Local Doctors Research Articles

Chronic Illness and visiting clinic before hospitalization at the onset of Stroke: Shiga Registry

Abstract Background Prompt action at stroke onset is required to improve prognosis. Some previous studies indicated that visiting local clinics may initially delay access to specialized care. We examined the relationship between the presence of chronic diseases known as risk factors for stroke and visiting a local clinic before admission to the hospital for acute stroke care. Methods This study utilized data from stroke patients aged 18 and older who were registered in the Shiga Stroke and Heart Attack Registry (SSHR) from January 2011 to December 2015. We excluded cases with onset during hospitalization or those with impaired consciousness assessed by the Japan Coma Scale (JCS > =10). The presence of comorbid chronic diseases was determined based on the past history and medications presented at admission. Local clinics are defined as clinics or hospitals that are not equipped to provide acute stroke treatment. Multivariate logistic regression analyses, adjusting for sex, age, modified Rankin Scale score before onset, and stroke subtypes, were performed to calculate odds ratios and 95% confidence intervals for visiting a clinic before hospitalization according to the presence of chronic diseases such as hypertension, diabetes, dyslipidemia, and atrial fibrillation, respectively. Results Data from 11,111 out of 14,620 registered cases were analyzed. Among these participants, 5,774 had hypertension, 1,951 had diabetes, 2,111 had dyslipidemia, and 882 had atrial fibrillation. A total of 2,405 (21.6%) cases visited a local clinic at stroke on set. The adjusted odds ratios for visiting clinics by the presence of hypertension were (1.22, 95% CI: 1.11 -1.34), diabetes (1.14, 1.01-1.28), dyslipidemia (1.07, 0.95 -1.20), and atrial fibrillation (0.80, 0.67 -0.95). Conclusions The present study indicated that individuals with hypertension and/or diabetes are more likely to initially visit a local clinic at stroke onset, whereas those with atrial fibrillation were not. Key messages • Approximately 20% of mild stroke patients first consult local or primary care doctors at stroke onset. This trend was particularly observed in individuals with hypertension and diabetes. • Emphasizing the need for direct access to specialized emergency care for individuals with chronic diseases is important to avoid delays in acute stroke care.

Emergency Medical Access Control System Based on Public Blockchain

IT has made significant progress in various fields over the past few years, with many industries transitioning from paper-based to electronic media. However, sharing electronic medical records remains a long-term challenge, particularly when patients are in emergency situations, making it difficult to access and control their medical information. Previous studies have proposed permissioned blockchains with limited participants or mechanisms that allow emergency medical information sharing to pre-designated participants. However, permissioned blockchains require prior participation by medical institutions, and limiting sharing entities restricts the number of potential partners. This means that sharing medical information with local emergency doctors becomes impossible if a patient is unconscious and far away from home, such as when traveling abroad. To tackle this challenge, we propose an emergency access control system for a global electronic medical information system that can be shared using a public blockchain, allowing anyone to participate. Our proposed system assumes that the patient wears a pendant with tamper-proof and biometric authentication capabilities. In the event of unconsciousness, emergency doctors can perform biometrics on behalf of the patient, allowing the family doctor to share health records with the emergency doctor through a secure channel that uses the Diffie-Hellman (DH) key exchange protocol. The pendant’s biometric authentication function prevents unauthorized use if it is stolen, and we have tested the blockchain’s fee for using the public blockchain, demonstrating that the proposed system is practical.

Acute Myocarditis, the Dilemma in the General Practice Setting in the Years of the Coronavirus Pandemic Era: An Italian Experience

