First-visit Patients Research Articles

Bladder Neck Angle Associated with Lower Urinary Tract Symptoms and Urinary Flow Rate in Patients with Benign Prostatic Hyperplasia

To evaluate the effect of the funnel-shaped structure of the bladder neck in patients with benign prostatic hyperplasia (BPH), we investigated the correlation of the bladder neck angle (BNA) with the urinary flow rate and lower urinary tract symptoms (LUTS). The cohort comprised 281 first-visit patients. The anatomical prostatic parameters, including BNA, total prostate volume, prostate urethral angle, intravesical prostatic protrusion, and prostate urethral length, were measured by transrectal ultrasonography. The International Prostate Symptom Score (IPSS), postvoid residual urine volume, and uroflowmetric measurements were evaluated. As revealed by multivariable linear regression analysis, BNA was independently associated with the peak flow rate (Qmax) and IPSS. The mean BNA significantly differed according to the severity of prostate symptoms and Qmax, and the mean BNA was 85.5°±17.4° and 89.84°±16.31° in patients with severe prostate symptoms and a Qmax<10 ml/s (P <0.001 and <0.001, respectively). The linear regression analysis showed that BNA was positively associated with the total IPSS (R=0.718, P <0.001) and inversely associated with Qmax (R=0.569, P <0.001). In addition, the mean BNA in patients with acute urine residual (AUR) was higher than that in patients without AUR (86.04°±16.36° vs 63.75°±15.14°, P <0.05). BNA is significantly correlated with LUTS and urinary flow rate in patients with BPH. Our findings suggest that BNA could play an important role in the pathogenic mechanism of BPH and AUR.

A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients

BackgroundThe psychological and sexual health of different populations are negatively affected during the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about psychological distress and erectile function of male recovered patients with COVID-19 in the long term. AimWe aimed to evaluate psychological distress and erectile function of male recovered patients with COVID-19 in the mid-to-long terms. MethodsWe recruited 67 eligible male recovered patients with COVID-19 and followed them up twice within approximately 6 months of recovery time. The psychological distress and erectile function were assessed by validated Chinese version of paper questionnaires. OutcomesThe primary outcomes were Symptom Checklist 90 questionnaire for psychological distress and International Index of Erectile Function-5 for erectile function. ResultsIn the first visit, COVID-19 patients with a median recovery time of 80 days mainly presented the following positive symptoms: Obsessive-Compulsive, additional items (ADD), Hostility, Interpersonal Sensitivity, Depression, and Somatization; while the dimension scores in Somatization, Anxiety, ADD, and Phobia were higher than Chinese male norms. Besides, the prevalence of erectile dysfunction (ED) in the first-visit patients was significantly higher than Chinese controls. In the second visit, the primary psychological symptoms of COVID-19 patients with a median recovery time of 174 days were Obsessive-Compulsive, ADD, Interpersonal Sensitivity, and Hostility, while all dimensions scores of Symptom Checklist 90 were lower than Chinese male norms. Moreover, second-visit patients had no significant difference with Chinese controls in ED prevalence. In addition, it suggested that GSI was the independent risk factor for ED in the regression analysis for the first-visit patients. Clinical ImplicationsThe study showed the changes of psychological symptoms and erectile function in COVID-19 recovered patients, and provided reference on whether psychological and sexual supports are needed after a period of recovery. Strengths and LimitationsTo our knowledge, it is the first study to comprehensively evaluate the psychological distress and erectile function of COVID-19 recovered patients in the mid-to-long terms. The main limitations were the low number of analyzed participants, and the psychological distress and erectile function of healthy Chinese men over the same period were not evaluated, and the psychological and sexual related data of participants prior to COVID-19 were not available. Additionally, there was a selection bias in comparing COVID-19 patients with healthy controls. ConclusionWith less impact of COVID-19 event, the impaired erectile function and psychological distress improved in COVID-19 recovered patients with a recovery time of nearly half a year.Hu B, Ruan Y, Liu K, et al. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021;18:1863–1871.

