Doctor's Office Research Articles

GERD - still current problem of society, diagnosis, practical methods of management and treatment

Introduction and purpose: Gastroesophageal reflux disease (GERD) is a very common digestive disease worldwide. About half of all adults will report symptoms of reflux at some point in their lives. The symptoms of the disease are non-specific, which is why doctors of many specializations face the problem both in doctor's offices and hospital rooms. GERD is a disorder with troublesome symptoms and complications resulting from the regurgitation of gastric contents into the esophagus, causing subjective symptoms and related complications, negatively affecting the quality of life. Symptoms negatively affect the quality of life of patients, lowering well-being, physical activity, and social functioning. Diagnosis is based in most cases on the observation of symptoms, which is why this paper presents the symptoms that should be taken into account when diagnosing patients. Therapeutic procedures, selection of the appropriate form of treatment: conservative, pharmacological and surgical, were discussed.Materials and methods: The review was based on the analysis of materials collected in the "Pubmed" database, books and other scientific articles.Summary: Gastroesophageal reflux disease is an important health problem because it is associated with impaired daily functioning and morbidity. Proper management of GERD symptoms can result in significant improvements in patients' well-being, including reduction in physical pain, increase in vitality, physical and social functioning, and improvement in emotional well-being. In some patients, only lifestyle modification and a change in habits are enough to reduce the occurrence of symptoms. First-line drugs are proton pump inhibitors. Endoscopic examination should be performed when pharmacological therapy is ineffective or in the event of alarm symptoms, i.e. dysphagia, weight loss, anemia, bleeding and recurrent vomiting. Surgical treatment is used as a last resort when pharmacological treatment fails.

Knowing Is Not Doing: A Qualitative Study of Parental Views on Family Beverage Choice.

Sugary drink consumption is associated with adverse health outcomes in children, highlighting the need for scalable family interventions that address barriers to water consumption. To inform development of a scalable, health-care-system-based intervention targeting family beverage choice, a formative qualitative study was conducted using semi-structured interviews with parents whose children were identified as over-consuming sugar-sweetened beverages (SSB) and/or fruit juice (FJ). The first goal of these interviews was to understand, in a diverse real-world patient population, what parents viewed as the primary drivers of their family's beverage choices, and explore how these drivers might need to be addressed in order to make changes to beverage consumption. A second goal was to explore parental preferences for planned intervention components. An exploratory goal of the interviews was to examine whether knowledge, attitudes, and beliefs around family beverage choice differed across racial and ethnic groups in this sample. Semi-structured phone interviews were conducted and interviews audio-recorded and transcribed. 39 parents/caregivers of children ages 1-8 who over-consumed sugary drinks as determined by screenings at pediatric visits. Parents were interviewed about family beverage choices and preferences to inform development of a multi-component intervention. Thematic analysis was performed, including comparison of themes across racial/ethnic groups. Parents expressed that sugary drinks were unhealthy and water was a better alternative. Most were familiar with the health consequences of excess sugar consumption. They identified many reasons why sugary drinks are chosen over water despite this knowledge. One common reason was concern about tap water safety. Few differences were noted across racial and ethnic groups in our sample. Parents were enthusiastic about a technology-based intervention to be delivered through their child's doctor's office. Knowledge is not enough to change behavior. Beverage interventions need to be easy to access, make water more appealing, and elevate beverage choice above the "white noise" of everyday life. Delivering an intervention in a clinical setting could provide an extra level of care, while technology would reduce the amount of live contact and decrease the burden for clinicians and parents.

Carter family issues statement about health of former First Lady

In a statement released May 30 by the family of former President Jimmy Carter, it was shared that former First Lady Rosalynn Carter has dementia. The family's news was distributed through The Carter Center, a not‐for‐profit organization geared toward promoting peace, protecting democracy and fighting disease, founded by Jimmy and Rosalynn Carter. “She continues to live happily at home with her husband, enjoying spring in Plains and visits with loved ones,” the Center release stated. “Mrs. Carter has been the nation's leading mental health advocate for much of her life. First in the Georgia governor's mansion, then in the White House, and later at The Carter Center, she urged improved access to care and decreased stigma about issues surrounding mental health. One in 10 older Americans have dementia, a condition that affects overall mental health. We recognize, as she did more than half a century ago, that stigma is often a barrier that keeps individuals and their families from seeking and getting much‐needed support. We hope sharing our family's news will increase important conversations at kitchen tables and in doctor's offices around the country. As the founder of the Rosalynn Carter Institute for Caregivers, Mrs. Carter often noted that there are only four kinds of people in this world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers. The universality of caregiving is clear in our family, and we are experiencing the joy and the challenges of this journey. We do not expect to comment further and ask for understanding for our family and for everyone across the country serving in a caregiver role.”

