General Medical Clinic Research Articles

Streamlined Ophthalmologist-Led Pathway to Diagnosis and Accessibility of Genetics Testing for Patients with Inherited Retinal Dystrophies in Canada

ObjectiveTo investigate the ability of a new clinical model to improve accessibility and expedite the pathway to molecular diagnosis for patients with suspected inherited retinal diseases (IRD). DesignRetrospective cohort study of electronic patient records. ParticipantsAll patients referred to general medical genetic clinic between September 2017 to September 2019 and an ophthalmologist-led IRD clinic between October 2021 to July 2023 for suspected IRD were included. MethodsThe difference in timeliness and accessibility to diagnosis and genetics testing for patients referred for suspected IRDs were compared based on whether they were referred to general medical genetics clinic or an ophthalmologist-led IRD clinic. Main Outcome MeasuresThe primary outcomes were time to consult from referral; time from initial consult to molecular diagnosis; and the time from initial consult to genetics result disclosure and counseling. Secondary outcomes included number of prior providers investigating the chief complaint; the proportion of patients undergoing genetics testing; and the range of diagnostic investigations undertaken. Results473 patients were included, with 212 cases from general medical genetics clinic and 261 from medical retina clinic. The mean time from referral to initial consult was 14 months (±3.33 months) and 4 months (±3.4 months) for general medical genetics and the ophthalmologist-led IRD clinic respectively. The mean time from initial consult to genetics disclosure and counselling was 6 months (±3.6 months) and 3.5 months (±1.8 months) for medical genetics and the ophthalmologist-led model respectively. The total time from initial referral to genetics disclosure and counselling for the medical geneticist-led clinic model was 20-24 months. The total time from initial referral to genetics disclosure and counselling for ophthalmologist-led retinal clinic was 5-8 months. The average number of prior providers seen prior to presenting to ophthalmologist-led retina clinic was 2.05 (range 1-10). ConclusionsShifting from the traditional medical genetics model to the new ophthalmologist-led IRD clinical model may improve accessibility and expedite the pathway to molecular diagnosis and subsequent gene therapy trials for patients with suspected IRDs.

Recognition of overweight and obesity by patients and medical practitioners and their practices related to weight reduction; a cross-sectional study

Introduction: Accurate perception of weight by overweight/obese patients and the acknowledgment of their excess weight by medical practitioners are pivotal in managing obesity. This study aims to assess knowledge, perception and practices related to weight reduction among overweight/obese patients and the recognition of their overweight status and interventions by medical practitioners.Methods: This descriptive cross-sectional study interviewed 317 overweight/ obese patients during their first visits to general medical clinics at the University Hospital of Kotelawala Defence University. A structured questionnaire assessed their demographic characteristics, comorbidity, knowledge, perception and practices related to weight reduction. Recognition and management of overweight/ obesity by medical practitioners were evaluated through recall of previous six-month consultations and review of medical records.Results: Among the study participants, 163 (51.4%) were obese and 154 (48.6%) were overweight. Only 63 (19.9%) patients knew the meaning of BMI, and 306 (96.5%) could not define the ideal BMI for a Sri Lankan adult. Less than half (45.4%) considered overweight/obesity a medical problem. Body weight misperception observed among 92 (59.7%) overweight and 150 (92.0%) obese participants. Of the 267 participants who reported being evaluated by another medical practitioner in the previous six months, 102 (38.2%) were told the diagnosis of overweight/obesity. However, weight status was documented only in seven (2.6%) patient records. Nonetheless, 110 (41.2%) patients had received weight reduction advice during previous consultations, and 68 (61.8%) had attempted to lose weight.Conclusions: Low comprehension of the term BMI and misperception of body weight among the studied population is concerning. Patients who received weight reduction advice from medical practitioners were more inclined to lose weight. However, acknowledgment and intervention of the excess weight status of overweight /obese patients by medical practitioners were largely inadequate.

