Hospital Outpatient Clinic Research Articles

Patient satisfaction with rehabilitation services following traumatic brain injury: a quality registry study.

To examine factors associated with patient satisfaction with rehabilitation services received after traumatic brain injury. Cross-sectional study. Persons with mild to severe traumatic brain injury (n = 1,375) registered in the "Oslo TBI Registry - Rehabilitation" quality register at Oslo University Hospital from 1 January 2018-31 July 2022. Sociodemographics, injury-related variables, patient-reported outcome measures, global functioning, and rehabilitation-related variables were recorded at hospital outpatient visits. The patients reported satisfaction with services received at the outpatient clinic and in primary healthcare at the final follow-up. Multivariable logistic regression models were applied to examine factors associated with patient satisfaction. Of 316 patients, 83% reported satisfaction with services received at the hospital outpatient clinic. Belief in recovery (odds ratio [OR] = 2.73), shorter time to follow-up (OR = 0.39), and lower symptom burden (OR = 0.96) significantly increased satisfaction. Among 283 patients, 62% reported satisfaction with services in primary healthcare, where belief in recovery (OR = 2.90), shorter time to follow-up (OR = 0.50), higher age (OR = 1.04), and higher number of rehabilitation services received in primary healthcare (OR = 1.32) significantly increased satisfaction. Across service levels, the strongest associated factors for satisfaction were belief in recovery and shorter time to follow-up, suggesting that timely delivery of traumatic brain injury-related specialized services could increase overall satisfaction.

A deep learning based method for left ventricular strain measurements: repeatability and accuracy compared to experienced echocardiographers.

Speckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values. We hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists. Data consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values. DL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58-0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03-1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland-Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance. The study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.

Successful Management of High-Risk Pregnancy with TORCH Infection History and Chronic Hypertension

A 41-year-old pregnant woman of Javanese ethnicity attended the outpatient clinic of a private hospital, presented with fifth pregnancy and no living children due to a history of ectopic pregnancy, two times IUFD, and one time neonatal death. The patient also had a history of chronic hypertension and asthma. The examination showed positive IgG Toxoplasma and CMV antibody levels. The patient's blood pressure also never touched the normal limit since the beginning of pregnancy. At the end of pregnancy, she had very high blood pressure and proteinuria. According to WHO Maternal Mortality Rate (MMR) is still very high, where two of the five highest causes are infection and hypertension in pregnancy. High risk pregnancies require special attention in monitoring during pregnancy and management. In a history of bad obstetrical history it is necessary to screen for infection which can be done by antibody serology testing. A positive IgG indicates immunity to the virus, if possible it is necessary to check IgG Avidity to determine whether therapy is still needed or can rely on the immune system that has been formed. Chronic hypertension (Systolic Blood Pressure (SBP) > 140 mmHg and / or Diastolic Blood Pressure (DBP) > 90 mmHg since < 20 Weeks Gestational Age (WGA) until 42 days after delivery). First-line Labetalol and Nifedipine or second-line Methyldopa and Hydrochlorothiazide should be considered depending on the condition and gestational age. If there are signs of preeclampsia, termination should be done if possible, along with antihypertensives and anticonvulsants such as MgSO4.

Effects of Kinesio tape on individuals with carpal tunnel syndrome: a randomized controlled study

ObjectiveCarpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS.MethodThis was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR).ResultsBoth the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65–3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22–1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33.ConclusionThis study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude.Clinical Trial Registrationhttps://doi.org/10.1186/ISRCTN82192319, ISRCTNregistry (No. ISRCTN82192319).

Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework

BackgroundLanguage and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians.MethodsIn this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework.ResultsWe identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians’ lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments.ConclusionCultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups.

Identifying and Estimating Frailty Phenotypes by Vocal Biomarkers: Cross-Sectional Study.

Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are seldom discussed in the literature on the aging voice. This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers. Participants aged ≥60 years who visited the geriatric outpatient clinic of a teaching hospital in central Taiwan between 2020 and 2021 were recruited. We identified 4 frailty phenotypes: energy-based frailty, sarcopenia-based frailty, hybrid-based frailty-energy, and hybrid-based frailty-sarcopenia. Participants were asked to pronounce a sustained vowel "/a/" for approximately 1 second. The speech signals were digitized and analyzed. Four voice parameters-the average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4)-were used for analyzing changes in voice. Logistic regression was used to elucidate the prediction model. Among 277 older adults, an increase in A1 values was associated with a lower likelihood of energy-based frailty (odds ratio [OR] 0.81, 95% CI 0.68-0.96), whereas an increase in A2 values resulted in a higher likelihood of sarcopenia-based frailty (OR 1.34, 95% CI 1.18-1.52). Respondents with larger A3 and A4 values had a higher likelihood of hybrid-based frailty-sarcopenia (OR 1.03, 95% CI 1.002-1.06) and hybrid-based frailty-energy (OR 1.43, 95% CI 1.02-2.01), respectively. Vocal biomarkers might be potentially useful in estimating frailty phenotypes. Clinicians can use 2 crucial acoustic parameters, namely A1 and A2, to diagnose a frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype.

The role of Pharmaceutical Marketing in Prescribing Decisions in a Developing Country: A Comprehensive Study Exploiting Theory of Planned Behaviour

Background: Prescription medicines have become a major component of health systems in both developed and developing countries contributing to, may be, more than half of the total health care expenditure in the developing countries. Although literature directly attributing rise in medicines expenditure to prescribers’ decision, but still only a few researches had employed studies with sound theoretical foundations to comprehensively examine prescribing decision behaviours. Our objective was to investigate potentially modifiable factors, which may influence prescribing decisions of physicians employing theory of planned behaviour. Method: A quantitative survey approach was used to investigate the proposed hypotheses. Population was physicians in outpatient clinics in both private and governmental hospitals in Sana’a, capital city of Yemen. A structured questionnaire was designed to measure the influence of drug-promoting marketing techniques on physicians’ prescribing decisions. Data was collected through an anonymous survey questionnaire. The hypotheses were tested by multiple regressions analysis. Ethical approval was obtained from the Ethical Committee of the Ministry of Public Health and Population (MoPHP), and participants provided written consent before enrolling in the study. Result: Physicians admitted the presence of promotional influence on their prescribing decision. The study revealed that receiving low-value promotional items, belief of physicians that it is appropriate to accept both low- and high-value promotional items, physicians’ exposure to company-direct sources of information, and drug promotion-related factor all are positively and significantly related to physicians’ prescribing decisions (? = 0.438, p <0.001; ? = 0.089, p =0.027; ? = 0.157, p <0.001; ? = 0.093, p =0.032; and ?= 0.118, p = 0.007 respectively). Conclusion: This research clarified the role played by pharmaceutical companies to influence prescribing decisions of physicians. Therefore, could provide theoretical framework for policymakers in Yemen, and other countries with similar conditions, to develop a suitable policy and strategy in terms of drug promotion.

The association between nicotine dependence and sleep quality in patients referred to a smoking cessation outpatient clinic: A cross-sectional study.

Nicotine addiction is one of the most common forms of dependence. It is shown to be associated with many chronic diseases that develop mostly through smoking. The association between sleep quality and smoking or nicotine addiction has not been clarified yet. This study aimed to investigate the association between nicotine addiction and sleep quality. In this cross-sectional study, the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Fagerström test for nicotine dependence (FTND), and Hospital anxiety-depression scale (HADS) were administered to patients who applied to the smoking cessation outpatient clinic of a reference hospital between April and June 2023. FTND measured nicotine dependence, and its association with sleep quality estimated by PSQI was assessed by binary logistic regression with the potential confounders. In the study group of 280 participants, 67.1% were male, and 57.8% had poor sleep quality. The median (IQR) FNTD score was 7.0 (3.0), and the median global PSQI score was 6.0 (5.0). Poor sleep quality increased by 1.12 times (AOR=1.12; 95% CI: 1.02-1.22, p=0.016) for each unit increase in hospital anxiety score and by 1.22 times (AOR=1.22; 95% CI: 1.05-1.42, p=0.011) for each unit increase in FTND score. Increased nicotine dependence and anxiety are independently associated with poor sleep quality. The findings support smoking cessation efforts. It is recommended to study the effect of combating anxiety and tobacco addiction to improve sleep quality.