Myocarditis is inflammation of the muscle tissue of the heart (myocardium) and unlike most heart disease it tends to affect young people more often. Myocarditis can go almost unnoticed, frequently heals without results, but can sometimes be very serious and life threatening. However, many symptoms are non-specific and difficult to evaluate in the general practice setting. In order to diagnose myocarditis it is necessary to carry out some instrumental tests, too. Very important are the EKG and the dosage of cardiac markers in the blood. The echocardiogram allows you to highlight the valvular and muscle alterations that occur during inflammation and the same thing can be done by myocardial magnetic resonance. For those reasons, myocarditis is difficult to diagnose in the setting of General Practitioner (GP) and therefore it is underdiagnosed or misdiagnosed. The presence of nonspecific symptoms, fatigue and dyspnea, especially in a young person, it can lead the GP to suspect a myocarditis. We present a case of myocarditis in a young person. The patient, without a clinical history of important pathologies, presented asthenic and respiratory symptoms with progressive worsening of the clinical picture. We described the reasons of the diagnostic and therapeutic procedures. The general medicine setting is currently unsuitable for taking care of patients of this type, as the waiting times for the necessary examinations. The evaluation and follow-up are not within the reach of local doctors in Italy or with too long waiting times, so monitoring and optimizing therapies remain difficult outside the hospital.

Public Knowledge and Awareness About Hemorrhoids and the Reasons for Late Presentation to Local Doctors in Makkah Region, Saudi Arabia: A Cross-Sectional Exploratory Study.

Background Hemorrhoids, also known as piles, manifest as anal lumps with or without bleeding. This study aims to explore and assess the public knowledge and awareness about hemorrhoids and the factors leading to late presentation to local doctors in the Makkah region of Saudi Arabia. Methodology A questionnaire-based, cross-sectional study was conducted targeting the Saudi population aged 18 years and more living in the Makkah region. The study was conducted from May 1 to May 29, 2023. Data collection was done using electronic Google Forms for data collection. The questionnaire was divided into three main sections covering demographics, knowledge items, and personal and family history of hemorrhoids. Results A total of 495 participants completed the study questionnaire. Participants' ages ranged from 18 to 65 years with a mean age of 25.1 ± 13.7 years old. Overall, 414 (83.6%) were males. Only 106 (21.4%) had an overall good knowledge level. The majority of the participants (78.6%, 389) had poor knowledge. Pain (78% of the participants) was the most common reason for seeking medical advice, followed by feeling uncomfortable (43.3%), and the presence of blood or blood spots in the stool (41.1%). Among others who never sought medical advice, the most reported reason was being embarrassed (66.7%). Conclusions This study revealed that the prevalence of early seeking medical advicewas low as many did not because of stigma. The main reasons for seeking medical care were disease-related symptoms, and embarrassment was the main reported barrier.

Malaria prevention practices among patients attending the NTOUM departmental hospital, Northwest Gabon

Introduction: In Gabon, a territory located in Central Africa, prevention is an essential measure in the fight against malaria. The aim of this study was to evaluate, in the Komo-Mondah department, the prophylaxis practices employed by the inhabitants of the commune of Ntoum and the prevalence of anti-malarial drugs prescribed by local doctors. Methods: We carried out a prospective, cross-sectional study over a 3-month period, on patients of both sexes and of all ages who came for consultation to the departmental hospital of Ntoum. Patients who had a prescription for malaria drugs at the end of their medical visit were included in the study. Results: Of the 248 subjects enrolled, children under 5 years of age were the main victims (84%).Indeed, children under 5 were two (2) and three (3) times more likely to test positive to malaria than the age group 16-24 (OR = 2.44 [1.05 - 5.63]; P ˂ 0.05) , 25 and over (OR= 3.10 [1.46 - 6.59]; P ˂ 0.05), respectively. Anti-malaria prophylaxis was practiced by 80% of the study population. Patients who declared sleeping under a bed net appear to be protected compare to those who did not (OR= 0.53 [0.28 - 0.97] ; P ˂ 0.05). Self-medication was recorded in 29% of patients, and the drugs most commonly prescribed by doctors were artemisinin-based combinations, including Artefan (51%), Coartem (30%) and Eurartesim (2%). Conclusion: Although conventional prophylaxis measures (vector control and chemoprevention) are adopted by many Gabonese, careful pharmacological management and the implementation of targeted, long-term prevention-surveillance and health education strategies will enable effective malaria control in this part of Gabon.

