Medicine Unit Research Articles

THE IMPACT OF HEALTH SUPPLY AND DEMAND ON HEALTH OUTCOMES IN PRIMARY HEALTH CARE SERVICES: PANEL DATA ANALYSİS

The aim of this study is to determine the impact of health supply and demand on health outcomes in primary health care services. For this purpose, the population of the study consists of the Eastern Anatolia Region. Sampling was not determined in the study, and data from 14 provinces in the region were evaluated. The dependent variable of the study is the number of deaths, while the independent variables are the number of family medicine units and the number of primary care applications. The research data were tested separately for each province considering the time period 2012-2021. According to the results of the study, the increase in the number of family medicine units leads to a decrease in the number of deaths in Erzurum, Van and Ağrı, as in the whole panel. On the other hand, the increase in the number of primary care visits decreases the number of deaths in Muş and Hakkari, but increases it in Malatya and Bitlis.

Impact of hyponatremia in patients hospitalized in Internal Medicine units: Hyponatremia in Internal Medicine units.

The aim of this study was to analyze the impact and the clinical and evolutionary characteristics of hypotonic hyponatremia in patients hospitalized in Internal Medicine units. Prospective multicenter observational study of patients with hypotonic hyponatremia (<135 mmol/L) in 5 hospitals in southern Spain. Patients were included according to point prevalence studies carried out every 2 weeks between March 2015 and October 2017, by assessing demographic, clinical, analytical, and management data; each patient was subsequently followed up for 12 months, during which time mortality and readmissions were assessed. A total of 501 patients were included (51.9% women, mean age = 71.3 ± 14.24 years), resulting in an overall prevalence of hyponatremia of 8.3%. The mean comorbidities rate was 4.50 ± 2.41, the most frequent diagnoses being heart failure (115) (23%), respiratory infections (65) (13%), and oncological pathologies (42) (6.4%). Of the total number of hyponatremia cases, 180 (35.9%) were hypervolemic, 164 (32.7%) hypovolemic, and 157 (31.3%) were euvolemic. A total of 87.4% did not receive additional diagnostic tests to establish the origin of the condition and 30% did not receive any treatment. Hospital mortality was 15.6% and the mean length of stay was 14.7 days. Euvolemic and admission hyponatremia versus hyponatremia developed during admission were significantly associated with lower mortality rates (P = .037). Mortality at 1 year and readmissions were high (31% and 53% of patients, respectively). Hyponatremia was common in Internal Medicine areas, with hypervolemic hyponatremia being the most frequent type. The mortality rate was high during admission and at follow-up; yet there is a margin for improvement in the clinical management of this condition.

#1926 Persistence to first- and second- generation potassium binder treatment—an observational study based on the DEMONSTRATE database

