Outpatient Clinical Practice Research Articles

Cognitive-Behaviourism, Constructivism and Humanism in Paediatrics Specialty Training: From theory to practice.

The study of human learning is constantly changing and developing facilitated using learning theories like cognitive-behaviourism, constructivism and humanism which are the main guide for both academic and clinical training including paediatrics. Current advances in medical education in postgraduate medical training suggests that trainees, educational and clinical supervisors can hugely benefit from robust understanding of learning theory and its right application in clinical practice in outpatient clinics, inpatient ward rounds, clinical skills teaching and multidisciplinary meetings. Consultants and senior medical staff involved in teaching and training of postgraduate doctors in paediatrics can review these theories and their approaches to targeted learning goals to increase skill set to cope with present demand and to produces sound and skilled paediatricians. The aim of this narrative review is to provide paediatricians clinical and educational supervisors opportunities to be theoretically grounded in the dynamics of selected learning theories leveraging on their right application to achieve the learning goals of paediatric specialty training and inform excellent medical scholarship. The combination of these theories in the raising of next generation of paediatrician is a viable pathway in postgraduate medical training.

Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes.

AimsInformation and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR).MethodsA cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the ‘incorrect’ setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up.Results47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician’s preference to consider other treatment options; 2. patients’ preferences.ConclusionsWe could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients’ preferences.

The practical use of the Patient Enablement and Satisfaction Model in nurse-led outpatient cardiac clinics

BackgroundThe Patient Enablement and Satisfaction Model (PESM) developed in primary care, theorises the mechanisms through which nurses may impact upon patients’ experience of satisfaction and enablement, enhancing their capacity to manage their health. AimTo evaluate the applicability of the PESM in an ambulatory chronic care setting. MethodsWe applied Corbin and Strauss’ criteria for evaluating the practical value of a conceptual model in diverse clinical settings, to inform our framework analysis of nurses’ perceptions of the applicability of the Model. An education session and resource was provided to nine nurses who worked in four nurse-led outpatient cardiac clinics in an Australian city in July 2017. These same nurses were interviewed before and after implementing The Model in clinical practice. FindingsThe PESM was practical and useable in all four clinics. It aligned with the clinics’ chronic disease self-management aims and was viewed as realistic and flexible in response to patients’ needs. The Model stimulated discussion about scope of practice, identifying differences in education between those with chronic disease management training and those without, and ways to address these gaps. DiscussionUse of the PESM facilitated the provision of a consistent, person-focussed approach to chronic disease management in this study. While the PESM resonates with other chronic disease models, we believe its grounding in patient-centred nursing research enhances its natural fit in nurse-led clinics. ConclusionThe PESM and accompanying education resource provides a concrete knowledge translation tool to support evidence-based chronic disease management practice in outpatient cardiology clinics.

Private practice outpatient fine needle aspiration clinic: A 2018 update.

This review updates a 2008 report on the establishment of a pathologist-directed ultrasound-guided fine needle aspiration (USGFNA) biopsy clinic in a private practice setting. During this time, ultrasound evaluation of the thyroid has evolved from simply sampling a nodule to a reliable cancer risk assessment (CRA). Because of perceived poor reliability in many local radiology thyroid ultrasound reports, first endocrinologists and then pathologists began performing their own ultrasound evaluations, cancer risk assessments, and USGFNAs. The present review covers a wide range of topics, including incorporating ultrasound data into a report, the uniqueness of the thyroid as an USGFNA target, artifact pseudocomplexity mimicking neoplasia, the pathologist's ability to acquire thyroid cancer risk assessment expertise, and distinguishing a true thyroid nodule from a pseudonodule with appropriate documentation. The use of ultrasound does not change the core need for high-level biopsy and smear-making techniques. Two national courses offer advanced training and certification. Selection of mission-appropriate ultrasound machines is discussed along with the pitfalls of purchase. Determining the location of a USGFNA clinic requires several considerations, as does the layout detail of the clinic interior for optimal patient comfort and experience. Ultrasound does not obviate the pathologist's anticipation of patient concerns or of providing information, including revealing a cancer diagnosis. The goal of this review is to help guide the reader to successfully and beneficially bring the science of USGFNA to patients in an understandable and caring way.

