Medical Outpatient Clinic Research Articles

Meditation and Its Effect on Chronic Physical Illnesses among Medical Outpatients at the National Hospital of Sri Lanka

Objective: Assess the knowledge, attitudes and practices about meditation and its effect on chronic physical illnesses among patients attending medical outpatient clinics at the National Hospital of Sri Lanka. Results: The population mean age was 61 and 110 (46%) practised meditation. Buddhists practised different forms of meditation whereas people following other religions mainly concentrated on God as their predominant form of meditation. The majority (87.4%) who meditated were not formally trained. Approximately two thirds (60%) of the cohort showed a significant interest in being formally trained. More people believed meditation can help control psychiatric illnesses compared to physical illnesses (79% vs. 56.7%). Female patients who had at­tended religious schools tended to believe in meditation more. Conclusions: Almost half of the sample patient population (46%) practised meditation of some form. The majority of the cohort was not trained in meditation but showed interest in pursuing meditation as a means of adjunctive therapy for their chronic physical diseases.

Evaluation of Blood Stream and Biliary Tract Infections Related to Percutaneous Transhepatic Cholangiography and Prophylaxis Given in Patients with Malignancy.

Percutaneous transhepatic cholangiography (PTC) is an invasive procedure used in patients with obstructive jaundice in the progress of some malignancies, and its most common complication is infection. We aimed to evaluate the patients who underwent PTC regarding their cultures, prophylaxis, and antibiotics used for treatment. In this cross-sectional study, patients who underwent PTC and were followed up in a medical oncology outpatient clinic between 2010-2017 were evaluated retrospectively. Patients' data were obtained from the hospital record system (FONET), epicrisis forms, and patient progress files. A total of 93 patients were included in the study. Prophylaxis was given in 50% of the cases. Complications developed in 68% of the cases after the intervention, and the infectious disease clinic consulted all. Blood cultures were obtained from 89% of the febrile patients; however, bile cultures were obtained only from 29%. The rate of resistant Gram-negative enteric bacteria in growing microorganisms was 52% (n=13). It was determined that 65% of the initiated empirical treatments were appropriate for the growth of microorganisms. The growth rate was significantly higher in blood cultures than in bile cultures. The lower growth rate in bile culture was attributed to the low number of bile cultures. There was no significant difference regarding the growth rate and drug resistance of the microorganisms. Therefore, we think giving antibiotics as treatment rather than prophylaxis is more appropriate. Taking cultures will ensure that patients receive appropriate antibiotic therapy for the causative agent.

Glycated Haemoglobin as an Index of Glycaemic Control: Ethnic Variation among Patients with Type 2 Diabetes Mellitus in a Malaysian Tertiary Hospital

Introduction: Previous studies have revealed ethnic differences in glycated haemoglobin (HbA1c) value at the same glucose concentration. This study aimed to determine ethnic variation in HbA1c as an index of glycaemic control among type 2 diabetes mellitus (T2DM) patients. Methods: This cross-sectional, retrospective study recruited 293 T2DM patients by simple random sampling at the medical outpatient clinic of a tertiary hospital. Results: Ethnicity was equally distributed with 33.4% Malays and Indians, respectively, and 33.1% Chinese. Significant difference in ethnicity was noted between HbA1c groups ≤6.5% and >6.5%. Indians had the highest median HbA1c (8.3%), followed by Malays (7.7%) and Chinese (7.2%) [p=0.004]. Malays had lower HbA1c compared with Chinese at lower fasting plasma glucose (FPG) whereas Chinese had lower HbA1c compared with Malays at higher FPG, crossing over at FPG 2.8 mmol/L. Indians had higher HbA1c compared with Chinese and Malays except at FPG cross-over of 16 mmol/L where Malays were higher than Indians. FPG and ethnicity were independent predictors of HbA1c. An increase of 1 mmol/L in FPG resulted in an increase of 0.44% in HbA1c. Indians and Malays had 0.60% and 0.47% higher HbA1c, respectively, than Chinese. Conclusion: This pilot study in Malaysia examined ethnic variation in the relationship between FPG and HbA1c among T2DM patients. Since HbA1c is higher in Indians and Malays compared with Chinese at any given FPG, the hypoglycaemia risk may be increased in Indians and Malays when treatment strategies are focussed on using similar target HbA1c values to treat them.

