Patients Attending Specialist Clinics Research Articles

Vulvar quality of life index (VQLI) - A simple tool to measure quality of life in patients with vulvar disease.

Vulvar disease leads to significant disease burden and reduced quality of life (QOL). However, vulvar disease-specific instruments to measure QOL are lacking. We developed the Vulvar Quality of Life Index (VQLI) to comprehensively and reproducibly assess symptomatic, psychosexual and physical aspects of vulvar disease. The VQLI was inferred from a review of the literature regarding QOL of vulvar disease, and responses from a cohort of patients attending specialist clinics. Seven domains and a 15-item questionnaire were developed. This was tested and optimised prior to validation on 248 women, using a control group as a baseline. The VQLI was further tested on 157 women, and the total VQLI score was compared to a self-determined Likert global score on how vulvar disease had impacted their overall health. The VQLI had excellent internal consistency (Cronbach's alpha, 0.93), and test-retest reliability showed that 9/15 questions had a substantial weighted kappa value of 0.5 or above, with good intraclass correlation coefficient (0.88; CI 0.8-0.93). Spearman correlations were consistently positive. Further testing on 157 women demonstrated a significant relationship between the total VQLI score and the effect of vulvar disease on overall health, with high levels of the impact of vulvar disease on overall health associated with high total VQLI score (P<0.001). The VQLI is a validated, fast and reliable tool to measure the global impact of vulvar disease on QOL and can be used to monitor response to treatment or in a research setting.

Factors Influencing Selected Health Outcome among Patients Attending Universiti Teknologi MARA Medical Centre

There is an increasing attention in evaluating patient experiences during medical consultation as a measure of healthcare quality. The objective of this study was to evaluate the level of satisfaction, enablement and adherence and its associated factors among patients attending specialist clinics in Universiti Teknologi MARA Medical Cenre (PPUiTM). A cross sectional sectional study was conducted at four specialist clinics: obstetric & gynaecology, orthopedics, cardiology and respiratory. Data was collected using self administered questionnaire, involving a total of 220 patients. Variables studied were patient centred communication, patient factor (age, gender, education, income and health status) and the selected outcomes were patient satisfaction, enablement and adherence. Results show 91.7% of the resepondents understood their illness after consultation with providers, 88.9% were satisfied with overall services, 56.7% were complied with medication and 55% perceived provider’s communication as a patient centred. Three variables showed a significant association with at least one health outcome studied, which were age, health status and patient centred communication, P<0.05. Majority of the patient have positive evaluation towards care that they received, consultation with providers successfully enhanced their understanding regarding illness and have a good compliance with medication. Further study should be done to investigate other variables that might affects patient’s outcome.

Hepatitis C genotype distribution in patient and blood donor samples in South Africa for the period 2008-2012.

There are limited molecular epidemiological studies of hepatitis C at a national level in South Africa. The introduction of newer treatment modalities for hepatitis C requires knowledge of the genotypes as these may have different prognostic and therapeutic implications. This retrospective study describes genotype distributions of patients attending specialist clinics and a blood donor group studied during the period 2008-2012 in South Africa. Residual samples from diagnostic viral load testing from specialist clinics in South Africa (n=941) and from the South African National Blood Service (n=294) were analysed quantitatively by real-time PCR and genotyped using the Versant line probe assay or sequencing. Genotype 1 was predominant in blood donors (34%), whilst genotype 5a was prevalent in patients (36%). In the blood donor group, genotype 4 was detected for the first time. Genotype 2 was rare in the patient group and not detected in blood donors. Genotype 1 was the predominant genotype in the younger age groups (less than 30years), whereas genotype 5a was found at higher proportions in the older age groups for both the patient and blood donor groups, comprising more than 60% of genotypes in those older than 50years. Genotypes 1 and 5 were at highest proportions across all provinces compared to other genotypes. In blood donors, genotype 1 was predominant among Caucasians (43%) and genotype 5a among Blacks (54%). Such information is required for planning the impact on the health sector with regard to newly emerging therapies for hepatitis C and burden of disease.

Age-Related Differences in Quality of Life in Swedish Women with Endometriosis.

