to overcome the limitations in the number, quantum and range of available clinical learning experiences. Semi-structured interviews were conducted with medical practice teams in four rural general practices to understand how medical trainees' education in rural general practices can be sustained in such circumstances. Key considerations included optimising the available experiences to assist medical trainees to generate the kinds of mental models needed by trainees to conduct medical work, and particularly, when it became even more restricted through remote or physically distanced consultations. It also identified lessons learnt during COVID-19 pandemic lockdowns to inform and improve the provision of trainees' experiences in such practices. Providing experiences for trainees to participate fully in clinical activities is imperative. A sequenced set of experiences was proposed to incrementally prepare trainees to engage in and conduct clinical consultations remotely using digital technologies. Such an approach may not always be easy or possible to enact but offers a pathway of experiences most likely to lead to positive outcomes for the trainees whilst maintaining patient care and safety considerations.

A digital intake tool to avert outpatient visits in a FIT-based colorectal cancer screening population: study protocol of a multicentre, prospective non-randomized trial - the DIT-trial

BackgroundCurrently all participants of the Dutch colorectal cancer (CRC) screening program with a positive faecal immunochemical test (FIT) are seen at the outpatient clinic to assess their health status, receive information on colonoscopy and CRC risk, and provide informed consent. However, for many patients this information could probably also safely be exchanged in an online setting, in order to reduce the burden for patients, healthcare system, and environment. In this study we will evaluate if a face-to-face pre-colonoscopy consultation can be replaced by a Digital Intake Tool (DIT) in a CRC screening population.MethodsThis is a prospective multicentre single-arm, non-randomized study with a non-inferiority design. The DIT will triage a total of 1000 participants and inform them about CRC risk, colonoscopy, sedation, and provide bowel preparation instructions. Participants identified as high-risk (i.e., red-triaged) will be contacted by phone or scheduled for an appointment at the outpatient clinic. The primary outcome measure will be adequate bowel preparation rate, defined as the proportion of participants with a Boston Bowel Preparation (BBPS) score ≥ 6. To compare our primary outcome, we will use colonoscopy data from 1000 FIT positive participants who visited the outpatient clinic for pre-colonoscopy consultation. Secondary outcomes will include participation rate, colonoscopy adherence rate, patient experience in terms of satisfaction and anxiety, knowledge transfer, number of outpatient visits that can be averted by the DIT, and cost-effectiveness of the tool. Ethical approval was obtained from the Medical Ethical Committee of the Erasmus Medical Center (MEC-2021-0098).DiscussionThis study aims to assess if a face-to-face pre-colonoscopy consultation can be replaced by an eHealth assessment and education tool in a FIT-based CRC screening program. In case favourable results are established, the intervention evaluated in this study could significantly impact CRC screening programs, benefiting both patients and healthcare systems on a (inter)national scale. Additionally, it would enable more personalized care as the DIT can be easily customized and made feasible in other languages, thereby enhancing healthcare accessibility.Trial registrationDutch Trial Register: NL9315, date of registration: March 8th, 2021.

Caregivers and Family Members’ Vulnerability in End-of-Life Decision-Making: An Assessment of How Vulnerability Shapes Clinical Choices and the Contribution of Clinical Ethics Consultation

Patient-and-family-centered care (PFCC) is critical in end-of-life (EOL) settings. PFCC serves to develop and implement patient care plans within the context of unique family situations. Key components of PFCC include collaboration and communication among patients, family members and healthcare professionals (HCP). Ethical challenges arise when the burdens (e.g., economic, psychosocial, physical) of family members and significant others do not align with patients’ wishes. This study aims to describe the concept of vulnerability and the ethical challenges faced by HCPs in these circumstances. Further, it assesses the contribution of clinical ethics consultation (CEC) in assisting HCPs to face these difficult ethical conundrums. Two clinical cases are analyzed using the Circle Method of CEC. The first regards the difficulty faced by the doctor in justifying treatments previously agreed upon between the patient and his/her friends. The second regards the patient’s concern about being a burden on their family. Family burdens in EOL settings challenge PFCC in that patient autonomy may be disregarded. This compromises shared decision-making between the patient, family and HCPs as a core component of PFCC. In their ability to promote a collaborative approach, CECs may assist in the successful implementation of PFCC.

Decision aids for promoting shared decision-making: A review of systematic reviews.

In the context of shared decision-making (SDM), experts have advocated the use of validated decision aids (DAs) as valuable tools for facilitating SDM in various healthcare scenarios. This comprehensive review attempts to analyze a vast corpus of DA research by performing thorough searches across four prominent databases (PubMed, CINAHL, Embase, and Web of Science). Independent reviewers selected relevant reviews, extracted data, and assessed review quality using the AMSTAR II tool. A total of 34 systematic reviews were identified and evaluated in this review, encompassing a wide range of outcomes associated with using DAs. These outcomes include patient knowledge, patient involvement in SDM, decision conflict, decision regret, satisfaction, and adherence. In addition, DAs positively affect healthcare provider outcomes by increasing satisfaction, reducing decision conflicts, and lengthening clinical consultations. This review highlights the need for additional research in specific contexts such as long-term care, mental health, and reproductive health to better understand the benefits and challenges of implementing DAs in these settings. Such research can contribute to the improvement of SDM practices and patient-centered care.

