Outpatient Department Of Internal Medicine Research Articles

Linguistic adaptation and validation of All Aspects of Health Literacy Scale (AAHLS): A health literacy assessment tool for use in Hindi-speaking population.

Background Health literacy plays an important role in determining healthcare and medication outcomes. There is a lack of an appropriate, validated scale to assess health literacy status among the Hindi-speaking population. We translated and validated the English version of the All Aspects of Health Literacy Scale (AAHLS) into Hindi. Methods We translated the scale as per WHO guidelines on translation and adaptation of instruments. We did preliminary pilot testing in 30 bilingual subjects and evaluated cross-language concordance of the scale. The final translated scale so obtained after cross-cultural adaptation was tested in a validation study on 130 subjects from the outpatient department of internal medicine in which test-retest repeatability, construct validity, discriminant validity and internal consistency were assessed. Analysis was done using paired t-test, one-way ANOVA, Cronbach α and intra-class correlation coefficient. Results An excellent correlation between Hindi and English versions of the scale for various factors ensured cross-language concordance. Hundred percentage response rate was observed in the validation study. The scale showed good internal consistency (Cronbach α=0.99). The difference in total mean AAHLS score was not statistically significant across different age groups, genders and educational levels. Factor analysis showed a positive correlation among four factors/components of health literacy. For test-retest reliability, the intra-class correlation coefficient for all the items in different factors was significant (range 0.88-1.00; p<0.0001). Significant association of critical literacy sub-scores with functional (r=0.274, p=0.002) and communicative (r=0.283, p=0.001) sub-scores revealed a good construct validity. Conclusion The Hindi translated version of the AAHLS scale is a valid and reliable tool to assess health literacy in the Hindi-speaking population.

Status of glycemic control and lipid profile in type 2 diabetes mellitus: A descriptive cross-sectional study

Introduction: Dyslipidemia in diabetes mellitus is commonly seen in the form of high total cholesterol (TC), high lowdensity lipoprotein (LDL), high triglyceride (TG) and low high-density lipoprotein (HDL) levels. This study was done to study the association of glycemic control with lipid profile in Type 2 Diabetes Mellitus (T2DM) patients. Methods:This was a cross sectional, observational study conducted from December 2018 to June 2020 at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa. It involved 125 patients of type 2 diabetes mellitus (68 males and 57 females), who visited in outpatient department of Internal Medicine. Laboratory tests [(Fasting Blood Sugar(FBS), Post Prandial Blood Sugar (PPBS), Glycosylated Hemoglobin (HbA1c), Renal Function Test (RFT) and Fasting Lipid Profile] were noted. The data was analyzed with SPSS Version 25. Descriptive statistics like frequency, percentage,mean and standard deviation (SD) were calculated. Independent t-test was used to measure the association between glycated hemoglobin with blood glucose level and glycated hemoglobin with lipid profile. Results: The study patients were categorized into two groups on the basis of HbA1C level [(good glycemic control ≤7 (n=33) and poor glycemic control &gt;7 (n=92)]. In good glycemic control the mean TC was 143.30, LDL 71.88, HDL 43.70, VLDL 29.55, TG 134.39 mg/dl while in poor glycemic control the mean TC was 182.47, LDL 114.85, HDL 32.03. VLDL 36.61, TG 179.33 mg/dl with p-value &lt;0.05. Conclusions: There was significant positive association of HbA1c with TC, LDL, VLDL, TG and significant negative association with HDL.

Diabetes Mellitus among Patients with Non-alcoholic Fatty Liver Disease Visiting the Outpatient Department of Internal Medicine in a Tertiary Care Centre.