The purpose of this observational study was to evaluate the impact of endometriosis on quality of life (QoL) in different age groups of Swedish women with endometriosis. Recruitment occurred through the Endometriosis Association (Sweden) (n = 400) and five gynecology departments of five Swedish hospitals (n = 400). All voluntary female members of the patient organization and patients attending specialist clinics due to endometriosis (n = 800) were invited by sending them a questionnaire. An age- and gender-matched sample of the general Swedish population was used as a control group when analyzing SF-36 data. A postal questionnaire (including SF-36) was distributed to 800 women. The questionnaire was evaluated by using descriptive statistics, and SF-36 was evaluated according to standard methods. Of the 449 (56%) self-administered questionnaires returned, 431 (96%) contained evaluable answers. Women with endometriosis have significantly lower SF-36 scores than the general female Swedish population, and the score depends on the women's age. Younger women experience more symptoms and have a lower QoL score compared with women in the older age group. Women with endometriosis have significantly lower QoL than the general female Swedish population and it depends on the women's age, where younger women express more symptoms and have a lower QoL compared with women in the older age group. Our results highlight that more healthcare resources should be focused on younger women with endometriosis.

Tracking Parkinson's: Study Design and Baseline Patient Data.

Background:There is wide variation in the phenotypic expression of Parkinson’s disease (PD), which is driven by both genetic and epidemiological influences.Objectives:To define and explain variation in the clinical phenotype of PD, in relation to genotypic variation.Methods:Tracking Parkinson’s is a multicentre prospective longitudinal epidemiologic and biomarker study of PD. Patients attending specialist clinics in the United Kingdom with recent onset (<3.5 years) and young onset (diagnosed <50 years of age) PD were enrolled. Motor, non-motor and quality of life assessments were performed using validated scales. Cases are followed up 6 monthly up to 4.5 years for recent onset PD, and up to 1 year for young onset PD. We present here baseline clinical data from this large and demographically representative cohort.Results:2247 PD cases were recruited (1987 recent onset, 260 young onset). Recent onset cases had a mean (standard deviation, SD) age of 67.6 years (9.3) at study entry, 65.7% males, with disease duration 1.3 years (0.9), MDS-UPDRS 3 scores 22.9 (12.3), LEDD 295 mg/day (211) and PDQ-8 score 5.9 (4.8). Young onset cases were 53.5 years old (7.8) at study entry, 66.9% male, with disease duration 10.2 years (6.7), MDS-UPDRS 3 scores 27.4 (15.3), LEDD 926 mg/day (567) and PDQ-8 score 11.6 (6.1).Conclusions:We have established a large clinical PD cohort, consisting of young onset and recent onset cases, which is designed to evaluate variation in clinical expression, in relation to genetic influences, and which offers a platform for future imaging and biomarker research.

Knowledge, attitude, and use of internet for medical information by patients attending specialist clinics in ABUTH Zaria-Nigeria

Background: Internet is a relatively new medium of disseminating health information. Studies on Internet usage for health information among patients have mainly been done in developed countries, and very few studies have been carried out in developing world. Objectives: These were to determine the percentage of patients attending specialist clinics that use Internet for health information, describe types of information sought and if patients share the information with their physicians. Materials and Methods: This was a cross-sectional descriptive study. Stratified sampling with equal allocation was done from four specialist clinics and respondents were then selected by simple random sampling. Results: One hundred and ninety-four respondents participated in the study. The mean age of respondents was 31.24 ± 1.0 years. Majority were computer-literate 135 (69.60%) and had tertiary education 108 (55.70%). Sources of access to Internet and search engines used were phone set 167 (86.10%) and Google 147 (75.90%). Types of information sought on the Internet were on disease condition 55 (39.86%) and drug treatment 22 (15.94%); majority of respondents found the information useful 125 (64%) and shared it with their physicians. Educational status and not the age of respondents was significantly associated with computer literacy and Internet use (x2 = 46.03, df = 5, P = 0.001). Conclusion: The study revealed that respondents are knowledgeable on the use of Internet, how to search for information and a high proportion of the patients use it. With increasing access to mobile phones, Internet users will continue to rise overtime and so will demand for seeking medical information. Practical Implications: Health care professionals must acknowledge the use of Internet by their patients in search for knowledge, be ready to discuss such information and provide reliable guide to useful health websites.

Patient perceptions about laparoscopy at Komfo Anokye Teaching Hospital, Ghana.