Video consultation in general practice during COVID-19: a register-based study in Denmark.

During the COVID-19 pandemic, general practices in Denmark rapidly introduced video consultations (VCs) to prevent viral transmission. To study the use of VCs in daytime general practice by describing the rate of VCs, and the patient characteristics associated with having VCs. Register-based study of consultations in daytime general practice in Denmark. We included all consultations in daytime general practice from 1 January 2019-30 November 2021. We calculated the rate of video use and categorised the general practices into no, low, and high use. Logistic regression was used to calculate adjusted odds ratios (aOR) for having a VC for different patient characteristics when contacting a video-using practice, stratified for low- and high-using practices. A total of 30 148 478 eligible consultations were conducted during the pandemic period. VCs were used mostly during the early stage pandemic period, declining to about 2% of all clinic consultations in the late-stage period. Patients having more VCs were young, had a long education, were employed, and lived in big cities. In low-using practices, native Danes and 'western' immigrants had higher odds of receiving a VC than 'non-western' immigrants, and patients with ≥2 comorbidities had lower odds than those without comorbidities. Patients of a younger age, with long education, or employment had higher odds of receiving a VC, while patients of an older age and patients who had retired had lower odds. This difference in the access to VCs warrants further attention.

Can Consultation by a Clinical Pharmacist Prevent Morbidity and Mortality in Patients Undergoing Bariatric Surgery?

The purpose of this work was to investigate the effect of clinical pharmacist consultation on the long-term morbidity and mortality outcomes among patients undergoing bariatric surgery. In this retrospective cohort study, 165 bariatric patients at Herzliya Medical Center who were identified as complex cases and were consulted by a clinical pharmacist (2013-2019) were compared with a wider group of bariatric patients with chronic diseases who were recorded in the Israeli General Bariatric Registry during the same years. The primary outcomes were rates of surgical complications, re-hospitalizations, and death up to one year after surgery. The secondary outcome was the rate of re-hospitalizations in different time periods. The twelve (12)-month rate of re-hospitalization in the intervention group was 10.9% vs. 19.5% in the comparison group (p = 0.005); the rate of documented postoperative complications was 2.7% vs. 3.9% (p = 0.462), and mortality was null vs. 0.16%, respectively. As for the secondary outcomes, the rates of re-hospitalizations in the periods of 0-30, 31-90, 91-180, and 181-365 days after surgery were 1.8% vs. 5.3% (p = 0.046), 2.4% vs. 4.1% (p = 0.278), 3.6% vs. 4.8% (p = 0.476), and 7.3% vs. 9.9% (p = 0.256) in the intervention vs. comparison cohorts, respectively. In conclusion, this study demonstrates the importance and benefit of referring to a specialized clinical pharmacist around bariatric surgery for improving patient safety, especially in complex patients. This is the first study to look at the long-term effects of clinical pharmacist consultation on re-hospitalization and mortality among bariatric patients, and our encouraging outcomes should hopefully stimulate more studies to show the invaluable role of specialized clinical pharmacists.

Impact of COVID-19 restrictions on diabetes mellitus management in Qatari primary care settings

IntroductionIn 2019, Coronavirus Diseases 2019 (COVID-19) emerged as a pandemic making diabetic patients among the most vulnerable to this virus. Previous studies showed contradicting evidence for the impact of “lockdown” on the management of diabetic patients. New models of service delivery were introduced in Primary Health Care Corporation (PHCC) (Qatar’s largest primary care provider) to ameliorate the risk of infection to both patients and health care workers including converting face to face chronic disease appointments (NCD, antenatal, and preventive visits) to telephone and video consultations. This study aimed to compare access and outcomes of PHCC registered diabetics pre-COVID and during the COVID-19 lockdown period.MethodsThe study was conducted as a 3 year historic cohort using PHCC’s electronic health record system. Individuals with an established diagnosis of diabetes mellitus (DM) before January 2019 and having at least one clinical encounter per year in a PHCC health center during the study period starting Jan 2019 to Dec 2021 were recruited. Pre-COVID-19 period was defined as the interval between January 2019 and February 2020, while the COVID-19 lockdown period was defined as the interval between February 2020 to December 2021. The study used a paired observation approach on selected process indicators on delivery of health services in line with PHCC’s diabetes management guidelines (at least two HbA1C tests done per year and at least one each of the following per year—low-density lipids (LDL) test, ophthalmology screening, podiatry assessment, health education and dietetics clinic consultations) and outcome indicators (blood pressure readings and the results of two laboratory tests: blood HbA1c and serum LDL level).ResultsCOVID-19 was associated with an overall mean reduction of 0.9 per year of consultations. Similarly, the delivery of annual assessments as per guidelines were also impacted. Of these, the probability of achieving the designed target for two HbA1C tests per year was reduced by almost a half (paired OR=0.47) during COVID-19 compared to pre- COVID-19 period. Conversely, a significant increase in the probability of having at least one each of LDL test, ophthalmology screening and dietetics consultation was observed (paired OR=1.84, 1.62 and 1.94 respectively) during COVID-19. The probability of having inadequate glycemic control (HbA1C > =7%) was significantly increased by 32% during COVID-19 period. Likewise, the probability of experiencing inadequately controlled blood pressure was significantly increased by 47% during the pandemic. Conversely, the probability of having Inadequately controlled blood lipids (LDL 2.6 mmol/L+) was significantly reduced by 9%.ConclusionsThe impact of the COVID-19 pandemic on the primary health care services in Qatar has highlighted PHCC’s resilience by the introduction of virtual consultations during COVID-19 restrictions. Only one process indicator was significantly impacted during COVID-19 restrictions, namely having at least two HbA1C tests per individual with diabetes per year. However, the control of the disease according to HbA1c and blood pressure measurements showed a noticeable deterioration during COVID-19.

