General Patient Care Research Articles

Quality of life in adults with congenital heart disease with and without pulmonary hypertension: a comparative study.

Pulmonary vascular disease and pulmonary hypertension (PH) belong to the most relevant complications of congenital heart disease (CHD) in the long-term course. Although PH might lead to a severely impaired quality of life (QOL), there are no current studies comparing QOL in adults with CHD (ACHD) with and without PH. Therefore, this study aimed to systematically examine QOL in ACHD with and without PH in order to generate a more differentiated understanding of their overall health-status and to employ newly gained findings into general care of this particular patient population. In this comparative cross-sectional study, a representative sample of 803 adults with various forms of CHD with or without PH was analyzed. Data collection took place between September 2017 until February 2018 in a tertiary care center for ACHD. Medical data was retrieved from medical records. QOL was assessed using the EQ-5D-5L questionnaire. Descriptive methods, chi-square and t-tests were used to compare QOL of patients with and without PH. Of 803 patients, 752 patients had no PH [93.6%; 47.3% female; mean age: 34.9±11.83 (range, 18-86) years], 51 were identified with manifest PH [6.4%; 55.8% female; mean age: 41.9±12.17 (range, 21-69) years]. PH patients showed significantly worse overall QOL [mean no PH: 86.78±13.30 (8.2-100) vs. mean PH: 81.79±12.77 (43.6-100); 95% confidence interval (CI): 1.43 to 9.46; P=0.013], worse crosswalk index [mean no PH: 93.29±12.86 (-11, 100) vs. mean PH: 89.73±11.77 (47-100); 95% CI: 0.08 to 7.56; P=0.043], and worse VAS [mean no PH: 80.12±16.50 (15-100) vs. mean PH: 72.56±16.80 (40-100); 95% CI: 3.29 to 12.17; P=0.004]. However, after adjusting for age, only the VAS stayed significant (P=0.039). The QOL within the dimensions mobility (P<0.001), self-care (P=0.002), and usual activities (P=0.007), were significantly decreased in PH patients. Overall, anxiety and depression (11.08%) as well as pain and discomfort (11.03%) were the most impaired dimensions in both patient groups. Since QOL is a significant predictor of outcome, PH-CHD patients need an early provision of psychosocial, health promoting support in addition to dedicated care and targeted PH treatment. It is therefore pivotal to timely identify unique psychosocial impairments in order to enhance quantity and QOL in this particularly vulnerable patient population.

Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020).

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

General practice perspective on the use of telehealth during the COVID-19 pandemic in Australia using an Action Research approach: a qualitative study

ObjectivesTelehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode,...

Impact of COVID-19 pandemic on physical and mental health status and care of adults with epilepsy in Germany

BackgroundTo mitigate the potential consequences of the coronavirus disease 2019 (COVID-19) pandemic on public life, the German Federal Government and Ministry of Health enacted a strict lockdown protocol on March 16, 2020. This study aimed to evaluate the impact of the COVID-19 pandemic on physical and mental health status and the supply of medical care and medications for people with epilepsy (PWE) in Germany.MethodsThe Epi2020 study was a large, multicenter study focused on different healthcare aspects of adults with epilepsy. In addition to clinical and demographic characteristics, patients were asked to answer a questionnaire on the impact of the first wave of the COVID-19 pandemic between March and May 2020. Furthermore, the population-based number of epilepsy-related admissions in Hessen was evaluated for the January-June periods of 2017–2020 to detect pandemic-related changes.ResultsDuring the first wave of the pandemic, 41.6% of PWE reported a negative impact on their mental health, while only a minority reported worsening of their seizure situation. Mental and physical health were significantly more negatively affected in women than men with epilepsy and in PWE without regular employment. Moreover, difficulties in ensuring the supply of sanitary products (25.8%) and antiseizure medications (ASMs; 19.9%) affected PWE during the first lockdown; no significant difference regarding these impacts between men and women or between people with and without employment was observed. The number of epilepsy-related admissions decreased significantly during the first wave.ConclusionsThis analysis provides an overview of the general and medical care of epilepsy patients during the COVID-19 pandemic. PWE in our cohort frequently reported psychosocial distress during the first wave of the pandemic, with significant adverse effects on mental and physical health. Women and people without permanent jobs especially reported distress due to the pandemic. The COVID‐19 pandemic has added to the mental health burden and barriers to accessing medication and medical services, as self-reported by patients and verified in population-based data on hospital admissions.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00022024. Registered October 2, 2020, http://www.drks.de/DRKS00022024