Frequency, Demographic and Clinicopathological Characteristics of Skin Cancer Patients Treated and Followed Up in the Medical Oncology Outpatient Clinic

Frequency, Demographic and Clinicopathological Characteristics of Skin Cancer Patients Treated and Followed Up in the Medical Oncology Outpatient Clinic

Evaluating quality of life and satisfaction with pharmaceutical care services among patients with type II diabetes mellitus receiving care in a resource-limited setting

Objectives: Quality of life assessment is considered an important measure of outcome in long-term illness and management. Patient satisfaction surveys are essential in obtaining a comprehensive understanding of the patient’s needs and their opinion of the service received. The purpose of this study was to determine the health-related quality of life (HRQOL) and satisfaction with pharmaceutical care services among patients with type II diabetes mellitus (DM) receiving care in Nigeria. Materials and Methods: A cross-sectional prospective study was conducted among 120 patients with type II DM receiving treatment at General Hospital Ikot Ekpene in Akwa Ibom state, Nigeria. Patients who met the eligibility criteria and attended clinic appointments at the medical outpatient clinic as well as those admitted into the medical wards of the hospital during the period of the study were recruited. Data on the extent of patients’ satisfaction with pharmaceutical care as well as their quality of life in diabetes were obtained using the patient satisfaction with pharmaceutical care questionnaire, and the patient quality of life based on diabetes related complaints questionnaire. The duration of the study was 7 months. Data obtained were analyzed using the Statistical Program and Service Solutions version 25.0 computer package with statistical significance set at P < 0.05. Results: The quality of life of the patients based on diabetes-related complaints was poor. Fatigue was the most frequently reported complaint (n = 116; 96.6%), followed by polyuria (n = 106; 88.33%). The overall mean scores of patient satisfaction with pharmacists’ friendly explanation and management of therapy were 4.03 (±0.52) and 3.53 (±0.44), respectively. There was a statistically significant relationship between patients’ satisfaction with pharmacists’ friendly explanations and patient complaints of weight changes (r = 0.219; P < 0.05), decreased energy levels (r = 0.205; P < 0.05), and numbness (r = 0.270; P < 0.01). Furthermore, there was a statistically significant relationship between patients’ satisfaction with pharmacists’ therapy management and patients’ complaint of fatigue (r = 0.187; P < 0.05), numbness (r = 0.189; P = 0.05), and blurred vision (r = 0.204; P < 0.05). Conclusion: The HRQOL of the patients was poor as the majority of the patients had diabetes-related complaints. Patients’ satisfaction with the pharmaceutical care services offered was good. Periodic evaluation of the quality of life and satisfaction with health-care services among patients with DM is recommended.

Improving Communication Between Doctors and Patients in Medical Clinics by Using Modern Communication Technologies

Effective communication between doctors and patients is crucial for delivering quality healthcare and ensuring patient satisfaction. With the advancement of modern communication technologies, there is an opportunity to enhance communication channels in medical clinics. This article explores the utilization of modern communication technologies to enhance communication in medical clinics. The study aims to assess the effectiveness of these technologies, explore their benefits and challenges, and identify strategies for their successful implementation. The advancements discussed include telemedicine and virtual consultations, secure messaging and patient portals, remote monitoring and wearable devices, electronic health records (EHRs), patient education and information dissemination, as well as online appointment scheduling systems and automated reminders. By leveraging these technologies, medical clinics can improve efficiency, accessibility, and patient satisfaction, ultimately leading to better healthcare outcomes

Passive wrist deviation to increase the ultrasound identified procedural safe zone in carpal tunnel syndrome: A retrospective cohort study.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated. To identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS. Retrospective cohort study. Quaternary medical center multidisciplinary outpatient hand clinic. Twenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment. Ultrasound-identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial-ulnar deviation as well as in passive ulnar and radial deviation. The ultrasound-identified safe zone distance with the wrist in each of the three positions. The interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs. This study demonstrates that the ultrasound-measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound-guided injections.

Awareness of chronic hepatitis C in the Western Black Sea Region.