A novel homozygote nonsense variant of MSH4 leads to primary ovarian insufficiency and non-obstructive azoospermia.

Both non-obstructive azoospermia (NOA) and primary ovarian insufficiency (POI) are pathological conditions characterized by premature and frequently complete gametogenesis failure. Considering that the conserved meiosis I steps are the same between oogenesis and spermatogenesis, inherited defects in meiosis I may result in common causes for both POI and NOA. The present research is a retrospective investigation on an Iranian family with four siblings of both genders who were affected by primary gonadal failure. Proband, an individual with NOA, was subjected to clinical examination, hormonal assessment, and genetic consultation. After reviewing the medical history of other infertile members of the family, patients with NOA went through genetic investigations including karyotyping and assessment of Y chromosome microdeletions, followed by Whole exome sequencing (WES) on the proband. After analyzing WES data, the candidate variant was validated using Sanger sequencing and traced in the family. WES analysis of the proband uncovered a novel homozygote nonsense variant, namely c.118C>T in MSH4. This variant resulted in the occurrence of a premature stop codon in residue 40 of MSH4. Notably, the variant was absent in all public exome databases and in the exome data of 400 fertile Iranian individuals. Additionally, the variant was found to co-segregate with infertility in the family. It was also observed that all affected members had homozygous mutations, while their parents were heterozygous and the fertile sister had no mutant allele, corresponding to autosomal recessive inheritance. In addition, we conducted a review of variants reported so far in MSH4, as well as available clinical features related to these variants. The results show that the testicular sperm retrieval and ovarian stimulation cycles have not been successful yet. Overall, the results of this study indicate that the identification of pathogenic variants in this gene will be beneficial in selecting proper therapeutic strategies. Also, the findings of this study demonstrate that clinicians should obtain the history of other family members of the opposite sex when diagnosing for POI and/or NOA.

Artificial intelligence-generated patient information leaflets: a comparison of contents according to British Association of Dermatologists standards.

Patient information leaflets (PILs) can supplement a clinical consultation and provide additional information for a patient to read in their own time. A wide range of PILs are available for distribution by the British Association of Dermatologists (BAD) and undergo rigorous review ahead of publication. In the UK, 7.1 million adults are estimated to have the reading age of a 9-year-old child and 43% are unable to comprehend written health information. To determine whether artificial intelligence (AI) can produce PILs that include a similar degree of content to current BAD PILs. Using the AI tool ChatGPT, 10 PILs were generated, and their contents compared with those of existing BAD PILs using an author-generated list of commonly included themes. Omissions were noted and a repeat series of PILs generated using targeted request phrasing. The readability of AI-generated PILs was also analysed. AI-generated PILs were found to include similar factual content to BAD PILs but excluded information that was felt to be more pertinent to patient concerns such as curability and heritability. Targeted request phrasing saw AI generate PILs including this content. The readability of AI-generated PILs was beyond that of a large number of UK adults. Where a condition-specific PIL is not readily available, an AI-generated PIL can provide relevant information of lesser quality than existing BAD PILs, which may be inaccessible to some patients. Specific caution is advised regarding AI-generated medication-specific PILs.

Digital health evolution and application: astronauts, starlings and Hedwig Kiesler

Digital health technologies in the NHS have had a largely leisurely uptake over recent years. The COVID-19 pandemic, however, witnessed a sharp rise in their application, with remote clinical consultations in primary, secondary and tertiary care being undertaken using readily available software. Similar applications have supported the implementation of virtual wards, enabling early supported patient discharge, and numerous examples of home health technologies have enabled patients to be monitored remotely for range of health conditions. There are several terms for digital health, including telemedicine, e-health and telecare. While the pandemic contributed to the rise in digital healthcare, many of these technologies have been in existence for several years. This paper will briefly explore the history and evolution of digital health technology and discuss a number of key policies and guidance documents in some detail, including their impact on urgent and prehospital practice.