The Estimation of Copper Serum Level Among Obese Children

Background: Obesity means an excess amount of body fat. No general agreement exists on the definition of obesity in children as it does adults. Most professionals use published guidelines based on the body mass index (BMI), or a modified BMI for age, to measure obesity in children. Others define obesity in children as body weight at least 20% higher than a healthy weight for a child of that height, or a body fat percentage above 25% in boys or above 32% in girls Objective: to estimate the serum level of copper among obese children. Methods: This comparative study was conducted on fifty of overweight and/or obese children (based on BMI) and thirty of clinically healthy, age and sex matched children's served as controls also, the cases and controls were selected randomly from the pediatrics outpatient clinic of Benha University Hospital and Sheben El Kom Educational hospital, in the period between 2013 to 2015. Parental consent was obtained for all children included in the study. Results: In the current study there were no significant difference found between patients and control group regarding age, sex and residence, but there was significant difference between the two groups regarding income and socioeconomic state. P=0.04. Also, there were no static difference in height in patient when compared to control group, and patients had a higher statically significant Weight, BMI and Skin fold thickness when compared to control group. Additionally, that there were significantly higher rate of frequent bad nutritional habits including shipping breakfast (p=0.022) consumption of energy- dense food and food consumption during TV watch in patients than controls. P< 0.001 and the children's physical activity levels were lower in the patient’s group than the control group. P<0.001. Conclusion: The obesity varied remarkably with different socioeconomic levels. Obese children had a characteristic nutritional pattern like skipping breakfast and consumption of energy dense food

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

CRP Levels and Vitamin D as Predictors of Asthma Control: A Data-Driven Approach

Background: Asthma is a chronic inflammatory disease of the airways characterized by episodic exacerbations and airflow obstruction. Elevated C-reactive protein (CRP) levels indicate systemic inflammation and are associated with increased disease severity in asthma. Additionally, vitamin D is thought to modulate immune responses and inflammation, potentially influencing asthma control. This study explores the relationships between CRP levels, vitamin D levels, and asthma control, as measured by the Asthma Control Test (ACT). Objectives: The primary objective of this study was to assess the correlation between CRP levels, vitamin D levels, and asthma control in adult patients with asthma. The study aimed to determine whether CRP and vitamin D could serve as predictive markers for asthma control. Methods: This single-center, prospective observational study enrolled 40 adult patients with confirmed asthma from the outpatient pulmonary clinic of ESIC Government Hospital, Guwahati, Assam, India. Asthma control was evaluated using the ACT, with scores categorized as well-controlled (ACT ≥ 20) or poorly controlled (ACT < 20). Serum CRP and vitamin D levels were measured using the ELISA method. Pearson’s correlation coefficient and ANOVA were employed to analyze the relationships between these variables. Results: The study found a moderate negative correlation between CRP levels and ACT scores (r = -0.58), indicating that higher CRP levels were associated with poorer asthma control. Patients with CRP levels greater than 10 mg/dL had significantly lower mean ACT scores compared to those with lower CRP levels. In contrast, a strong positive correlation was observed between vitamin D levels and ACT scores (r = 0.879), with higher vitamin D levels associated with better asthma control. The ANOVA test revealed significant differences in ACT scores across different vitamin D and CRP categories (p < 0.05). Conclusions: The study suggests that elevated CRP levels are indicative of poorer asthma control, while higher vitamin D levels are associated with better control of asthma. CRP and vitamin D levels may serve as valuable biomarkers for assessing asthma severity and guiding treatment strategies. However, the variability in response to vitamin D supplementation highlighted the need for personalized approaches to asthma management. Further research is required to confirm these findings and explore the underlying mechanisms.

Analysis of factors affecting the accuracy of colposcopic diagnosis of cervical lesions: a retrospective cohort study.