Rapid access nurse-led atrial fibrillation clinics reduce hospital readmissions

Abstract Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia and in the UK accounts for about 1.5% of healthcare expenditure mainly through recurrent hospital admissions (1). The European Society of Cardiology 2020 AF guidelines (2) provides a clear framework of all the different components required to provide good patient-centred integrated AF management of which very little is done well within an emergency inpatient setting. Purpose We have developed a nurse led Rapid Access AF (RAAF) clinic aiming to prevent repeat admissions and improve patients overall AF care. Methods All patients discharged from our institution's emergency department (ED) or acute medical ward with a primary diagnosis of atrial fibrillation are suitable for the Rapid Access AF clinic. At the clinic the patients are given patient education, advise about risk factor modification, access to an "AF hotline" and a simple initial management plan should symptoms worsen with advise about when to attend the emergency department. Patients are then reviewed at a weekly multidisciplinary meeting with the local AF doctors where longer term strategies are made. The clinics have been operating now for 2 years and we have audited the 3 months from January to March 2022 with further follow up at 6 months. Results 41 out of 64 patients presenting to the emergency department with AF were admitted. However, whether in the ED or subsequent medical ward, treatment as a whole was very simple AF management, similar to that of outpatient care ( e.g. in ED Beta Blockers 34%, Digoxin 16%, oral Flecainide 5%, IV Amiodarone 12.5%, direct current cardioversion 1.5%, no clear AF treatment 16%, anticoagulation in patients with CHADSVASC 2+ 92%). 36 out of 64 patients were discharged to RAAF clinic and were seen on average 22 days post discharge. Readmission rates were 11% vs 32% at 30 days in patients discharged to RAAF compared to standard care and 14% vs 60% at 6 months. Conclusion Patients admitted to hospital with a primary diagnosis of AF are at high risk of early readmission. A rapid access AF clinic is effective at significantly reducing hospital readmission rates whilst also providing more holistic integrated AF management.

АНАЛИЗ ДЕЯТЕЛЬНОСТИ ВРАЧЕЙ-ДЕРМАТОВЕНЕРОЛОГОВ, ОКАЗЫВАЮЩИХ МЕДИЦИНСКУЮ ПОМОЩЬ СЕЛЬСКОМУ НАСЕЛЕНИЮ В РЕСПУБЛИКЕ БАШКОРТОСТАН

Relevance. Currently, there is a low staffing of medical organizations with local doctors and medical specialists, including dermatovenerologists. This determines the low availability of primary medical care for the rural population for diseases of the skin and subcutaneous tissue. Purpose of the study. To analyze the activities of dermatovenerologists in providing primary specialized medical care to the rural population for diseases of the skin and subcutaneous tissue in the Republic of Bashkortostan. Materials and methods. The calculation of indicators characterizing the activities of dermatovenerologists in the Republic of Bashkortostan for 2017-2021 was carried out: the provision of the population with dermatovenereologists, staffing of regular positions of dermatovenereologists, staffing with individuals, part-time ratio, share of visits per one rural resident and one patient with skin diseases, number of visits in connection with the disease, in connection with the preventive purpose. Results. Level of supply of dermatovenerologists in the Republic of Bashkortostan in 2021. amounted to 0.54 per 10 thousand population. In recent years, the provision of dermatovenerologists in the rural population remains low: in 11.1% of rural areas there are no dermatovenerologists, and in 31.5% the level of provision is insufficient. For the period 2017-2021 a decrease in the number of visits to a dermatovenerologist for skin diseases was established by 16.3% (per rural resident from 0.29 to 0.24 visits per resident), as well as a decrease in the number of visits to a dermatovenerologist by 22.0% . (from 4.63 to 3.61 visits per patient). An extremely low volume of telemedicine consultations was revealed, which is a significant factor in reducing the availability of medical care for the rural population. Conclusions. In the Republic of Bashkortostan in recent years, the provision of dermatovenerologists for the rural population remains insufficient. Thus, there is a need to develop measures aimed at improving primary specialized medical care provided by dermatovenerologists to the rural population of the Republic of Bashkortostan.

Trust and COVID-19 vaccine hesitancy in the Dominican Republic: a national cross-sectional household survey, June–October 2021

ObjectiveThis study investigates the role of trust in shaping COVID-19 vaccine acceptance in the Dominican Republic (DR) during the COVID-19 pandemic.DesignCross-sectional household survey.SettingRandomly selected households across 134 clusters in the...