IntroductionLaparoscopy has become the gold standard for many surgical cases in the developed world. It however, remains a rarity in developing countries for several reasons, a major one being cost. This study aimed to determine the knowledge and attitude of patients attending Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana toward laparoscopic surgery and their willingness to pay for it.MethodsA cross-sectional survey was conducted among patients attending specialist clinics at KATH.Results1070 patients participated. Mean age was 40±15years. 54% were city-dwellers. 14% had salary-paying jobs. None had undergone prior laparoscopic surgery. 3% had knowledge of laparoscopy. 95% preferred laparoscopy to open surgery mainly because of faster recovery and less post-op pain. Age >45years (AOR = 0.53, p = 0.03) and higher education (AOR = 2.00, p = 0.04) were significant predictors of patient choice. Among those preferring laparoscopy, 78% were willing to pay more than the baseline cost of open surgery for laparoscopy. A history of previous abdominal surgery (AOR = 0.67, p = 0.02), having a salaried job compared with being unemployed (AOR = 2.36, p < 0.01) and living in the city compared with the village (AOR = 1.78, p = 0.04) were significant predictors of patients’ willingness to pay more for laparoscopy.ConclusionKnowledge about laparoscopy and its benefits are severely lacking among patients at KATH. Once educated about its benefits, most people prefer laparoscopy even if they needed to pay more for it even in resource-limited countries like Ghana.

Factors influencing support for National Health Insurance among patients attending specialist clinics in Malaysia.

This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrolment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered.

Superior blood pressure control among hypertensive patients attending Specialist clinics in Malaysia

Background The prevalence of hypertension in Malaysia is alarmingly high. The National Survey in 2006 showed that 43% of people above 30 years old have hypertension and only 8% reached target blood pressure (BP) of <140/90mm Hg. Among treated patients, only 26% reached target BP. We aimed to evaluate BP control among hypertensives attending Specialist institutions in Malaysia. Methods This prospective study aimed at determining BP control among hypertensive patients attending three specialist institutions in Malaysia located in Kuala Lumpur (KL), Kuantan and Kota Bharu (KB).

Use of the internet by patients attending specialist clinics in Sri Lanka: a cross sectional study

BackgroundThe internet is a relatively new medium of disseminating health information. Studies on Internet usage for health information are mainly done in developed countries and very few studies have been carried out in developing countries.MethodsThe Internet usage of patients who were attending specialist clinics in Teaching Hospital Karapitiya and Southern Hospital in Galle, Sri Lanka was investigated. The study was carried out on the following specialities; General Medicine, Pediatrics, General Surgery and Cardiothoracic surgery. Information was collected using an investigator-administered questionnaire while patients were waiting for a consultation.ResultsThree hundred and fifty five patients (or guardians in the Pediatric clinic) participated in the study. One hundred seventy two (48.3%) participants have heard about the Internet. There was a relationship between awareness of the Internet and age, educational level and the clinic attended. There was no difference of awareness depending on the gender or the hospital. Only three participants (0.97%) have used the Internet to find information about their disease conditions. Close relatives searched the Internet about the conditions of two participants. Altogether, the Internet was used to search information on the disease condition of five participants (1.4%).ConclusionVery low usage of the Internet for health information retrieval in this study is probably due to low awareness of the Internet and low educational level. This low usage of Internet and the associated reasons shown in this study can be generalized to Sri Lanka and probably to other low-income countries that have lower educational level than Sri Lanka.

Mood disorders and Gilles de la Tourette's syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications

Gilles de la Tourette's syndrome (GTS) consists of multiple motor tics and one or more phonic tics. Psychopathology occurs in approximately 90% of GTS patients, with attention-deficit/hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) being common. Depression is common, with a lifetime risk of 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of GTS patients attending specialist clinics, respectively. In controlled studies embracing over 700 GTS patients, the patients were significantly more depressed than controls in all but one instance. In community and epidemiological studies, depression in GTS individuals was evident in two of five investigations. Clinical correlates of depression in people with GTS appear to be: tic severity and duration, the presence of echophenomena and coprophenomena, premonitory sensations, sleep disturbances, obsessive–compulsive behaviors/OCD, self-injurious behaviors, aggression, conduct disorder (CD) in childhood, and, possibly, ADHD. Depression in people with GTS has been shown to result in a lower quality of life, potentially leading to hospitalization and suicide. The etiology of depression appears to be multifactorial. Bipolar affective disorder (BAD) and GTS may be related in some individuals. However, it is noted that sample sizes in most of these studies were small, and it is unclear at the present time as to why BAD may be overrepresented among GTS patients.

