Patients In Outpatient Clinic Research Articles

The concurrent validity of the Abilitator: a self-assessment questionnaire on functioning and work ability

AimThe Abilitator is a self-assessment questionnaire which was developed to evaluate the perceived work ability and different aspects of functioning of working-age people. The present study aimed to explore the concurrent validity of the Abilitator.Subject and methodsThe participants (n = 177) were patients of a rehabilitation outpatient clinic. Their mean age was 47.1 years. Using Spearman’s correlation coefficients, we assessed the concurrent validity of the Abilitator to compare it to the HAD, RAND-36, EQ-5D, and WHODAS 2.0 (12-item short version) questionnaires.ResultsThe five domains of the Abilitator showed fair to moderate correlation coefficients with the previously validated and accepted measures of functioning. The strongest correlations were found in specific domains measuring similar constructs, namely social inclusion and RAND-36 vitality/fatigue (rs = 0.58), psychological functioning and RAND-36 emotional well-being (rs = 0.67) and HAD depression (rs = −0.65), everyday activities and total score of EQ-5D (rs = 0.63), cognitive functioning and WHODAS 2.0 cognition (rs = 0.57), and physical condition and RAND-36 physical functioning (rs = 0.70). Analysis by subpopulations of gender and age group showed a broadly similar pattern to that of the total sample. In general, stronger correlations were seen among women and among those of a younger age (50 years or under).ConclusionThe Abilitator questionnaire has acceptable concurrent validity for assessing different aspects of the functioning of working-age people.

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

PurposeLong waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.Design/methodology/approachThis observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).FindingsOver an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.Practical implicationsThis waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.Originality/valueAlthough there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.

Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study

Immersive virtual reality is proving effective as a non-pharmacologic analgesic for a growing number of painful medical procedures. External fixator surgical pins provide adjunctive stability to a broken pelvic bone until the bones heal back together, then pins are removed. The purpose of the present case study was to measure for the first time, whether immersive virtual reality could be used to help reduce pain and anxiety during the orthopedic process of removing external fixator pins from a conscious patient in the orthopedic outpatient clinic, and whether it is feasible to use VR in this context. Using a within-subject within wound care design with treatment order randomized, the patient had his first ex-fix pin unscrewed and removed from his healing pelvic bone while he wore a VR helmet and explored an immersive snowy 3D computer generated world, adjunctive VR. He then had his second pin removed during no VR, standard of care pain medications. The patient reported having 43% less pain intensity, 67% less time spent thinking about pain, and 43% lower anxiety during VR vs. during No VR. In addition, the patient reported that his satisfaction with pain management was improved with the use of VR. Conducting simple orthopedic procedures using oral pain pills in an outpatient setting instead of anesthesia in the operating room greatly reduces the amount of opioids used, lowers medical costs and reduces rare but real risks of expensive complications from anesthesia including oversedation, death, and post-surgical dementia. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive non-pharmacologic form of treatment for acute pain and anxiety during medical procedures in the orthopedic outpatient clinic. Recent multi-billion dollar investments into R and D and mass production have made inexpensive immersive virtual reality products commercially available and cost effective for medical applications. We speculate that in the future, patients may be more willing to have minor surgery procedures in the outpatient clinic, with much lower opioid doses, while fully awake, if offered adjunctive virtual reality as a non-pharmacologic analgesic during the procedure. Additional research and development is recommended.

New method of measuring subjective well-being: prospective validation study of the ‘Daily Experience Sampling Questionnaire’ (DESQ) in patients with psoriasis and healthy subjects in Germany

ObjectivesTo validate the newly developed Daily Experience Sampling Questionnaire (DESQ) that measures affective subjective well-being (SWB). The DESQ is an end-of-day diary in which respondents retrospectively rate their SWB at...

Evaluation of indications for amniocentesis in cases of normal fetal ultrasound results.