Abstract Background and Aims Hyperkalemia (HK) is a common electrolyte abnormality mainly caused by reduced renal potassium excretion in patients with chronic kidney disease (CKD). Potassium binders, such as sodium polystyrene sulfonates (SPS) are widely used but may lead to adverse gastrointestinal (GI) symptoms, reducing their tolerability. Patiromer and sodium zirconium cyclosilicate (SZC) are newer ion exchange resins for treatment of HK which may cause fewer GI side-effects. This study aims to evaluate the persistence to first- (SPS) and second-generation potassium binder (patiromer and SZC) treatment and the related clinical characteristics. Method In this observational study based on the DEMONSTRATE database, a novel national and regional database comprising laboratory data from six regions in central Sweden (18% of the Swedish population), linked to the national health registry data, we selected all patients in Sweden having at least one pharmacy dispensation of either first (SPS) or second (patiromer or SZC) generation potassium binder between July 2005 and December 2022. By semi-automatically interpreting the prescribed dosages in combination with the amount of medical supply, duration for each dispensation was estimated and episodes of potassium binder treatments were established. For all potassium binder episodes, we described patient characteristics and persistence to treatment. Results are mainly presented by treatment episodes and by strata of (a) all, (b) first and (c) second generation potassium binders. Results Between July 2005 and December 2022, we identified 68 133 treatment episodes of potassium binders for 32 424 patients (Table 1). Of these, 31 730 individuals and 66 309 treatment episodes were attributed to first generation (throughout the study period), and 1,276 individuals and 1,824 treatment episodes to second-generation potassium binders (between 2018-2022) Mean (SD) age was slightly lower in patients initiating second compared to first generation potassium binders; 68.5 (15.6) vs 65.2 (16.6) years. Potassium binder treatment was more common in men compared to women (66.9% vs. 33.1%) with similar gender distribution between first- and second-generation potassium binders. Comorbidities were more common in patients initiating treatment with second than first generation potassium binders, notably for heart failure (40.0% vs. 29.7%) and dialysis (38.8% vs 29.2%). RAASi and MRA were more often prescribed to the second generation potassium binders vs first; 70.8% vs 62.9% for RAASi and 18.8% vs. 8.5% for MRA. Second generation potassium binders were more commonly initiated in cardiology/internal medicine units (41.7% vs. 34.8%) and dialysis (38.8% vs. 29.2%). Persistence was higher among patients treated with second generation potassium binders (Fig. 1). Conclusion Second generation potassium binders were more often prescribed to younger patients that had more co-morbidities being slightly more persistent to treatment when compared to patients on first generation potassium binders.

#1802 Treatment with potassium binders in central Sweden—an observational study based on the DEMONSTRATE database

Abstract Background and Aims Hyperkalemia (HK), defined as a plasma potassium level (&amp;gt; 5.0 mmol/L), is associated with adverse outcomes, including cardiac arrhythmias and mortality. Until recently, HK was managed mainly with sodium polystyrene sulfonate (SPS) (first generation potassium binders) but concerns regarding the safety profile warranted new alternatives. The second-generation potassium binders, patiromer and sodium zirconium cyclosilicate (SZC) were introduced in Sweden in 2018 and 2019 respectively. The aim of this observational study was to understand the current use of new potassium binders, the related potassium values triggering treatment and to describe the clinical characteristics of patients treated with first- and second-generation potassium binders (SPS and patiromer/SZC respectively) in Sweden. Method An observational study based on laboratory data from six regions in central Sweden (18% of the Swedish population), linked to national health registry data, comprising information on clinical events and pharmacy drug dispensations. All treatment episodes of potassium binders between 01 July 2005 and 31 December 2022 were selected and restricted to patients with information on potassium values. A new treatment episode was defined as a gap of at least 120 days to the prior pharmacy dispensations of potassium binders. We analyzed potassium values (up to 60 days prior to initiation of potassium binders), demographics, comorbidities and treatments. Results are mainly presented by treatment episodes and strata of; (a) all, (b) first- and (c) second-generation potassium binders. Results In total, we identified 13 441 treatment episodes of which 13 218 episodes (n = 7086 individuals), were attributed to first generation potassium binders (throughout the study period) and 223 episodes (n = 151 individuals) to second-generation potassium binders (from 2018-2022) (Table 1). Baseline characteristics are presented by treatment episodes. Baseline potassium value prior to treatment was 5.6 (0.8) mmol/L for first and 5.6 (0.7) for second generation potassium binders. Mean eGFR prior to treatment was 22.3 (16.3) ml/min/1.73 m2 for first and 18.7 (16.0) for second-generation potassium binders. Compared to first generation, second-generation potassium binders were prescribed to patients with more comorbidities (41.7% vs 32.1% for heart failure, 88.3% vs 81.7% for hypertension, and 39.5% vs 28.9% for dialysis) and more frequently from cardiology/internal medicine units (41.7% vs 30.0%). Distribution of potassium levels at baseline is shown in Fig. 1. Conclusion Compared to first- generation potassium binder, we observed fewer treatment episodes with second generation potassium binders, of which majority had a more severe comorbidity profile. There was no difference in potassium values prior to treatment between first- and second-generation potassium-binders.