Preferences for Rectal Sexually Transmitted Infection Sample Collection and Sexual Behaviors Among Adolescent and Young Adult Women Accessing Primary Care Services.

High prevalence of asymptomatic rectal chlamydia and gonorrhea among women is increasingly recognized. Screening is controversial because of lack of natural history data. Barriers to screening may include reluctance to discuss anal sex and collect rectal samples. This study describes the prevalence of sexual contact exposing adolescent and young adult women to extragenital sexually transmitted infections and acceptability of self-collection and clinician collection of rectal samples, preference for self- versus clinician-collected rectal samples, and preference for home or doctor's office for sample collection. Participants were recruited from a primary care office and completed structured interviews assessing types of sexual contact and attitudes about rectal sampling. Differences were tested using χ2 and 2-sided Fisher exact test. Of 110 cisgender women (aged 14-22 years) enrolled, the average age was 18.4 years (SD, 1.7 years), 83% reported a history of extragenital contact, 22% reported history of receptive anal intercourse. A majority of participants reported self- and clinician-collected rectal samples to be acceptable (86% and 73%, respectively), with preferences for self-collection (71%) over clinician collection (29%, P < 0.001) and collection at the doctor's office (85%) over home (15%, P < 0.001). Adolescent and young adult (AYA) women engage in behaviors that increase the risk of rectal sexually transmitted infection (STI). Self- and clinician-collected rectal samples were acceptable. A majority of AYA women preferred to collect rectal samples in the doctor's office rather than at home. This may reduce adolescents' access to direct-to-consumer STI services. Offering in-clinic, self-collected rectal samples may improve uptake of rectal STI screening in adolescent girls.

Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey.

Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors' offices. We explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions. A cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors' offices. Respondents indicated their willingness to receive messages from their doctors' offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from "unwilling" to "willing." We present the percentage of respondents who indicated that they were "willing" to receive information via specific electronic mode. Chi-square tests were used to compare participants' willingness by social characteristics. In total, 133 people completed the survey (response rate 27%). The average respondent age was 64 years, 82 (63%) respondents were female, 106 (83%) were White, 20 (16%) were Black, and 1 (1%) was Asian. In total, 75 (58%) respondents had a bachelor's degree or higher; 26 (20%) resided in rural areas, 37 (29%) in suburban areas, 50 (39%) in a town, and 15 (12%) in a city. The majority, 73 (57%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75%) respondents were willing to receive information from their doctor's office via their patient portal, 98 (74%) via email, 75 (56%) via text, 60 (45%) via the hospital website, 50 (38%) via telephone, and 14 (11%) via social media. About 6 (5%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes. To optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services.

Color Selection Study Of Children's Outpatient Clinic Interior Related To Patient Stress Level

The interior of an outpatient clinic is generally a very scary thing for children, especially when they are sick. This is because if you are sick, the patient's stress level will increase, especially pediatric patients. Seeing this trend, it is considered important to minimize the patient's stress level, because the patient's increased stress level can cause the patient's immune system to decrease so that it is more difficult in the healing process. One of the patient's stress levels can be caused by the interior atmosphere in the waiting room and doctor's office. One way to minimize patient stress levels is by implementing the right colors in the interior of waiting rooms and doctors' offices in pediatric outpatient clinics. Given this, it is considered necessary to examine interior studies related to color selection in patient waiting rooms and pediatrician offices. The method used in this study is the method of discriptive analysis. To design the right interior in the childcare clinic, you should use a concept that can display a warmer, calmer, and cheerful interior , besides being supported by facilities with attractive designs so that children can forget about their stresnya due to the illness they suffer. While currently the selection of the right color of the interior of the pediatric clinic, especially in the waiting room and doctor's practice, is still not considered, only payattention to the necessary facilities. Colors that are suitable to be applied to the interior of the practice and waiting room of the children's outpatient clinic include soft and fresh warna such as blue, green, yellow and orange are usually quite effective in providing a warm, calm, and cheerful sensation for children, especially those who are experiencing It hurts. But it does not rule out the possibility of implementing other colors that also need to encourage pediatric patients such as red, but should not be implemented too dominantly

Trust and virtual communication during the COVID-19 pandemic for adults with asthma from low-income neighborhoods: What have we learned?