Childhood Ailments in Two Mining Towns in North West Tasmania in the Late Nineteenth and Early Twentieth Century

The discovery of tin in northwest Tasmania precipitated a flood of miners into the area, followed shortly, inevitably by their families. Paediatrics became part of the local doctors’ practice. Childhood ailments excluding infectious diseases in the mining towns of Waratah and Zeehan in north-west Tasmania as documented in the local newspapers a century ago are described. The challenges of working in such a remote environment and the diverse skills expected of a medical practitioner in a situation similar to today’s remote general practice are outlined. Details of the infectious conditions experienced in that environment have been previously published.

송대 사대부의 의학지식 축적과 확산: 옹저(癰疽)의 사례를 중심으로

In the Chinese medical history, the literati officials of the Song period (960-1279) played a crucial role in the enormous accumulation and dissemination of medical knowledge. More specifically, they compiled and wrote medical books and thereby contributed to the collection and spread of medical knowledge. It is noteworthy that they noted abscess (癰疽), which belongs to the discipline of surgery, as a single disease in addition to Shanghan(傷寒). Previous studies have not examined this topic sufficiently. Most studies focused on the overall interest in medicine by literati officials during the Song period or Shanghan or some specific diseases endemic to the southern region. This study focuses on activities of the literati officials during the Song period for the accumulation and dissemination of knowledge about abscess. A previous study noted that literati officials during the Song period had an influence on the development of a scholarly, pulse check-based internal medicine, and this trend continued into the Ming and Qing. This study examines the way the literati officials of the Song period communicated with each other in the discipline of surgery, the efforts they made to treat abscess, and the way they interacted with local doctors specializing in abscess, and thereby elucidates diverse aspects of a medical culture during the Song period.

A prospective audit on adult thromboprophylaxis and therapeutic anticoagulation prescribing and administration practices in Galway University Hospitals

Abstract Introduction Anticoagulants are high-alert medications that can cause significant patient harm if used inappropriately.[1] These preparations have been identified as a significant medication safety concern in Galway University Hospitals and are one of the most frequently reported medication incidents in Ireland.[2] A key performance indicator agreed by the local Medication Safety Subgroup and Drugs and Therapeutics Committee was to conduct an anticoagulation audit against local guidelines to identify patterns and develop quality improvements. Methods A prospective audit was conducted over six weeks from September to November 2022 by five interprofessional data collectors using a data collection tool and accessing drug records and clinical notes. Development of the tool was guided by national[1] and local guidelines as well as design input from local expert specialist doctors and pharmacists. Adult inpatients on all wards receiving thromboprophylaxis (after 24 hours of admission) or therapeutic anticoagulation were included. Paediatrics and psychiatry were excluded. The protocol and tool were approved by the local Clinical Audit Committee, piloted with three inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Data analysis was carried out by two independent researchers to confirm reliability of results. Results A total of 242 inpatients were audited on 26 wards: -Patients prescribed thromboprophylaxis (52%; 126/242). -Patients prescribed therapeutic anticoagulation (26%; 63/242) -Patients not prescribed anticoagulants (22%; 54/242) Most patients (92%; 216/234) did not have a thromboprophylaxis risk assessment form completed/signed. Nineteen patients (35%; n=54) not prescribed thromboprophylaxis or therapeutic anticoagulation should have been prescribed anticoagulation. High compliance with guidelines (>80%) included: i) anticoagulants prescribed in correct section of drug record, ii) appropriate agents prescribed, iii) correct dose and frequency, iv) few dose delays and omissions, and v) indication mostly documented. Low compliance with guidelines (<35%) included: -Patient height and weight not documented: unable to calculate creatinine clearance to determine accurate dose. -Incorrect administration times for once daily therapeutic dosing (should be in morning to facilitate surgery next day) and twice daily dosing (mostly 8am and 10pm = gap of 14 hours and 10 hours). Conclusion Results have identified varying levels of compliance with local anticoagulation guidelines. To date, there has been continuous targeted education and training on appropriate anticoagulation use for doctors, nurses, and pharmacy staff inclusive of the development and implementation of a new bespoke eLearning module for high-alert medications (which includes the appropriate use of anticoagulants specific to Galway University Hospitals). High leverage strategies, such as electronic prescribing, is a current consideration to standardise practices. Strengths include study robustness, interprofessional collaboration, and transferability to other hospitals. Perhaps reducing the scope in a re-audit which will be conducted in 2024 to identify any improvements in medication safety and patient care with these agents may allow for further in-depth analysis.