Chronic hepatitis C (CHC) can be cured with oral antivirals. Awareness of CHC is a substantial barrier to the World Health Organization's goal of eradicating HCV by 2030. This study aimed at evaluating CHC awareness among different departments in a Western Black Sea Region University Hospital. Anti-HCV and HCV RNA test results of all patients admitted to our center for whatever reason and who underwent anti-HCV screening between January 2017 and January 2022 were analyzed. CHC awareness has been defined as the presence of HCV RNA testing for anti-HCV positives. Of the 63,963 patients who underwent anti-HCV testing, anti-HCV positivity was observed in 2%. HCV RNA was tested in 647 (48.8%) patients who had tested positive for anti-HCV. The HCV RNA was positive in 212 (32.7%) patients tested. Only 66 (29.7%) of those with positive HCV RNA test results had received antiviral therapy. The distribution of HCV RNA testing rates for patients with positive anti-HCV by different departments were as follows: 33% (n=78/232) in medical inpatient clinics, 78% (n=539/685) in medical outpatient clinics, 7% (n=16/223) in surgical inpatient clinics, 7% (n=14/183) in surgical outpatient clinics, and 0% in the emergency department. The prevalence of anti-HCV positivity in our region was 2%. Less than half of the patients tested for anti-HCV had HCV RNA testing, and less than a third of the HCV RNA-positive patients received antiviral therapy. To meet the WHO's HCV eradication target by 2030, it is necessary to increase physicians' awareness of CHC.

Parasitic study of cervicitis in women with diabetes in AL-Najaf AL-Ashraf Governorate

The current study dealt with the detection of parasitic infection in the cervix of (114) vaginal swabs and urine samples taken from women who complain of vaginitis and visits to the Department of Obstetrics and Gynecology at Al-Zahra Teaching Hospital, Al-Manathera General Hospital and women’s medical outpatient clinics in Najaf Governorate for the period from ( 1/5/2020) until (31/1/2021). It was detected that 23) were infected with the vaginalis parasite Trichomonasn at a rate of (20.17%), and women with diabetes recorded the highest rate of infection (69.6%) with the vaginalis parasite. Trichomonas The current study also indicated that women who use contraceptives recorded the lowest infection rate (26.08%) with the vaginalis parasite. Trichomonas, and the highest rate of infection with the vaginalis parasite (Trichomonasn.) was 47.8% in the age group (23-32) years, in addition to that, the highest infections were recorded in the city and the low economic level (60.9%) and (60.89%), respectively, and according to the months of the year The month of November recorded the highest infection rate (34.78%). The statistical analysis indicated that there were significant differences at the level of P&lt;0.05.

Assessment of Health Literacy Level among Clients Attending King Salman Armed Forces Hospital, Tabuk

A cross sectional study will be done among a convenience sample of clients attending surgical, medical out-patient clinics of King Salman Armed Forces hospital (KSAFH) in Tabuk city. A pretested structured questionnaire will be utilized in data collection included demographic characteristics and HLS-Q12 Arabic version after its validation.

Unemployment among cancer patients during COVID-19 pandemic

Aim: The survival rate of cancer patients is increased which resulted in an increased number of cancer survivors in working life. Return to work of cancer patients resulted in improved health outcomes and quality of life. However, cancer survivors have a high risk of unemployment. The COVID-19 pandemic caused global economic distress and put a great burden on the healthcare system which affected the cancer survivors further. COVID-19 may be a concurrent risk along with cancer, as a barrier for return to work. We investigated the factors that are associated with unemployment among cancer survivors, during the COVID-19 pandemic. Thus, we aimed to detect risk factors for unemployment amongst cancer patients during the COVID-19 pandemic. Therefore, we aimed to maintain the employment status of cancer survivors and prevent undesired individual and global economic and health outcomes.&#x0D; Material and Method: This is a cross-sectional, descriptive study. Control patients who applied to the Medical Oncology outpatient clinic were over 18 years old, diagnosed with cancer, completed adjuvant chemotherapy and/or radiotherapy treatment, the disease has not relapsed, and working before March 2020 were included in the study. The survey collection process for the study was carried out between July 2020 and November 2020.&#x0D; Results: There were 146 participants (65 male (44,5%) and 81 female (%55,5)). 42 (28.8%) of the 146 participants stated that they quit their jobs during the pandemic. Being a government employee, having a good-high household income and a high degree of education was protective against losing their jobs.&#x0D; Conclusion: It is very important to understand the causes of unemployment among cancer survivors and solve these issues in order to increase the well-being, quality of life, and survival of the patient, as well as improve the economic and social status of society.