Assessment of Testosterone Levels, Kidney Function and Alkaline Phosphatase in Patients with Benign Prostatic Enlargement in Kirkuk City/Iraq

The present study is designed to evaluate the concentration of Testosterone, Creatinine, Urea urea, and alkaline phosphatase levels in patients with benign prostatic hyperplasia. This study was conducted for the period from the beginning of October 2023 to the end of February 2024 at Kirkuk Hospital. General and specialized medical clinics in the city of Kirkuk. The study included (70) males with benign prostatic hyperplasia, ages (45-75) years, and average weight (82) kg. In addition to 20 samples of healthy people with the same rate of ages and weights of patients, study samples were distributed as follows: The first group: the control group and included (20) healthy males, and the second group: the patient group and distributed to three groups according to the age groups first category ( 45-55) years and included 25 patients, the second age group (56-65) years and included 20 patients, the third age group (66-75) years and included 25 patients. The results of the current study showed a significant increase (p ≤ 0.05) in the concentration of urea, creatinine and alkaline phosphatase enzyme in patients with benign prostatic hyperplasia compared to healthy people, and the current study showed a significant decrease (P ≤ 0.05) in testosterone concentration in patients with benign prostatic hyperplasia compared to healthy people. According to age groups, the results showed no significant differences (p ≤ 0.05) in the concentrations of urea, creatinine and alkaline phosphatase enzyme in patients with prostatic hyperplasia, and the results showed a significant decrease (p≤ 0.05) in the concentration of testosterone according to the age groups of patients with benign prostatic hyperplasia.

Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study.

Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.

Non-alcoholic fatty liver disease in Tanzania: prevalence, determinants, and diagnostic performance of triglycerides-glucose index and triglycerides-glucose index –body mass index compared to the hepatic ultrasound in overweight and obese individuals

BackgroundNon-alcoholic fatty liver disease (NAFLD), which is closely associated with metabolic syndrome (MetS), is rarely reported in Tanzania, where MetS is prevalent. The purpose of this study was to determine the prevalence and associated factors of this condition in overweight and obese individuals and to correlate standard ultrasound diagnosis with triglyceride-glucose index (TyG) and TyG-body mass index (TyG-BMI).MethodsA cross-sectional analysis was performed in 181 adult outpatients attending a general medical clinic. The presence of fatty liver was detected by ultrasound. Demographic, clinical, and laboratory data were collected and analyzed using STATA 15. To compare categorical variables, a chi-square test was employed, while a Student’s t-test was used to compare continuous variables. Additionally, a multivariate regression analysis was conducted to identify the determinants of NAFLD. A significance level was set at p < 0.05. The discriminatory power of TyG and TyG-BMI for diagnosing NAFLD was evaluated using Receiver Operating Characteristic (ROC) Curve analysis and the Area Under the ROC Curve (AUC) was reported.ResultsThe overall prevalence of NAFLD was 30.4% (55/181). The prevalence’s of NAFLD in patients with class III obesity, class II obesity, class I obesity and overweight were 50.0% (12/24),, 38% (19/50), 23.7% (18/76), and 19.5% (6/31),respectively. NAFLD was strongly predicted by hyperuricemia (≥ 360 μmol/L) (p = 0.04) and TyG ≥ 8.99 (p = 0.003). The best cut-off values of TyG and TyG-BMI to predict NAFLD were 8.99 [AUC 0.735; sensitivity 70.9%, specificity 79.3%] and 312 [AUC 0.711; sensitivity 60% and specificity 75.4%] respectively.ConclusionsThe prevalence of NAFLD is high among people with overweight and obesity in Tanzania. We did not find sufficient evidence to recommend the use of TyG and TyG-BMI as surrogates for hepatic ultrasound in detecting NAFLD, and further evaluation is recommended.

The burden of substance use and (mental) distress among asylum seekers: a cross sectional study.

Asylum seekers are a particularly vulnerable population due to a wide range of external stressors. Traumatic events and difficult social/economic prospects can lead to an elevated susceptibility for substance use disorders. The aim of the present study was to determine whether asylum seekers suffering from mental or physical distress present higher levels of substance use disorder (SUD) in a state reception center in Germany and whether there are identifiable risk or protective factors. We performed a hierarchical logistic regression on data of N = 238 people who had applied for asylum in Germany to analyze the SUD variance explanation by (1) sociodemographic, (2) flight-specific, and (3) psychometric (ERQ, SOC-9 L, SCL-K9) variables. On level (4), we included the location of data collection (walk-in clinic or accommodation,) as an indicator of individual's need for a psychologist's or General practitioner's help in order to assess for the participant's (mental) distress. Low educational level, lower sense of coherence, and mental distress (location of data collection in the psychosocial or general medical outpatient clinic) were associated with SUD. Those suffering from SUD seemed to be less aware of external stressors as SUD was also associated with low levels of reported post-migratory stress. The association of SUD with psychological distress and lower education reaffirms the concept that some vulnerable groups are at a higher risk for substance-related difficulties. Strengthening the sense of coherence with targeted interventions might enable at-risk groups to cope better with forthcoming burdens and help with abstaining from current or future consumption.