Screening of stroke risks among middle-aged and elderly people in Shanghai community general outpatient clinics

Objective To screen stroke risks among middle-aged and elderly people in community outpatient clinics in Shanghai. Methods A stroke risk screening was conducted among people aged 45-75 years selected with convenient sampling method from 10 community health service centers in Putuo district, Yangpu district and Pudong New Area of Shanghai during January to July 2017. The questionnaire and clinical measurement were used for screening. Multivariate logistic regression analysis was used to analyze the risk factors in subjects with high stroke risk. Results In this study, 1 094 individuals with high stroke risk were screened out from 1 750 participants (62.5%). The proportion of high risk cases was higher among men (66.7%, 473/709) than that among women (59.7%, 621/1 041) , unmarried, divorced or widowed (75.0%, 90/120) than married or cohabitants (61.6%, 1 004/1 630) , living alone (72.1%, 70/97) than living with others (61.9%, 1 024/1 653) (χ2=8.969, 8.571, 4.081; P<0.01). Compared with non-high-risk subjects, the high-risk subjects had higher BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, serum creatinine and homocysteine, and were more likely to have carotid plaques or stenosis, the difference was statistically significant (P<0.05). Multiple logistic regression analysis showed that unmarried/divorce/widowed, high BMI, systolic blood pressure, fasting blood glucose, total cholesterol, and carotid plaque or stenosis were positively associated with high stroke risk(OR=2.015, 1.173, 1.013, 1.456, 1.139, 1.026, 2.103; P<0.05). Conclusions The proportion of high stroke risk individuals among middle-aged and elderly people is higher in community general practice outpatient clinics in Shanghai. Patients with high BMI, systolic blood pressure, fasting blood glucose and total cholesterol, and carotid plaque or stenosis, as well as those unmarried/divorced/widower should be the subjects for stroke intervention. Key words: Stroke; Middle-aged and elderly; Community health center; High risk

Prolongation of the QT interval in patients with coronary heart disease as consequence of drug-drug interactions on metabolic rate

Objective:Prolongation of the QT interval in patients with coronary heart disease (CAD) is a risk factor of polymorphic ventricular tachycardia (PVT) and as consequence, the sudden death. Drug-drug interactions (DDI) on metabolic rate involving cytochrome P-450 (CYP) is the one of the major cause of Long QT Syndrome (LQTS). The aim of the present study was to improve the safety of combined pharmacotherapy when using drugs that affect the QT interval.Method and Results:Medication occurrence of potential dangerous combination of medicines that are affected on QT interval duration in patients with CAD are researched (outpatient medical records (patient history) analysis). Clinical relevance of DDI, which are associated with changes in CYP enzyme activity, categorized by drugs.com Medication Guide. Finding potential dangerous combination of medicines that are affected on QT interval duration were administered to patients with CAD in 3.6% cases in outpatient clinical practice. The most often prescribed combination of drugs is amiodarone and torasemide (13.3% evidence of all concomitant administration that are leading to QT prolongation). The potential mechanism of Amiodarone and Torasemide interaction on metabolic rate that are leading to QT prolongation are competitive substrates CYP 2C8 and a result of inhibited CYP 2C9 by amiodarone.Conclusion:Ability to predict the prolongation of the QT interval caused by DDI on metabolic rate make possible to improve the safety concomitant administration to patients with CAD.