Diabetes mellitus is a chronic metabolic illness which is mainly associated with reduced physical activity and obesity. Diabetes mellitus and non-alcoholic fatty liver disease may coexist and synergistically lead to poor clinical outcomes. The aim of the study was to find out the prevalence of diabetes mellitus among patients with non-alcoholic fatty liver disease in a tertiary care centre. A descriptive cross-sectional study was conducted among patients with non-alcoholic fatty liver disease in the outpatient department of Internal Medicine of a tertiary care centre between 1st January 2022 and 29th June 2023. Convenience sampling was done. A convenience sampling technique was used. The point estimate was calculated at a 95% Confidence Interval. Among 150 patients with non-alcoholic fatty liver disease, diabetes mellitus was seen among 18 (12%) (6.80-17.20, 95% Confidence Interval). Diabetes mellitus was more prevalent in males 12 (66.67%) in patients with non-alcoholic fatty liver disease. The prevalence of diabetes mellitus among patients with non-alcoholic fatty liver disease was found to be lower as compared to similarly reported research studies. diabetes mellitus; fatty liver; non-alcoholic fatty liver disease; prevalence.

Unraveling the Connection: Visceral Adipose Tissue and Vitamin D Levels in Obesity.

Vitamin D deficiency and insufficiency are widespread on a global scale, with multiple factors playing a role in their development, such as limited exposure to sunlight, inadequate dietary consumption, as well as obesity and abdominal fat accumulation. Abdominal obesity, assessed with waist circumference (WC), is associated with metabolic syndrome and has been linked to low vitamin D levels. This study aimed to investigate the relationship between visceral adipose tissue (VAT) and vitamin D levels, particularly examining the potential threshold for vitamin D storage and sequestration using adipose tissue. The study was conducted between 2020 and 2022 with 58 patients from an internal medicine outpatient department. Patients with certain medical conditions and those taking medications affecting bone metabolism were excluded. Blood samples were collected at baseline and after 6 months of monthly cholecalciferol supplementation. Ultrasonography was used to evaluate adipose tissue measurements, including subcutaneous adipose tissue thickness, VAT, preperitoneal adipose tissue (PPAT), and prerenal adipose tissue (PRAT). Anthropometric measures such as the waist-to-hip ratio and waist-to-height ratio were also assessed. The results showed that all subjects had significant hypovitaminosis D at baseline. After 6 months of supplementation, the mean increase in vitamin D levels was 9.6 ng/mL, with 55.2% of subjects becoming deficient. The study revealed a significant correlation between follow-up vitamin D levels and waist circumference, hip circumference, and VAT. VAT exhibited a strong correlation not only with vitamin D levels but also with waist circumference. When analyzing gender differences, males showed a higher weight and waist-to-hip ratio, while females had higher body adiposity indexes and subcutaneous adipose tissue measurements. In conclusion, this study highlights the relationship between VAT and vitamin D levels, emphasizing the potential role of adipose tissue in vitamin D availability. Waist circumference was identified as a surrogate measure for VAT evaluation. Furthermore, the study showed variations in vitamin D response to supplementation between genders, with a higher percentage of males reaching normal vitamin D levels. Predictive factors for vitamin D levels differed between genders, with waist circumference being a significant predictor in males and body adiposity index in females.

The Effect of Ginger Supplementation on the Improvement of Dyspeptic Symptoms in Patients With Functional Dyspepsia.

Background Functional dyspepsia (FD) is a common gastrointestinal disorder with a higher occurrence in the Western world. Conventional medications are not effective for FD with patients turning to alternative herbal medicines such as ginger. This study aimed to evaluate the effect of ginger supplementation on the improvement of FD symptoms. Methodology A before-and-after clinical study was conducted at the University of Debrecen, Internal Medicine outpatient department over a period of four weeks. Two Swanson ginger supplements each at a dose of 540 mg/day before lunch and dinner were given to 51 FD patients. Wilcoxon signed-rank test was used to estimate the differences in FD symptoms after ginger supplementation and at the baseline. The p-value was determined to test the association between variables, with p-values <0.05 considered the cutoff for statistically significant association. Results In this study, after four weeks of ginger supplementation, we observed a significant change in most dyspepsia symptoms as follows: postprandial fullness (p = 0.033, 95% CI = 0.01-0.26), early satiety (p = 0.001, 95% CI = 0.10-0.37), epigastric pain (p = 0.000, 95% CI = 0.16-0.42), epigastric burning (p = 0.003, 95% CI = 0.10-0.45), and heartburn (p = 0.209, 95% CI = -0.04-0.20). Conclusions Based on our findings ginger can be considered as a promising alternative supplementary medicine for FD.