8 A prospective audit on outpatient clinical activity in a consultant-led general medical and specialist geriatric clinic

Abstract Background It is recognised that there is a significant unprecedented pent-up demand on Irish healthcare services due to the COVID-19 pandemic. This has resulted in lengthy acute hospital scheduled care waitlists. We identified a national protocol that provides guidance in the area of outpatient waiting list management. The aim of this audit was to determine if our practice was consistent with national guidance. Methods We conducted a prospective audit on a consultant-led medical and specialist geriatric clinic between January to March 2023 and collected data in relation to referral reason, triage category, waitlist times, clinic attendance, hospital admissions, inter-specialty communication and resolution of clinical problem prior to outpatient clinic attendance. Results We included 67 patient appointments in this audit. Median waitlist time was 15.5 weeks. There were 2 urgent referrals, both were not seen within the Clinically Recommended Timeframe (CRT). 94% were seen within the CRT. 11 patients (16.4%) failed to attend their clinic appointment, only 3 of which cancelled beforehand. 5 patients (7.5%) were inpatients during waitlist time and 4 had reason for outpatient referral addressed during their inpatient stay. 8 patients (11.9%) had same referrals sent to a second point of contact, only 5 had correspondence available in medical records at time of audit. Conclusion Our findings indicate that the majority of our waitlist times fall within national target recommendations, however more robust pathways need to be developed to ensure urgent referrals are seen promptly. They also indicate inter-specialty and patient communication need to be enhanced to minimise duplicate or unnecessary appointments that add to waitlist burden.

Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial

ObjectiveWe aimed to test the hypothesis that automated fibrosis score calculation and electronic reminder messages could increase the detection of advanced liver disease in patients with type 2 diabetes.DesignIn this...

Prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients in a tertiary hospital in Lagos: a cross-sectional study.

periodontitis is the sixth leading long-term complication of diabetes mellitus which can impair diabetic patients' metabolic control. Patients with both diabetes mellitus and periodontal disease present with the challenge of managing these two chronic diseases, each of which may impact the other. The aim of this study was to determine and compare the prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients attending a large tertiary hospital in Lagos, Nigeria. this was a cross-sectional comparative study involving 110 diabetics and 110 non-diabetic patients aged 40 years and above. They were recruited from the diabetes and general medical out-patient clinics respectively in a large tertiary hospital in Lagos using a systematic sampling method. Data was collected using an interviewer-administered questionnaire. In addition, blood tests for glycated haemoglobin and oral examination using a simplified periodontal examination were conducted. The prevalence and severity of periodontitis and oral hygiene practices were compared between both groups. Data were analyzed with IBM SPSS version 21 Software. the prevalence of periodontitis was higher among the diabetics 100 (90.9%) compared to the non-diabetic patients 79 (71.8%), and this was statistically significant (p<0.001). Severity of periodontitis among both groups was also statistically high 54 (49.1%) vs. 35 (31.8%) p<0.001. the prevalence of periodontitis was higher and more severe among diabetics compared to non-diabetics. Oral hygiene practices in both groups are not statistically significant p>0.05. Oral health education programs targeted at diabetic patients should be carried out to prevent and control periodontitis.

Efficacy and Safety of Warfarin Therapy: Comparison Between Specialized INR Clinic and General Medical Clinic