Low-income and marginalized adults disproportionately bear the burden of poor asthma outcomes. One consequence of the structural racism that preserves these inequities is decreased trust in government and health care institutions. We examined whether such distrust extended to health care providers during the pandemic. We enrolled adults living in low-income neighborhoods who had required a hospitalization, an emergency department visit, or a prednisone course for asthma in the prior year. Trust was a dichotomized measure derived from a 5-item questionnaire with a 5-point Likert scale response. The items were translated to the binary variable "strong" versus "weak" trust. Communication was measured using a 13-item questionnaire with a 5-point Likert scale. Logistic regression was used to examine the association betweencommunication and trust, controlling for potential confounders. We enrolled 102 patients, aged 18 to 78 years; 87% were female, 90% were Black, 60% had some post-high school education, and 57% were receiving Medicaid. Of the 102 patients, 58 were enrolled before the March 12, 2020, pandemic start date, and 70 (69%) named doctors as their most trusted source of health information. Strong trust was associated with a negative response to the statement "It is hard to reach a person in my doctor's office by phone." There was no evidence of an associationbetween the overall communication scores and trust. Satisfaction with virtual messaging was weaker among those with less trust. These patients trust their physicians, value their advice, and need to have accessible means of communication.

Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey.

While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making. We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice. We developed a brief text message program offering educational information consisting of components of shared decision-making regarding CRC screening (eg, for whom screening is recommended, screening test options, and pros/cons of options). The program and postprogram survey were offered to members of an online panel. The outcome of interest was program acceptability measured by observed program engagement, participant-reported acceptability, and willingness to use similar programs (behavioral intent). We evaluated acceptability among historically marginalized categories of people defined by income, literacy, and race. Of the 289 participants, 115 reported having a low income, 146 were Black/African American, and 102 had less than extreme confidence in their health literacy. With one exception, we found equal or greater acceptability, regardless of measure, within each of the marginalized categories of people compared to their counterparts. The exception was that participants reporting an income below US $50,000 were less likely to engage with sufficient content of the program to learn that there was a choice among different CRC screening tests (difference -10.4%, 95% CI -20.1 to -0.8). Of note, Black/African American participants reported being more likely to sign up to receive text messages from their doctor's office compared to white participants (difference 18.7%, 95% CI 7.0-30.3). Study findings demonstrate general acceptance of text messages to inform and support CRC screening shared decision-making.

Evaluation of Reducing the Excess Abdominal Skin, Subcutaneous Tissue and Anterior Abdominal Wall Laxity: A Prospective Observational Study at Dhaka Medical College Hospital

Background: Lax abdominal muscles cause laxity or bulging. This is generally a consequence of age or post-pregnancy, causing the abdominal rectus muscles and fascia that overlies and divides them to weaken. Abdominoplasty, a popular cosmetic surgery, has improved in recent years. helped minimize abdominal fat and skin. Medical institutions are diagnosing and treating obesity at an increasing pace. Objective: The purpose of the study was reduce the excess abdominal skin,subcutaneous tissue and anterior abdominal wall laxity. Methods: The duration of this prospective observational research was from July 2014 to April 2015. The research population consisted of patients hospitalized to the Plastic Surgery Department of Dhaka Medical College Hospital and numerous private hospitals in Dhaka with extra abdominal skin and abdominal wall laxity owing to various causes, such as past pregnancy or severe weight loss. From the study population, 30 instances that satisfied the enrollment requirements were chosen. Results: The majority of patients (26, or 86.67 %) were female, and 76 % were married. At the time of surgery, the average age was 41.3 years. The total complication rate was 40%, with just four serious complications (13.33%) and the most being mild (9, 30 % ). Seroma (3, 10%), infection (2, 6.67%), hematoma (2, 6.67%), wound dehiscence (1, 3.33%), partial flap loss (2, 6.67%), umbilical stenosis (1, 3.33%), epidermolysis (1, 3.33%), DVT (1, 3.33%) were the most prevalent complications (1, 3.33 % ). Very excellent (19, 66.3%), good (9, 30%), and adequate were patients' ratings of satisfaction (2, 6 % ). No patient reported low or extremely bad satisfaction. Conclusion: Abdominoplasty may be done with little risk and provides excellent results. Patients reported relief from their symptoms and satisfaction with the result. However, there was a high rate of mild problems, most of which involved wound healing. At most cases, problems were mild and quickly treated in a doctor's office.