Sleep medicine in the Kyrgyz Republic: past, present, and future.

As in many other Low and Middle Income Countries (LMICs) around the world, sleep disorders in the Kyrgyz Republic remain mostly undiagnosed and untreated. This article aims to describe the current state of practice of sleep medicine in the Kyrgyz Republic from the perspective of local and international health care workers who are active in the field and to propose a strategy to challenge the status quo. We performed a policy analysis and interviewed local doctors working in the field. We identified 3 major barriers to the practice of sleep medicine and namely education and training, financial constraints and infrastructure and equipment. We then propose a multistep strategy to improve the current situation based on 3 pillars: knowledge sharing, implementation research activities and policy changes. Despite being at its early days and facing major challenges, sleep health in the Kyrgyz Republic is being recognized as a priority by health care workers in the field and now requires attention at local and government level. Furthermore, north-south academic partnerships represent an effective tool for knowledge sharing and should be further incentivised. Cirri L, Bolotbek uulu A, Shakiev N, etal. Sleep medicine in the Kyrgyz Republic: past, present, and future. J Clin Sleep Med. 2024;20(7):1213-1216.

Improvement of Organizational Measures for Detection and Diagnosing of Tuberculous Infection and Tuberculosis in Adolescents in the Republic of Kazakhstan

The objective: to improve organizational measures for detection and diagnosing of tuberculous infection and tuberculosis in adolescents in the Republic of Kazakhstan.Subjects and Methods. Screening was conducted among 27,648 adolescents aged 15-17 years from regions of the Republic of Kazakhstan with a high burden of tuberculosis. It was planned to use TRA tests and fluorography in parallel, while local doctors, district and school nurses, and nurses in vaccination rooms were preliminary trained by pediatric phthisiologists to perform the test, evaluate its results and monitor manifestations of adverse events (AEs) caused by TRA test.Results. 27,648 adolescents (aged 15-17 years) were given TRA test. No adverse events were observed during TRA skin test. Latent tuberculous infection was diagnosed in 320 (1.2%) adolescents. During further examination, 10 patients were diagnosed with drug susceptible pulmonary tuberculosis with no bacillary excretion. Based on the study results, to detect LTBI and tuberculosis in adolescents, in addition to fluorography examination, it is necessary to use TRA skin test with in the groups facing a high risk of tuberculosis.

Two cities, two stages in transforming society-a mixed methods study comparing doctors' adoption of mobile apps for communication with patients in Hangzhou and Yancheng, China.

Mobile apps have become commonplace in doctor-patient communication over the last 20 years. Doctors mainly use two kinds of app, social networking apps (i.e., WeChat) and medical platform apps (i.e., Haodf). The purpose of this study was to investigate whether the attributes of social interaction in local society impact doctors' choice of mobile apps to communicate with patients. This article addresses two research questions: (a) To what degree do doctors' adoption patterns in different societies differ? (b) Why do doctors choose certain mobile apps to communicate with patients? This study employed a mixed methods research design to analyze doctor's adoption behavior patterns in two cities, Hangzhou (HZ) and Yancheng (YC), which represent two stages in transforming society. Various patterns, measured as the percentage of doctors who utilize the medical platform app of Haodf among all doctors and the average service counts per doctor, were compared in three groups of tertiary hospitals: the top ones in HZ, the average ones in HZ, and the average ones in YC. We also conducted thematic content analysis of qualitative data from semi-structured interviews with 20 purposely selected doctors in the two cities. The percentages of doctors who have adopted the app of Haodf from the three groups of tertiary hospitals were 49.97%, 41.00%, and 32.03%, with an average service counts per doctor of 261, 182 and 39, respectively. According to the interviewees, doctors from YC are more likely to use social networking apps to communicate with patients than their HZ counterparts to maintain social connections with their relatives, friends, colleagues, and others. This study demonstrates that doctors' choices of mobile apps are dependent upon social context. In traditional society, where people have close ties, the logic of using social networking apps lies in doctors' need to maximize the utility of their knowledge by maintaining social connections with others. In modern society, where the close ties between people have gradually weakened, the logic of using medical platform apps lies in doctors' needs for reputation marketing, either for themselves or for institutions, their affiliated departments or hospitals.