Oral care and protocols in cancer patients

With the passage of time and new emerging techniques significant progression is seen in cancer treatment modalities. However, oral care of the cancer patients is of utmost importance since chemotherapy notably impacts the oral health of cancer patient’s majorly causing mucositis and various other infections. Oral problems are more common in cancer patients, and 80% of patients suffer from them. These oral problems have a profound effect on a patient's ability to eat, drink, and speak and are often accompanied by pain, which can lead to increased demand for systemic drugs, longer hospital stays, and an increased risk of life-threatening system infections. The aim of this research is to review the available information about the oral care and protocols in cancer patients. The dentist's role in the integrated care of oncology patient includes ongoing involvement from diagnosis to end. Various protocols are advised in literature which include the use of dental floss and mouthwash, prior to chemotherapy in oral hygiene procedures, requirement of comprehensive clinical and radiographic examinations when assessing oral health, antibiotic prophylaxis, extractions and certain other protocols. Basic oral care which refers to actions that should be included in a general patient care throughout cancer treatment to maintain good oral health and reduce the risk of local inflammation and infection, is essential for cancer patients. However, future clinical and comprehensive research into oral care protocols among cancer patients could further strengthen the literature and highlight the role of the dentist in this regard.

Medical Conditions, Oral Health Practices, and Barriers to Treatment among Patients Visiting a Teaching Dental Hospital in Eastern Saudi Arabia.

Objective To assess the prevalence of medical conditions, oral hygiene practices, and dental visits among patients who attended a teaching dental hospital in Dammam, Saudi Arabia. Materials & Methods. This retrospective cross-sectional study used patient records from 2009 to 2015 from the dental hospital of the College of Dentistry Imam Abdulrahman Bin Faisal University, Dammam. Patients' demographics, medical history, oral hygiene practices, reasons for attending the facility, attendance patterns, and smoking habits were studied. Results The study included 1502 records of patients with 65.1% of males and 34.9% of females. The prevalence of medical conditions was 25.7% in the study. The most common medical conditions included diabetes mellitus (7.2%), hypertension (6.5%), and anemia (4.7%). Only 21.8% reported visiting the dental hospital in the past one year. The prevalence of smoking was 16.7%, and this did not differ significantly between healthy and medically compromised patients (P=0.165). Fillings were the most common (21.6%) reason for visiting a dental hospital, followed by treatment for periodontal problems (12.9%) and oral lesions (12.6%), whereas treatment for braces (orthodontics) was the least common (5%) reason for visiting the hospital. The reasons for visiting the hospital did not differ significantly between healthy and medically compromised patients (P > 0.05). The three most common barriers to dental visits included long waiting time (18.1%), fear of dental treatment (14.4%), and difficulty in getting an appointment (11.3%). Conclusion The study showed that dental patients had a high prevalence of medical conditions. Diabetes mellitus was the most prevalent problem. Most patients visited the dental hospital to receive restorative treatment, and a long waiting time was the most common barrier to dental visits. Public health measures should be taken to improve the general health and oral care of patients.

Sistem zdravstvene zaštite u Mađarskoj pred izazovima epidemioloških situacija

In my study, I intend to explore the impact of the current epidemic situation on the health care system in Hungary. To this end, the legal environment applicable to the epidemic situation and the measures related to the health care system in the context of the epidemic situation will be presented. I think that in the 21st century and beyond, it will be increasingly important to deal with emerging epidemics, to which all countries must be able to respond appropriately. Managing the epidemic situations effectively and appropriately is in the interest of society as a whole. Furthermore, public health considerations are essential, and every country has to enhance efforts to fight epidemics. In the 21st century, states still have to consider their task to provide the necessary financial resources to combat epidemics. Health care systems should be suitable to meet public health and epidemiological considerations and the demands of general patient care.