Background: Although warfarin is known as effective oral anticoagulant to prevent thromboembolic events, its’ narrow therapeutic index requires ambient and good follow-up to reduce its therapeutic complications. There is a continuous debate whether the best practice to accomplish this goal is in a specialized international normalized ratio clinic (INR-C) or in a general medical clinic (General-C). Few, if any, studies have been done in Sudan to compare the safety and efficacy of anticoagulant therapy in those clinics. Thus, the objective of this study was to compare the efficacy and safety of anticoagulant therapy in INR-C and in General-C. Methods: This is a prospective hospital-based study where 200 patients were divided into two groups (group A and B) of 100 patients. Group A were in the INR-C at Ahmed Gasim specialized hospital and group B in the General-Cat AL-Shaab teaching hospital. The study was conducted from September 2019 to April 2020. All patients were on warfarin treatment and regular follow-ups were conducted. Demographic and clinical data were collected and analyzed statistically using SPSS version 20. Ethical approval was obtained from the ethical committee of the Sudanese Medical Specialization Board (SMSB). Results: Of the 200 patients, 118/59% were females and 82/41% were males. Target international normalized ratio (INR) for group (A) was achieved in 56% of the patients in the first visit, increased to 63% in the second visit, and 75% in the third follow-up, compared with 24% of the patients from group (B) in the initial and second follow-up visit, to 43% in the third visit (P value=0.05). Knowledge about drug and food interaction of coagulation agents was higher (91%) among patients in group (A) compared with group (B) (56%). Drug interaction awareness was found in 89% of the patients in group (A) compared with only 40% in group (B) (P value=0.05). Major bleeding was reported in 2% and 14% of the patients of group (A) and (B) respectively, whereas minor bleeding was seen in 4% of group (A) and 11% of group (B). Conclusion: The study showed that INR-C is more efficient and safer for patients on regular warfarin therapy compared with the General-C.

Obstructive sleep apnea, chronic obstructive pulmonary disease and hypertensive microvascular disease: a cross-sectional observational cohort study

Hypertensive microvascular disease is associated with an increased risk of diastolic heart failure, vascular dementia and progressive renal impairment. This study examined whether individuals with obstructive sleep apnoea (OSA) had more retinal hypertensive microvascular disease than those with chronic obstructive pulmonary disease (COPD) and hospital controls. This was a single-centre, cross-sectional, observational study of participants recruited consecutively from a general respiratory clinic and a general medical clinic. OSA was diagnosed on overnight polysomnography study (apnoea:hypopnoea index ≥ 5), and controls with COPD had a forced expiratory volume/forced vital capacity (forced expiratory ratio) < 70%. Individuals with both OSA and COPD were excluded. Hospital controls had no COPD on respiratory function testing and no OSA on specialist physician questioning. Study participants completed a medical questionnaire, and underwent resting BP measurement, and retinal photography with a non-mydriatic camera. Images were deidentified and graded for microvascular retinopathy (Wong and Mitchell classification), and arteriole and venular calibre using a semiautomated method at a grading centre. Individuals with OSA (n = 79) demonstrated a trend to a higher mean arterial pressure than other hospital patients (n = 143) (89.2 ± 8.9 mmHg, p = 0.02), and more microvascular retinopathy (p < 0.001), and narrower retinal arterioles (134.2 ± 15.9 μm and 148.0 ± 16.2 μm respectively, p < 0.01). Microvascular retinopathy and arteriolar narrowing were still more common in OSA than hospital controls, after adjusting for age, BMI, mean arterial pressure, smoking history and dyslipidaemia (p < 0.01, p < 0.01, respectively). Individuals with OSA demonstrated a trend to a higher mean arterial pressure than those with COPD (n = 132, 93.2 ± 12.2 mmHg and 89.7 ± 12.8 mmHg respectively, p = 0.07), and more microvascular retinopathy (p = 0.0001) and narrower arterioles (134.2 ± 15.9 and 152.3 ± 16.8, p < 0.01). Individuals with OSA alone had more systemic microvascular disease than those with COPD alone or other hospital patients without OSA and COPD, despite being younger in age.

Comparison of willingness and preference for genetic counseling via telemedicine: before vs. during the COVID-19 pandemic