The Placebo Response in the Treatment of Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis

The placebo response is conventionally asserted to be high in chronic fatigue syndrome (CFS) because of the latter's subjective nature and obscure pathogenesis, but no systematic review of placebo responses has been undertaken. We report such a study. Patient expectation is known to be important in the placebo response. It is also known that CFS patients attending specialist clinics often have strong physical attributions regarding causation and hence skepticism about psychological or psychiatric interventions. If so, the placebo response in CFS may be influenced by the type of intervention according to its perceived rationale. We aimed to estimate the summary placebo response in clinical trials of CFS and to determine whether intervention type influences the placebo response in CFS. We searched Medline, Embase, Cochrane Library, PsychInfo, and the references of the identified articles, and contacted experts for controlled trials (randomized or nonrandomized) of any intervention on CFS patients reporting the placebo response as a clinical improvement in physical or general outcomes. Data were extracted from the articles and validity assessment conducted by one reviewer and checked by a second. Meta-analysis and metaregression were performed. The pooled placebo response was 19.6% (95% confidence interval, 15.4-23.7), lower than predicted and lower than in some other medical conditions. The meta-regression revealed that intervention type significantly contributed to the heterogeneity of placebo response (p = .03). In contrast with the conventional wisdom, the placebo response in CFS is low. Psychological-psychiatric interventions were shown to have a lower placebo response, perhaps linked to patient expectations.

A targeted approach significantly increases the identification rate of patients with undiagnosed haemochromatosis.

To determine the optimal means of identifying patients with undiagnosed haemochromatosis. Case-control study where cases are defined by the presence of specific clinical diagnoses or symptoms. Primary care patients were recruited from three Oxfordshire practices and secondary care patients were recruited from those patients attending specialist clinics in Amiens University Hospital. A total of 569 patients recruited via hospital clinics and 60 primary care patients (recruited from 4022 consultations) presenting with the following haemochromatosis associated conditions, diabetes, arthralgia/chronic fatigue, osteoporosis or arthropathy were studied. The control group, a total of 991 healthy volunteers, were recruited through a Health Appraisal Centre. Patients and controls were included in the study if they or their family members had not previously been diagnosed with hereditary haemochromatosis. Serum ferritin concentration, transferrin saturation (Tsat) and presence of HFE mutations, C282Y and H63D. The check-up in controls consisted of a questionnaire, clinical examination, biochemical tests and screening for the presence of the C282Y and H63D mutations. Patient groups presenting with unstable diabetes or chronic fatigue and arthralgia together with a raised serum ferritin concentration showed an enrichment in the haemochromatosis-associated genotype HH/YY, odds ratio (OR) = 40.1, confidence interval (CI) = 8.0-202.1 and OR = 103, CI = 22.9-469.7, respectively. Patients presenting to hospital clinics with haemochromatosis associated conditions should be screened biochemically for iron overload. Only those with a serum ferritin >300 microg L-1 or Tsat >40% should subsequently go on to be genotyped for HFE mutations. The patients at greatest risk of having undiagnosed haemochromatosis are those presenting with unstable diabetes, or fatigue and/or arthralgia in the absence of any other explanation.

Proceedings of the British Medical Ultrasound Society 25th Annual Meeting

The improvement in treatment of patients with cystic fibrosis has resultedin increased life expectancy. Complications, previously rare are becoming increasingly important, particularly the development of liver disease withresulting portal hypertension. Early detection of changes of liver disease could allow treatment and so prevent or delay the development of portal hypertension. We report the use of detailed abdominal ultrasound, including spectral and colour Doppler, to assess changes of early liver involvement in 105 cystic fibrosis patients attending specialist clinics in the West of Scotland. Two groups of Patients were assessed using a strict examination protocol by two senior radiologists.Group 1 105 patients with cystic fibrosis, in whom the clinical status of liver disease was unknown to the examining radiologist;Group 2, a group of 105 patients who wereattending for routine renal ultrasound, matched for age and sex, who had no evidence of cardiorespiratory or hepatic disease.