The relationship between infertility family stigma, self-stigma and psychological well-being in female first-visit patients at a reproductive medicine center in Taiwan

IntroductionSteeped in Chinese culture which considers continuing the family lineage highly important, infertility stigma endorsed by others and oneself can both negatively impact psychological well-being in women with infertility in Taiwan. The aim of the present study was to find out whether family stigma attached to infertility has a direct effect on psychological well-being, or whether it is only when family stigma is internalized into self-stigma that psychological well-being is affected.Material and methodsThe present study had a cross-sectional design, approved by an institutional review board in Taiwan. 245 female participants with infertility completed measures on infertility stigma, self-esteem, and positive and negative affect. The main question of this study was analyzed by conducting structural equation modeling.ResultsThe present study found that none of the direct effects of family stigma on self-esteem, negative affect, or positive affect were significant, while the indirect effects of family stigma on the three psychological well-being indexes through the mediator of self-stigma were significant.ConclusionsSelf-stigma fully mediates the effect of family stigma on self-esteem, positive affect, and negative affect in women with infertility. Collectively, stigma endorsed by others does not necessarily lead to negative psychological well-being. The negative influence comes from internalizing public/family stigma into self-stigma.

Validity and reliability of the self-administered Visual Aura Rating Scale questionnaire for migraine with aura diagnosis: A prospective clinic-based study.

To assess the validity and reliability of the self-administered Visual Aura Rating Scale (VARS) questionnaire using a hospital-based sample in a cross-sectional setting. Visual aura is the most common type of aura manifesting in 98%-99% of migraine with aura (MA). The VARS is a diagnostic rating scale used to quantify the cardinal characteristics of MA and has shown high sensitivity and specificity in the diagnosis of visual aura. We translated the VARS into Korean and constructed a five-item self-administered questionnaire based on the VARS. We consecutively recruited first-visit patients with migraine at the neurology clinics of two university hospitals. The scoring of the self-administered VARS questionnaire was the same as that for the original VARS. We assessed criterion validity and internal consistency reliability. The diagnosis of migraine and aura was assigned by two headache neurologists based on a comprehensive clinical assessment using the International Classification of Headache Disorders, 3rd edition. A total of 240 participants with migraine were enrolled. Of these, 55 (22.9%) had MA. All participants with MA had visual aura. Receiver operating characteristic curve analysis revealed that a cutoff score of 3 provided the highest rate of correct identification of patients ([200/240], 83.3%), with a sensitivity of 96.4% (95% confidence interval [CI], 84.5%-99.6%) and specificity of 79.5% (95% CI, 72.9%-85.0%). Cronbach's alpha coefficient was 0.852. The self-administered VARS questionnaire is a valid and reliable instrument for the screening of visual aura in patients with migraine in neurology outpatient clinics.

Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study.

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

Does cognitive behavioral therapy using a self-check sheet improve night-time frequency in patients with nocturia? Results of a multicenter randomized controlled trial.

To determine whether cognitive behavioral therapy using a self-check sheet is effective in improving night-time frequency of patients with nocturia. We carried out a multicenter, open-labeled, randomized controlled trial in eight institutions. Patients having two or more episodes of nocturia were randomly assigned to either cognitive behavioral therapy with completion of frequency volume charts regularly (cognitive behavioral therapy group) or frequency volume charts regularly alone (frequency volume charts group). The cognitive behavioral therapy checklist was composed of eight items: wake up time/bedtime, mealtime, napping, alcohol/caffeine intake, water intake, salt intake, exercise and taking a bath. A physician explained cognitive behavioral therapy within 5min using a brief manual. The patients in the cognitive behavioral therapy group filled out the self-check sheet every day. The primary end-point was the difference in night-time frequency based on the International Prostate Symptom Score Q7 at 4weeks. Of the 100 first-visit patients randomly allocated, 37 in the cognitive behavioral therapy group and 41 in the frequency volume charts group completed the protocol. No difference was observed in the mean±standard deviation of night-time frequency at 4weeks between the cognitive behavioral therapy group (2.6±1.0) and the frequency volume charts group (3.1±1.2; P=0.056). However, when six patients with achievement of cognitive behavioral therapy of <50% were excluded from the analysis, night-time frequency at 4weeks was significantly lower in the cognitive behavioral therapy group (2.5±1.0) than in the frequency volume charts group (3.1±1.2; P=0.027). The efficacy of cognitive behavioral therapy using a self-check sheet for nocturia remains to be shown. However, strictly practicing cognitive behavioral therapy might be beneficial to these patients.