The objective of this study was to analyze indications for amniocentesis in cases of patients with normal fetal ultrasound results between 11+0 and 13+6 weeks of gestation. The results of first-trimester screening tests performed between 2014 and 2018 on 6,863 patients of the Prenatal Testing Outpatient Clinic at the Clinical Department of Obstetrics and Gynecology, Pomeranian Medical University, Szczecin, Poland, were analyzed. The inclusion criteria were a singleton pregnancy and normal results of fetal ultrasound between 11+0- and 13+6-weeks' gestation. Depending on the calculated risk of fetal trisomy 21, the patients were divided into three groups (group A = RS > 1:300, group B = RS 1:300 - 1:999, group C = RS ≤ 1:1000). Subsequently, values such as PAPP-A and fβ-hCG protein levels and maternal age were analyzed for each of the groups. The patients, 6,310 (91.94%) met the inclusion criteria. A high risk of fetal trisomy 21 was identified for 514 women (8.15%). Group B had 733 (11.62%) and group C 5,063 (80.23%) patients. In group A, an fβ-hCG level of ≥ 2.000 MoM was shown for 50.97% of the women. A PAPP-A level ranging from 0.001 to 0.499 MoM was observed for 38.72% of group A patients. The mean maternal age in groups A, B and C was 36.45, 36.08 and 31.64 years, respectively. In the first-trimester, patients with normal ultrasound results obtained during prenatal screening tests, the main cause of an increased risk of trisomy 21 was elevated PAPP-A and fβ-hCG concentrations. According to this paper's authors, in these cases extension of diagnosis to include other gestational complications, e.g. preeclampsia, should be considered.

Aumento da sobrevida de pacientes com cardiopatias congênitas após assistência perinatal e neonatal adequada: relato de caso

Objetivo: Demonstrar o aumento da sobrevida dos pacientes com cardiopatias congênitas em condições desfavoráveis após adequada assistência neonatal e da correta indicação de interrupção do parto. Detalhamento do caso: Lactente, masculino, 7 meses de idade, paciente em um Ambulatório pediátrico em uma cidade do Estado de São Paulo. Paciente nasceu de 30 semanas e 3 dias de gestação, via parto cesárea por taquicardia fetal e diminuição do movimento fetal, pesando 1900 gramas, medindo 41 centímetros e com APGAR 3/6. Ao nascer, foi colocado em ventilação mecânica, apresentou depressão neonatal, síndrome de desconforto respiratório do recém-nascido, taquicardia supraventricular, hidropsia fetal e hipoglicemia neonatal. Em ecocardiograma foi mostrado transposição congênita corrigida dos vasos da base (TCGA) e uma insuficiência tricúspide de grau leve. O eletrocardiograma revelou ritmo sinusal, frequencia cardiaca de 136 bpm, eixo a zero graus e intervalo PR curto – evidenciando uma possível síndrome de Wolff-Parkinson-White. O Holter de 24h, exibiu 43 episódios de taquicardia juncional paroxística e raras extrassístoles. Considerações finais: A importância de uma triagem pós-natal adequada em relação às taquicardias e apnéias proporciona ao paciente um tratamento precoce, e consequentemente um prognóstico melhor do que se tivesse tido o diagnóstico na fase adulta, período que prevalece os diagnósticos de TCGA.

Clinical Outcome of Percutaneous Trigeminal Nerve Block in Elderly Patients in Outpatient Clinics.

ObjectiveTrigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic. MethodsTwenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients. ResultsAll patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications. ConclusionPercutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

Clinicoepidemiological profile of ear, nose, throat patients in outpatient clinic of tertiary health care facility in Punjab

Background: This study evaluated the profile of ailments in patients presenting to outpatient clinic of tertiary care hospital of North India that caters to ENT diseases in population of Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir.Methods: A retrospective study was undertaken by analysing the medical records of patients managed at the department of otorhinolaryngology and head and neck surgery at the tertiary care hospital, Punjab from Jan 2018 to Dec 2018 and all essential data was collected.Results: Total no. of patients presenting to the ENT OPD during the period of assesment were 32,475. 49.30% were males and 50.70 % were females, respectively. 29.70% were children below 15 years. The number of patients presenting per month were 2706, with maximum no. of patients presenting in the month of August to November. Patients with ear diseases were 9280 (28.57%), Nose diseases were 11963 (36.83%), and throat diseases were 11232 (34.58%).Conclusions: This study showed that awareness of ENT ailments and visits for specialised treatment is on the rise rather than primary level treatment at local or general medicine or family physician level.