Cervical cancer is a leading cause of cancer-related deaths among women. However, in developing countries, the primary focus for cervical cancer prevention and control remains on the timely detection and treatment of precancerous lesions. This study aims to evaluate the accuracy of colposcopic diagnosis of cervical intraepithelial lesions and analyze the factors influencing its accuracy. This study collected data from 512 eligible patients who visited the gynecology outpatient clinic of the Second Hospital of Jilin University from January 2022 to August 2023. The final diagnosis was based on the highest grade observed in both biopsy pathology and postoperative pathology. A self-controlled, retrospective analysis was conducted to evaluate the accuracy of colposcopic diagnosis. Univariate analysis was used to assess the impact of factors such as menopausal status, duration of menopause, high-risk human papillomavirus (HR-HPV) genotypes, and transformation zone (TZ) types on the accuracy of colposcopic diagnosis of cervical lesions. The overall colposcopy diagnostic concordance rate was 78.71%. The concordance rates between the premenopausal and postmenopausal groups differed significantly (χ 2 = 75.450, p < 0.05). The HPV16/18 positive group and the non 16/18 HR-HPV positive group also showed a significant difference in concordance rates (χ 2 = 5.890, p < 0.05). There were significant differences in concordance rates between TZ2 and TZ3 (χ 2 = 10.585, p < 0.05), as well as between TZ1 and TZ3 (χ 2 = 14.607, p < 0.05). Factors such as menopausal status, duration of menopause, HR-HPV genotypes, and TZ types influence the accuracy of colposcopic diagnosis. Therefore, a comprehensive evaluation incorporating these factors should be performed in clinical practice to enhance diagnostic accuracy.

The effect of digital storytelling on women's human papilloma virus awareness: Randomized controlled experimental study.

This study aims to determine the effectiveness of the digital storytelling (DS) method in increasing human papilloma virus (HPV) awareness. The study was conducted in the gynecology and obstetrics outpatient clinic of a state hospital between April and December 2023. The universe of the study consisted of women who applied to the outpatient clinic between these dates and volunteered. A total of 80 women who met the inclusion criteria were included in the study (n = 40 for each group). Data for the study were gathered using Personal Introduction Form and Human Papilloma Virus Knowledge Scale. Repeated measures ANOVA method was used to determine the difference between the pre-training, post-first training and post-second training measurement scores according to the intervention and control groups. For significant ANOVA results, measurements with differences were compared pairwise using Bonferroni correction. All statistical analyses were examined at the p < 0.05 significance level. Socio-demographic characteristics and HPV awareness levels of women in the intervention and control groups were similar before training (p > 0.05). After the activity conducted with the digital story method in the intervention group, the HPV awareness levels of women in this group increased significantly (p < 0.05). Considering the development in each group, an increase in posttest scores is observed in both groups. However, when the increase amounts in each group in the intervention and control groups were examined, it was determined that all awareness levels increased more in the intervention group. In the intergroup comparison, it was determined that the mean measurements of general HPV knowledge, general HPV vaccine knowledge, and knowledge of the current HPV vaccination program of women in the intervention group at the first and second follow-ups after the training were higher than those in the control group. The DS method was effective in raising HPV awareness given to the intervention group. Health professionals and researchers can benefit from DS in providing health education and consultancy services such as HPV awareness.