A comparison of the characteristics of adult medicine patients seeking telemedicine consultations versus in-person consultations in a Philippine public hospital

Background Telemedicine employs the use of technology to increase access to health care. This is especially relevant in developing countries where accessibility is an important issue. In developed countries, studies have shown that despite greater availability and accessibility, there are still disparities in telemedicine use. In the Philippines, however, it is unknown what factors are related to telemedicine use since its underutilization precludes proper characterization of telemedicine patients. We sought to compare the characteristics of telemedicine patients and patients consulting in-person in the internal medicine outpatient department of a Philippine public hospital. Methods This is a retrospective descriptive study. Chart reviews were done for patients who consulted from May 2021 to July 2021. They were classified as either having telemedicine consults only or having in-person consults only. Each group was characterized and compared according to demographics, socioeconomic characteristics, health behaviors, and reasons for consultation. Results Unadjusted analyses showed that younger, single, or employed individuals were more likely to use telemedicine. However, in adjusted analyses, no demographic factors were associated with telemedicine use. Only the patient type and medical concern were significantly different between patient groups in this public hospital setting. New patients and those consulting for clearance/referral purposes or endocrine-related symptoms were more likely to seek teleconsults. Conclusions The findings showed which patients are more likely to use telemedicine in the Philippines. Continued telemedicine use for these patients should be explored to complement in-person medical care.

Association of urinary albumin-to-creatinine ratio with lipid abnormalities and glycemic control in patients with type 2 diabetes mellitus.

While proteinuria aggravates dyslipidemia in diabetic patients, dyslipidemia further worsens proteinuria via inflammatory cytokines-mediated glomerular damage. Urinary albumin creatinine ratio (ACR) is an easy and reliable method of detecting proteinuria. This study aims to determine the association of ACR with lipid abnormalities and glycemic control in the Nepalese population. This was a cross-sectional study conducted among 201 diabetes patients visiting the outpatient department of internal medicine. Based on ACR values, patients were categorized as nonalbuminuric (less than 300μg/mg) or albuminuric (more than 300μg/mg). An unpaired t-test was used to compare the mean of various lipoproteins in these two categories. Binary logistic regression was used to check the association of ACR with sociodemographic factors (age, sex, and education), hypertension, and glycated hemoglobin. Albuminuric patients had higher mean cholesterol (192.8±53.5 vs. 184.2± 37.6; P=0.209), triglyceride (194.9±97.8 vs. 164.4±73.7; P=0.017) and low-density lipoprotein (99.9±38.4 vs. 90.0±27.4; P=0.034) but lower high-density lipoprotein (53.9±18.5 vs. 61.3±19.9; P=0.008) compared to nonalbuminuric patients. There was a significant difference in mean HbA1c values across albuminuria and nonalbuminuria groups (7.1±1.1 vs. 6.7±0.8; OR: 1.4, 95% CI=1.1-1.9, P=0.030). Urine ACR of more than 30mg/gram was associated with higher triglyceride and low-density lipoprotein levels and lower high-density lipoprotein levels. The HbA1c level strongly correlates with the development of albuminuria.

Utilization Rate of Primary Health Services in the Diagnosis, Treatment, and Follow-Up of Patients Diagnosed with Rheumatic Disease

In this study, we aimed to investigate the utilization of primary health care in the diagnosis, treatment and follow-up of patients diagnosed with rheumatic disease. For this purpose, 350 patients with rheumatic disease were included in the survey and 26-question about the demographic information of the patients, utilization of primary health care during and afterwards the diagnosis process of the disease. The mean age of the participants was 48.67±13.26, and 73.7% (n=258) of them were female. The patients were diagnosed with rheumatic disease an average of 6.74±6.07 years ago. Joint pain was the most common complaint with a rate of 79.7%. 22% (n=77) of the patients were referred to first internal medicine outpatient department. First admission rate to a family physician was 12.3% (n=43) and 55.8% (n=24) of these patients were referred to higher care for diagnosis. 69.1% (n=242) of the patients were diagnosed in a tertiary healthcare institution. According to the analysis results, 47.7% of the patients had a prescription from their family physician for their rheumatic diseases, but only 6% (n=21) went to their primary care physician for check-ups for their rheumatic diseases. In our study, the rate of use of primary care services was high when patients' rheumatic disease symptoms first begin and were only prescribed prescription drugs after diagnosis. The tendency to prefer primary care for follow-up was low. Contributing to all processes of the rheumatic disease will reduce the workload of hospitals and contribute to a cost-effective approach. For this, the factors that will eliminate the negative perceptions of patients towards primary care can be reviewed and the rate of patients' preference for primary care can be increased.