Assessment of Nurse’s Knowledge Regarding Diabetic Ketoacidosis in Laâyoune City, Morocco

Background: Diabetic ketoacidosis represents a life-threatening complication of diabetes, standing as the foremost cause of mortality associated with the condition. The proficient management of patients suffering from diabetic ketoacidosis hinges upon the expertise and proficiency of nurses, who play a pivotal role in the comprehensive care and treatment of these individuals. Aim: The objective of this study was to assess the knowledge of nurses in the Department of Medicine and Intensive Care Unit at Moulay El Hassan Ben El Mehdi Hospital concerning the biological and clinical parameters, as well as the management protocols, for patients diagnosed with DKA. Methods: A self-administered questionnaire was distributed to nurses working in both the Department of Medicine (n=8) and the Intensive Care Unit (n=10) at Moulay El Hassan Ben El Mehdi Hospital in Laâyoune. The questionnaire included variables covering demographic characteristics, clinical information, and biological parameters. Results: The majority of nurses (88.8%) demonstrated adequate knowledge regarding the definition of DKA, with most nurses in both departments displaying familiarity with the biological and clinical manifestations of the condition. In terms of management practices, all nurses reported utilizing saline solution or glucose serum based on the patient's blood glucose levels. Conclusion: The study suggests the implementation of standardized educational programs within intensive care units to enhance nurse staffing, improve the level of patient care, and elevate the quality of care delivered to this patient demographic.

Comparing Outcomes of Community-Acquired Pneumonia Patients Discharged from General Medicine and Respiratory Units in Australia: A Propensity Score-Matched Analysis.

Background/Objectives: Community-acquired pneumonia (CAP) is a common emergency presentation in Australia, with the choice of admitting specialty unit often influenced by pneumonia severity and comorbidities. However, it remains unclear whether there are between-specialty differences in patient characteristics and outcomes. We sought to address this issue by investigating the characteristics and outcomes of CAP patients admitted to General Medicine (GM) versus Respiratory units. Methods: This retrospective observational study utilised data from the two largest metropolitan hospitals in South Australia, encompassing all non-COVID-19-related CAP admissions throughout 2021 to 2023. The hospital length of stay (LOS), in-patient and 30-day mortality, and 30-day readmission rates were assessed by propensity score matching (PSM) using 17 variables. Results: Of the 3004 cases of non-COVID-19 CAP admitted across the two hospitals during the study period, 2673 (71.8%) were admitted under GM units and 331 (9.1%) under Respiratory units. GM patients were, on average, a decade older, presented with a significantly higher burden of comorbidities, exhibited a greater prevalence of frailty, and had higher pneumonia severity compared to those admitted under a Respiratory unit (p < 0.05). Unadjusted analysis revealed a shorter median LOS among GM-admitted patients (5.9 vs. 4.1 days, p < 0.001). After PSM adjustment, patients admitted under the Respiratory units had an 8-fold higher odds of a longer LOS compared to GM (adjusted odds ratio [aOR] 8.53, 95% CI 1.96-37.25, p = 0.004). Other clinical outcomes were comparable between the two groups. Conclusions: Our findings indicate that GM units compared to Respiratory units provide efficient and safe care for patients requiring hospitalisation for CAP.

Perspective: Advancing the science regarding temporomandibular disorders

This Special Issue was initiated in response to the call for improved research by the National Academies of Sciences, Engineering, and Medicine (NASEM) (United States) Consensus Study Report on Temporomandibular Disorders (TMDs), a set of putatively localized musculoskeletal conditions. In this Special Issue, the importance of systems biology for TMDs emerges from each of three separate publications. The importance of systems biology to patients is anchored in two domains—laboratory research and clinical observation. The three publications fully speak to the underlying goals in the NASEM recommendations for initiatives: that research on TMDs needs to broaden, that integration between basic and clinical science needs to improve, and that while better evidence is needed, clinicians need to utilize the evidence that already exists. All three of these initiatives, taken together, would lead to better understanding of these complex diseases and to better care of patients with these diseases.

