Outpatient Clinical Practice Research Articles

Refining interprofessional, outpatient transitions of care services to reduce hospital readmissions.

Transitions of care between healthcare facilities are associated with increased risk of adverse events and hospital readmissions. Previous studies employing pharmacists in transitions of care showed reduced 30-day readmissions, however, many were without an active comparator. There is no standardized approach to pharmacist involvement in transitions of care services, making it difficult to ascertain where pharmacist expertise is most meaningful. This paper aims to compare the 30-day hospital readmissions between an interprofessional hospital discharge visit (iHDV) with physician and pharmacist involvement to a non-interprofessional HDV (PHDV) without pharmacist involvement. This was a retrospective quality improvement initiative examining patients of two outpatient clinical practices within a large, academic medical centre. The primary analysis compared 30-day hospital readmission rates for patients with a scheduled PHDV or iHDV within 30-days of index hospital discharge date, regardless of attendance at the HDV. The secondary outcome compared 30-day hospital readmission rates for patients who completed a PHDV or iHDV. Primary and secondary outcomes were evaluated using bivariate analysis and multivariate analysis by stepwise logistic regression, for both intention-to-treat (ITT) and per protocol (PP). This study found significantly lower 30-day hospital readmissions for patients scheduled for a PHDV compared to an iHDV (16.7% vs 21.5%, P = .0230) in an unadjusted analysis, but no significant difference in adjusted analyses (P = .4856). Per-protocol analysis found no significant difference in 30-day hospital readmission rates between groups in unadjusted and adjusted analyses. Visit completion rates were significantly different between groups, with approximately twice as many PHDV group patients completing visits as compared to the iHDV group (74.1% vs 61.5%, P < .0001). This study demonstrates an interprofessional clinic visit employing a clinical pharmacist in the post-hospital discharge visit did not significantly reduce 30-day hospital readmission rates compared to a post-hospital discharge visit without pharmacist involvement.

A Clinical Update on Childhood Hypertension.

Hypertension is one of the leading morbid factors in adults but often a less noticeable concern in childhood age group. Young population is now more vulnerable to lifestyle disorders leading to early chronic diseases if not addressed due to presence of ignorance and inadequate assessment. To label hypertension in pediatric age group, blood pressure should be ≥ 95th percentile for age, height and sex in small children. Purpose of review is to unfurl the knowledge for monitoring and management of hypertension in children. We emphasize the need to spread awareness in community, especially in rural areas of low and middle economy nations, which is surely lacking despite available tools for more then 60-70 years. Comprehensive clinical update on recent information on epidemiology, the diagnosis, evaluation and management of pediatric hypertension for outpatient clinic practice.

Nurses' Experiences When Introducing Patient-Reported Outcome Measures in an Outpatient Clinic: An Interpretive Description Study.

Application of patient-reported outcome measures (PROM) seems to be a step toward person-centered care and identifying patients' unmet needs. To investigate the experiences of nurses when PROMs were introduced in a hematological clinical practice as part of a multimethod intervention study. The qualitative framework was guided by the interpretive description (ID) methodology, including a focused ethnographic approach with participant observations and interviews. The instruments introduced were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Outcomes and Experiences Questionnaire. Analysis was inspired by Habermas' critical theory. The analysis revealed 2 predominant themes of nurses' experiences: "PROMs are only used when there is time-which there rarely is" and "PROMs cannot be used without a strategy, just because they are present." Nurses' experiences with PROMs depended on the systems' rationale, resulting in limited capacity to use and explore PROMs. Nurses believed that PROMs might have the potential to support clinical practice, as PROMs added new information about patients' conditions but also identified needs within supportive care, leaving the potential of PROMs uncertain. Simply introducing PROMs to practice does not necessarily actuate their potential because use of PROMs is dependent on institutional conditions and mandatory tasks are prioritized. This study contributes knowledge of nurses' experiences when introducing PROMs in a hematological outpatient clinical practice. Findings can guide future PROMs research within the field of nursing.

Improving clinic utilization and workload capture for clinical pharmacy specialists.