The COVID-19 pandemic required genetic counseling services, like most outpatient healthcare, to rapidly adopt a telemedicine model. Understanding the trends in patients’ preferences for telemedicine relative to in-person service delivery both before and after the advent of the COVID-19 pandemic may aid in navigating how best to integrate telemedicine in a post-COVID-19 era. Our study explored how respondents’ willingness to use, and preference for, telemedicine differed from before to after the onset of the COVID-19 pandemic. Respondents included patients, or their parent/guardian, seen in a general medical genetics clinic in 2018, prior to the COVID-19 pandemic, and in 2021, during the COVID-19 pandemic. Respondents were surveyed regarding their willingness to use telemedicine, preference for telemedicine relative to in-person care, and the influence of various factors. Among 69 pre-COVID-19 and 40 current-COVID-19 respondents, there was no shift in willingness to use, or preference for, telemedicine across these time periods. About half of respondents (50.6%) preferred telemedicine visits for the future. Of the 49.4% who preferred in-person visits, 79.1% were still willing to have visits via telemedicine. Predictors of these preferences included comfort with technology and prioritization of convenience of location. This study suggests that a hybrid care model, utilizing telemedicine and in-person service delivery, may be most appropriate to meet the needs of the diverse patients served. Concern for COVID-19 was not found to predict willingness or preference, suggesting that our findings may be generalizable in post-pandemic contexts.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12687-022-00598-9.

Identifying obstructive sleep apnea in patients with epilepsy: A cross-sectional multicenter study

ObjectiveSeveral screening questionnaires for obstructive sleep apnea (OSA) have been introduced. No study has compared the performance of different questionnaire in the same patients with epilepsy. Herein, we compare the performance characteristics of four common questionnaires for assessing the probability of OSA in patients with epilepsy. MethodsThis cross-sectional multicenter study was conducted among adult epilepsy patients attending neurology and general medical clinics in Thailand. Before performing full polysomnography (PSG), all participants completed the STOP-BANG, STOP-BAG, SA-SDQ, and NoSAS questionnaires. OSA was defined by apnea/ hypopnea index (AHI) criteria of AHI: ≥ 5, ≥ 15, and ≥ 30. Discriminatory ability was assessed by area under the receiver operating characteristics (ROC) curve (AUC) and likelihood ratio. To improve discriminative ability, we created 3 ranges of the score to predict lower, middle, and higher probability of OSA as defined by each diagnostic criterion. ResultsA total 166 patients with epilepsy were included. OSA prevalence was 38%. Overall, NoSAS had higher AUC at all AHI criteria but not significantly higher than that of other scales. Using prediction cut-points for NoSAS of ≥ 4 and ≥ 8 to predict OSA defined by AHI ≥ 5, the likelihood ratios for the 3 ranges were 0.37, 2.22 and 9.81 respectively. ConclusionAmong the 4 scales, the 2-cut-point NoSAS score had the highest discriminatory ability at each AHI cutoff.

Parents' versus Grandparents' Attitudes about Childhood Vaccination.

Background: We investigated and compared practices and attitudes about childhood vaccination between young parents and their parents and identified influences and sources of information in the County of Zadar, Croatia. Methods: This research was conducted in six general practice and paediatric medical clinics. It included 300 volunteers, including 150 younger parents and 150 older grandparents. Information was collected with a survey questionnaire. The survey data were statistically processed. Results: The 300 participants were divided into 2 groups. Most of the respondents were married, employed, had a high school education, and had a good economic status, often with two children and living in the city. Generally, the attitude towards vaccination was positive. Healthcare workers made the most important influence on the decision for vaccination. The younger age group was significantly affected by social networks and the internet and wanted more information. They were afraid of the adjuvants in vaccines. The older respondents held that vaccination must be legally regulated and did not believe the anti-vaccine media headlines. Conclusions: Our respondents had positive attitudes towards childhood vaccination, noticed the benefits of vaccinating children, and held that untreated children represent a risk for the community. They were well informed and satisfied with the collaboration with medical professionals, although the media and social networks had some impact on attitudes.

Multidrug Resistant E-Coli in Patients with Urinary Tract Infections Presenting to Internal Medicine Clinics of Two Tertiary Care Hospitals in Lahore, Tip of the Iceberg