A robust optimization model for tactical capacity planning in an outpatient setting.

Tactical capacity planning is a key element of planning and control decisions in healthcare settings, focusing on the medium-term allocation of a clinic's resources to appointments of different types. One of the most scarce resources in healthcare is physician time. Due to uncertainty in demand for appointments, it is difficult to provide an exact match between the planned physician availability and appointment requests. Our study uses cardinality-constrained robust optimization to develop tactical capacity plans which are robust against uncertainty, providing a feasible allocation of capacity for all realizations of demand to the extent allowed by the budget of uncertainty. The outpatient setting we consider sees first-visit patients and re-visit patients, and both patient types have access time targets. We experimentally evaluate our robust model and its practical implications under different levels of conservatism. We show that we can guarantee 100% feasibility of the robust tactical capacity plan while not being fully conservative, which will lead to the clinic saving money while being able to meet demand despite uncertainty. We also show how the robust model helps us to identify the critical time periods leading to worst case physician peak load, which could be valuable to decision-makers. Throughout the experiments, we find that the step of translating available data into an uncertainty set can influence the true conservatism of a solution.

Human immunodeficiency virus, diabetes mellitus and thyroid abnormalities: Should we be screening?

BackgroundDiabetes mellitus (DM) and human immunodeficiency virus (HIV) are associated with thyroid abnormalities. Scarce literature exists on the prevalence of thyroid abnormalities in people living with HIV (PLWH) and DM (PLWHD). Guidelines vary regarding thyroid-stimulating hormone (TSH) screening in PLWH and/or DM.ObjectivesThis study describes thyroid abnormalities in PLWHD and HIV-uninfected people living with DM (PLWD).MethodThis was a cross-sectional analysis of demographic, clinical and biochemical data including TSH results of first-visit patients to the Edendale Hospital diabetes clinic between January 2016 and December 2017.ResultsA total of 915 patients were enrolled: 165 PLWHD and 750 PLWD. Overall prevalence of thyroid disorders in PLWD was 8.53% (64/750). The occurrence of ‘total’ thyroid disorders and of ‘subclinical-hypothyroidism’ (SCH) was higher in PLWHD than PLWD (23.03% vs. 8.53% and 20.61% vs. 4%, p < 0.001; respectively). People living with HIV and diabetes with thyroid disorders had lower CD4 counts than PLWHD without thyroid disorders (376.08 ± 333.30 vs. 509 ± 341.7 cells/mm3; p = 0.004). Subclinical-hypothyroidism was more common in patients on antiretroviral therapy [ART] (27/136 [19.85%] vs. 4/27 [14.81%], p < 0.001). A significant number of PLWHD acquired HIV before the onset of DM (107/165 [64.85%] vs. 58/165 [35.15%], p < 0.001). Patients on ART were more likely to develop DM, OR 2.66 (95% CI 1.11–6.38).ConclusionOur study showed an increased prevalence of thyroid disorders (especially SCH) in PLWD and a higher prevalence in PLWHD. Young, overweight, female PLWHD were at risk of SCH. People living with HIV and DM on ART demonstrated an increased prevalence of thyroid dysfunction and poor lipaemic control. The introduction of combined communicable–non-communicable disease clinics might provide an integrated patient screening option.

A Study of the Initial Dose of Sweet Bee Venom for the Treatment of Patients with Lower Back Pain

Sweet bee venom (SBV) causes less hypersensitivity reactions compared with whole bee venom. To determine the appropriate SBV initial dose for pharmacopuncture treatment of lower back pain, the initial dose, and the dose which caused hypersensitivity were retrospectively reviewed between January 1st, 2017 and December 31st, 2019. There were 523 first-visit patients who received SBV pharmacopuncture for lower back pain and 41 showed hypersensitivity. No systemic reactions were observed and localized reactions were not severe. Hypersensitivity was observed during the first (7 cases), and fifth treatments (8 cases). An initial SBV (10%) volume of 0.1 mL was used in 2 cases, 0.2 mL in 6 cases, 0.6 mL in 41 cases, and 1.2 mL in 474 cases. The hypersensitivity rate during the first and fifth treatment was 1.34% and 1.53%, respectively. As a result, 1.2 mL of SBV was considered the acceptable initial dose. However, for safer treatment, we recommend limiting the initial dose of SBV to 0.5 mL.