The Place to Purchase Drugs for Community Self-Medication at Green Hills Moncongloe Housing, Maros Regency

Self-medication or self-medication is part of the community's efforts to treat minor ailments by using over-the-counter drugs, limited over-the-counter drugs and mandatory pharmacy drugs without consulting a doctor first. Most people self-medicate because they don't have time to go to the doctor, the distance to the puskesmas, hospital or doctor's office is far from home. So that people choose where to buy drugs at pharmacies, grocery stalls, minimarkets and drugstores. The purpose of this study was to find out where to buy drugs for self-medication in the Green Hills Moncongloe Housing Complex, Maros Regency. The method used in this research is descriptive method, namely research that includes surveys with data collection techniques in the form of questionnaires. This research was conducted at the Green Hills Moncongloe Housing Complex, Maros Regency which was carried out in February - March 2023 by distributing questionnaires to 50 respondents. From the results of the study it can be seen that of the 50 respondents, 29 people (58%) bought drugs at pharmacies, 16 people (32%) at grocery stalls, 3 people (6%) minimarkets, and finally 2 people (4%) drugstores. So it can be concluded that more people choose places to buy medicines at pharmacies because people believe that medicines sold at pharmacies can be trusted for their quality and authenticity and the public can obtain information about the drugs they buy.

White Coat Effect: Is It Because of the Hospital Setting, or Is It Physician-Induced?

White coat hypertension (WCH) patients are those individuals who have high blood pressure (BP) in the medical environment but are normal during their daily activities. White coat hypertensive patients with normal daytime ambulatory blood pressure monitoring (ABPM) rapidly progress to sustained hypertension. WCH is mainly treated with non-pharmacological methods. Alpha-1 agonists and beta blockers are logical treatment choices for patients with fixed hypertension with the White Coat Effect (WCE). Masked hypertension patients are those individuals who have normal values at the doctor's office but elevated BP at home or during 24-hour ABPM (24-hour or daytime). ABPM is a more practical and reliable method for detecting patients with WCH. This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana, over the course of one year (December 2015 to November 2016). The primary objective of the study was to determine whether there was a difference in blood pressure readings between the home setting and the hospital setting. The secondary objective was to determine whether the difference, if present, between the hospital and home readings was due to the hospital setting, physician presence, or a combination of both. Patients with stage 1 hypertension were included in the study, irrespective of antihypertensive treatment. Patients with ischemic heart disease, chronic liver failure, and chronic kidney disease who could not follow protocol instructions were excluded. In our study, the mean age of patients was 53.91±12.86 years. The patient's mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings at the hospital were higher than their home readings (p-0.012; p-0.001, respectively). Mean hospital SBP and DBP readings recorded by the physician were higher than readings recorded by patients alone at home (p-0.002; p-0.014, respectively) and alone at the hospital (p-0.004; p-0.001, respectively). BP readings taken by the physician with a manual sphygmomanometer were significantly lower than those taken with a digital sphygmomanometer by patients and physicians in all settings (p<0.05). The mean rise in BP was significant in both the physician's presence and the hospital environment (p<0.05 for both), and this rise was more significantly associated with the hospital effect than the physician effect (p<0.05). Misdiagnosis of hypertension results in inappropriate prescription and overuse of antihypertensive medications for individuals who are not persistently hypertensive. So it is very important to rule out WCH in both the hospital setting and the physician's presence, more precisely by ABPM. WCH can be diagnosed with regular BP monitoring by a digital sphygmomanometer at home.

Abstract 751: Disparities in physician office visit wait time among US cancer survivors