HEART FAILURE WITH RELAPSING ATRIAL FIBRILLATION: BELOW THE SURFACE

Abstract Advances in pharmacologic and device therapy have greatly improved prognosis of patients with HFrEF. However, the typical clinical course is still characterized by recurring symptoms, worsening functional status and risk of frequent hospitalizations. A 72–years–old male patient with arterial hypertension, poorly controlled T2DM, TIA and chronic kidney disease presented to Cardiology service in 2018 with dyspnoea on effort and first evidence of EF 35% at echocardiography. He was admitted for elective coronary angiography, which demonstrated limited coronary heart disease of circumflex artery and its first marginal branch, treated by PTCA and stenting. CMR confirmed severe LV dysfunction, but also revealed extensive fibrotic areas with ischaemic and non–ischaemic patterns beyond revascularized regions. With such evidences, HF treatments were intensified, with titration of disease– modifying therapies and DOAC was added for asymptomatic paroxysmal AF. CRT–D was implanted for QRS of 160 msec, which was narrowed to 130 msec. Nevertheless, in one–year time the patient presented worsening of symptoms with several hospital admissions for acute HF and AF with fast rate. A switch to rhythm–control strategy was hence chosen. DCCV was performed, after an initial deferral for thrombosis of LAA due to poor adherence to DOAC. However, three–days after DCCV, the patient presented again to emergency services for dyspnoea, left upper flank pain and AF with fast rate. He was admitted to Acute Medicine Unit and treated with high flow O2, iv Furosemide and Digoxin, analgesics. CT chest and abdomen with contrast was performed in the suspicion of systemic venous thromboembolism for persistent type 1 respiratory failure, raised D–dimer and elevated liver function tests, despite appropriate anticoagulation. CT revealed an unexpected left superior pulmonary vein thrombosis, splenic and small left renal infarcts. The patient was discharged after recovery on subcutaneous heparin. At 15–day review, the patient was in stable conditions and awaiting completion of coagulation screening tests. This case study addresses some important aspects in the care of HF. An accurate assessment of HF aetiology and recurrent triggers, a timely planning of pharmacologic and device treatments, alongside with management of co–morbidities, therapeutic adherence and appropriate anticoagulation, can provide the clinician powerful tools to accomplish the difficult task of managing HF below the surface.

Demographic and disease profile of patients availing Traditional Medicine services in Bhutan: a cross-sectional study

Introduction: The study was conducted in 2019 and 2020 across 19 Traditional Medicine Units in Bhutan with the objective to assess the socio-demographic characteristics and disease patterns of patients seeking Traditional Medicine services. Method: This was a cross-sectional study and structured questionnaires were used for the interview. Data was gathered from 19 Traditional Medicine Units affiliated with 20-bedded hospitals. Disease diagnoses were recorded as per the Bhutan TM Disease Code. Results: A total of 1541 patients voluntarily participated in the survey. Of these, 950 (61.65%) were new patients, 946 were females (61.39%), 1514 (98.31%) were Bhutanese and 26 (1.96%) were non-Bhutanese. The majority of service recipients were farmers 873 (56.76%). The maximum visitors were from the eastern region (700, 45.43%) and the least was from the southern part of the country (88, 5.71%). The age range of participants spanned from 15 to 106 years, with a mean age of 43.75 (±16.32) years. Among the 56 different diseases documented during the survey, the highest prevalence was observed for tsakar (neurological disorder): 271 (16.76%), followed by phoney (gastrointestinal disorder): 180 (16.76%) and yama gosin (sinusitis): 139 (8.60%). Conclusion: The usage of Traditional Medicine is popular among all ages of Bhutanese citizens and international visitors. Tsakar and phoney disorders were the most common conditions requiring medical intervention.