SECONDARY HYPERTENSION IN THE INTERNAL MEDICINE OUTPATIENT DEPARTMENT OF A PORTUGUESE HOSPITAL

Objective: Secondary hypertension is an uncommon form of hypertension and universal screening is not beneficial or cost-effective. Consequently, investigation is reserved for selected cases, according to clinical suspicion, and is often referred to a specialist. The aim of this study was to characterize the evaluation of secondary hypertension in the Internal Medicine Outpatient Department of a portuguese hospital. Design and method: This longitudinal retrospective study analysed patients referred to our Internal Medicine Outpatient Department for hypertension evaluation in 2021. Patient records and results were analysed, focusing on indication for evaluation, testing performed and identified causes of secondary hypertension. Results: A total of 147 patients were referred for hypertension evaluation, 7 (4,76%) of which were explicitly referred for secondary hypertension screening. Testing was conducted in 105 patients (71,43%), with basic evaluation (CBC, renal function, thyroid function) in 71 patients (48,30%) and additional testing (such as endocrine, renovascular, obstructive sleep apnoea screening) performed in 34 patients (23,13%). Considering age criteria, resistant hypertension, and other clinical clues, 60 patients (40,82%) had a documented indication for additional testing for secondary hypertension. Additional testing was requested in 5 patients (3,40%) not meeting these criteria, most of whom needed testing to follow-up investigations ordered in primary care without clear indication. Conversely, a small proportion (6,12%) met criteria for additional testing that wasn’t requested: 22% already had a previous screening ordered in primary care negative for secondary hypertension; 44% were evaluated for hypertension-mediated organ damage without further screening. Patients in which specific evaluation was complete at the time of this study, a secondary cause was identified in 9 patients (6.12%), all with a previous diagnosis of Obstructive Sleep Apnea. Conclusions: The prevalence of secondary forms identified didn’t significantly differ from the described 5-10% overall prevalence of secondary hypertension and reiterated the identification of OSA as an exceedingly common recognized cause of hypertension. This study emphasised that extensive testing was mostly non-diagnostic and was associated with inconclusive results leading to further investigations, raising costs and risks. This suggests that careful selection of patients and method of screening by a specialist is beneficial.

Effect of Prior Antibiotic Treatment on Blood Culture in an Outpatient Department of General Internal Medicine: A Retrospective Case-Control Analysis.

The effect of antibiotics administered before blood cultures performed in general internal medicine outpatient settings is not well known. We conducted a retrospective case-control study including adult patients who underwent blood cultures in the general internal medicine outpatient department of a Japanese university hospital between 2016 and 2022. Patients with positive blood cultures were included as cases and matched patients with negative blood cultures were included as controls. Univariable and multivariable logistic regression analyses were performed. A total of 200 patients and 200 controls were included. Antibiotics were administered prior to blood culture in 20% of patients (79/400). Oral antibiotics were prescribed to 69.6% of the prior antibiotics (55/79). Prior antibiotic use was significantly lower among patients with positive than negative blood cultures (13.5% vs 26.0%, p = 0.002) and was an independent predictive factor in univariable (odds ratio, 0.44; 95% confidence interval, 0.26-0.73; p = 0.002) and multivariable (adjusted odds ratio, 0.31; 95% confidence interval, 0.15-0.63; p = 0.002) logistic regression models for positive blood culture. The area under the receiver operating characteristic (AUROC) curve of the multivariable model for predicting positive blood cultures was 0.86. There was a negative correlation between prior antibiotic use and positive blood cultures in the general internal medicine outpatient department. Therefore, physicians should interpret the negative results of blood cultures performed after the administration of antibiotics with care.