Abstract Background: Disparities are well-documented in the time spent seeking medical care in the US. Studies have found that minority populations are likely to have longer wait times securing healthcare access and higher total time spent at clinic visits. However, this relationship has not been previously examined among the cancer survivor population, which constitutes about 17 million people in the US. Methods: Study data were derived from the 2018 National Health Interview Survey, a nationally representative survey of US adults. Study sample was restricted to cancer survivors (n=2,940; N=23,310,174). The primary outcome of this study was reports of prolonged wait times during doctor office visits. Weighted multivariable logistic regression were used to estimate adjusted associations between prolonged wait times during doctor office visits and sociodemographic and behavioral characteristics of cancer survivors. All analyses were conducted using STATA version 14.2. Results: Respondents who identified as Black/African American were almost 3 times more likely than their White counterparts to report prolonged wait times during doctor office visits (aOR 2.65, 95% CI; 1.296, 5.419). Similarly, respondents who identified as Hispanic were almost 3 times more likely than non-Hispanic respondents to report prolonged wait times during doctor office visits (aOR 2.604, 95% CI; 1.347, 5.035). Respondents in the $50,000 - $74,999 income bracket were less likely to report prolonged wait times during doctor office visits than respondents who earned less than $35,000 (aOR: 0.50, 95% CI, 0.276, 0.916). Conclusion: Black/African American and Hispanic cancer survivors had increased odds of reporting prolonged wait times during doctor office visits. Disparities in cancer health and survivorship are well documented among racial minorities. Addressing disparities in healthcare experiences and access will be crucial in dispelling existing cancer health disparities. Citation Format: Onyema Chido-Amajuoyi, Ikenna Nnamani, Owhofasa Agbedia. Disparities in physician office visit wait time among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 751.

Management of arterial hypertension: home blood pressure measurement is a cornerstone for telemonitoring and self-management.

The development of mobile telephones has made it possible to design blood pressure (BP) monitors with data transmission via cellular lines, contributing to the emergence of "e-health". Today, the direct-to-consumer marketing of devices create a new context allowing an algorithmic processing of information for remote decision-making either by the patient or by a healthcare professional. The home BP telemonitoring (HBPT) is the remote transmission of BP values, measured at home and transmitted to the doctor's office or hospital, by means of telehealth strategies. In this context, randomized controlled trials (RCTs) studies have demonstrated HBPT ability in improving patients' compliance and adherence to treatment and in accomplishing better hypertension control rates. The level of evidence for the drop in BP is "moderate" and the place of HBPT is not clearly established in current practice. Digital interventions have the potential to support patient in self-management. This approach presupposes the prior acquisition of skills, the level of which must be adapted to the level of health literacy of each patient. Few of medical applications (mobile apps or web-apps) for hypertension can be regarded as accurate and safe for clinical use and to date, we do not have high quality evidence to determine the overall effect of the use smartphone apps on BP control.

Smartphones: The Next Doctor's Office?

Smartphones: The Next Doctor's Office?

Analisis Kesiapan Pelaksanaan Rekam Medis Elektronik (RME) Dengan Metode Doctor's Office Quality-Information Technology (DOQ-IT) di Klinik Pratama Polkesmar

In order to realize digital transformation, quality data integration is an important element, especially in the field of health services. All Health Service Facilities are expected to have implemented Electronic Medical Records (EMR) following the provisions no later than December 31, 2023. In order to comply with these regulations, health service facilities must prepare all the components needed to implement EMR. The purpose of this study was to analyze the readiness of implementing RME using the Doctor's Office Quality-Information Technology (DOQ-IT) method at the Polkesmar Primary Clinic. The type of research used was descriptive quantitative. Methods of data collection were through filling out questionnaires. Ease of use analysis was done using the EHR Assessment and Readiness Starter Assessment from DOQ-IT. The total readiness score of the Polkesmar Primary Clinic in implementing EMR was 128,45 in category III, which meant that the Polkesmar Primary Clinic was very ready to implement EMR. Readiness for implementing EMR could be ranked as the strongest, namely Human Resources readiness (4,50), Governance and Leadership readiness (4,64), Organizational Work Culture readiness (4,69), and IT Infrastructure readiness (4,54).

Abstract P364: Healthcare Utilization Among Asian, African, and Latino Immigrants With Hypertension or Diabetes in the 2010-2018 National Health Interview Survey