6967 Simple Prediction Model for Vitamin D Deficiency in Women with Osteoporosis or Risk Factors for Osteoporosis

Abstract Disclosure: T. Mullikapipat: None. N. Dumrongwongsuwinai: None. O. Vallibhakara: None. S. Rattanasiri: None. S. Vallibhakara: None. W. Wajanavisit: None. B. Ongphiphadhanakul: None. H. Nimitphong: None. Background: People at high risk of vitamin D deficiency, such as those at risk of osteoporosis, should have their 25-hydroxyvitamin D [25(OH)D] levels assessed. The availability and cost of 25(OH)D measurement in Thailand are both restricted. The objective of this study was to create a model for predicting vitamin D deficiency in women with osteoporosis or risk factors for osteoporosis. Methods: This was a cross-sectional study of women with or at risk of osteoporosis who visited Ramathibodi Hospital's outpatient clinics (medicine, obstetrics and gynecology, and orthopedic) between August 2016 and August 2019. All participants were assessed their 25(OH)D using a chemiluminescent assay (Liaison, DiaSorin Inc.; Stillwater, MN). Each participant completed a questionnaire to determine vitamin D intake through supplementation and sun exposure, as well as the existence of factors impacting vitamin D status. Vitamin D deficiency was defined as 25(OH)D levels less than 30 ng/mL. Logistic regression analyses were used to examine the predictors of vitamin D deficiency. In the vitamin D deficiency prediction model, odds ratios (OR) were converted into simple scores. The sensitivity, specificity, and positive and negative predictive values of the different cutoffs in the total risk score were calculated and used to establish the optimum cutoff for those at high risk of vitamin D deficiency. Internal validation on this model was carried out using a bootstrap resampling method of 1000. Results: Sixty percent of participants had vitamin D deficiency. The final model (n=488) for the prediction of vitamin D deficiency consisted of BMI ≥ 25 kg/m2 [OR 1.15, 95% confidence interval(CI) 0.99-2.30), no exercise (OR 1.59, 95% CI 1.02-2.49), exercise 1-2 times/week (OR 1.40, 95% CI 0.79-2.46), sunlight exposure &amp;lt; 15 minutes/day (OR 1.70, 95% CI 1.04-2.78), no vitamin D supplementation (OR 8.76, 95% CI 5.02-15.28), and vitamin D supplementation ≤ 20,000 IU/day (OR 2.31, 95% CI 1.34-3.96). The area under the curve was 0.747. At a cutoff of 6.6 in total risk score (range 4-13.6), the model predicted vitamin D deficiency with a sensitivity of 71.9 and a specificity of 65.3. The internal validation by Bootstrap revealed a ROC of 0.752 (95%CI 0.751-0.754). Conclusions: In women at risk of osteoporosis, a simple questionnaire can uncover variables related to vitamin D deficiency. The risk score might be used in clinical practice to identify individuals who could benefit from vitamin D supplementation without requiring 25(OH)D levels to be measured. However, external validation in a different cohort is required before implementation. Presentation: 6/2/2024

12242 Enhancing Continuous Glucose Monitor Utilization In Lower Economic Community Hospital Outpatient Clinics: A Quality Improvement Initiative

Abstract Disclosure: V. Mehta: None. S. Deshpande: None. M. Nieman: None. K. Pereira: None. B. Agrawal: None. S.R. Russell: None. Continuous glucose monitors (CGM) measure the blood glucose level (BGL) and have been used for better glucose control, especially in patients requiring insulin. Primary care physicians (PCP) manage diabetic patients on a large scale in the US, especially in rural settings, and data shows that CGMs are prescribed less in PCP settings than in endocrine clinics. Our study aimed to understand internal medicine (IM) residents' knowledge about CGMs and their application in a community hospital outpatient clinic serving lower-economic populations and demonstrates how a clinical pharmacist (PharmD) led educational intervention successfully increased the adoption of CGMs. A survey was done using a form with multiple-choice questions. 50 residents participated and responded anonymously. Data was analyzed by calculating percentages based on answers, providing understanding of their perspectives on CGMs. 78% knew about and correctly identified CGM. When asked to name indications of CGM, answers varied and included uncontrolled diabetes (34%), insulin-dependent diabetes (34%), elderly and non-compliant patients (14%), any diabetic (12%), and others. Only 14% reported to have had formal training in use and interpretation of CGMs, 70% had prescribed, 34% knew how to apply the device, and 42% knew how to interpret the BGL. More than 95% self-reported having either poor/beginner or fair knowledge about the usage, application, and interpretation, whereas more than 80% professed to need more training to be more confident about prescribing the device. After the survey, our PharmD conducted session demonstrating the indications, types, usage, application, and interpretation of CGM. Following this, an impactful increase in patients who were appropriately prescribed and received CGM was observed. Technologies used in medicine have increased, CGM, being one of them. More than 100 million Americans have prediabetes or diabetes, with more than 10 million using insulin. Hence, access to CGM is crucial for patients for better management. Despite the benefits, many factors play a role in limiting their use, including prescription, cost, insurance coverage, social factors, willingness of the patients, discomfort, and decreased knowledge. Non-compliance, difficulty in application and picking the device from pharmacy was also observed in our clinic. A study by Sherrill et al. on use of CGMs (2014-2020) showed that use of CGM increased almost ten times in 2020 (v/s2014); most patients were younger, employed, and had better insurance coverage.With advances in technology, easier and more efficient devices are available to assess patients' glycemic control. Pharmacists play key role in ensuring continued education among practitioners and trainees. Continued efforts to increase awareness is required to ensure that latest advances are adequately incorporated into graduate medical education. Presentation: 6/3/2024