Digital phenotyping for monitoring and prediction of physical activity level during pregnancy

Abstract Background Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. Physical activity (PA) during pregnancy may reduce the adverse pregnancy outcomes. Digital phenotyping can develop interactive risk profiles to better reflect a person’s daily mobility than traditional retrospective self-assessment questionnaires. Therefore, the aims of the proposed research are to 1) test the acceptability and applicability of the BEIWE app during pregnancy, 2) characterize daily physical mobility during pregnancy, and 3) describe differences in physical mobility in women with and without diabetes. Methods This prospective cohort study will include 20 pregnant women with GDM and 20 without GDM from the Diabetes Center of the Medical Clinic or outpatient clinics of the Tübingen Women’s Clinic, Tuebingen, Germany. The study was approved by the Ethics Committee of the University Hospital Tuebingen (004/2022BO1). At baseline (22 weeks gestation), participants will be instructed to download the app. Passive data (phenotypic information) is collected automatically during the observation period. The follow-up assessment will be conducted three weeks after delivery. The acceptance of the app and comparison of the groups with and without diabetes will be conducted through Statistical analysis. Results Recruitment of participants has started and follow-up assessment is estimated to be finalized in fall 2022. Study design and results will be presented at the conference. Conclusions PA during pregnancy has been associated with minimum risk of a pregnancy, and self-monitoring of PA via an app may play a role in improving pregnancy outcomes. However, the success of Apps depends on their validity and reliability, which lack evidence. Key messages • The result of the study will develop a qualification measure for PA with no intervention. • It also provides information for planning and conducting subsequent intervention studies.

Correlation Between Physical Activity, Body Composition, And Micronutrition Intake In Patients Of Knee Osteoarthritis At The Medical Rehabilitation Clinic, Fatmawati Hospital Jakarta In 2021

Background : Osteoarthritis (OA) is a degenerative joint disease associated with joint cartilage damage that usually occurs in the aging process. This study is to analyze the correlation between physical activity, body composition, and the micronutrients intake such as vitamin C, D, E, and Calsium the patients with knee OA at the Medical Rehabilitation Clinic (MRC) at Fatmawati Hospital, Jakarta in 2021.Methods: This is a cross sectional quantitative research. The samples were 45 patients who have been diagnosed with knee osteoarthritis in outpatient medical rehabilitation clinic at Fatmawati General Hospital Jakarta who met the inclusion criteria.Results : the results of statistical tests showed that there was a significant difference in the average percentage of body fat with the gradation of OA patients, p value = 0.004. However, there was no significant difference between the average physical activity score, and intake of macronutrients (energy, protein, fat and carbohydrates), BCAAs (arginine and histidine), and intake of micronutrients (vitamin C, vitamin D, vitamin D, vitamin E and Calcium)Conclusion: Percent body fat is the variable with the highest correlation among other factors.

Cognitive functioning and prevalence of seizures among older persons in Uganda: A hospital-based, cross-sectional study.

There is limited data on the prevalence of seizures and dementia among older persons in Uganda. We evaluated cognitive functioning, and the prevalence and factors associated with seizures among older persons attending an outpatient medical clinic in Uganda. We randomly selected older adults (60 years and above) attending Kiruddu National Referral Hospital medical outpatient clinics between October 2020 and March 2021. We excluded individuals with a history of head injury, brain tumors, mental retardation, co-morbidity with HIV and patients who have had recent brain surgery. Cognitive functioning was assessed using the Identification for Dementia in Elderly Africans (IDEA) tool. We enrolled 407 participants, with a median (inter-quartile range) age of 67 (64–73) years. Majority were female (n = 292, 71.7%). The prevalence of seizure was 1.5% (95% confidence interval [CI]: 0.7–3.3). All 6 participants reported generalized tonic-clonic seizure type. Self-reported seizure was associated with being female (adjusted prevalence ratio [aPR]: 0.79, 95%CI: 0. 67–0.93, P = .02) and residing in Mukono district (aPR: 17.26, 95%CI: 1.64–181.55, P = .018). Overall, 114 (28.1%) participants had cognitive deficit; 9 (2.2%) dementia and 105 (25.9%) impaired cognition. Cognitive deficit was independently associated with female gender (aPR: 0.61, 95%CI: 0.44–0.85, P = .003), formal employment (aPR: 0.53, 95%CI: 0.35–0.81, P = .003), age 70–74 (aPR: 1.69, 95%CI: 1.00–2.86, P = .049), and ≥ 75 years (aPR: 2.81, 95%CI: 1.71–4.61, P = .001). Prevalence of seizures among participants with cognitive deficit was 5.3% (6/114). Among older persons attending a medical clinic in Uganda, almost one-third had cognitive deficit with seizure prevalence being higher among these individuals.