Dental injuries at the Xi'an, China Stomatological Hospital: A Retrospective Study.

In order to enrich epidemiological knowledge regarding traumatic dental injuries (TDI) in China, and to further improve the treatment, prevention and education of TDI, the aim of this study was to retrospectively analyze the TDI that presented to the emergency dental department at the Stomatological Hospital in Xi'an, China. This retrospective study included all first-visit patients who presented with TDI at the Stomatological Hospital affiliated with the Fourth Military Medical University in Xi'an, China, between January 2013 and June 2019. Data were extracted using the terms of diagnosis of TDI from the hospital database. Overall, 965 (606 males and 359 females) files were reviewed. The average age was 22.8±13.4years. Among the 2059 teeth injured (average of 2.1 teeth per patient), the maxillary incisors (1751; 85.0%) were the most prevalent teeth to present with injuries, while the main types of injuries were concussions (14.8%) enamel-dentin-fractures (14.50%) and enamel-dentin-pulp fractures (14.0%). After initial examination and diagnosis, 4.2% patients refused treatment. The epidemiological statistics of TDI in Xi'an, China show consistency with other studies from around the world, but they also vary in diagnosis proportion and the choice of treatments. This information may further instruct treatment, prevention and emergency resources distribution to target the high-risk groups.

The impact of the COVID-19 epidemic on the utilization of emergency dental services

Background/PurposeTo assess how the current COVID-19 epidemic influenced peoples' utilization of emergency dental services in Beijing, China. MethodsThe first-visit patients seeking emergency dental services before or at the beginning of the COVID-19 epidemic were retrieved. Their demographic characteristics and the reasons for visiting were recorded and analyzed. ResultsThere were 2,537 patients involved in this study. Thirty-eight percent fewer patients visited the dental urgency at the beginning of the COVID-19 epidemic than before. The distribution of dental problems has changed significantly. The proportion of dental and oral infection raised from 51.0% of pre-COVID-19 to 71.9% during COVID-19, and dental trauma decreased from 14.2% to 10.5%. Meanwhile, the non-urgency cases reduced to three-tenths of pre-COVID-19. ConclusionWithin the limitation of this study, the COVID-19 epidemic had a strong influence on the utilization of emergency dental services.

The Role of Myofascial Trigger Points in the Treatment of Reversible Functional Scoliosis

Background: The pathophysiology of reversible functional scoliosis caused by pelvic obliquity is still widely overlooked. The focus of this retrospective study is to observe the occurrence of myofascial trigger points (MTrPs) in patients with reversible pelvic obliquity causing functional scoliosis and leg length discrepancy (LLD). Method: A retrospective study of 100 consecutive first-visit patients in a physiatric practice was undertaken. The total number of patients included in the study, 111, was determined so that that the number of participants having a reversible pelvic obliquity, amounted up to 100. A Palpation Meter ® was used to determine the height difference in the iliac crests and scapular angles before and after the aligning manoeuvres instructed to be performed by the patient. The method of establishing pelvic symmetry using patients own muscle strength (Muscle Energy Technique) has been described in authors two previous articles and is here reiterated. The incidence of three known types of functional scoliosis associated with pelvic obliquity was registered: innominate upslip, innominate anterior rotation and torsion of the sacrum. Each of them causes a distinct pattern of functional scoliosis. MTrPs were identified by local muscle palpation, indicated by their referred pain patterns. The MTrPs were treated with dry needling. Only the MTrPs where needling caused a local twitch response or symptomatic pain radiation was registered. Besides, the M. iliopsoas mobility was assessed lying prone Findings: Eighty-four of them had identifiable MTrPs localized in 36 different muscles. The muscle most frequently harbouring TrPs was the gluteus medius. Moreover, 84 of the 100 had a unilateral shortening of the iliopsoas muscle. This study does not include a follow up. The re-establishment of symmetry during the visit was verified. The fact that the study was implemented by one physician leaves it open to bias. The results have a tentative character calling for further research. Conclusion: The studies covering reversible pelvic obliquity are still lacking though the condition appears to be quite common among patients suffering from musculoskeletal pain. MTrPs may be considered a major source in producing pain in patients having functional scoliosis. There seems to be a strong correlation between functional scoliosis and occurrence of MTrPs. Functional scoliosis imposes persistent muscle strain that perpetuates TrPs in the paraspinal and associated musculature. Correcting the pelvic obliquity causing LLD and functional scoliosis can contribute to treatment of myofascial pain. Dry needling is widely considered a manageable option in the treatment of MTrPs.