Patient characteristics and mortality across diagnostic settings in COPD

BackgroundMany patients with chronic obstructive pulmonary disease (COPD) are diagnosed late, e.g., at first acute exacerbation of COPD (AECOPD). AECOPD increases the risk of death. We aim to investigate patient characteristics and mortality across diagnostic settings among patients with COPD. MethodsThis nationwide Danish study allocated 107,023 patients with a first-time registered COPD-related hospital contact between 2010 and 2018 based on diagnostic setting: primary care (prior inhalation medication use), hospital outpatient clinic or hospital admission. Multivariable logistic regression was employed to investigate patient characteristics and mortality across these diagnostic settings. ResultsIn total, 81,035 (75.7 %) patients were diagnosed in primary care, median age 63 years (interquartile range (IQR) 53–71); 11,302 (10.6 %) at an outpatient clinic, median age 68 years (IQR 60–76), and 14,686 (13.7 %) during hospital admission, median age 73 years (IQR 65–81). Patient characteristics associated with diagnosis during hospital admission encompassed age (odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.05–1.05, p < 0.001), male sex (OR 1.14, CI 1.10–1.19, p < 0.001), and number of comorbidities, which increased from one comorbidity (OR 2.64, CI 2.50–2.79, p < 0.001) to six or more comorbidities (OR 12.37, CI 11.26–13.60, p < 0.001). Diagnosis during hospital admission due to AECOPD was associated with increased one-year mortality (OR 1.24, CI 1.16–1.33, p < 0.001) compared to diagnosis in primary care. ConclusionPatients diagnosed with COPD in hospital settings were generally older, predominantly male, and had more comorbidities. Patients diagnosed in primary care prior to their first AECOPD admission had higher one-year survival.

Effect of online infant care training and postpartum counseling based on Meleis' transition theory on mothers' readiness for care and breastfeeding: a randomized controlled trial.

Mothers must acquire the knowledge and skills needed to fulfill their responsibilities and take care of themselves and their babies. This study aimed to examine the effects of online baby care education and postpartum counseling based on Meleis' transition theory on mothers' readiness for baby care and breastfeeding. This randomized controlled trial was conducted between May 2022 and May 2023 at the pregnancy follow-up outpatient clinic of a state hospital. The study sample consisted of 102 pregnant women (52 in the intervention group, 50 in the control group). The mean scores of the intervention group compared to the control group were significantly higher immediately after birth and at 1, 2, and 3 months postpartum. Change over time was significantly higher in repeated measurements of National Institute of Child Health and Human Development scale scores of the intervention and control groups (P=0.001). In the first 24 hours, mothers in the intervention group breastfed more successfully than those in the control group (P<0.001). Mothers in the intervention group exclusively breast fed at a significantly higher rate immediately and at 1, 2, and 3 months postpartum compared to the control group (P<0.001). A statistically significant difference was noted in mean infant height and weight in the intervention group compared to the control group (P<0.05). Theory-based online education initiated during pregnancy and counseling continued up to 3 months postpartum positively affected the mothers' abilities to care for their infants. Mothers who received education and counseling breastfed their babies more successfully on the first day and breast fed exclusively at a higher rate in the first 3 months.