Developing and validating a comprehensive measure of coordination in patient aligned care teams

Background/ObjectiveDespite numerous extant measures assessing context-specific elements of care coordination, we are unaware of any comprehensive, team-based instrument that measures the requisite mechanisms and conditions required to coordinate successfully. In this study we develop and validate the psychometric properties of the Coordination Practices Survey, a context-agnostic measure of coordination for primary care teams.MethodsCoordination items were developed based on a systematic literature review; items from previously developed scales were adapted and new items were created as needed; all items were refined after subject matter expert review and feedback. We collected data from Primary Care teams drawn from 1200 Veterans Health Administration (VHA) medical centers and outpatient clinics nationwide. 1645 primary care team members from 512 patient aligned care teams in the Veterans Health Administration completed the survey from 2015 to 2016. Psychometric properties were assessed after data collection using Cronbach’s alpha, intraclass correlations and multilevel confirmatory factor analysis to assess the factor structure.ResultsOur findings confirmed the psychometric properties of two distinguishable subscales of coordination: (a) Accountability and (b) Common Understanding. The within- and between-team latent structure of each subscale exhibited adequate fit to the data, as well as appropriately high Cronbach’s alpha and intraclass correlations. There was insufficient variability in responses to the predictability subscale to properly assess its psychometric properties.ConclusionWith context-specific validation, our subscales of accountability and common understanding may be used to assess coordination processes in other contexts for both research and operational applications.

24.1 Suicide Risk Screening in Pediatric Neurodevelopmental Medical Clinics

Children with neurodevelopmental disabilities (NDDs) have long been considered to have lower risk for suicidal ideation when compared to typically developing peers. Our discussion focuses on a study of suicide risk screening at outpatient medical clinics serving children with NDDs. We will review the planning for and implementation of universal suicide risk screening in this setting. We will also describe the outcomes along with the lessons learned.

DIETARY AND CARDIO-METABOLIC RISK FACTORS AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS ATTENDING MEDICAL OUT-PATIENT CLINIC OF A FEDERAL TEACHING HOSPITAL IN NIGERIA

The increasing prevalence of cardio-metabolic risks contributes to an increase in the prevalence of diabetes mellitus. Although the cardiovascular risk factors among type 2 diabetic patients is well known, the dietary and cardio-metabolic risk factors has not been fully investigated. This study was carried out to determine the cardiometabolic risk factors in 45 purposively-selected adult diabetic patients attending the Medical Out-Patient Clinic, University College Hospital (UCH), Ibadan. A 24-hour dietary recall was used to determine the dietary intake of the patients. Weight and height were measured to determine body mass index (BMI) which was categorized as underweight (&lt;18.5kg/m2), normal weight (18.5-24.9kg/m2), overweight (25-29.9kg/m2) and obese (≥30.0kg/m2) and also waist-hip ratio. Biochemical parameters (triglyceride, blood pressure, total cholesterol, fasting blood glucose, high and low density lipoprotein cholesterol) were obtained from their hospital records. Data were analyzed using descriptive statistics, Chi-square test and correlation at p&lt;0.05. The mean age of the patients was 61.3±8.15 years. Their mean BMI was 30.2±6.94kg/m². About (37.8%) of the patients had systolic stage one hypertension, 88.9% had normal triglyceride, 55.6% had normal fasting blood glucose and 80.0% had normal total cholesterol. Less than half (44.4%) of the patients were obese, 33.3% had high waist-hip ratio. A positive and signicant correlation was only observed between regular exercise and fasting blood glucose of the patients. The cardiometabolic risk factors were slightly high among type 2 diabetic patients in UCH, Ibadan. Diabetic individuals should be educated to maintain healthy lifestyles, comply with the right diets in order to reduce complications.

Awareness of sick day rules and use of steroid cards among patients taking long term synthetic oral glucocorticoids for immunosuppression and adrenal hormone replacement at a tertiary hospital in Ethiopia: A cross-sectional study

Background: Glucocorticoids are among the most commonly prescribed medications owing to their generic anti-inflammatory and immunosuppressive effects. Adrenal insufficiency and adrenal crisis are among the major serious adverse effects of long course glucocorticoid treatment. Patient education on sick day rules and the use of steroid treatment identifiers are some of the strategies that are commonly employed to mitigate the risk of AI and adrenal crisis. This study aimed to assess awareness of sick day rules and the use of steroid cards at a tertiary referral hospital in Ethiopia. Methods: A cross-sectional study was conducted at the outpatient medical clinics at Tikur Anbessa Specialized Hospital over a study period of consecutive six months. A total of 100 patients from medical and endocrine clinics who fulfilled the eligibility criteria were recruited to take part in the study on the day they attended their routine follow-up clinics. Interviewer administered questioner regarding sick day rules and use of steroid identifier was used and statistical analysis was done using SPSS software version 20.