Translations in Green: Colonialism, Postcolonialism, and the Vegetal Turn

ABSTRACT: This paper explores the coloniality of botany and its transnational genealogy by examining critical questions about agency of representation of botanical nomenclature. We use two examples— Hortus Malabaricus in the seventeenth century, and the Traditional Knowledge Digital Library (TKDL) from the twenty-first century—as bookends to examine the legacies of colonial botany. The Hortus is a comprehensive treatise developed by Hendrik van Rheede, the governor of Dutch Malabar, with the help of local botanists, doctors, and physicians. It remains one of the most comprehensive works on the flora of Asia and the tropics. The impetus for the Hortus was the desire for a catalogue of local plants so colonists could more efficiently extract the rich botanical resources in Asia. The TKDL is a digital repository of traditional knowledge of India. The impetus was to establish prior use of herbs and medicines in India and challenge global biopiracy of traditional Indian knowledge. Both the Hortus and the TKDL are repositories that respond to colonial regimes of power—the former for more efficient colonial extraction, and the latter to thwart it. Yet both are caught up in Western norms of botanical nomenclature. Drawing on feminist, postcolonial, and transnational studies, this paper examines the two moments to explore the enduring and shifting meanings of transnational colonial regimes of power.

Physical Activity on Referral in Brussels

Since 2017, Huis voor Gezondheid has been coordinating the Physical Activity On Referral project in Brussels with the approval of the Flemish Government. The aim of this project is that doctors motivate their patients to adopt a more active lifestyle and that people from Brussels move more. If the patient is sufficiently motivated, the doctor can refer this patient to the Physical activity on referral-coach via a referral letter. The coach motivates and supports the patient on their way to a more active lifestyle. He does this through motivational interviewing and by sounding out which low-threshold exercise initiatives the patient wants to integrate into his daily life.
 In principle, every inhabitant of the Brussels-Capital Region can be referred to the coach. The project is mainly intended for people with an inactive lifestyle and for people with certain health risks or health problems for which exercise has already been shown to have a positive influence. Children cannot be referred, interested persons must be at least 18 years old.
 The project pays attention to the vulnerable population by mapping the local low-threshold exercise offer and by providing lower rates for people with an increased allowance for the coach. In Brussels especially this group is important to include and to pay extra attention to.
 In short, this project focuses on prevention, on keeping people healthy for as long as possible through integrated care.
 Scope of the project: The project currently is active in 4 municipalities in Brussels: Anderlecht, Sint-Jans-Molenbeek, Schaarbeek and Brussels-city.
 Partners: Physical Activity On Referral starts from a local intersectoral network in which local and regional partners from different sectors are represented such as local authorities, doctors, health and welfare services, providers of low-threshold exercise options, organizations that reach vulnerable groups,…. Each municipality consists of an intersectoral network. These regional partners are crucial for the succes of the project. Without all these partners, we would not be able te reach as many citizens as we do now.
 The interventions: Every year, Huis voor Gezondheid organizes several intersectoral local antennas within each municipality to discuss the progress of the project. In addition, Huis voor Gezondheid is also organizing a major event to bring all partners together of the project.
 Results: Since 2017 to the end of 2021 we have reached a total of 464 patients
 
 2017: 14 patients
 2018: 115 patients
 2019: 154 patients
 2020: 85 patients
 2021: 96 patiënts
 
 Learnings and next steps: The evaluations of patients and doctors show that patients move more after following a trajectory with the coach. In 2023 we will implement the project within the municipality of Jette.

The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey

BackgroundThe COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova.MethodsWe present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic.ResultsResults highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking.ConclusionsDuring the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.