ASSOCIATION BETWEEN HEALTH LITERACY AND NURSING DEPENDENCY IN HEART FAILURE PATIENTS: A RETROSPECTIVE STUDY

Abstract Background Approximately 6.7 million Americans over 20 years of age have heart failure (HF) and 33% of the US adult population without known symptomatic HF is at–risk for HF. To understand self–care protocols, patients should understand and use health information and literature suggests a positive relation between health literacy (HL) and self–care. Health literacy (HL) is a potential risk factor for health outcomes and can be defined as “personal knowledge and competencies obtained through daily activities, social interactions and across generations”. However, even though HL has gained international relevance, it remains underestimated in most world countries. Moreover, HL is poorly measured in hospitalized HF patients and its relationship with nursing dependency is still poorly studied. We aimed to describe HL levels by analyzing the relationship between HL and nursing dependency. Methods A retrospective design was used by selecting 608 adult patients with HF consecutively admitted in cardiovascular and internal medicine units of an Italian university hospital across 1 year. Single Item Literacy Screener (SILS) was used to measure HL and was systematically reported on electronic health records; nursing diagnoses were collected from the clinical nursing information system to measure nursing dependency. Results The mean age of the sample was 75.50 ± 13.06. HL levels were low (SILS &amp;gt;2) in approximately 26% of the hospitalized patients (n=159; 26.2%). A mean of 4.1 ± 3.4 nursing diagnosis per patient was identified. A significant difference was observed between patients with adequate HL (n=449) and low HL (n=159) in terms of nursing diagnoses (mean 2.76 ± 20.3 VS mean 8.69 ± 2.79; p&amp;lt; .001, respectively). A statistically significant linear association (Spearman’s correlation coefficient) was observed between the HL score and the number of NDs. Conclusion HL was associated with the number of NDs in HF patients. Understanding the relationship between HL and nursing dependency can allow the planning of targeted interventions to improve the patient’s health outcomes, representing a key element for public health.

Patient Satisfaction Survey in Traditional Medicine Units in Bhutan, 2023: a cross-sectional survey

Background: Assessing patient satisfaction is a vital component of any robust health service. In this study, we assessed the level of patient satisfaction with the TM services across health facilities in Bhutan in 2023. Methods: This study was a cross-sectional study conducted among adults availing TM services between March and April 2023. Patient satisfaction was scored against given statements on a Likert scale. Data were analysed to examine the overall levels of satisfaction with TM services. Results: There were 353 respondents surveyed across 46 TM units. Patients reported high satisfaction scores on the cleanliness of the health facility and its toilets, availability of sitting facilities in waiting rooms, clarity of direction and signage in the hospitals, and good communication skills of receptionists and TM practitioners. High scores were also recorded on the time provided by TM practitioners to patients and the ability to receive timely care. However, patients reported lower scores on the availability of all amenities for the drungtshos to provide the desired services to the patient. However, only 44.41% of participants reported adequate satisfaction with the services. The domain-wise satisfaction scores: satisfaction (44.19%), Physical environment (31.44%), Courtesy (52.12%), Quality of care (48.48%), Interpersonal (56.37%), Communication (56.37%), Time spent with health professionals (28.61%) and Accessibility and convenience (37.68%). Conclusions: Only four in every ten participants were highly satisfied with Traditional Medicine services at various public health facilities in Bhutan. Such patient satisfaction surveys serve as a benchmark for quality improvement initiatives.

Self-reported respiratory and gastrointestinal outcomes in children with isolated congenital diaphragmatic hernia: A prospective multicentre study.