Association between Glycated Hemoglobin and Lipid Profile in Type 2 Diabetes Mellitus Patients Attending Tertiary Care Hospital: A Cross Sectional Study

INTRODUCTION Glycated haemoglobin levels are routinely measured in type 2 diabetes mellitus to monitor their glycaemic control. Lipid disorder in diabetes is common issues either independently or in association with type 2 Diabetes mellitus. We aim to establish the association between Glycated haemoglobin and lipid profile in type 2 diabetes mellitus patients attending our centre. MATERIAL AND METHODS This is hospital based cross-sectional study conducted on 161 patients conducted in out-patient department of internal medicine and from 10/02/2079 to 20/04/079 at Devdaha Medical College and Research Institute (DMCRI). Patients were enrolled after taking informed consent fulfilling inclusion and exclusion criterias. Data were entered on Microsoft Excel 2010 and analyzed using SPSS v25. RESULTS Among 161 Participants, male to female ratio was almost 1:1, with mean age of diabetes of male and female was 58.1 ± 11.2 standard deviation (SD) and 56.7 ± 10.4 SD, with 13.04% were alcohol consumer; 1.86% were smokers; 57.76% of them had high blood pressure; (29.19%) had known dyslipidaemia and 11.18% had hypothyroidism. While comparing controlled (HBA1c&lt;7%) with uncontrolled (HBA1c ≥7%) glycated hemoglobin and level of different components of lipid profile like total cholesterol, triglyceride, LDL- cholesterol and HDL-cholesterol, there is statistical correlation [χ²=4.67; df=1; p=0.031] between only high triglyceride level and uncontrolled type 2 diabetes. CONCLUSION High value of glycated hemoglobin not only measures uncontrolled type 2 diabetes but can also be considered for high lipid disorder biomarker. Early detection of high glycated hemoglobin could prevent complications related with diabetes independently or in combine with dyslipidemia.

Medical Needs of Adults with Down Syndrome Presenting at a Regional Medical and Rehabilitation Center in Japan.

Down syndrome (DS) is the most frequent chromosomal aberration; however, knowledge of associated health issues in adulthood is inadequate. We analyzed health data from Japanese adults with DS. We conducted a retrospective chart review of 151 patients with DS who visited the Internal Medicine Outpatient Department of the Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled. Endocrine disorders such as obesity, hyperlipidemia, and hyperuricemia were most common in adulthood (≤40 years) and senescence (>40 years); neurological diseases were more prevalent in senescence. Multimorbidity was noted even patients with DS who were younger than 30 years, and the prevalence increased with age. Only 21 patients (13.9%) with DS visited our hospital with referral letters from pediatricians; 94 patients (62.3%) visited without such referrals from other medical institutions. Patients without a referral letter had a mean of 3.1 comorbidities per patient. Moreover, medical care for some people with DS was interrupted during childhood. Prevention and detection of comorbidities in patients with DS requires continuous medical care from childhood through adulthood. Recently, DS has been diagnosed by chromosome testing and genetic counseling. Clinical geneticists and genetic counselors can help patients with DS, and their caregivers, to obtain appropriate health care and achieve well-being on their own by seamlessly engaging them throughout childhood and adulthood.

Hypothyroidism among Type 2 Diabetic Patients Visiting Outpatient Department of Internal Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Diabetes-thyroid relationship is said to be bidirectional. Insulin resistance and hyperinsulinemia in type 2 diabetes mellitus increase free thyroxine but decrease free tri-iodothyronine and thyroid-releasing hormone synthesis. Thyroid dysfunction may in turn impose an adverse effect on glucose metabolism in type 2 diabetes mellitus. Undetected thyroid dysfunction can worsen glycemic control and predispose type 2 diabetes mellitus patients to cardiovascular and other diabetes-related complications. Recognition and timely treatment of thyroid dysfunction in type 2 diabetes mellitus patients can delay diabetic complications. The aim of this study was to find out the prevalence of hypothyroidism among type 2 diabetic patients visiting the outpatient Department of Internal Medicine of a tertiary care centre. A descriptive cross-sectional study was conducted from 17 April 2021 to 5 September 2021 after obtaining ethical approval from the Institutional Review Committee (Reference number: 130120202). A total of 384 type 2 diabetic subjects were recruited for the study. Convenience sampling method was used. Point estimate and 95% CI were calculated. Among 384 patients, the prevalence of hypothyroidism was found in 127 (33.07%) (28.36-37.78, 95% Confidence Interval). Among them, 56 (44.09%) were male and 71 (55.90%) were female. The mean age was 55.17±7.53 years. The prevalence of hypothyroidism was higher than in the other studies done in similar settings. chronic kidney disease; thyroid stimulating hormone; thyroxine; triiodothyronine.