Clinical and endovascular practice in interventional radiology: a contemporary European analysis

BackgroundThe purpose of this survey was to determine the current trends in endovascular practice by Interventional Radiologists (IR’s) across Europe and to understand the engagement by Interventional Radiology (IR) with clinical practice. CIRSE European members were invited to participate in an online survey between July 11th, 2016 and August 8th, 2016. A 54 question survey was created to capture a comprehensive overview of IR endovascular practice and clinical engagement.ResultsFour hundred and five valid responses were received (9.9%) from a broad geographic distribution from across Europe. 76% of IR’s practised in centres with more than 400 beds as 60% worked in an academic or university teaching hospital. 36% dedicated 80–100% of their time to IR and 59% dedicated at least 60% of their time to IR. 24/7 IR on-call was available in the hospitals of 73% or respondents. 78% had dedicated IR nursing staff and 67% had nursing support on-call, 55% had inpatient admission privileges and 27% had dedicated IR inpatient beds. 65% of IR’s had admitting rights to day-case beds. 42% ran IR outpatient clinics and 36% performed ward rounds. 81% of respondents performed peripheral arterial disease (PAD) intervention and IR was the main provider of PAD intervention in 67% of centres. Vascular Surgery or Medicine were the main referrers (71%) to IR for PAD intervention. 37% of centres had a hybrid operating theatre and 80% of IR’s had access to this.ConclusionIR remains a substantial player in the field of PAD Intervention. The continued evolution of outpatient clinics and clinical practice is key to retention and future expansion in the field of endovascular therapy for PAD.

Management of Patients with Type 2 Diabetes Shared between a Specialized Outpatient Clinic and General Practice Was Noninferior to Mono Management in a Specialized Outpatient Clinic—A Prospective, Randomized, Noninferiority Trial

To ensure high-quality care for patients with type 2 diabetes (T2D), it is necessary to consider how clinical management is organized. We investigated if management of patients with T2D shared between a specialized outpatient clinic and primary health care has a non-inferior outcome of HbA1c compared to ‘mono’ management in a specialized outpatient clinic.The study was a 12-month randomized controlled, non-inferiority trial. Non-inferiority margin for HbA1c was 4.4 mmol/mol. Patients with T2D and incipient complications were eligible for the study. The shared care intervention consisted of one annual comprehensive check-up at the outpatient clinic and three quarterly visits at the primary health care physician. The control group was offered four quarterly visits at the outpatient clinic, including an annual comprehensive check-up.We randomized 140 patients (age: 65.0±0.9 years (mean±SEM), BMI: 30.8±0.5 kg/m2, diabetes duration: 9.1±0.5 years, HbA1c: 51.9±0.8 mmol/mol, systolic blood pressure: 135.6±1.1 mmHg) with no significant baseline differences between the groups. Ninety-five (68%) patients had peripheral neuropathy, 26 (19%) microalbuminuria, and 21 (15%) previous major cardiovascular event. At end-of-trial, mean HbA1c change from baseline was 2.0 mmol/mol in the intervention group and 0.9 mmol/mol in the control group. The between-group difference of 1.1 mmol/mol (95% confidence interval: -2.0, 4.1) met the pre-specified non-inferiority criterion. Our study shows that a shared care program is non-inferior to an established program in a specialized outpatient clinic in maintenance of glycemic control of T2D patients with incipient complications. Shared care could be part of future T2D management, as more patients will benefit from the specialized diabetes team while keeping close contact with the primary care physician. Disclosure L. Munch: None. B.B. Bennich: None. D. Overgaard: None. H. Konradsen: None. H.V. Middelfart: None. N. Kaarsberg: None. F.K. Knop: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Amgen Inc.. Speaker's Bureau; Self; Merck Sharp &amp; Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Consultant; Self; Amgen Inc.. Advisory Panel; Self; MedImmune, Sanofi. Consultant; Self; Sanofi. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. T. Vilsb ll: Advisory Panel; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Consultant; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Speaker's Bureau; Self; Amgen Inc., Boehringer Ingelheim GmbH, Eli Lilly and Company, AstraZeneca, MSD K.K., Sanofi, Novo Nordisk A/S. Research Support; Self; Eli Lilly and Company, Novo Nordisk A/S. M. R der: None.