A NEW SIMPLE, PERSONALIZED, AND QUANTITATIVE EMPIRICAL METHOD FOR DETERMINING 131I ACTIVITY IN TREATING GRAVES' DISEASE.

The 131I activity for treating Graves' disease (GD) is usually determined based on physician's experience. This study aimed to design an empirical method that was not only personalized and quantitative, but also simple, convenient, and easy to grasp. The study population comprised patients with GD, selected between May 2013 and May 2016, who received 131I therapy in the Outpatient Department of Shanghai Ninth People's Hospital. The first-visit patients of physician 1 were placed in the traditional group: the activity of 131I (mCi) was calculated using the routine formula: [empirical activity (0.07-0.12 mCi/g) × thyroid mass]/[24-h thyroid 131I uptake]. The first-visit patients of physician 2 were placed in the personalized group. The activity of 131I (mCi) was calculated in two steps. First, the initial activity was calculated: 0.1 mCi/g × thyroid mass (g), and then a personalized and quantitative calibration table of 131I activity was used to obtain a final 131I activity. The cure rate with a single activity of 131I was recorded 1 year later. The traditional and personalized groups included 241 and 282 patients, respectively. Interestingly, the personalized group achieved a higher cure rate [86.5% (244/282) versus 73.4% (177/241), P = 0.000] with a relatively higher 131I activity for the first treatment [8.7 (7, 3.5-30) mCi versus 6.7(6, 2.5-30) mCi, P = 0.000] compared with the traditional group, while the incidence rate of permanent hypothyroidism was not significantly different between the two groups (P = 0.175). The empirical method designed in this study was reliable.

\u201c7/12\u201d patient touch point strategy: a novel method to increase patient attendance and recommendation

The US dental system is not likely to see major expansions in dental care use in the foreseeable future. The rise of dental care utilization among low-income children as well as wealthy seniors did not offset flat dental utilization among adults since the Great Recession. Similarly in Spain, the increase in the number of dental practitioners surpasses the rate of population growth. Hence, in order to remain economically viable in this competitive market, one important aspect for every dental office is to retain patients besides attracting new ones. Patients may be lost to follow-up due to a number of factors, including a lack of attention from the dental practice or a lack of trust in the provider. The “7/12" patient touch point strategy of marketing builds consumer loyalty as a result of a strong patient–provider relationship. Furthermore, this method aims to facilitate the patient’s decision to visit their dentist when it is time for preventative treatments. The purpose of this study was to measure the efficacy of a “7/12” patient touch point strategy when compared to the traditional annual recall with respect to number of active patients, percentage of word-of-mouth-recommended patients, and overall number of first-visit patients. We executed the relationship marketing concept through a novel “7/12” patient touch point approach, in which the patient was exposed to seven separate exposures in a period of 12 months. The efficacy of the “7/12” patient touch point was analyzed for 48 months across 10 clinics (24 months before and 24 months after the “7/12” strategy implementation). The “7/12” patient touch point strategy resources consisted of online and printed materials with a focus on oral health knowledge. fter analyzing the efficacy of the “7/12” patient touch point, we found an average increase of 86.91% in the number of active patients, 24.12% in the number of word-of-mouth-recommended patients, and 38.05% in the number of first visits across all clinics. This novel “7/12” patient touch point approach may be successful in increasing the retention of existing patients and generating new patients. Furthermore, this method promotes preventative care and oral health maintanance for patients and economic progress for the dental clinic.