Background: The commonly presenting infections in medical outpatients’ department are that of Urinary tract. If not treated properly these can lead to hospitalization and can increase the morbidity and mortality. Escherichia coli is found to be the most frequent bacterium causing these infections. The available literature may not under representing the prevalence of E. Coli which is multi drug resistant and is seen in general medical outdoor and internal medicine clinics of our local population, because urine sample is usually sent for culture only in complicated patients. Objective: To determine the prevalence of multi drug resistant E. Coli and its resistance to the most commonly used antimicrobial agents in Internal Medicine Clinics of Bahria International Hospital, and Farooq Hospital, West wood branch, Lahore. Study Design: This is an observational study done retrospectively carried out at Internal Medicine Clinics of Bahria International Hospital Lahore and Farooq Hospital, Lahore from 1st January 2019 to 31st December 2020. Methodology: One hundred and ninety adult patients with urinary symptoms and suspected UTI were enrolled. We analyzed the available urine culture reports and susceptibility against the pathogens. The testing was interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. Results: The most common microorganism was E. Coli (70%) followed by klebsiella (17.9%), enterococcus (8.9%) and Acinetobacter (3.2%) in both complicated and uncomplicated urinary tract infections. 75 % females were E. coli positive as compared to the male (58.6%). Patients aged greater than 60 and less than 20 years were mostly affected with E. coli. Most of the isolated pathogens were highly resistant to ampicillin, cotrimoxazole, and cephalexin (70%–95.5%). Conclusion: E. coli is found highly resistant to antimicrobial agents used to treat UTI at family medicine practice. No difference could be appreciated in the apportioning of resistant E. coli in both complicated and uncomplicated UTIs. This study emphasizes that we should collect data at National level and prepares a proper guideline for choosing appropriate antibiotics in patients with UTI presenting to general medical clinics. Key words: E. coli, Multidrug resistance, Urinary tract infection, Antibiotics, Pyelonephritis

Assessing Frailty in the General Medical Clinic of a Tertiary Hospital in Northern Malaysia: The FRAIL Scale or the Clinical Frailty Scale.

Background Frailty potentially influences clinicians' decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia. Methods The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS. Results The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p=0.481). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients. Conclusion Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.

Relationship between childhood trauma, personality, social support and depression in women attending general medical clinics in a low and middle-income country

BackgroundAssociations between childhood trauma, personality, and Major Depressive Disorder (MDD) have been well established in studies conducted in high-income countries. However, there are limited studies on these associations in low and middle-income countries (LMICs), where MDD is highly prevalent. We assessed the relationships between childhood trauma, personality, and MDD in women in Karachi, Pakistan. MethodIn this cross-sectional study of 455 female patients attending general medical outpatient clinics, a diagnosis of MDD was confirmed using the Structured Clinical Interview for DSM-IV (SCID); retrospective reports of childhood trauma were collected using the childhood trauma questionnaire (CTQ); and Big Five personality traits were assessed using the NEO Personality Inventory Revised (NEO PI-R). Other measures included the Life Events Questionnaire (LEQ) and the Multidimensional Scale of Perceived Social Support (MSPSS). Factors independently associated with MDD were determined using logistic regression analyses. ResultsOf the 455 women recruited between August 1, 2011 and July 31, 2013, 242 (53%) had a diagnosis of MDD. Women with MDD were significantly more likely to be separated, had more stressful life events and higher CTQ scores. Higher perceived social support, conscientiousness and extraversion were independently associated with significantly reduced odds of MDD. There were no significant associations between CTQ scores and any of the NEO PI-R subscales. LimitationsRatings of childhood trauma were based on retrospective recall. ConclusionMDD and a history of childhood trauma were highly prevalent in Pakistani women attending general medical clinics. Interventions to prevent childhood trauma and promote social support in women may improve public mental health in LMICs like Pakistan.

Prescribing pattern of proton pump inhibitors among patients visiting the outpatient general medicine clinic in a tertiary care teaching hospital in Nepal

PurposeThe purpose of this study is to evaluate the prescribing pattern of proton pump inhibitors (PPIs) in patients visiting the outpatient general medical clinic in a Tertiary Care Teaching Hospital.Design/methodology/approachA hospital-based cross-sectional study was conducted in 419 patients aged ≥18 years, visiting the outpatient general medicine clinic of a tertiary hospital and prescribed with at least one PPI, from July to September 2016 using a purposive sampling technique. Descriptive statistics were performed using IBM-SPSS 20.0 (IBM Corporation, Armonk, NY, USA).FindingsPatients were mostly less than 30 years (30.78%) and female (58.95%). Pantoprazole was the most frequently prescribed PPIs (57.04%). The majority of PPIs were prescribed for acid peptic disorder (APD) (33.65%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) prophylaxis (30.79%). Most of the PPIs were prescribed for twice-daily administration (68.26%). Nearly one-fourth (21.72%) of the patients presented with at least one additional medical condition, and almost all (99%) patients were receiving at least one additional drug along with PPIs.Originality/valueThe study suggests that PPIs are frequently prescribed and their use has been extended to other conditions that in fact do not require acid anti-secretory therapy. Result has highlighted the need for an interdisciplinary collaboration between pharmacists and medical professionals for the rational use of PPIs and promotion of PPIs prescription from the National List of Essential Medicines.