To evaluate medium-term self-reported respiratory and gastrointestinal (GI) outcomes in children with congenital diaphragmatic hernia (CDH). Self-reported respiratory and GI outcomes correlated with prenatal severity indicators. Prospective study at three fetal medicine units. Families of children prenatally diagnosed with isolated, left-sided CDH surviving for >1 year. Families received validated questionnaires for GI outcomes (Infant Gastroesophageal Reflux Questionnaire Revised, I-GERQ-R, for infants aged <2 years, or Paediatric Gastro-oesophageal Symptom and Quality of Life Questionnaire, PGSQ, for children aged aged 2-8 years or >9 years) and respiratory outcomes (preschool respiratory outcome questionnaire, for children aged ≤5 years, or the International Study of Asthma and Allergies in Childhood asthma questionnaire, for children aged 6-8 years or ≥9 years). Prenatal data collected from the medical records included lung size (percentage observed/expected lung-to-head ratio, O/E LHR %), liver position, fetal endoluminal tracheal occlusion (FETO) gestational age (GA) at delivery, and perinatal data included birthweight, location, patch repair and respiratory support. The GI and respiratory scores were correlated with O/E LHR using linear and logistic regression models. Univariate analysis was used to evaluate associations with perinatal variables. We obtained 142 responses from 342 families (representing a response rate of 45%). The baseline characteristics of participants and non-participants were comparable. No correlations between perinatal variables and respiratory or GI scores were identified. Children aged ≤5 years with lower O/E LHR values reported higher respiratory scores (P = 0.0175); this finding was not reported in older children. Overall, the children who underwent FETO (n = 51) had GI (P = 0.290) and respiratory (P = 0.052) scores that were comparable with those of children who were expectantly managed. Families and children with prenatally diagnosed CDH reported fewer respiratory symptoms with increasing age. There was no correlation between O/E LHR or the use of FETO and self-reported outcomes.

Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients

Adherence to guideline recommendations for venous thromboembolism prophylaxis (VTE) in hospitalized medical patients is suboptimal despite national policies and institutional interventions. The aim of this quality improvement project was to improve adherence to guidelines and decrease the overuse of VTE prophylaxis in order to reduce the institutional cost for heparins. A multidisciplinary anticoagulation stewardship program (ACSP) using the audit and feedback strategy was implemented on the medicine inpatient units at a teaching hospital in Canada. The primary outcome measure was a comparison, pre and post introduction of the ACSP, of the costs per 6-month period for prophylactic dose enoxaparin and unfractionated heparin on the medicine units. The balancing measures were the 90-day VTE rate and major bleeding rate during the hospitalization. Six months after the implementation of the ACSP, the cost was decreased by >50 % without any observed negative impact on patient safety. This study demonstrates the potential for anticoagulation stewardship programs to optimize the use of VTE prophylaxis and reduce the associated costs and risks.

Questionable Immunity to Mumps among Healthcare Workers in Italy-A Cross-Sectional Serological Study.

Highly contagious diseases, such as mumps, are a global concern as new epidemics continue to emerge, even in highly vaccinated populations. The risk of transmission and spread of these viruses is even higher for individuals who are more likely to be exposed, including healthcare workers (HCWs). In healthcare settings, both HCWs and patients are at risk of infection during the care process, potentially leading to nosocomial epidemic outbreaks. Mumps is often underestimated compared with measles and rubella, despite being milder and less likely to spread. In fact, the risk of complications following mumps infection is extremely high, especially if the disease occurs in adulthood. The measles-mumps-rubella (MMR) vaccine has been shown to be an excellent preventive measure. Unfortunately, the mumps component appears to be less effective in inducing immunity than those for measles and rubella (two-dose effectiveness of 85%, 95% and 97%, respectively). The main aim of our study was to investigate the prevalence of detectable mumps antibodies (serum IgG antibodies) in a cohort of Italian and foreign HCWs in relation to personal and occupational factors. We included in the study 468 subjects who underwent health surveillance at the Occupational Medicine Unit of the Tor Vergata Polyclinic in Rome during the period from January 2021 to March 2023. In our study, the proportion of HCWs found to be unprotected against mumps was very high (8.3%), and those found to be immune are below the WHO threshold for herd immunity (95%). From our data, it seems essential that all occupational health services carry out an accurate screening with a dose of anti-mumps antibodies to assess serological protection before starting a job, regardless of an individual's vaccination history. This approach is proving to be beneficial, accurate, as it allows all serologically non-immune individuals to be vaccinated in the workplace, including those who would be protected by their vaccination history but have lost the antibody response.