Symptomatology differences of major depression in psychiatric versus general hospitals: A machine learning approach

BackgroundSymptomatology differences of major depressive disorder (MDD) in psychiatric and general hospitals in China leads to possible misdiagnosis. Looking at the symptomatology of first-visit patients with MDD in different mental health services, and identifying predictors of health-seeking behavior using machine learning may help to improve diagnostic accuracy. Methods1500 patients first diagnosed with MDD were recruited from 16 psychiatric hospitals and 16 general hospitals across China. Socio-demographic characteristics, causal attribution, symptoms of depression within and outside Diagnostic and Statistical Manual of Mental Disorders (DSM) framework were collected using a self-made questionnaire. A predictive model of 62 variables was established using Random forest, symptom frequencies of patients in general hospitals and psychiatric hospitals were compared. ResultsThe machine learning approach revealed that symptoms were strong predictors of health-seeking behavior among patients with MDD. General hospitals patients had higher frequencies of suicidal ideation (χ2=15.230, p<0.001), psychosis (χ2=14.264, p<0.001), weight change (all p<0.001), hypersomnia (χ2=25.940, p<0.001), and a tendency of denying emotional/cognitive symptoms compared with psychiatric hospitals patients. LimitationsStigma and preference bias were not measured. Severity of current depressive episodes was not assessed. Data of previous episode(s) was not presented. ConclusionsSymptom evaluation targeting specific patient population in different hospitals is crucial for diagnostic accuracy. Suicide prevention reliant on collaboration between general hospitals and psychiatric hospitals is required in the future construction of Chinese mental health system.

The Changing Profile of Patients in a Geriatric Medicine Led Memory Clinic over 12 Years.

Memory clinics play an important role in enabling early dementia diagnosis and intervention. Few studies have investigated the changing patient profiles at memory clinics over time. We studied the trend of patient characteristics in a geriatric medicine-led memory clinic over 12 years to improve services and care to meet their needs. Data from 2340 first-visit patients seen at a memory clinic from 2005-2017 were extracted from a registered database and analysed. ANOVA, Pearson chi-square and non-parametric tests were used to describe and compare between patients with dementia (PWD) and patients with no dementia (PND). Data included diagnoses of dementia and mild cognitive impairment, age, education, MMSE scores and comorbidities. Patients averaged 77.2 ± 8.3 years of age with mean MMSE score of 16.2 ± 6.7. Those diagnosed with dementia were older (78.3 ± 7.9 years) and almost half (48.4%) had moderate or moderately severe dementia (FAST 5-6). Over time, there was a growing proportion of patients with mild cognitive impairment (MCI) and mild Alzheimer's dementia. Many PWD had co-morbidities of hypertension (65.9%), hyperlipidemia (55.1%), diabetes (33.5%) and 28.4% were frail. The findings call for services to better diagnose and manage patients at the earlier stages of cognitive impairment and provide holistic interventions for those with frailty and other co-morbidities. The continued rise in number of patients presenting to memory clinics provides impetus to expedite integration of tertiary-based memory clinics with primary and community care providers to better support PWD and their families.

Features of Online Hospital Appointment Systems in Taiwan: A Nationwide Survey.

Background: In the Internet era, many web-based appointment systems for hospitals have been established to replace traditional systems. Our study aimed to highlight the features of online appointment systems for hospitals in Taiwan, where patients can visit outpatient departments without a referral. Methods: All hospitals online appointment systems were surveyed in October 2018. Features of first-visit registrations were analyzed and stratified according to the hospitals’ accreditation levels. Results: Of the 417 hospitals, 59.7% (249) had public online appointment systems. For first-visit patients, only 199 hospitals offered the option of making appointments online from 7 to 98 (mean 38.9) days prior to the appointment itself. Before appointments, 68 (34.2%) hospitals recommended specialties for patients to choose according to their symptoms, and only 11 (5.5%) had a function for sending messages to doctors. After appointments, 176 (88.4%) provided links to real-time monitoring of outpatient service progress. Conclusions: More than half of the hospitals in Taiwan have public online appointment systems. However, most of these systems simply fulfill the function of registration, and rarely take the opportunity to improve efficiency by gathering information regarding patients’ medical history or reasons for making the appointment.

Urinary neutrophil gelatinase-associated lipocalin as a biomarker to monitor renal function in patients with obstructive ureteral calculi.