The Relationship between Sense of Coherence, Resourcefulness and Functional Health Status of Geriatric Patients with Diabetes Mellitus.

Background: T2DM is a public health problem that is widespread, serious, and growing among elderly people with a major impact on their health and well-being. Sense of coherence (SOC) and resourcefulness are important resources that may empower the person and give a greater capacity to manage different life challenges including the burden of such chronic disease in a health-promoting manner. Aim: Determine the relationship between sense of coherence, resourcefulness and functional health status of geriatric patients with diabetes mellitus. Setting: Five outpatient clinics at The Main University Hospital in Alexandria, namely geriatric medicine clinic, general medical clinic, diabetes clinic, cardiovascular clinic and nephrology clinic. Alexandria, Egypt. Subjects: 120 geriatric patients who are 60 years old and above, diagnosed with T2DM and have no or mild cognitive impairment. Tools: Five tools were used to collect data, short portable mental status questionnaire, socio-demographic and clinical data of geriatric patients with diabetes mellitus structured interview schedule, sense of coherence scale, resourcefulness scale and the Dartmouth Primary Care Cooperative Information Project/World Organization of National Colleges, Academies, and Academic Associations of General Practice/Family Physicians (COOP/WONCA) charts. Results: The result revealed that there is a statistically significant relationship between SOC, overall resourcefulness and all the functional health status scores of the study older adults as higher levels of SOC and resourcefulness were associated with better functional health status among the study participants. Conclusion: a statistically significant relationship between SOC, overall resourcefulness and all the functional health status scores of the study older adults as higher levels of SOC and resourcefulness were associated with better functional health status among the study participants. Recommendations: Develop in-service training programs for nurses and health care providers (HCPs) at different health care settings on how to assess SOC and resourcefulness skills and orienting them with the role of such concepts on health and well being of older adults and different ways for promoting them.

Sociodemographic Determinants of the Level of Knowledge of Prostate Cancer and Prostate Cancer Screening Services among Patients Attending a Secondary Health Facility in Southern Nigeria

Background: Late presentation of prostate cancer is rampant in sub-Saharan Africa with attendant high morbidity and mortality. A good knowledge level of prostate cancer and prostate cancer screening services is paramount in preventing late presentation and its management challenges. This study assesses the sociodemographic factors affecting the knowledge level of prostate cancer and prostate cancer screening tools and services among patients attending a secondary health facility in southern Nigeria. Methods: This was a descriptive cross-sectional study amongst men aged 40 years and above attending the general outpatient, surgical outpatient, and medical outpatient clinics in Central Hospital, Auchi, southern Nigeria. A pretested and structured questionnaire was used. Sociodemographic determinants of the knowledge level of prostate cancer and prostate cancer screening were determined based on responses to the questionnaire. Data were analyzed using SPSS version 21. The level of significance was set at 0.05. Results: A total of 143 men participated in this study. Respondents’ age range was between 40 to 98 years with a mean age of 58.91±13.55 years. Overall, 55(38.5%) respondents had good knowledge of prostate cancer while 43(30.1%) had good knowledge of prostate cancer screening. A third (31.2%) think they are at risk of developing prostate cancer, only 9.1% had been screened for prostate cancer. In all, 86.7% of respondents were willing to know more and to be screened in the future. Whereas, age, occupation, average monthly income, and level of education were the statistically significant sociodemographic predictors of level of knowledge of prostate cancer, the only factors that influenced the level of knowledge of prostate cancer screening services were occupation and educational status. Conclusion: Knowledge level about prostate cancer disease and prostate cancer screening services was low among men attending outpatient clinics in Auchi Central Hospital. Respondents’ age, occupation, average monthly income, and level of education significantly affect their prostate cancer knowledge level while knowledge of prostate cancer screening services was determined by the occupation and educational status of the respondents. Interventional campaigns aimed at increasing the knowledge level about prostate cancer and screening services are urgently required.