The effectiveness of a pain management programme on pain control and quality of life in patients with metastatic cancer.

Pain is one of the most frequent symptoms in cancer patients and has a negative impact on their physical, emotional and functional status, as well as their quality of life (QOL). This study evaluated the effectiveness of a pain management programme on pain control and QOL among patients with metastatic cancer receiving systemic chemotherapy. The authors investigated whether a pain management programme contributes to a better pain control and improvement in QOL in the outpatient setting. The authors conducted a randomised, single-blinded, controlled, single-centre study of metastatic cancer patients experiencing cancer pain and requiring opioid therapy. Patients were enrolled from the Medical Oncology Outpatient Clinic, Songklanagarind Hospital, Prince of Songkla University, Thailand. Participants were randomly assigned to two strategies: pain assessment and management based on the programme developed by the researchers ('pain management programme' arm), and pain management by individual medical oncologists per the routine procedure ('standard of care' arm). Demographics questionnaires, a pain intensity assessment using the Numeric Rating Scale (NRS) and the Functional Assessment of Cancer Therapy-General (FACT-G, version 4) were used to assess the QOL and cancer pain severity at baseline and at two follow-up visits. Between November 2016 and July 2017, 64 consecutive patients were randomly assigned to the two treatment groups. Most were male (79.7%), with a mean age of 55.1 (±13.8) years. The majority of patients (23; 35.9%) had squamous cell carcinoma of the head and neck, with other prevalent types being lung cancer (9.4%), esophageal cancer (9.4%) and colorectal cancer (9.4%). The most frequent metastatic sites were the lungs (28.1%), liver (26.6%), and bone (20.3%). Compared with standard care, pain intensity was significantly lower among the patients receiving the pain management programme: 4.0 ±2.2 versus 5.1 ±1.8 (P = 0.033) and 3.3 ±1.7 versus 4.7 ±2.1 (P = 0.025) at visit 1 and 2, respectively. Likewise, QOL measures scored higher in the pain management programme group: 71.2 ±15.4 versus 58.6 ±14.5 (P = 0.002) and 71.8 ±15.5 versus 55.4 ±16.3 (P = 0.002) at visit 1 and 2, respectively. Furthermore, there was a statistically significant positive correlation between pain control and QOL improvement (P = 0.011). The investigated pain management programme significantly improved both pain control and QOL in metastatic cancer patients receiving systemic chemotherapy in the outpatient setting.

CN15 Individual factors leading to delay in diagnosis in patients with colorectal cancer and their illness perceptions

The purpose of this study was to determine the time elapsed between the first symptoms and seeking medical help, factors contributing to the delay and disease perception in patients with colorectal cancer. The study was conducted at the medical oncology outpatient clinic of a University Hospital in Ankara and included 114 patients who were diagnosed with colorectal cancer. The data were obtained by using the questionnaire form and the brief illness perception questionnaire. The elapsed time between patients’ first symptoms and seeking medical health was classified into ‘‘normal’’ when it was less than one month, ‘‘delay’’ when it was between one and three months, ‘‘long-term delay’’ when it was more than three months, and ‘‘very serious delay’’ when it was more than six months. In the analysis of the data, chi-square test, one-way analysis of variance and correlation tests were used. The mean elapsed time between patients’ first symptoms and seeking medical health was 7.27±11.02 month (range: 1 - 62.5 month), 60.6% of patients were delayed over a month and there is a serious delay in 31.6% of them. Most of the patients (76.3%) stated that they did not know the signs and symptoms of colorectal cancer and 16.7% stated that they had a screening test. It was determined that 89.9% of patients experienced symptoms and signs before colorectal cancer diagnosis. The most common complaints were changes in bowel habits (20.3%), rectal bleeding (14.1%) and abdominal pain (10.3%). When the factors contributing to the delay were evaluated, 60% of them did not stated any reason, 17% stated perceiving the symptoms as temporary or insignificant. A significant relationship was found between the delay in diagnosis and level of education and the change in bowel habit (p<0.05). The mean score of brief illness perception was found to be 21.74 ± 11.36 (range: 0- 56). The three most important factors that they believed to cause illness were stress (32.8%), nutrition (24.9%) and sadness (13.6%). Although the individuals participating in the study have symptoms that may be a symptom of colorectal cancer; there was considerable delay in the time to seeking medical help due to lack of awareness about the symptoms of colorectal cancer.