Patients' Preference for Physician Attire in the Internal Medicine Outpatient Department.

To investigate patients' preference and the attitude towards physician attire in an internal medicine clinic in China. This study was conducted from 1 January 2021 to 30 June 2021 in a tertiary care hospital in China. We surveyed 126 patients in the hospital with 6 sets of pictures of commonly worn physician attires in the hospital setting with a two-part questionnaire. The first part listed respondent demographics to collect basic information. The second part of the questionnaire was administered to adult patients who received care in the internal medicine clinics (outpatients). Survey forms collected demographic data (age, gender, patient age, education, marital status, and employment status), asked questions regarding 6 specific attires (scrubs, scrubs and white coat, casual, casual and white coat, business suit, and formal and white coat), and behavioral items (professional, responsible, reliable, knowledgeable, succession rate, and medical safety), finally, to assess the preference of attire on overall perception. Scrubs and white coat scored the highest through 6 domains about physicians' attire (professional, reliable, responsible, knowledgeable, medical safety, and succession rate, p < 0.05 for all comparisons). A casual suit without a white coat was the least preferred across the surveyed attributes. There was a significant preference gap between wearing a white coat and not wearing a white coat (p < 0.001). Physician attire to white coat was considered as more professional, reliable, responsible, knowledgeable, having greater medical safety, and a higher success rate than attires without white coat. Patients felt that the physician wearing a white coat was better than other attires. Scrubs and white coat was the most popular attire. Hospital or related authorities may promote the standardized wearing of white coats, leading in a greater patient-physician relationship.

The Clinical and Biological Manifestations in Women with Iron Deficiency Without Anemia Compared to Iron Deficiency Anemia in a General Internal Medicine Setting: A Retrospective Cohort Study.

PurposeThe clinical presentation of iron deficiency is not well understood. We aimed to identify the clinical manifestations of iron deficiency without anemia in women.Patients and MethodsWe conducted a retrospective cohort study of women who visited the general internal medicine outpatient department of a university hospital in Japan between 2016 and 2022. Women who were prescribed iron supplements were included in the study. Anemia was defined as hemoglobin levels below 12 g/dl. Iron deficiency was defined as serum ferritin levels < 30.0 μg/l. The primary outcome was the difference in symptoms between patients with iron deficiency with and without anemia. The secondary outcome was the ratio of symptom, hemoglobin, and serum ferritin improvement (levels > 30.0 μg/l after treatment), comparing the measurements at the beginning and after supplementation.ResultsA total of 147 women were included in the final analysis. There were no significant differences in the initial symptoms and the ratio of symptom improvement between the groups. Compared to patients with iron deficiency anemia, patients with iron deficiency without anemia had high initial serum ferritin levels (14.8 vs 7.1 μg/l, p<0.001), and hemoglobin (13.2 vs 9.9 g/dl, p<0.001). Iron supplements significantly improved the serum ferritin level in two groups and the hemoglobin in iron deficiency anemia. After treatment, iron deficiency without anemia still had high serum ferritin levels (37.7 vs 28.2 μg/l, p=0.017) and hemoglobin (13.3 vs 12.3 g/dl, p < 0.001).ConclusionThere were no differences in any of the investigated symptoms and the ratio of the symptom improvement depending on the anemic state in iron deficiency. After iron supplementation, the serum ferritin levels in the iron deficiency without anemia group improved. Hemoglobin and serum ferritin in iron deficiency without anemia were still highly comparable to that of iron deficiency anemia.