Health literacy and its association with the control of hypertension

Health literacy (HL) involves self-care skills of healthy people and those with chronic diseases. To assess the association between HL and blood pressure (BP) control in patients with hypertension. A cross-sectional survey was conducted from April to June 2022 in a family medicine unit from the Mexican Institute for Social Security (IMSS). This survey included 349 adults of 18 years of age or older with hypertension diagnosis and antihypertensive pharmacological treatment. HL was measured with the European Health Literacy Survey HLS-EU-Q12M, validated in Mexico. The characteristics of participants with and without BP control were compared with chi-square. Multiple Poisson regression was applied to assess the association between HL and BP control, and it was controlled based on the clinically important covariates. 60.2% of patients with hypertension had BP controlled; 23.8% had inadequate HL, 44.4% problematic HL, and 31.8% sufficient HL. Sufficient HL was associated with BP control only in patients with high school or higher education (adjusted prevalence ratio 2.18, 95% confidence interval 1.16-4.08). Only 60% of hypertensive patients achieve control of their BP. Sufficient HL is associated with greater likelihood of BP control in patients with high school or higher education.

IMPACT OF REMOTE MONITORING ON PATIENTS’ QUALITY OF LIFE. A SINGLE CENTRE STUDY

Objective: PROSIT (Patient Reported Outcomes and Smart Imaging in Telecardiology) is an innovative research initiative designed to explore the efficacy of remote patient monitoring in cardiovascular care. This project leverages wearable technology and patient-reported data to enhance the management of cardiac conditions, aiming to improve both patient outcomes and quality of life. Design and method: We evaluated 100 Caucasian patients, affected by hypertension, who access to Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli” from April to October 2023. Patients were divided in three groups: group A, with a wearable device (Hi) for continuous monitoring and an app with manual vital signs reporting, group B with only manual vital signs reporting through app on personal devices, and group C as the control group. The app for A and B group was able to suggest patient-physician interaction evaluating data inputted. All patients were assigned in different groups with a randomized approach based on factors such as age, gender, ejection fraction, presence of atrial fibrillation, and pulmonary embolism. Results: Telemonitoring usage has led patients to experience safe feelingsin their daily lives. In fact, patients in group B (app only) and A (app and Hi device) presented an improvement, notably significant for those in group A (p&lt;0,05), compared to group C. In contrast, group C did not change their responses after one month of follow-up. Despite encountering minor issues during the trial, all enrolled patients believe that the telemonitoring program and telemedicine visits are commendable. Although the patients themselves have pointed out areas for improvement in the software, this does not diminish the substantial foundation that this technology signifies. No change was found in treatment adherence or blood pressure control. Conclusions: This study leads up to a future where digital support to medical practice will play a crucial role in accessing patient care and therapies, both for patients and clinicians alike. Patients are ready to embrace a new method for accessing care and being monitored by clinicians, one that integrates the old and the new, keeping pace with the times.

A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) has been a significant contributor tomortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on,but the indicators of its early detection are still elusive. The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. Atotal of 110 patientsunderwent a sleep study, of which68 (61.8%)had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09vs 0.930, p = 0.001). HbA1c >7%was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. OSAfrequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalenceof OSAin persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.

Improving clinical reasoning and communication during handover: An intervention study of the BRIEF-C tool

BackgroundExisting handover communication tools often lack a clear theoretical foundation, have limited psychometric evidence, and overlook effective communication strategies for enhancing diagnostic reasoning. This oversight becomes critical as communication breakdowns...

Fetal premature atrial contractions: natural course, risk factors and adverse outcome.