To assess a quality improvement initiative aimed at improving clinic utilization and encounter and intervention workload capture for clinical pharmacy specialists. This initiative aided in justification of clinical pharmacy services, identification of clinical areas for intervention, and incorporation of all modalities to appropriately document clinical care. In order to objectively demonstrate clinical pharmacy service value to stakeholders, pharmacy administrators and clinical pharmacy specialists at the North Florida/South Georgia Veterans Health System performed clinic scheduling and profile reviews using data extracted from the Veterans Health Administration electronic health record and analytic software. Outpatient clinical pharmacy specialty practice areas were primarily investigated; the specialty areas included are as follows: cardiology, infectious disease, mental health, oncology, pain management/palliative care, and specialty clinics (a collection of medical and surgical subspecialties). The first intervention entailed completing a worksheet and assessing clinic utilization data. Then, an evaluation was performed to assess the number of encounters, clinical interventions, clinic modalities, and coding for each clinic. Next, a meeting was arranged with each like clinical pharmacy specialist practice group to discuss this collected data. During these meetings, the delineation of where workload was generated and the activities taking place in an average workday were discussed. Finally, clinics were adjusted to reflect appropriate clinic coding and mapping of the average workday. Metrics were evaluated pre intervention (October through December 2017) and post intervention (July through September 2018). After intervention, there were statistically significant increases in clinic utilization, total encounters completed, and total interventions recorded in the composite group of clinical pharmacy specialists. The increases in clinic utilization, total encounters, and interventions observed for the clinical pharmacy specialists suggest the beneficial role of pharmacy administrators' collaboration with clinical pharmacy specialists to improve workload capture and access to quality care, to justify clinical pharmacy services, and to identify opportunities for pharmacy clinical intervention.

‘Learning the Ropes’—Preparing Palliative Care Clinicians for Outpatient Practice (FR479)

•Establish the elements of an educational needs assessment to guide training of outpatient PC clinicians.•Review a subset of HPM fellowship milestones and discuss their relationship to basic knowledge, skills, and attitudes essential for outpatient PC practice.•Identify educational methods to prepare PC clinicians for successful outpatient practice and integrate these educational methods into their local practices. Outpatient palliative care (PC) practices are increasingly prevalent as the recognized value of concurrent palliative- and disease-directed care grows in various disease types. PC providers who practice exclusively in a consultative inpatient model, as well as learners (such as Hospice and Palliative Medicine (HPM) fellows, Advanced Practice Provider (APP) students, and clinicians transitioning from other specialties) are often unprepared for the unique clinical challenges of outpatient PC practice. Needs vary significantly based on prior practice locations and clinician experience, since HPM fellows and APPs can come from a variety of specialties. Therefore, PC programs must be equipped to identify the unique educational needs of outpatient PC providers at their institution and apply established educational methods to meet these unique learning needs and promote productive outpatient clinical practice. This concurrent session will present the results of needs assessments of faculty, learners, and APPs at six institutions with established outpatient PC practices and will provide participants with tools to conduct their own assessments. A case-based approach will be used to identify the knowledge, skills, and attitudes required to overcome these challenges. Alignment of these educational domains to ACGME Milestones for HPM Fellowships will be highlighted to identify broadly-applicable categories of learning objectives for multidicipliary outpatient PC providers in varied practice settings. Finally, a sample of time-efficient, interactive, and clinically-focused educational modalities will be presented. Upon completion of this concurrent session, attendees will be equipped with a plan to conduct their own local needs assessment and implement simple educational strategies for the outpatient setting.

The use of long acting antipsychotics in outpatient care

To determine the frequency of administration, efficacy and safety of long acting antipsychotics in day-to-day psychiatric practice in outpatient clinics. The study included 90 patients with schizophrenia treated with haloperidol decanoate (n=18), rispolept consta (n=19), clopixol depot (n=25), paliperidone palmitate (n=25). Symptoms of schizophrenia were assessed with PANSS during 12 months. The use of long acting antipsychotics has proven to be effective and safe to control all symptom clusters in patients regardless of the disease duration.

Thyroid Radiology Practice: Diagnosis and Interventional Treatment of Patients with Thyroid Nodules

갑상선 영상의학 진료란 갑상선 질환 환자를 영상의학적 방법을 활용하여 질병 진단과 중재적 치료를 하는 의료 행위로 정의될 수 있으며 주요 진료 대상은 갑상선 결절 질환 환자들이다. 갑상선 결절의 진단은 일차적으로 초음파 영상진단과 생검에 의해서 이루어지고 결절의 치료는 비수술적 중재적 치료와 갑상선절제술이다. 갑상선 낭종 혹은 낭성우세 양성 결절에서는 에탄올절제술이 일차적 치료법이고 고주파절제술은 고형 혹은 고형우세 양성 결절과 갑상선 재발암 치료에 적용되고 있다. 갑상선 영상의학 진료는 갑상선 결절 질환 환자의 진단 및 비수술적 치료의 대부분을 담당하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다. 환자에게 최적의 갑상선 영상의학 진료를 제공하기 위해서는 영상의학과 외래에서 환자를 진료하는 것이 바람직하며 외래 중심의 갑상선 영상의학 진료를 확대하도록 함께 노력해야 할 시점이다.