Our study aimed to investigate the clinical significance of urinary neutrophil gelatinase-associated lipocalin (NGAL) as an effective real-time monitoring biomarker of renal function in patients with obstructive ureteral calculi presenting renal colic. A cohort of 89 first-visit patients with renal colic caused by unilateral ureteral calculi were retrospectively reviewed. 46 of which received double-J ureteral stent placement (group 1) and the remaining 43 treated conservatively with analgesics and hydration (group 2) when diagnosed. Urinary NGAL (uNGAL) values in the baseline, 2h and 1day after treatments were recorded. The variation of this parameter over time and the association with patients' characteristics were analyzed. uNGAL levels decreased as time went by for patients receiving double-J ureteral stent placement (47.23 ± 28.32ng/mL for baseline, 40.73 ± 21.86ng/mL for 2h and 34.67 ± 18.00ng/mL for 1day after operation; p = 0.0363). Nevertheless, for those treating conservatively, the levels emerged a mild increase (50.63 ± 32.30ng/mL, 56.00 ± 32.01ng/mL and 60.63 ± 34.08ng/mL, correspondingly; p = 0.3708). By analyzing the association between uNGAL variation and patients' characteristics of group 1, operation duration showed the best correlation coefficient (Pearson r = 0.6106, r2 = 0.3728, p < 0.0001). uNGAL can be used as a biomarker to monitor the renal function effectively when serum creatinine (sCr) was within normal limits. And double-J ureteral stent can be considered as a protective factor to renal function in patients with obstructive ureteral calculi presenting renal colic.

Survivin Measurement improves Clinical Prediction of Transition From Arthralgia to RA—Biomarkers to Improve Clinical Sensitivity of Transition From Arthralgia to RA

Background: Arthralgia often predates development of rheumatoid arthritis (RA). A set of joint symptoms commonly found in patients during their transition from arthralgia to RA, has been recently proposed.Aim: To combine clinical and serological markers and to improve recognition of imminent rheumatoid arthritis (RA) among patients with arthralgia.Methods: The total of 1,743 first-visit patients attending the rheumatology ward in Gothenburg for joint symptoms were identified during 12 consecutive months. Among those, 63 patients were classified as RA, 73 had undifferentiated arthritis and 180 had unexplained arthralgia. New RA cases, which prospectively developed during 48 months, comprised the preclinical (pre) RA group. The joint symptoms of the first-visit were analyzed aiming to distinguish patients with arthralgia and arthritis, and patients with pre-RA, who later developed the disease. The receiver operating characteristics curves were constructed. In the model, symptoms with the odds ratio >2.0 between the arthralgia and pre-RA were combined with information about RA-specific antibodies, C-reactive protein (CRP), and survivin in serum.Results: The proposed set of clinical symptoms distinguished the arthralgia patients from RA and pre-RA. Presence of survivin in serum showed strong association with clinical joint symptoms in arthralgia. A combination of symptoms in several small joint areas, increasing number of joints with symptoms, and patient's experience of swelling in small hand joints at the first visit identified pre-RA cases with 93% specificity. Grouping those symptoms with information about survivin, RA-specific antibodies, and CRP (or gender) in the final algorithm achieved 91% specificity and 55.2% of positive prediction for transition from arthralgia to RA.Conclusion: Clinical and serological parameters in combination aid recognition of imminent RA among arthralgia patients with appropriate sensitivity.

Easy screening of outpatients for atrial fibrillation by analyzing fingertip pulse wave variation

Atrial fibrillation (AF), which can lead to cardioembolic stroke, is often not properly diagnosed in hospital outpatient departments or medical clinics. We therefore used a pulse analysis to screen patients for AF, and examined the benefits of using this method in screening. We performed screening of the hospital's first-visit and ambulatory patients during the afternoon in 2014 (total number, 50,875; true number, 16,356), mainly targeting patients older than 65 years of age. Among the true number of outpatients, the device was used on 5,013 patients, 8,656 times. We independently developed a pulse analysis software application which analyzed the pulse interval variation. We assessed the accuracy of this analytical method in the detection of AF. AF was detected in 56 patients, who were considered for or introduced to anticoagulation treatment. In their cases, the method was considered useful for detecting undiagnosed or untreated AF. This figure amounts to 0.34% of all outpatients and 1.1% of the patients who were screened in 2014. The average age was 76.9±7.7 years, 67.9% of the patients had a CHADS2 score of more than 2, half had a history of arrhythmia in the past, and 37.5% were first-visit patients. The sensitivity of the device used was 89.7%. Using the method described in this study, we detected asymptomatic AF in numerous patients, and demonstrated that this method is potentially useful in screening outpatients for asymptomatic AF.