Background: Cardiovascular disease (CVD) morbidity and mortality disproportionately affect racial and ethnic minority groups and can be mitigated by preventative services. However, research describing healthcare use in immigrants with CVD risk in the US is limited. Hypothesis: Immigrants with hypertension or diabetes will have lower healthcare utilization (HCU) than US-born non-Hispanic (NH) White adults. Methods: We analyzed cross-sectional data from the 2010-2018 National Health Interview Survey on 75,631 adults including Asian (N=3,120), African (N=393), and Latino (N=7,315) immigrants and US-born NH White adults (N=64,803) with hypertension or diabetes. HCU was defined as seen/talked to a general doctor, ≥1 doctor’s office visit, and ≥1 emergency department (ED) visit in the past 12 months. We used logistic regression to examine HCU disparities between immigrants and NH White adults and compared HCU among immigrants stratified by length of US residence. Results: Participants had a mean (±SE) age of 60.4 (±0.1) years, and 52% were female. Compared to NH White adults, Asian (adjusted odds ratio [aOR]: 0.79, 95% CI: 0.69-0.89, Table ), African (aOR: 0.68, 95% CI: 0.50-0.93), and Latino (aOR: 0.68, 95% CI: 0.62-0.74) immigrants were less likely to have seen/talked to a doctor in the past 12 months. All immigrant groups were also less likely to have ≥1 doctor office visit. Asian (aOR: 0.61, 95% CI: 0.55-0.68) and Latino (aOR: 0.85, 95% CI: 0.79-0.91) immigrants were less likely to have ≥1 ED visit than NH White adults. Compared to those with &lt;10 years of US residence, HCU improved in immigrants with ≥10 years of residence (data not shown). Conclusion: Immigrants with CVD risk use less health services than NH White adults, yet HCU improves with longer US residence. CVD health policies must account for heterogeneity among immigrant groups, with targeted efforts toward recent immigrants, to improve HCU and prevent CVD complications.

The Analisis Standar Bangunan dan Prasarana Ruang Nurse Station, Ruang Kepala Rawat Inap, dan Ruang Dokter Jaga di Ruang Rawat Inap Rumah Sakit Dr. Soetarto Yogyakarta

Introduction: dr. Soetarto Hospital as a private institution has challenges to provide optimal services to the community. Hospitals must meet the technical requirements of hospital facilities and infrastructure to support complete health services, especially in inpatient rooms. The inpatient room at the dr. Soetarto includes the Ksatria Room (VIP), Nusa Indah Room (VVIP), ICU Room, Emergency Room, Perwira Room, Husada Room, Kartika Room, and Kirana Room. This study aims to analyze the standards of hospital buildings and infrastructure in inpatient rooms in accordance with Permenkes No. 24 of 2016.&#x0D; Method: The method used in this study is observation and in-depth interviews with resource persons using a questionnaire that is in accordance with the Regulation of the Minister of Health No.24 of 2016 concerning Technical Requirements for Hospital Buildings and Infrastructure in the Inpatient Unit of Dr. Soetarto Hospital in Yogyakarta.&#x0D; Result and Discussion: The results showed that the nurse station with an average score of 86.6% did not meet the standards, the inpatient center office 100% met the standards, and the doctor's office on duty met the standards 100%. Based on the results of the research and discussion, it can be concluded that the average calculation of the three inpatient rooms at dr. Soetarto Yogyakarta by 95.5% and can be stated very well

Biohacking Queer and Trans Fertility: Using Social Media to Form Communities of Knowledge.

Biohacking involves individuals determining, developing, and directing relevant activities to meet their personal biological goals. Biohacking fertility is a resilient method that trans and genderqueer people use to meet their reproductive and family-planning needs in the face of historic medical marginalization and oppression. In this study, nine participants were recruited from three different Facebook groups specific to queer and trans fertility, family planning, pregnancy, and parenting. Each participant's posts and comments to their respective Facebook group(s) were analyzed, followed by interviews with participants. A total of 1,155 Facebook posts were collected. Biohacking activity-understood as a web of activity including gathering information, applying knowledge to personal circumstances, and sharing personal experiences and knowledge-was found in each of the three groups. Participants identified these online groups as safer spaces to learn more about their own fertility and find community. Participants were active in these groups to biohack their fertility at home and to become empowered at the doctor's office or fertility clinic, ultimately achieving agency in their fertility and family planning.