Health Empathy Map: Creation of an Instrument for Empathy Development

Abstract: Introduction: Empathy is a multidimensional construct that requires the ability to perceive and understand the others’ perspectives, as well as feel their emotional state. It is an intellectual skill to be learned and represents one of the domains of emotional intelligence. The aim of this study was to create an instrument for the teaching and practice of empathy skills in medical education scenarios, called the “Health Empathy Map” (HEM). Method: This is a qualitative and descriptive study, aimed at developing the Health Empathy Map. The study had 3 phases: (1) Adaptation of the empathy map for medical education scenarios (2) Adequacy of the instrument content performed by teachers from the Outpatient Clinic of José do Rosário Vellano University, during teacher training (3) Assessment of content and feasibility of the instrument, first performed using the focal group technique and then by third-year medical students during outpatient clinic practice and in the tutorial group. Results: The adequacy of the instrument for medical education teaching scenarios was based on conceptual aspects of empathy: perspective-taking, emotional sharing and empathetic concern, as well as suggestions from the outpatient clinic teachers, focal group participants and medical students. All suggestions were debated and accepted, after a consensus that indicated advances and improvements of the instrument, in order to allow its use by students in health learning scenarios. Conclusion: The final version of the HEM was considered by participants of different phases of the study, as an educational instrument with great instructional potential, in terms of stimulating the development of empathy, with a broad use in medical education scenarios.

Health Empathy Map: Creation of an Instrument for Empathy Development

Abstract: Introduction: Empathy is a multidimensional construct that requires the ability to perceive and understand the others’ perspectives, as well as feel their emotional state. It is an intellectual skill to be learned and represents one of the domains of emotional intelligence. The aim of this study was to create an instrument for the teaching and practice of empathy skills in medical education scenarios, called the “Health Empathy Map” (HEM). Method: This is a qualitative and descriptive study, aimed at developing the Health Empathy Map. The study had 3 phases: (1) Adaptation of the empathy map for medical education scenarios (2) Adequacy of the instrument content performed by teachers from the Outpatient Clinic of José do Rosário Vellano University, during teacher training (3) Assessment of content and feasibility of the instrument, first performed using the focal group technique and then by third-year medical students during outpatient clinic practice and in the tutorial group. Results: The adequacy of the instrument for medical education teaching scenarios was based on conceptual aspects of empathy: perspective-taking, emotional sharing and empathetic concern, as well as suggestions from the outpatient clinic teachers, focal group participants and medical students. All suggestions were debated and accepted, after a consensus that indicated advances and improvements of the instrument, in order to allow its use by students in health learning scenarios. Conclusion: The final version of the HEM was considered by participants of different phases of the study, as an educational instrument with great instructional potential, in terms of stimulating the development of empathy, with a broad use in medical education scenarios.

Atopic dermatitis: the use of antihistamines for children in outpatient clinical practice

Atopic dermatitis: the use of antihistamines for children in outpatient clinical practice

The Treatment Algorithm for Meibomyitis, Hordeolum and Halazion

Despite the fact that the frequency of treatment the eyelids inflammatory diseases affecting the modified sebaceous glands (Meibomian glands, Zeiss glands) is very high in outpatient clinical practice, and the basic principles of treating this pathology are well known to everyone, there are always many questions. Therefore, interdisciplinary approach with gastroenterologists, dermatologists, endocrinologists and other specialists is often required treatment of this patients group. In addition, the transition of the inflammatory process to a chronic form and the encapsulation of the inflammatory focus and / or the formation of a halazion requires an accurate algorithm of actions from the practitioner, which depends on the duration of the pathological process. There is always a question — what form of an antibacterial drug is better to prescribe — ointment or drops? In addition, there is no consensus on the use of hormone therapy in the treatment of meibomyitis, hordeolum and chalazion. This article presents an algorithm for the prevention and treatment of this group of patients, which involves a certain sequence of therapeutic and preventive measures, depending on the severity and duration of the inflammatory process. Eyelid hygiene (warm compresses + self-massage of the eyelids with gel) is recommended in case of chronic blepharitis clinical signs, complaints of dryness, discomfort, wearing contact lenses. In case of the acute inflammatory process — meibomyitis and/or hordeolum in addition to eyelid hygiene, local antibiotic therapy is recommended. If a halazion is forming the choice of treatment tactics (local instillation therapy, intracapsular administration of a prolonged corticosteroid or surgical treatment) depends on the halazion duration (more or less than 2 months). The presented algorithm has the practical importance, since adequate treatment will not only eliminate the focus of chronic infection on the eyelids, but also improve the patient’s quality of life, since the presence of such a disease gives pronounced psycho-emotional discomfort because of its localization zone.