Quality of life (QOL) of patients with schizophrenia and epilepsy attending an outpatient clinic in a tertiary care hospital in Sri Lanka

Background: Schizophrenia and epilepsy are chronic relapsing disorders, that share common disadvantages that affects QOL.Methods: A cross-sectional descriptive study was conducted on 68 patients with schizophrenia and 68 patients with epilepsy, presenting to psychiatry and neurology clinics of the Colombo South Teaching Hospital (CSTH). The validated Sinhala and Tamil version of the WHO QOL 100 was used to assess the QOL.Results: Schizophrenia group had poorer QOL in physical (p&lt;0.05), social (p&lt;0.01), independence (p&lt;0.05) and environmental (p&lt;0.05) domains, compared to epilepsy. Longer duration of illness (&gt; 5 years) was associated with poorer QOL in the independence (p&lt;0.05) and social domains (p&lt;0.05) and longer duration of untreated illness was associated with lower QOL in the physical (p&lt;0.01) and social domains (p&lt;0.01) in schizophrenia group.Conclusions: Patients with schizophrenia had poorer QOL compared to patients with epilepsy. Longer duration of untreated illness was associated with poorer QOL in both groups.

Influence Of Metabolic Syndrome On Functionality And Cognition In Elderly People

Background: In the aging process, physiological changes occur that increase the elderly person's potential to develop Metabolic Syndrome (MS) and lead to a decrease in functional and cognitive capacity. Thus, the objective was to associate the presence of Metabolic Syndrome with the functional and cognitive capacity of elderly patients receiving outpatient care. Materials and Methods: A cross-sectional study was conducted with elderly individuals receiving care at the nutrition outpatient clinic of a university hospital. The NCEP-ATP III criteria were used to diagnose Metabolic Syndrome. Nutritional status was determined by Body Mass Index (BMI). Functional capacity was assessed through Activities of Daily Living (ADLs) using the Katz Index, and Instrumental Activities of Daily Living (IADLs) using the Lawton and Brody scale. The Mini-Mental State Examination (MMSE) was used for cognitive assessment. Results: The sample consisted of 144 elderly individuals, mostly women (72.2%). All participants were classified as independent for ADLs and 82.63% for IADLs. The majority did not show cognitive deficits according to the MMSE (86.7%). There was no statistically significant correlation between the variables of Metabolic Syndrome and the MMSE. However, there was significance (p=0.001) between Metabolic Syndrome and nutritional status, as well as between the means of Waist Circumference, HDL-C, and systolic blood pressure. Conclusion: The components of Metabolic Syndrome were relevant to excess weight, but there was no significance for cognitive and functional deficits among the elderly participants in the study

Does hyperprolactinemia treatment affect pregnancy and perinatal outcomes?

The aim of this study was to assess obstetric and perinatal outcomes in women with hyperprolactinemia according to the type of treatment indicated, with cabergoline or bromocriptine. A retrospective cohort study with 464 women diagnosed with hyperprolactinemia was undertaken at the endocrine gynecology outpatient clinic of a tertiary hospital from May 2002 to February 2022. All women diagnosed with hyperprolactinemia who were being treated with dopamine agonists (cabergoline or bromocriptine) and who became pregnant during the follow-up were included. Women whose medical records did not provide data related to pregnancy and delivery were excluded. The women were divided into two groups according to the type of treatment: bromocriptine or cabergoline. Clinical and laboratory characteristics and obstetric and perinatal outcomes, such as complications during pregnancy, type of delivery, and intrapartum complications, were evaluated in both groups. Of the 464 women evaluated, 72 became pregnant during the follow-up, 66 of them were using dopamine agonists, while 6 were not using medication. The mean age of the women was 28.3±6.8 years. Among the causes of hyperprolactinemia, 48.6% were idiopathic, 45.7% were tumoral, and 3.7% had other causes. Most women with idiopathic hyperprolactinemia used bromocriptine, while those with tumoral hyperprolactinemia used cabergoline (p=0.04). There was no difference in obstetric outcomes according to the type of treatment used. The majority of women did not have any complications during pregnancy (76.3%) or intrapartum (86.8%). Regardless of the type of previous drug treatment with dopamine agonists, hyperprolactinemia does not alter obstetric outcomes.