SELF-CARE MANAGEMENT AND ITS ASSOCIATED FACTORS AMONG PATIENT WITH HYPERTENSION IN NEPAL

Background: Hypertension is currently a common and serious health issue that leads to cardiovascular disease and premature death around the world. Self-care practice is essential for blood pressure control and reduction of hypertension complications of cardiovascular and renal diseases. The objective of this study is to assess the level of self-care management and its associated factors among patients with hypertension. Methods: The cross-sectional study was conducted at the Internal medicine and Cardiac outpatient department of Kathmandu University Hospital, Dhulikhel on 386 participants diagnosed with hypertension with six months of diagnosis and age of 30-80 years. The participants were recruited conveniently in the study. Face to face interviews with participants using Hypertension Self-Care Profile (HTN-SCP) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess self-care management and perceived social support. Descriptive and inferential statistics were performed using SPSS version 23. Results: The mean age of the participants was 57.39 years. Half of the participants (52.3 %) had poor self-care practice. There is significant association between level of self-care practice with religion (p= &lt;0.001), educational level (p= &lt;0.001), area of residence (p= 0.001), income (p=&lt;0.001) and perceived social support (p= 0.001). Conclusions: The present study revealed that half of the participants had poor self-care practice. Based on the results, the study concluded that good self-care practices and social support influence better self-care practice among hypertensive patients which may eventually help to prevent complications in the coming future.

Incidence of Diagnostic Errors Among Unexpectedly Hospitalized Patients Using an Automated Medical History-Taking System With a Differential Diagnosis Generator: Retrospective Observational Study.

BackgroundAutomated medical history–taking systems that generate differential diagnosis lists have been suggested to contribute to improved diagnostic accuracy. However, the effect of these systems on diagnostic errors in clinical practice remains unknown.ObjectiveThis study aimed to assess the incidence of diagnostic errors in an outpatient department, where an artificial intelligence (AI)–driven automated medical history–taking system that generates differential diagnosis lists was implemented in clinical practice.MethodsWe conducted a retrospective observational study using data from a community hospital in Japan. We included patients aged 20 years and older who used an AI-driven, automated medical history–taking system that generates differential diagnosis lists in the outpatient department of internal medicine for whom the index visit was between July 1, 2019, and June 30, 2020, followed by unplanned hospitalization within 14 days. The primary endpoint was the incidence of diagnostic errors, which were detected using the Revised Safer Dx Instrument by at least two independent reviewers. To evaluate the effect of differential diagnosis lists from the AI system on the incidence of diagnostic errors, we compared the incidence of these errors between a group where the AI system generated the final diagnosis in the differential diagnosis list and a group where the AI system did not generate the final diagnosis in the list; the Fisher exact test was used for comparison between these groups. For cases with confirmed diagnostic errors, further review was conducted to identify the contributing factors of these errors via discussion among three reviewers, using the Safer Dx Process Breakdown Supplement as a reference.ResultsA total of 146 patients were analyzed. A final diagnosis was confirmed for 138 patients and was observed in the differential diagnosis list from the AI system for 69 patients. Diagnostic errors occurred in 16 out of 146 patients (11.0%, 95% CI 6.4%-17.2%). Although statistically insignificant, the incidence of diagnostic errors was lower in cases where the final diagnosis was included in the differential diagnosis list from the AI system than in cases where the final diagnosis was not included in the list (7.2% vs 15.9%, P=.18).ConclusionsThe incidence of diagnostic errors among patients in the outpatient department of internal medicine who used an automated medical history–taking system that generates differential diagnosis lists seemed to be lower than the previously reported incidence of diagnostic errors. This result suggests that the implementation of an automated medical history–taking system that generates differential diagnosis lists could be beneficial for diagnostic safety in the outpatient department of internal medicine.

Psychometric properties of Alcohol Use Disorder Identification Test screening tool among medical outpatients in Dilla University Referral Hospital, southern Ethiopia, 2020.