A 2-step fast-track elastometry service for advanced workup of nonalcoholic fatty liver disease (NAFLD) patients - single-center real-world experience of outpatient clinical practice.

Nonalcoholic fatty liver disease (NAFLD) is increasing globally with an estimated prevalence of approximately 25 %. Nonalcoholic steatohepatitis as the progressive disease entity often leads to fibrosis and end-stage disease. The magnitude of NAFLD patients are not diagnosed and have no access to further clinical assessment. Diagnostic pathways for individual risk evaluation fitting with available resources are of utmost importance in real-world clinical practice. Retrospective analysis of 1346 anonymized outpatient datasets at Würzburg University Hospital, Germany. Transient elastography (TE) with controlled attenuation parameter and laboratory-based risk scores (NFS, FIB-4) were the main diagnostic workup tools for risk stratification. After preselection based on questionnaire information NAFLD still accounts for one-fifth of patients in the liver outpatient service. More than 80 % of NAFLD patients receive their first-time diagnosis in our unit. Laboratory-based risk scores and TE are valuable tools for second-step risk assessment as shown in our clinical data analysis. Moreover, 65 % of NAFLD patients use inpatient services for at least 1 day. The policy to perform liver biopsy in high-risk patients above the recommended threshold of 9.6 kPa if any clinical doubt exists regarding the diagnosis of cirrhosis leads to a histological down staging in almost 80 %. Questionnaire-based referral from primary care followed by broadly available fast-track TE and eventually liver biopsy for selected patients is the standard practice in our unit. This approach represents a feasible model to handle the large gap between availability and clinical need for TE facilities.

Remote follow-up using patient-reported outcome measures in patients with chronic kidney disease: the PROKID study \u2013 study protocol for a non-inferiority pragmatic randomised controlled trial

BackgroundOutpatient care is steadily changing from hospital consultations to other platforms, such as phone consultation and online virtual clinics. It is prudent to maintain quality of care with such initiatives. Currently, patients with chronic kidney disease (CKD) have frequent scheduled visits, but it may be possible to optimise the frequency of hospital consultations using information from patient-reported outcome (PRO) questionnaires filled in at home (PRO-based follow-up). This approach may provide a more individually tailored follow-up based on actual needs for clinical attention. We aimed to evaluate the effectiveness of the quality of care, use of resources and patient outcomes associated with PRO-based follow-up in patients with CKD.MethodsThis study is a pragmatic, non-inferiority, randomised controlled trial in outpatients with CKD (Grove BE et al., Qual Life Res 27: S143, 2018). Newly referred patients with an estimated glomerular filtration rate (eGFR) of ≤40 ml/min 1.73m2 will be randomised to either:PRO-based remote follow-upPRO-based telephone consultationUsual outpatient follow-up (control group)In the two intervention groups, a diagnosis-specific PRO questionnaire completed by the patient at home will substitute for usual outpatient follow-up visits. The PRO questionnaire will in part be used as a screening tool to identify patients in need of outpatient contact and to identify focus areas. Responses from the questionnaire will be processed according to a disease-specific algorithm and assigned green, yellow or red status according to patients’ needs.The primary outcome will be loss of renal function evaluated by eGFR. Secondary outcomes are 1. Clinical outcomes, including initiation of acute dialyses, hospitalisation and mortality, 2. Utilisation of healthcare resources and 3. PRO measures, primarily quality of life (Euroqol EQ-5D) and illness perception (Brief Illness Perception Questionnaire (BIPQ).DiscussionBenefits and possible drawbacks of the PRO-based follow-up will be evaluated. If PRO-based follow-up proves non-inferior to usual outpatient follow-up, a reorganisation of routine clinical practice in nephrology outpatient clinics may occur. Further, results may impact other patient groups with chronic conditions attending regular follow-up.Trial registrationClinicalTrials.gov identifier NCT03847766 (Retrospectively registered on January 23, 2019).