Analysing student achievement of advanced pharmacy practice experience learning outcomes

Objectives: To assess the learning outcome achievement of the required Advanced Pharmacy Practice Experiences (APPE) for the purposes of accreditation, quality improvement, and practice readiness. Methods: At the end of each APPE rotation, students were evaluated on 11 professionalism criteria and 25 skills criteria via a rubric. For the four required rotations (ambulatory patient care, community pharmacy, inpatient general medicine patient care and hospital/health system pharmacy), professionalism and skills outcomes data for the class of 2020 were analysed. Results: A total of 6,293/6,303 (99.84%) of the professionalism ratings met expectations (received a score &gt; 2). The median professionalism rating was 3. A total of 14,286/14,325 (99.7%) of the skills ratings met expectations (received a score &gt; 3). The median skills rating was 4. Conclusion: Calculating and analysing APPE student achievement of learning outcomes supports accreditation standards, can be used for quality improvement and measures practice readiness.

BioTherapeutics, Education and Research Foundation position paper: Assessing the competency of clinicians performing maggot therapy.

In its mission to optimise the quality of patient care and the level of clinician training within the fields of biotherapy, the BioTherapeutics, Education and Research (BTER) Foundation and its Maggot Therapy Competency Committee identified qualities and achievements assessed to be the minimum standards that health care professionals should attain in order to be deemed competent in maggot therapy. The set of six standards were selected to reflect the same high degree of professionalism that is used by the Accreditation Council of Graduate Medical Education for assessing other medical specialists, but with an emphasis on the principles and practice of maggot therapy. For each domain in which competency is expected, the rationale has been explained, specific competencies have been articulated, and methods for demonstrating or evaluating those competencies have been suggested. Applicable to any clinician applying maggot dressings professionally, these recommendations should assist those who wish to identify, assess, or achieve competency in maggot therapy. Specifically, these six competencies include: (1) knowledge about wound care in general and maggot therapy in particular; (2) skill in general patient care, to a level commensurate with their professional role; (3) ability to communicate effectively with colleagues, patients, and the general public; (4) professional and ethical behaviour; (5) ability to deliver systems‐based health care; (6) incorporation of continuing education and quality improvement into their practice.

The Potential of OMICs Technologies for the Treatment of Immune-Mediated Inflammatory Diseases.

Immune-mediated inflammatory diseases (IMIDs), such as inflammatory bowel diseases and inflammatory arthritis (e.g., rheumatoid arthritis, psoriatic arthritis), are marked by increasing worldwide incidence rates. Apart from irreversible damage of the affected tissue, the systemic nature of these diseases heightens the incidence of cardiovascular insults and colitis-associated neoplasia. Only 40–60% of patients respond to currently used standard-of-care immunotherapies. In addition to this limited long-term effectiveness, all current therapies have to be given on a lifelong basis as they are unable to specifically reprogram the inflammatory process and thus achieve a true cure of the disease. On the other hand, the development of various OMICs technologies is considered as “the great hope” for improving the treatment of IMIDs. This review sheds light on the progressive development and the numerous approaches from basic science that gradually lead to the transfer from “bench to bedside” and the implementation into general patient care procedures.

Penentuan Tarif Pelayanan Gigi dan Mulut dengan Metode ABC pada Poli Gigi Umum RSGM UNIMUS

Background: The existence of Faculty of Dentistry has contributed to the establishment of the dental and oral hospital. A faculty of dentistry must have a dental and oral hospital as an effort to improve the quality of dentists and general patient care. Activity based costing is an accounting information system that identifies various activities done by an organization and calculates the costs of a product based on the activities required to produce, implement, and distribute it. The objective of the present study was to determine and realize dental and oral service costs using the ABC method at the general dental polyclinic of Unimus dental hospital. Method: This research is a qualitative descriptive case study design with open end method in form of Focus Group Discussion (FGD) with the director and management of Unimus dental hospital. Result: Based on the calculation of the cost for services at the general dental polyclinic of Unimus dental hospital with Activity Based Costing, it can be concluded that the highest cost is Rp. 1,202,809 for the service of Odontectomy M3 Class I A, and the lowest cost is Rp. 106,670 for Anamnesis / consultation without any action. The range is a result of discrepancies in the disposable items used in each of the action or service. Conclusion: The tariff has been concluded through Focus Group Discussion (FGD) with the director and management of Unimus dental hospital with accordance to the policy that 30% is allocated for medical service cost and 30% is apportioned for profit as the management expects.