Objective:A quick, efficient, and flexible screening tool is essential for identifying alcohol use disorder in a busy clinical context. The Alcohol Use Disorders Identification Test is the most widely used and validated screening tool in the outpatient context. The psychometric features of the Alcohol Use Disorders Identification Test have yet to be confirmed for Ethiopians. As a result, the purpose of this study was to evaluate the Alcohol Use Disorders Identification Test screening tool’s reliability and validity among medically ill patients in Ethiopia.Method:A total of 325 patients who visited the internal medicine outpatient department were included in this study. To diagnose alcohol use disorder based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the psychometric features of the Alcohol Use Disorders Identification Test were compared to the gold standard of Mini International Neuropsychiatry Interview. The reliability was determined by examining internal consistency. The receiver operating characteristic curve was established to calculate sensitivity and specificity of the screening tool. Construct validity was determined using confirmatory factor analysis.Result:The translated version of Alcohol Use Disorders Identification Test showed language clarity. Internal consistency was excellent (Cronbach’s α = 0.9). The Alcohol Use Disorders Identification Test provides an excellent receiver operating curve with cut-off point ⩾8 for females (sensitivity = 0.92, specificity = 0.87, positive predictive value = 70.2, negative predictive value = 96.9, likelihood ratio+ = 7.16, and likelihood ratio− = 0.1) and ⩾10 for males (sensitivity = 0.91, specificity = 0.84, positive predictive value = 72.6%, negative predictive value = 95.3%, likelihood ratio+ = 5.57, and likelihood ratio− = 0.10). Confirmatory factor analysis yielded good model fit indices for the two- and three-factor models, with the two-factor model outperforming the others.Conclusion:The Alcohol Use Disorders Identification Test has been proven to be a reliable tool for detecting alcohol use in gedofa-speaking medical outpatients.

Prevalence of lower urinary tract symptoms and influencing factors in women

Purpose: This study was conducted to determine the prevalence of LUTS in women and the influencing risk factors. &#x0D; Materials and Methods: This cross-sectional study was conducted with 377 women who presented to the internal medicine outpatient departments of a training and research hospital for examination. The data were collected with a questionnaire form and the “Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF)”. &#x0D; Results: The prevalence of at least one LUTS in women was 92.3%. A statistically significant relationship was found between the menopausal status, chronic cough, stress urinary incontinence (SUI) presence in the mother or sister, the presence of a large baby and SUI in a previous pregnancy, and the BFLUTS-SF total scores. &#x0D; Conclusion: We found that storage-related symptoms were most common in these women, and LUTS affected the sexual life and quality of life negatively. Therefore, it is necessary to increase the sensitivity of health professionals to this issue, and to raise the awareness of women about the risk factors, prevention, diagnosis and treatment of LUTS with future training.

Effect of Installation of Alcohol Gel Dispensers and Behavioral Nudges on Behavioral Drivers for Hand Hygiene: A Quasi-Experimental Study at a Tertiary Hospital during the COVID-19 Pandemic

Objective: To compare the level of hand hygiene behavioral drivers before and after installation of alcohol gel dispensers and behavioral nudges among outpatients and visitors at a tertiary hospital in Thailand during the coronavirus disease 2019 (COVID-19) pandemic.Material and Methods: A quasi-experimental study was conducted among outpatients and visitors in June 2020. We installed 12 alcohol gel dispensers with signs serving as behavioral nudges at a tertiary hospital in the Internal Medicine Outpatient Department (OPD), Surgery OPD, and the Pharmacy. We trained enumerators to interview outpatients and visitors regarding their behavioral drivers (beliefs about COVID-19 and hand hygiene based on the health belief model, plus handwashing social norms). We analyzed data using descriptive statistics.Results: Enumerators recruited 206 participants in the pre-intervention phase (refusal rate = 37.6%) and 219 participants in the post-intervention phase (refusal rate = 32.2%). There were significant differences between the pre-intervention and post-intervention phases with regard to self-efficacy for hand hygiene (92.0% vs. 100%, respectively), perceived lack of barriers to hand hygiene with alcohol (93.2% vs. 98.2%, respectively), and the proportion of participants who reported that hand hygiene had become a habit (7.5 vs. 18.8%, respectively). Reports of other domains of health beliefs (perceived severity of COVID-19, perceived benefits of handwashing) were homogeneous in both periods.Conclusion: We found differences in perceived lack of barriers and reported habit of hand hygiene but while self-efficacy was homogeneous in both periods. Issues regarding selection bias, construct validity, and generalizability may limit the usefulness of the study data. Caveats should be considered in the interpretation of the study findings.