Cerebral venous thrombosis and B12 deficiency

Infants with prematurity and necrotizing enterocolitis (NEC) are at increased risk for short bowel syndrome and subsequent nutritional deficiencies. In particular, ileal resection is associated with vitamin B12 malabsorption, which interferes with normal myelination and homocysteine metabolism.1, 2 Vitamin B12 deficiency is associated with neurodevelopmental delay as well as hyperhomocysteinemia, which increases the risk for venous thrombosis.2, 3 This eight-year-old boy presented with severe headache, dehydration, and lethargy. He developed acute onset severe frontal headache followed by decreased oral intake, decreased urine output, and recurrent vomiting. The headache was dull and radiating to the back of his head. At the same time, he appeared to be sleepy and less active. These symptoms lasted for two to three days before he was brought to the primary doctor's office and then referred to the emergency department. On assessment, he was tired-looking and exhibited mild microcephaly, but his neurological examination was normal, as was an examination by an ophthalmologist. He experienced mild global developmental delay. He was born at 25 weeks gestational age and had a prolonged stay in the neonatal intensive care unit, complicated by NEC and a hemicolectomy with ileostomy and removal of ileocecal valve. He had low normal levels of B12 for several years prior to presentation and was not treated (151 pg/ml after surgery [normal 160-950]). Brain magnetic resonance imaging and magnetic resonance venography (MRV) showed filling defects in the inferior sagittal, straight, torcula, and proximal transverse sinuses consistent with cerebral venous sinus thrombosis (CVST) with no evidence of acute infarction (Figure 1). Dehydration was initially considered to be the cause. Enoxaparin sodium was started at 1 mg/kg every 12 h with the goal of anti-Xa level between 0.5 and 1.0 U/ml. The hypercoagulation evaluation was normal. The B12 level was 86 pg/ml. His hematocrit was 33.3, and his mean corpuscular volume (MCV) was 87.4. He was not treated at that time. He was discharged within a week after the repeat imaging remained stable with the goal to continue enoxaparin sodium for three months. After three months, he again developed headache and lethargy, and MRV showed a new thrombus. Enoxaparin was switched to warfarin. After a year of warfarin, the clot resolved but he still had headaches. Two B12 levels were obtained, both below 200. His anemia worsened (hematocrit 24.7) and his MCV increased to 96.9. The homocysteine level was 184 μmol/L (normal <11.4). At this point, he began B12 injections (1000 mcg daily for one week followed by monthly and then quarterly injections thereafter). His B12 levels normalized and remained normal throughout his course. The warfarin was discontinued and thrombus has not recurred. Our patient had a difficult-to-treat CVST secondary to a condition predisposing to nutritional deficiency. His chronic B12 deficiency was overlooked by his treating physicians until he presented with a profound deficiency with megaloblastic anemia. The association between B12 deficiency and CVST has been described in children with nutritional deficiency and megaloblastic anemia.4 Previous authors suggested that testing for hyperhomocysteinemia and with B12 supplementation should be considered in pediatric patients with CVST.5 The diagnosis becomes even more crucial in patients with conditions known that promote nutritional deficiencies, such as a history of NEC and ileal surgery. In such children, early recognition of vitamin B12 deficiency and timely vitamin supplementation may prevent the occurrence of CVST as well as other manifestations of B12 deficiency, such as developmental delay.6, 7 In this patient, the B12 deficiency was chronic. While it is difficult to prove that the deficiency caused the CVST, it likley played a substantial role. Hyperhomocysteinemia can damage the vascular endothelium, predisposing to thrombus formation.8, 9 Consequently, vitamin B12 deficiency is a potential risk factor in children with CVST. Fatemeh Mohammadpour Touserkani: Conceptualization; supervision; writing – original draft; writing – review and editing. Theodora Andriotis: Conceptualization; investigation; writing – original draft; writing – review and editing. Yaoping Zhang: Conceptualization; supervision; writing – original draft; writing – review and editing. Steven Pavlakis: Conceptualization; supervision; writing – original draft; writing – review and editing. We would like to thank the patient's parents for their consent for this publication. The authors declare no conflict of interest.

Modern Dressings for the Treatment of Chronic Wounds and the Family Doctor - Case Reports

The appearance of modern dressings for the treatment of chronic wounds with the concept of moist wound healing has brought a completely new doctrine of their treatment, enabling significantly faster healing and thus a number of other benefits for health systems and health workers, patients with chronic wounds, and for society as a whole, reducing treatment costs drastically. The greatest benefit from their use is achieved by patients with chronic wounds, bearing in mind that a chronic wound significantly reduces and impairs the quality of life of patients. What makes modern dressings for the treatment of chronic wounds special is their simple use, which enables even family doctors to successfully treat chronic wounds with modern dressings, when the location of the wound itself and the involvement of frozen tissue allow it. They can be applied in the doctor's offices as well as in the patients' homes by the patrol services. Their application can be of particular importance to patients in rural areas where the health care system is more difficult to access and where the appointments of health workers, doctors and nurses are not daily. In those cases, patients, as well as their family members, can be educated to apply modern dressings for the treatment of chronic wounds by themselves with occasional control examinations by health workers.