Evaluation of malnutrition status and related risk factors in geriatric outpatient clinic.

BACKGROUND/OBJECTIVESMalnutrition risk and malnutrition among the elderly is a public health concern. In combating this health-related problem, it is critically important to evaluate the risk factors in a multidimensional way and to apply appropriate nutrition intervention based on the results.SUBJECTS/METHODSA cross-sectional study was conducted on 215 elderly patients (32.6% male, 67.4% female) in a geriatric outpatient clinic of a hospital in Turkey. Nutritional questionnaires that incorporated the 24-h recall method were applied to determine general characteristics of patients, their health status, nutritional habits, and daily energy and nutrient intakes. Mini Nutritional Assessment was used to determine nutritional status. Relevant anthropometric measurements were obtained.RESULTSThe subjects' mean age was 76.1 ± 7.0 years, and the prevalence of malnutrition (n = 7) and risk of malnutrition (n = 53) among the 215 subjects was 3.2% and 24.7%, respectively. Patients with malnutrition or risk of malnutrition were found to be single, have a depression diagnosis, in an older age group, have less appetite, more tooth loss, have more frequent swallowing/chewing difficulty, and have more frequent meal skipping. In addition, mean daily energy, carbohydrate, fat, fiber, vitamin E, vitamin B1, vitamin B2, vitamin B6, vitamin C, folates, potassium, magnesium, phosphorus, iron intake, and water consumption were found to be statistically significantly low in subjects with malnutrition or risk of malnutrition. After performing regression analysis to determine confounding factors, malnutrition risk was significantly associated with marital status, loss of teeth, appetite status, and depression.CONCLUSIONSRoutine nutritional screening and assessment of the elderly should be performed. If nutritional deficiencies cannot be diagnosed early and treated, self-sufficiency in the elderly may deteriorate, resulting in increased institutionalization.

Mutual Interaction of Clinical Factors and Specific microRNAs to Predict Mild Cognitive Impairment in Patients Receiving Hemodialysis.

Cognitive impairment (CI) is not uncommon in dialysis patients. Various factors have been implicated. This study aims to examine mutual interaction of various clinical factors for CI in patients receiving hemodialysis. A total of 48 hemodialysis patients in outpatient clinic were recruited from 2015 to 2017. Demographics, circulating uremic toxin concentrations, miRNA concentrations, and nerve injury protein concentrations were collected. Clinical dementia rating (CDR) scores were used to stratify the functional scores of the patients. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic test performance for predicting dichotomous results, and cumulative ROC analysis was used to examine the combined contribution of clinical factors. CDR scale 0 included 15 patients (mean age, 59.1 years); CDR > 0.5 included 33 patients (mean age, 64.0 years). On cumulative ROC analysis, the major predictors of mild CI were hemoglobin, age, sex, homocysteine, neuron-specific enolase (NSE), and miR-486. The cumulative area under the curve (AUC) on combining hemoglobin, age, and miR-486 was the highest (0.897, 95% confidence interval 0.806–0.988). Two dichotomized variables reached 81.82% sensitivity and 86.67% specificity, with the likelihood ratio for positive and negative results being 6.14 and 0.21, respectively. In conclusion, hemoglobin, age, and miR-486 display high-degree combined effects on mild CI in patients receiving hemodialysis.

Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines.

Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children's hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation. Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment. A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.

The Effectiveness of Structured Self-Care Model on Improvement of Self-Care Agency, Disability and pain Level among Patients with Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis causes progressive deterioration, with subsequent functional decline leading to disability Aim: To investigate the effect of structured self-care model on of self-care, disability and pain among patients with rheumatoid arthritis. Design: quasi experimental study design was used. A convenience sample of 60 adult patients, drawn from all the patients in outpatient clinic at Mansoura University Hospital from January 2019 to October 2019. Tool: An interview questionnaire include: Socio-demographic and medical data, Exercise for Self Care Agency ,World Health Organization Disability Assessment Schedule and Pain Disability Index (PDI). Results: Shows the patient get higher scores regarding level of exercise for Self Care Agency in follow up after 2 month (mean 119.9) and after 4month (mean 165.7) than pre-test (mean 104.9), as higher scores indicate higher level of self-care ,with highly statistically significant difference (p.v 0.01). There was a highly statistically significant difference (p.v 0.001**) regarding the mean score of the total disability assessment pre, after two and after four months among participant as the mean after four months (98.8±6.71) was increased compared with the mean pretest (160.48±3.7). Results shows the main items of pain disability index, pre, post two months and four months there a statistical significant regarding family and home responsibilities, recreation, social activity, life-support activity, occupation and total score. No statistical significant regarding sexual behavior .Conclusion & Recommendations. A structured self-care model help in improvement of self-care, disability and pain level among patients with rheumatoid arthritis. Self-management programs result in beneficial effect on disability and pain scores.