Telehealth Utilization to Improve the General Surgery Patient Care Experience

Patient satisfaction and quality of care are key components of the patient experience. A quality improvement project was conducted to evaluate whether the addition of a nurse practitioner-led telehealth visit reduced the number of unplanned contacts by postoperative patients within the general surgery department. Although the number of unplanned contacts did not decrease, survey data revealed patients were highly satisfied with the telehealth experience. This project provided insight into the common problem areas in postoperative patients. This information can be used to target preoperative teaching to improve the patient experience.

A Life and a Legacy: Dr Ian Jackson and the Establishment of Cleft and Craniofacial Surgery in India.

Dr. IT Jackson was a world leader in the field of Cleft and Craniofacial surgery. He played a pivotal role in the development of plastic surgery as a specialty in India. He featured in the Indian Plastic Surgeons meetings and conferences of Indian Society of Cleft Lip Palate and Craniofacial Surgery very often and became an integral part of these societies. India was very close to his heart. He allowed Indian plastic surgeons to visit his craniofacial institute to learn the nuances of craniofacial surgery. Many of us still practice the procedures popularised by him.Personal contact with Dr. Jackson was an enviable association. It was a boon for anyone who came in contact with him. He was my mentor as I spent 6 months with him. I have fond memories of his personal care and mentorship not only in the field of plastic surgery but also in general patient care and communication skills. His memory is engraved in our heart. This is an opportunity to pay our respect to the departed holy soul.

Post-Traumatic Stress Disorder and Burnout in Healthcare Professionals During the SARS-CoV-2 Pandemic: a Cross-Sectional Study.

IntroductionHealthcare professionals who are directly involved in the diagnosis, treatment, and general care of patients with SARS-CoV-2 are at risk of developing adverse psychological reactions. A cross-sectional study of healthcare professionals aimed to determine the impact of the SARS-CoV-2 pandemic on the mental health of healthcare professionals in two of the largest referral hospitals in Athens, Greece.MethodsThe study was conducted in the two largest SARS-CoV-2 referral hospitals in Athens, Greece. An assessment and the interrelationship of post-traumatic stress disorder, using the Impact of Event Scale-Revised [IES-R]) and burnout, using the Maslach Burnout Inventory [MBI]) was carried out.ResultsA total of 162 subjects were enrolled in the study. Fifty-six (35%) had an IES-R score > 33, suggesting post-traumatic stress disorder. Forty-nine (30%) had an MBI score > 27. Seventy-five (46%) had a personal accomplishment score of < 33 and 46 (28%) had a depersonalization score >10. Stepwise backward logistic regression revealed that the only independent variable that was retained regarding the presence of post-traumatic stress disorder was the emotional exhaustion score of the MBI (at a cut-off of 24 in this scale, the 95% CI of the odds ratio for the presence of post-traumatic stress disorder was 1.077-1.173).ConclusionsIn this sample of first-line Greek healthcare professionals against SARS-CoV-2, most of them were proven to be quite resilient to this challenge. One-third of them had post-traumatic stress disorder, which depended on their degree of emotional exhaustion. Healthcare professionals, as represented by this study, performed their duties without feeling helpless and developing adverse psychological reactions.

How can patient experience scores be used to predict quality inspection ratings? A retrospective cross-sectional study of national primary care datasets in the UK

ObjectivesThe relationship between patient feedback in the General Practice Patient Survey (GPPS) and Care Quality Commission (CQC) inspections of practices was investigated to understand whether there is an association between...

Cardiovascular risk profiles of GnRH agonists and antagonists: real-world analysis from UK general practice

PurposeAndrogen deprivation therapy (ADT) is the mainstay for the management of metastatic prostate cancer. Available pharmaceutical ADTs include gonadotropin-releasing hormone (GnRH) agonists and antagonists. Here, real-world data are presented from the UK general practitioner Optimum Patient Care Research Database. The study investigated the hypothesis that GnRH antagonists have lower cardiac event rates than GnRH agonists.MethodsThe incidence of cardiac events following initiation of GnRH antagonist or agonist therapy was investigated in a population-based cohort study conducted in UK primary care between 2010 and 2017.ResultsAnalysis of real-world data from the UK primary care setting showed that relative risk of experiencing cardiac events was significantly lower with degarelix, a GnRH antagonist, compared with GnRH agonists (risk ratio: 0.39 [95% confidence interval 0.191, 0.799]; p = 0.01). Patients that received degarelix as first-line treatment switched treatment more frequently (33.7%), often to a GnRH agonist, than those who initiated treatment with a GnRH agonist (6.7–18.6%).ConclusionScreening for known or underlying vascular disease and identifying those at high risk of a cardiac event is important for risk mitigation in patients with prostate cancer receiving hormone therapy. The GnRH antagonist degarelix conferred a significantly lower risk of cardiac events than GnRH agonists. Prior to treatment, patients should be stratified based on level of cardiovascular (CV) risk, and appropriate lifestyle, and pharmacological interventions to mitigate CV risk should be recommended. CV risk factors and patient response to the intervention should be monitored at regular intervals.