Fetal premature atrial contractions (PAC) are usually benign but may be associated with congenital heart defect (CHD) and tachyarrhythmia, which in turn carry a risk of cardiac failure and fetal death. We aimed to explore the frequency of adverse outcome and to identify risk factors for tachyarrhythmia in pregnancies complicated by fetal PAC. This was a retrospective cohort study of fetuses diagnosed with PAC at two academic centers in Amsterdam, The Netherlands, between 2007 and 2022. Cases with a congenital anomaly and those with a prior diagnosis of CHD or other arrhythmias were excluded. M-mode and Doppler tracings were reanalyzed and the frequency of PAC was recorded. The incidence of the following adverse outcomes was examined: underlying CHD not identified at the 20-week fetal anomaly scan, tachyarrhythmia, other arrhythmia, administration of antiarrhythmic therapy and death. Risk factors for tachyarrhythmia were analyzed using odds ratios (OR). In 24.1% of 1439 referred cases, PAC resolved before confirmation at the fetal medicine unit (FMU). Of the 939 included cases with confirmed PAC, the total incidence of adverse outcome was 6.8% (64/939). CHD was diagnosed in 14 (1.5% (95% CI, 0.9-2.5%)) cases, of which eight were diagnosed prenatally and six postnatally. Compared with baseline, the incidence of CHD was higher in the presence of fetal PAC (OR, 1.8 (95% CI, 1.0-3.3); P = 0.034). Tachyarrhythmia occurred prenatally and/or postnatally in 32 (3.4%) cases, of which eight (25.0%) showed signs of cardiac failure, and in 23 (71.9%) cases, antiarrhythmic therapy was required. No cases of tachyarrhythmia led to fetal or infant death. Risk factors for tachyarrhythmia were PAC with short runs of supraventricular tachycardia (OR, 98.7), blocked PAC (OR, 30.3), PAC in bigeminy (OR, 21.8), frequent PAC (one per 5-10 beats) (OR, 6.9), signs of cardiac failure (OR, 14.2) and the presence of a foramen ovale aneurysm (OR, 5.0). PAC are generally benign and often resolve spontaneously. However, fetuses with an irregular heart rhythm should be referred for advanced ultrasonography, which should focus on classifying the type of PAC and risk of adverse outcome. When risk factors for tachyarrhythmia are identified, weekly fetal heart-rate monitoring is advised until resolution of the PAC. In the absence of risk factors, standard obstetric care may be sufficient, with additional instructions to report reduced fetal movements. Should tachyarrhythmia or cardiac failure develop, referral back to the FMU is indicated. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Magnetic resonance imaging in the second trimester as a complement to ultrasound for diagnosis of fetal anomalies.

Fetal ultrasound has limitations, especially if the patient is obese or in cases with oligohydramnios. Magnetic resonance imaging (MRI) can then be used as a complement, but only few studies have focused on examinations in the second trimester. To validate MRI as a complement to diagnose fetal anomalies in the second trimester. This retrospective study retrieved data from January 2008 to July 2012 from the Fetal Medicine Unit and Department of Radiology at Uppsala University Hospital. Ultrasound and MRI findings were reviewed in 121 fetuses in relation to the final diagnosis, including postpartum follow-up and autopsy results. Of the 121 fetuses, 51 (42%) had a CNS anomaly and 70 (58%) a non-CNS anomaly diagnosed or suspected. MRI provided additional information in 21% of all cases without changing the management and revealed information that changed the management of the pregnancy in 13%. When a CNS anomaly was detected or suspected, the MRI provided additional information in 22% and changed the management in 10%. The corresponding figures for non-CNS cases were 21% and 16%, respectively. The proportion of cases with additional information that changed the management was especially high in patients with a BMI >30kg/m2 (25%) and in patients with oligohydramnios (38%). In five cases in category III, false-positive ultrasound findings were identified. MRI in the second trimester complements ultrasound and improves diagnosis of fetal CNS- and non-CNS anomalies especially when oligohydramnios or maternal obesity is present.