Dynamic posturography and posturographic training for Parkinson’s disease in a routine clinical setting

BackgroundPostural instability in Parkinson’s disease (PD) often is ill-responsive to drugs and DBS. Physiotherapy is recommended but practicability and cost effectiveness are debatable. Research question: Can a simple ‘plug and play’ posturography system produce clinically meaningful measures and elicit postural motor learning in PD patients? Methods40 moderately affected PD patients in a general neurology outpatient clinic who complained of postural instability were included to practice shifts and stabilization of the center of pressure (COP) in a low intensity (once weekly 20-25 minutes over 6 weeks) dynamic posturographic training using the Biodex balance systemTM. Average deviations from mean COP position and from the center of the base of support (BOS) with different degrees of visual feedback in static and dynamic posturographic tasks other than the training tasks, the Berg-Balance-Scale (BBS) and patient self-ratings (FES-I, ABC scale) were assessed before and after training. ResultsPosturographic performance was significantly better with eyes open than closed and more so with explicit visual feedback of COP position (p < 0.005). Only with this latter type of feedback and only the deviation form the BOS in dynamic and static posturography was significantly correlated with BBS and UPDRS III (p < 0.001). The deviation from the BOS under explicit visual feedback significantly improved after training (p < 0.005) whereas BBS, FES-I and ABC-scale did not. SignificanceOur posturography procedures were well applicable as a routine clinical tool. They yielded clinically valid measures when COP position was visible and directional shifts from the BOS centre were quantified. Our training was effective for this posturographic measure only. Its significance as a predictor for clinical efficacy of higher intensity and longer term training schedules is hypothesized and warrants further studies.

The New Normal of ENT OPD: Adapting Safe Practices.

The COVID-19 epidemic originating in China has spread rapidly worldwide and converted to pandemic proportions in March 2020. In India and densely populated countries like Brazil and USA the numbers are still rising. Clinicians all over the world are trying to contain it by minimizing the cross-transmission of disease among hospital staff members. In the field of Otorhinolaryngology (ENT) the doctors are exposed to high viral load while examining the patients. Therefore contingency plans are required for dealing with patients in outpatient clinics, and while performing diagnostic endoscopies, minor procedures in OPD and surgeries in operating rooms. Infected patients may shed severe acute respiratory syndrome coronavirus-2 particles into their environment via body secretions. Therefore, Otolaryngologists should be vigilant. In this submission, we share our experience of an innovative practice plan in redesigning the ENT OPD setup, endoscopy set up and OT so as to reduce the risk of transmission of virus not only to doctors but other healthcare workers. We hope that our modifications will serve as a guide for every Otolaryngologist throughout India towards performing their clinical duties confidently without any apprehension and ensuring adequate safety during this testing times in their small set-up/ clinical establishments.

Effectiveness of Structured Self-Care Model on Self-Care, Disability and Pain among Patients with Rheumatoid Arthritis