Applications of Blueprints on Hospital Residency Program

Residency programs are completely essential for medical school students. This pivotal experience enriches students’ education and yields an opportunity to secure jobs. Training local doctors is a laborious endeavor that faces many challenges during the recruitment cycle. Private medical schools have attempted to meet their goals by reducing waste and improving processes. This study aims to investigate the issues that arise in the service flow process on the hospital residency programs and to investigate the impact of risk on the provided service. Service blueprint techniques are applied to examine and provide a comprehensive understanding of hospital residency programs and the underlying resources and processes that make it possible. Data is collected from a private hospital to develop the initial and future service blueprint, providing strategic benefits for the hospital. The study helps in reducing the service process time by almost 90%.

The Changing Climate Is Changing Safe Drinking Water, Impacting Health: A Case in the Southwestern Coastal Region of Bangladesh (SWCRB)

This study focuses on investigating the impact of climate change on the availability of safe drinking water and human health in the Southwest Coastal Region of Bangladesh (SWCRB). Additionally, it explores local adaptation approaches aimed at addressing these challenges. The research employed a combination of qualitative and quantitative methods to gather data. Qualitative data were collected through various means such as case studies, workshops, focus group discussions (FGDs), interviews, and key informant interviews (KIIs). The study specifically collected qualitative data from 12 unions in the Shyamnagar Upazila. On the other hand, through the quantitative method, we collected respondents’ answers through a closed-ended questionnaire survey from 320 respondents from nine unions in the first phase of this study. In the next phase, we also collected data from the three most vulnerable unions of Shyamnagar Upazila, namely Poddo Pukur, Gabura, and Burigoalini, where 1579 respondents answered questions regarding safe drinking water and health conditions due to climate change. The findings of the study indicate that local communities in the region acknowledge the significant impact of sea-level rise (SLR) on freshwater sources and overall well-being, primarily due to increased salinity. Over 70% of the respondents identified gastrointestinal issues, hypertension, diarrhea, malnutrition, and skin diseases as major waterborne health risks arising from salinity and lack of access to safe water. Among the vulnerable groups, women and children were found to be particularly susceptible to waterborne diseases related to salinity. While the study highlights the presence of certain adaptation measures against health-related problems, such as community clinics and health centers at the upazila level, as well as seeking healthcare from local and paramedical doctors, it notes that these measures are insufficient. In terms of safe drinking water, communities have adopted various adaptation strategies, including pond excavation to remove saline water (partially making it potable), implementing pond sand filters, rainwater harvesting, and obtaining potable water from alternative sources. However, these efforts alone do not fully address the challenges associated with ensuring safe drinking water.

Online dialogue with medical professionals: An empirical study of an online “Ask the Doctor” platform

BackgroundAccessing medical resources has been a challenging issue in China, particularly for people who do not live in big cities. Online “Ask the doctor” (AtD) services are gaining popularity rapidly. On AtDs, patients or their caregivers can ask questions to medical professionals and receive medical advice without going through the hassles of visiting local hospitals or doctors’ offices. However, the communication patterns and remaining challenges of this tool are understudied. ObjectiveThe purpose of this study was to (1) explore the dialogue patterns between the patients and the doctors on an AtD service in China, (2) identify issues and remaining challenges in this new form of communication. MethodsWe conducted an exploratory study to analyze the dialogues between patients and doctors as well as patients’ reviews. To analyze the dialogue data, we took inspiration from the discourse analysis and focus on the various components of the dialogues. We also used thematic analysis to discover the underlying themes embedded in each dialogue, and identify themes from patient complaints. ResultsWe identified four stages in the dialogues between the patients and doctors, including the initiating stage, continuing stage, ending stage, and following up stage. We also summarized the common patterns in the first three stages and reasons for sending follow-up messages. Moreover, we identified 6 unique challenges of the AtD service, including (1) inefficient communication in the initial stage, (2) unfinished conversation in the ending stage, (3) communication is perceived as real-time by the patients, not by the doctors, (4) drawbacks of voice messages, (5) verge of the illegal behaviors, and (6) consultation is not worth the payment. ConclusionsThe AtD service provides the follow-up communication pattern which is considered as a good supplement of Chinese traditional health care. However, several barriers, such as ethical problems, mismatched perceptions and expectations, cost-effectiveness issue still need further investigation.