Analysis of changes in pharmacotherapy of stable angina over the five-year period at specialized out-patient level of medical care (pharmacoepidemiological study)

Introduction: Ischemic heart disease (IHD) remains the leading cause of death both in Europe and in Russia. The most common form of IHD is stable angina. There is compelling evidence that strict adherence to clinical guidelines greatly contributes to mortality reduction. However, the gap between modern knowledge and use of guideline-recommended medications remains significant. As shown by Western practice, one of the possible solutions of this problem is regular conduction of pharmacoepidemiological studies.&#x0D; Objective: Investigate the dynamics of drug prescription rates in patients with stable angina over the five-year period on the example of routine clinical practice of outpatient cardiology institution of Moscow for the purpose of further eliminating the prescribing gap for guideline recommended pharmacological strategies.&#x0D; Materials and methods: Our research work was performed as a retrospective pharmacoepidemiological study including two stages with five-year interval using cross-section method.&#x0D; Results and discussion: We found a significant increase in use of antiplatelets (82.7 vs. 56.2%, p&lt;0.05) and statins (45.6 vs. 16.1%, p&lt;0.05). Despite the unchanged use of ACE inhibitors, the prescription rate of angiotensin receptor blockers II increased (14.7 vs. 9.7%, p&lt;0.05). Analysis of anti-ischemic pharmacotherapy revealed an increase in beta-adrenoblockers use (74.3 vs. 63.6%, р&lt;0.05) and a decrease in use of long-acting nitrates (26.3 vs. 31.1%, р&lt;0.05) and calcium channel blockers (35.7 vs. 39.6%, р&lt;0.05). Significant changes were found in prescription rates and dosage regimens of single medications in each pharmacological group. The study results demonstrated an increase in frequency of capturing data on lipid profile and diet recommendations in patient records.&#x0D; Conclusion: Such type of pharmacoepidemiological study carried out for the first time made it possible to investigate the dynamics of specialists’ adherence to guidelines of stable angina pharmacotherapy in routine outpatient clinical practice.

Use of Phase III Slope of Volumetric Capnography in Outpatient Clinical Practice: A Descriptive Analysis

Use of Phase III Slope of Volumetric Capnography in Outpatient Clinical Practice: A Descriptive Analysis

Outpatient Appointment Block Scheduling Under Patient Heterogeneity and Patient No‐Shows

We study outpatient appointment block scheduling policies for single providers under conditions of patient heterogeneity in service times and patient no‐shows. The objective is to find daily appointment schedules that minimize a weighted sum of patients’ waiting time, the physician's idle time, and the physician's overtime. We contribute by suggesting new effective sequential block scheduling procedures motivated by actual outpatient clinic practices across the globe and grounded in the successful Toyota Production System load smoothing approach. Our block scheduling policy first assigns a sequence of different patient types within a time block. The policy then allocates repetitive blocks across a planning horizon. We start our analysis by studying the case with zero probability of no‐shows. Under the setting that the physician's idle time is zero, we propose a polynomial time optimal scheduling approach for two patient types, before demonstrating that the problem with at least three patient types is NP‐Hard. Various extensions to incorporate practical outpatient clinic environment dimensions are considered. We then extend our scheduling approach to incorporate reasonable patient no‐show probabilities. Finally, our block scheduling approach is adapted for scenarios where outpatient clinics use an open‐access scheduling environment, where patients make same‐day appointments. We compare our block scheduling policies against extant scheduling policy, finding our block scheduling policies surpass the benchmark method.

Utility of Automated Calls for Filling Care Gaps in Medical Practice: A 1-Year Initial Experience: 2017 Presidential Poster Award