Abstract Background: Rheumatoid arthritis causes progressive deterioration, with subsequent functional decline leading to disability Aim: To investigate the effect of structured self-care model on of self-care, disability and pain among patients with rheumatoid arthritis. Design: quasi experimental study design was used. A convenience sample of 60 adult patients, drawn from all the patients in outpatient clinic at Mansoura University Hospital from January 2019 to October 2019. Tool: An interview questionnaire include: Socio-demographic and medical data, Exercise for Self Care Agency ,World Health Organization Disability Assessment Schedule and Pain Disability Index (PDI). Results: Shows the patient get higher scores regarding level of exercise for Self Care Agency in follow up after 2 month (mean 119.9) and after 4month (mean 165.7) than pre-test (mean 104.9), as higher scores indicate higher level of self-care ,with highly statistically significant difference (p.v 0.01). There was a highly statistically significant difference (p.v 0.001**) regarding the mean score of the total disability assessment pre, after two and after four months among participant as the mean after four months (98.8±6.71) was increased compared with the mean pretest (160.48±3.7). Results shows the main items of pain disability index, pre, post two months and four months there a statistical significant regarding family and home responsibilities, recreation, social activity, life-support activity, occupation and total score. No statistical significant regarding sexual behavior .Conclusion & Recommendations. A structured self-care model help in improvement of self-care, disability and pain level among patients with rheumatoid arthritis. Self-management programs result in beneficial effect on disability and pain scores.

PRELIMINARY CHARACTERIZATION AND IDENTIFICATION OF GRAM POSITIVE HEMOLYSIS BACTERIA

One of the most important pathogens that threaten human health all over the world is Staphylococcus spp. characterization and identification of such pathogen considers a useful tool to control of some serious problems resulting by these bacteria. Therefore one hundred and twenty samples including blood, urine, abscess, semen, pus, sputum, ears, vaginal and spit swabs were collected from patients of Tanta University Hospital and outpatient clinics. A total of 126 Gram positive bacterial isolates were obtained from these clinical specimens. Of these isolates 107 bacterial strains were identified as Staphylococcus spp and 15 strains identified as Streptococcus spp in addition to 4 strains were identified as Enterococcus spp, preliminary identification was conducted on the basis of colony characteristics such as Gram staining, pigment production, hemolysis, catalase activity, coagulase test and fermentation of manitol sugar. Out of these strains, 30.95% have the potency to make alpha hemolysis while 30.95% have the ability to make beta hemolysis and 38.09% posse the capacity to make gamma hemolysis on blood agar medium. Beta hemolysis Staphylococcus spp were selected for study of some virulence factors on basis of coagulase production in which 17.24% of Staphylococcus spp were coagulase positive and 82.76% were coagulase negative Staphylococcus spp. Studying the susceptibility pattern of these strains to some commercial antibiotics was carried out. Further future studies are recommended to investigate the effect of some natural compounds on gene regulation that responsible for hemolysis process.

Patients and doctors: what kind of changes in outpatient clinic services can be made in concert?

Abstract Background Search for possible improvements in outpatient clinic services is a key task for health care professionals worldwide. It is important to consider the satisfaction of the main participants in primary care: patients and doctors. If patients unsatisfied with primary care will not seek help again, this will reduce their life quality and life expectancy. Unsatisfied doctors will work not efficiently nor for a long time. The work is devoted to the search for possible factors, which change may affect the improvement of the situation in clinics in terms of both doctors and patients. Methods The opinions of 1672 patients of Krasnoyarsk outpatient clinics were investigated with the usage of semi-structured interviews. The opinions of 283 physicians of the city were collected using an anonymous questionnaire. Data were analyzed using SPSS 22 by the following methods (p &amp;lt; 0.05): descriptive statistics, U test, χ2-test. Results Coherence of doctors' and patients' opinions investigated in different ways such as primary care satisfaction, desirable main changes, optimal time, duration and structure of appointment, physician's mission, the possibilities of additional medical remote consultations and difficulties in doctors' access. At some points, the answers were consistent; at some, a compromise or new ways of the solutions were required. Conclusions Almost 61% of the doctors prefer morning work time (8-12 am) and 15.5% prefer work in the evenings (18-20 pm) while only 38.1% of patients can visit a doctor in the morning time and 39.5% in the evening. The main changes to be made according to the general opinion of doctors and patients is a reduction of a waiting time of doctors' appointment (38.1% and 38.5% respectively) and the creation of an electronic queue (26.5% and 30.5% respectively). Remote consultation service have to be organized for patients: phone service is more appropriate as for the doctors (30.5%) so as for the patients (34.7%). Key messages The reduction of a waiting time of doctors’ appointment, creations of an electronic queue and a remote consultation service have to be organized to improve primary care system. There is inconsistency in time preferences that have to be solved: doctors prefer to work in morning time and many patients can visit clinics only in the evenings.