"I Am Sure That They Use My PROM Data for Something Important." A Qualitative Study About Patients' Experiences From a Hematologic Outpatient Clinic.

Patient-reported outcome measures (PROMs) in clinical practice have the potential to contribute to and support shared decision-making processes by giving voice to patient concerns during consultations. However, the perspectives of patients diagnosed with chronic hematologic cancer on the use of PROMs are unknown. To describe how patients diagnosed with hematologic cancer experience participating in a randomized PROM intervention study, including initial invitation, completion of questionnaires, and outpatient clinic visits. A qualitative conceptual framework guided the study, using Interpretive Description with a focused ethnographic approach to explore patient experiences with PROMs in applied practice. Analysis was inspired by Habermas' social theory of communicative action. The analysis revealed 3 predominant themes of patient experiences: that PROMs were "In the service of a good cause," "The questions are not really spot on," and "PROMs are sometimes used for something," that is, unknown to the patient. The patients' experiences were dominated by the perspective of the healthcare system and by gratitude and imbalanced power relations. During completion of questionnaires, patients struggled to identify with items, and the questionnaires were associated with low content validity. When visiting the outpatient clinic, patients reported that doctors and nurses rarely discussed patients' PROMs. This study contributes knowledge of patient experiences of the integration of PROMs in hematologic outpatient clinical practice. Findings can guide further research and improve future implementation of PROMs.

C-06 Differential and Dual Diagnosis of Alzheimer’s Disease and Personality Disorders: Performance on WAIS-IV Subtests

Abstract Objective Certain personality disorder (PD) diagnoses are related to the development of dementing disorders. There is a higher rate of comorbidity of PD in samples of patients with dementing disorders compared to healthy controls, which can lead to difficulties during the diagnostic process. The present study seeks to identify the neurocognitive correlates of those diagnosed with Alzheimer’s dementia (AD) compared to PD, potentially aiding in differential diagnosis. Method Data was collected as part of a large assessment outpatient clinical practice. The data contained 580 participants who came to the clinic with a variety of referral questions (e.g., neurological diagnosis, personality functioning, ADHD assessment). To measure cognitive functioning, participants were administered the WAIS-IV. Participants included 43 people diagnosed with AD and 18 with PD. Results Subtest scores for participants diagnosed with AD were lower than participants with PD. We adjusted the mean level difference using vocabulary. Using regression, we pulled out the variance associated with vocabulary as it is not susceptible to cognitive decline. Block design was significantly different for the two groups even after controlling for vocabulary (r-square = .06; p = .017). Matrix reasoning was significantly different for the two groups even after controlling for vocabulary (r-square = .09; p = .005). Conclusions The differential diagnosis of PD and dementing disorders is important, and thus these findings are important in beginning to understand the cognitive patterns in those with AD and PD. Past research has not controlled for intellectual functioning. However, additional research utilizing larger sample sizes and an extensive test battery is necessary.

Evaluation of a Commercial Colloidal Gold Assay for Detection of Influenza A and B Virus in Children’s Respiratory Specimens

Objective: To evaluate the clinical diagnostic value of colloidal gold assay for detection of influenza A and B virus. Methods: Results were compared for colloidal gold assay for influenza antigen detection and real-time RT-PCR for RNA detection. Results: By performing the colloidal gold assay, the positive rate was 25.67% (105/409) for influenza A virus and 8.56% (35/409) for influenza B virus. While tested by real-time RT-PCR, 107(26.2%) were positive for influenza A virus and 35(8.6%) for influenza B virus. Using real-time RT-PCR as the gold standard, the sensitivity and specificity of the colloidal gold assay were 84.1% and 95.0%, respectively, for influenza A virus and 85.7% and 98.7% for influenza B virus. Conclusion: This colloidal gold assay may be one of the viable tools for the rapid screening for influenza viruses in an outpatient clinical practice.