Inpatient Child and Adolescent Psychiatry as an Extracurricular Venue for Medical Student and Resident Education and Professional Development: Story Time and Teen Talk.

Comparatively little systematic data exists concerning medical student education from the inpatient child and adolescent psychiatry venue. Training in this venue is vulnerable to pressures including increasingly reduced lengths of stay and greater emphasis on clinical productivity. An extracurricular psychosocial opportunity during evening hours may be a productive means through which to provide meaningful patient exposure, training, and mentorship to trainees. We sought to evaluate the impact upon student beliefs and attitudes through participation in an initiative titled "Story Time and Teen Talk." Under the direct supervision of postgraduate resident physicians in psychiatry, students read fairy tales and children's literature to children and conducted group discussions with adolescents during weekly held evening hours. Students were invited to complete a 15-item questionnaire that surveyed the impact of their participation on their beliefs and attitudes concerning general medical education and patient care, the field of psychiatry, and training in child and adolescent psychiatry. A subset of students underwent a semi-structured interview which was evaluated via grounded theory analysis to determine qualitative themes related to impact of program participation. Thirty students (N = 30) completed the survey and five students (N = 5) completed the interview. The majority of students reported strongly agreeing or agreeing that participation impacted their attitudes and beliefs about general medical education and patient care in twelve of the thirteen assayed items. Themes from qualitative analysis supported these findings. Extracurricular opportunities may be a productive venue for graduate medical education and, specifically, child and adolescent psychiatry.

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea.

A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.

Osteoporosis Management in the Era of COVID-19

ABSTRACTOsteoporosis is a chronic condition that reflects reduced bone strength and an associated increased risk for fracture. As a chronic condition, osteoporosis generally requires sustained medical intervention(s) to limit the risks for additional bone loss, compromise of skeletal integrity, and fracture occurrence. Further complicating this issue is the fact that the abrupt cessation of some therapies can be associated with an increased risk for harm. It is in this context that the COVID‐19 pandemic has brought unprecedented disruption to the provision of health care globally, including near universal requirements for social distancing. In this Perspective, we provide evidence, where available, regarding the general care of patients with osteoporosis in the COVID‐19 era and provide clinical recommendations based primarily on expert opinion when data are absent. Particular emphasis is placed on the transition from parenteral osteoporosis therapies. It is hoped that these recommendations can be used to safely guide care for patients with osteoporosis until a return to routine clinical care standards is available. © 2020 American Society for Bone and Mineral Research.

Quality of life of chronic heart failure patients: a systematic review and meta-analysis.

Despite various individual studies on the quality of life (QOL) in patients with CHF, a comprehensive study has not yet been conducted; therefore, this study aims to assess the QOL of CHF patients. In the present systematic review and meta-analysis, PubMed, Scopus, and the Web of science databases were searched from January 1, 2000, to December 31, 2018, using QOL and heart failure as keywords. The searches, screenings, quality assessments, and data extractions were conducted separately by two researchers. A total of 70 studies including 25,180 participants entered the final stage. The mean QOL score was 44.1 (95% confidence interval (CI) 40.6, 47.5; I2 = 99.3%) using a specific random effects method in 40 studies carried out on 12,520 patients. Moreover, according to the geographical region, heart failure patients in the Americas had higher scores. In 14 studies, in which a general SF-36 survey was implemented, the average physical component score (PCS) and mental component score (MCS) were 33.3 (95% CI 31.9, 34.7; I2 = 88.0%) and 50.6 (95% CI 43.8, 57.4; I2 = 99.3%), respectively. The general and specific tools used in this study indicated moderate and poor QOL, respectively. Therefore, it is necessary to carry out periodic QOL measurements using appropriate tools as part of the general care of CHF patients.