Introduction: Automated outreach systems have been used in several clinical settings to reduce readmission rates, improve outcomes for chronic illness and reduce health-care utilization. To assess the potential for automated post-encounter calls to close common care gaps and those caused by service disruptions in an outpatient clinical practice, we reviewed the first full-year experience in a single-specialty gastroenterology practice. Methods: Automated post-encounter phone calls were made to all patients seen in the clinic during 2016. After confirming the identity of the patient accepting the call, the system asked four questions to identify care gaps related to instructions received during the visit, prescriptions, additional scheduling needs, and overall patient satisfaction. Data collected through an integrated dashboard was reviewed and analyzed for reach rates, issues opened for further staff action, types of care gaps identified, issue resolution rates, and staff actions taken. The practice schedule was examined to identify events during the year that might have disrupted service in the practice. Results: The system performed outreach in the form of automated telephone calls for 9,593 clinic visits, with a success rate of 82% (7,853 patients reached regarding their visit). Of these, 1,677 calls resulted in an issue opened for a staff response (21.4% of patients reached) in 55 different identified categories. A large number of issues opened were attributable to patient mistakes or improper documentation by staff. Patient satisfaction concerns resulted in 170 issues (2.1% of patients reached). Clinically important care gaps were identified in 462 issues (5.9% of patients reached). The ten most frequent issues comprised 474 (75.0%) of the 632 clinical or satisfaction issues opened. Of these, the most frequent issues were triggered by patient questions about instructions (187), prescription medications (120) and care coordination (105). When these issues were compared against known service disruption events that affected the practice during the year, the patterns detected suggest correlations. Conclusion: The automated outreach system resulted in a high reach rate and identified many clinically important service gaps for corrective actions. With small adjustments in the implementation process this type of hybrid-automated outreach system may improve care and mitigate the negative impact of service disruptions in outpatient clinical practice.Figure: Post-Visit Automated Call Engagement Metrics by Month.Figure: Most Frequent (“Top 10”) Actions Taken by Wichita Falls GI Associates Staff in 2016 by Month.Figure: WFGIA Care Gap Documentation and Key Service Disruptions by Month.

Improving Ambulatory Care Resident Training: Preparing for Opportunities to Treat Mental Illness in the Primary Care Setting

Purpose: The development of an outpatient psychiatry clinical practice learning experience for PGY2 ambulatory care pharmacy residents in preparation for the treatment of psychiatric disorders in the primary care setting is described. Summary: With the increased prevalence of psychiatric disorders, significant mortality, and limited access to care, integration of mental health treatment into the primary care setting is necessary to improve patient outcomes. Given the majority of mental health treatment occurs in the primary care setting, pharmacists in patient-centered medical homes (PCMHs) are in a unique position with direct access to patients to effectively manage these illnesses. However, the increased need for pharmacist education and training in psychiatry has prompted a large, Midwestern academic health system to develop an outpatient psychiatry learning experience for PGY2 (Postgraduate Year 2) ambulatory care pharmacy residents in 2015. The goal of this learning experience is to introduce the PGY2 ambulatory care residents to the role and impact of psychiatric clinical pharmacists and to orient the residents to the basics of psychiatric pharmacotherapy to be applied to their future practice in the primary care setting. Conclusion: The development of an outpatient psychiatry learning experience for PGY2 ambulatory care pharmacy residents will allow for more integrated and comprehensive care for patients with psychiatric conditions, many of whom are treated and managed in the PCMH setting.

Verification of Survival Predictors in Elderly Patients with Myelodysplastic Syndrome from Outpatient Clinical Practice

Summary Background Myelodysplastic syndrome (MDS) is a clonal disorder affecting older persons. We aimed to analyze the effectiveness of the scoring systems and of the number of received red blood cell (RBC) units in predicting survival. Methods The study included an unselected group of 73 patients with MDS who were diagnosed and treated in a single hospital over a period of 12 years. International Prognostic Scoring System (IPSS), revised IPSS (IPSS-R), WHO-Prognostic Scoring System (WPSS), Charlson Age-Comorbidity Index (CACI), and impact of performance status (PS) on overall survival (OS) and event free survival (EFS) were tested. The follow-up of received RBC units was conducted. Results The median age at diagnosis was 69.5 years, the median CACI was 3.0. The median survival times of the group were 7.04 and 2.78 years for OS and EFS, respectively. The concordance values of the IPSS, IPSS-R and WPSS are 0.812, 0.892 and 0.889 for OS; 0.785, 0.847 and 0.827 for EFS. The comorbidity index and PS were the only auxiliary criteria when determining the risk and selecting the therapeutic approach in MDS patients. In transfusion-dependent unchelated patients, both OS and EFS were negatively influenced by both higher ferritin levels and the numbers of RBC units; however, the risk does not continue to increase after more than 20 RBC units are administered. Conclusions IPSS-R is best suited as a predictor of survival. CACI and PS present auxiliary criteria for determining the risk. Number of received RBC units was detected as a significant predictor of survival.