Current Practices for Outpatient Initiation of Levodopa-Carbidopa Intestinal Gel for Management of Advanced Parkinson’s Disease in the United States

In 2015, the US Food and Drug Administration approved levodopa-carbidopa intestinal gel (LCIG; also known as carbidopa-levodopa enteral suspension in the US) for the treatment of motor fluctuations in patients with advanced Parkinson’s disease. LCIG provides a continuous infusion of levodopa and carbidopa by means of a portable pump and percutaneous endoscopic gastrojejunostomy tube. The delivery system has a two-fold pharmacokinetic advantage over orally administered carbidopa/levodopa. First, levodopa is delivered in a continuous rather than intermittent, pulsatile fashion. Second, delivery to levodopa’s site of absorption in the jejunum bypasses the stomach, thereby avoiding issues with erratic gastric emptying. In blinded prospective clinical trials and observational studies, LCIG has been shown to significantly decrease “off” time, increase “on” time without troublesome dyskinesia, and reduce dyskinesia. Consistent with procedures in previous studies, LCIG initiation and titration in the pivotal US clinical trial were performed in the inpatient setting and followed a standardized protocol. In clinical practice, however, initiation and titration of LCIG have a great degree of flexibility and, in the US, almost always take place in the outpatient setting. Nonetheless, there remains a significant amount of clinician uncertainty regarding titration in outpatient clinical practice. This review aims to shed light on and provide guidance as to the current methods of titration in the outpatient setting, as informed by the medical literature and the authors’ experiences.FundingAbbVie, Inc.Plain Language SummaryPlain language summary available for this article.

The Range and Reproducibility of the Liver Frailty Index.

The Liver Frailty Index (LFI), composed of 3 performance-based tests (grip strength, chair stands, and balance), is a tool specifically developed in patients with cirrhosis to objectively measure physical function, a critical determinant of health outcomes. We aimed to (1) determine the range of LFI scores in adults with chronic liver disease but without cirrhosis, (2) determine the range of LFI scores in adults without known liver disease, and (3) evaluate reproducibility of the LFI in adults with cirrhosis listed for liver transplantation. Intraclass correlation coefficient (ICC) assessed interrater reliability of the LFI. Included were 91 adults with chronic liver disease, 109 adults without known liver disease, and 166 adults with cirrhosis with median Model for End-Stage Liver Disease-sodium of 16. Median (interquartile range) LFI was 3.6 (3.1-4.1) in adults with cirrhosis, 3.1 (2.5-3.7) in adults with chronic liver disease but not cirrhosis, and 2.7 (2.2-3.2) in adults without liver disease (P<0.001). Using established LFI cutoffs for robust, prefrail, and frail categories, adults with cirrhosis or chronic liver disease were less likely to be robust (29% versus 53% versus 77%) and more likely to be prefrail (57% versus 42% versus 22%) or frail (14% versus 5% versus 1%) when compared with adults without liver disease (P<0.001). The LFI had excellent reliability with ICC of 0.93 (95% confidence interval, 0.91-0.95). In conclusion, the LFI has external validity in noncirrhotic populations and is highly reproducible among different raters. This objective assessment tool can be implemented in outpatient clinical practice or research to operationalize the concept of physical frailty.

Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians' weight screening practice in outpatient clinics, Saudi Arabia.

BackgroundBMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts.MethodsThis retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6–14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians’ identification of weight status. The recommended management plan for identified patients was also recorded.ResultsA total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians’ correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians—25% as compared to family medicine physicians—10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th - 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th - 95th} category—6% [p = 0.007].ConclusionPhysician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.

Anticoagulant therapy and components of the metabolic syndrome in patients with atrial fibrillation in real outpatient clinical practice

The aim of the study was to determine the prevalence of atrial fibrillation (AF) in patients hospitalized in the therapeutic and cardiology departments of the St. Petersburg hospital, and to analyze the prevalence of the number of components of the metabolic syndrome (MS) in patients with AF and anticoagulant therapy (ACT) assigned to outpatient stage to hospitalization. A retrospective analysis of 1760 case histories of patients hospitalized in the therapeutic and cardiology departments of the Therapy Clinic of the Faculty of Pavlov State Medical University named after IP Pavlov for 2017 was performed. It was established that AF was found in 16.5% (286) patients hospitalized in 2017. Among the causes of AF in patients, the number of components of MS was analyzed: 0 – 2.1% (6), 1 – 4.5% (13), 2 – 19.2% (55), 3 – 34.3% (98), 4 – 31.5% (90), 5 – 8.4% (24), thus MS with 3 or more components installed in 74.1% (212) surveyed in 2017. 58.7% (168) received ACT at the time of hospitalization, and 41.3% did not receive it (118). In 32,9% of patients with AF did not receive anticoagulant therapy at the prehospital stage, with no contraindications for administration. Among patients receiving ACT at the time of hospitalization, direct oral anticoagulants were prescribed 2 times more often than warfarin (69% and 31%, р = 0,01).