Score of Hearing Handicap Inventory for the Elderly (HHIE) Compared to Whisper Test on Presbycusis.

Presbycusis is a sensorineural type of hearing loss caused by a degenerative process of the hearing organ. Examination was done to detect hearing loss, with Audiometry as the diagnostic gold standard and screening with whisper test and using Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire. This study was aimed to compare the sensitivity and specificity between Hearing Handicap Inventory for the Elderly Screening questionnaire score and Whisper test in hearing loss of presbycusis patients in Dr. Soetomo Hospital. Subjects were elderly patients in outpatient clinic of Geriatry and Audiology of Dr. Soetomo General Hospital in Surabaya. Data samples were collected by consecutive sampling. All collected samples were analyzed statistically by Pearson correlation test to identify the correlation between variables. Results: Statistic analysis with Pearson correlation test obtained p-value = 0.001 and correlation coefficient (r) = 0.691 for HHIE-S questionnaire and p = 0.001 and (r) = 0.298 for Whisper test. The sensitivity of the Whisper test was 72.73% while the HHIE-S questionnaire was 61.82%. Both tests had the same specificity of 80%. Conclusions: The Whisper test is more sensitive than HHIE-S questionnaires in detecting hearing loss in presbycusis patients in outpatient clinic of Geriatry and Audiology of Dr. Soetomo General Hospital in Surabaya.

Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates

IntroductionSleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. The objective was to explore the occurrence of sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) patients, and their correlates.MethodsA broad data collection was performed in 137 Norwegian PsA outpatient clinic patients including demographics, disease activity measures for both skin and musculoskeletal involvement, and patient-reported outcome measures. Sleep disturbances and fatigue were defined present if the numeric rating scale (0–10) score was ≥ 5. Anxiety/depression was assessed using a questionnaire (1–3; 1 defined as no anxiety/depression). Descriptive statistics was applied, and associations were explored using univariate and adjusted linear regression analysis.ResultsThe mean age was 52.3 years, PsA disease duration 8.8 years; 49.6% were men and 54.8% were currently employed/working. The prevalence of sleep disturbances was 38.0%, fatigue 44.5%, and anxiety/depression 38.0%. In adjusted analysis, pain, fatigue, and higher mHAQ were associated with sleep disturbances. Sleep disturbances, pain, and anxiety/depression were associated with fatigue, whereas only fatigue was associated with anxiety/depression.ConclusionsThe prevalence of sleep disturbances, fatigue, and anxiety/depression was frequently reported by PsA patients. No measures reflecting skin involvement or objective measures of musculoskeletal involvement were independently associated with sleep disturbances, fatigue, or anxiety/depression. Our data suggest that patients’ perceptions of musculoskeletal involvement (pain or mHAQ) play an important role causing sleep disturbances and fatigue, whereas fatigue in PsA patients is strongly associated with anxiety/depression.

Outpatient pain clinic and intranasal fentanyl to improve sickle cell disease outcomes.

Acute pain events are a leading complication for sickle cell patients. In an attempt to improve pain outcomes, we developed an outpatient pain clinic, and included intranasal fentanyl in the opioid emergency department (ED) pain order set. We evaluated admission rates and opioid administration for patients that attended both the outpatient pain clinic and ED within a 3-month period. We recorded the admission rate, IV morphine equivalents, and time from triage for each opioid order and administration from both an outpatient pain clinic and ED visit within a 3-month period for an individual pediatric patient with sickle cell disease. Thirty patients received acute pain management in both settings. We identified a significant reduction in hospital admission when patients received care in the pain clinic as compared to the ED (17% vs 43%, P=.02). Additionally, outpatient pain clinic patients received significantly less IV morphine equivalents than patients received in the ED (5.6 vs 10.6 IV morphine equivalents, P<.0001). In the ED, intranasal fentanyl was administered in a significantly shorter time than patients ordered intravenous opioid (43 vs 75min, P=.02). The mean time to receiving an opioid in the outpatient pain clinic was 57min. The use of an outpatient pain clinic can reduce admission rates as compared to the ED. The use of intranasal fentanyl reduced the time to first opioid administration in the ED. Patient-centered research or quality improvement projects should continue to focus on novel approaches to acute pain event management.