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain.

Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.

Alcohol and tobacco use and the diseases treated in general practice.

To characterize the use of alcohol and tobacco and correlate both to the diseases of outpatients in a general practice outpatient clinic. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) questionnaire was answered by 300 randomly chosen subjects assigned to different groups according to the diseases being treated at the Outpatient General and Teaching Clinic of the Department of Internal Medicine, Hospital das Clínicas of the University of São Paulo's School of Medicine (HC-FMUSP, in the Portuguese acronym), São Paulo, Brazil. The consumption of tobacco and alcohol was characterized and its correlation with the groups of diseases being treated was calculated using Chi-square and Pearson test statistics. Compared to alcohol, tobacco use was more prevalent, more intense and showed more health-, social-, legal- and financial-related damage. Tobacco smoking presented a positive significant (p<0.0001) correlation with respiratory diseases. According to the questionnaire's criteria, few alcohol users would be referred to clinical interventions in comparison to smokers. Respiratory diseases and tobacco use were well correlated based on the ASSIST questionnaire. The preventive value of the questionnaire was more evident in relation to tobacco than alcohol consumption.

Microalbuminuria screening in diabetes

Microalbuminuria screening in diabetes

Short-Term Impact of a Combined Nutraceutical on Cognitive Function, Perceived Stress and Depression in Young Elderly with Cognitive Impairment: A Pilot, Double-Blind, Randomized Clinical Trial.

The prevalence of senile dementia is increasing worldwide, especially in the developed countries. Nevertheless, drug therapy isn't often enough to treat this condition. Researchers are evaluating the possible impact of a preventive approach, based on an improvement of lifestyle and the intake of micronutrients. Moreover, there is an increasing interest for combined nutraceuticals that can act as memory and learning enhancers, with a significant and beneficial potential on the cognitive disorders. To evaluate the effects of a rational assemblage of nutraceuticals on cognitive functions in a sample of 30 elderly subjects. Double bind, cross-over designed trial versus placebo Setting: outpatient clinical practice. 30 elderly subjects with basal Mini-Mental State Examination score between 20 and 27 and self-perceived cognitive decline. Treatment with a combination of nutraceuticals based on Bacopa monnieri, L-theanine, Crocus sativus, copper, folate and vitamins of B and D group. After2 months of treatment or placebo. Patients were evaluated with Mini-Mental State Examination (MMSE), Perceived Stress Questionnaire (PSQ) and Index and Self-Rating Depression Scale (SRDS). MMSE and PSQ Index significantly improved in the active treatment arm, both versus baseline and versus the parallel arm. Both groups experienced a significant improving in the SRDS scores. We obtained a good and significant improvement of the cognitive functions tested with the MMSE, PSQ-Index and SRDS score, after 2 months of combined therapy of nutraceuticals. Further confirmation will be needed to verify these observations on the middle and long term in a larger number of subjects.

Wearing off: A complex phenomenon often poorly recognized in Parkinson's disease. A study with the WOQ-19 questionnaire.

'Wearing off' refers to the phenomenology of movement disorders in Parkinson's disease (PD) that appears early and is much commoner than generally believed. It may be present in the form of either motor symptoms or non-motor symptoms. To investigate the utility of wearing-off questionnaire (WOQ-19, Italian version) in the outpatient clinical practice to assess the suitability of different combinations of treatment, in various stages of PD. 73 consecutive patients (58% male and 42% female) suffering from PD were recruited through the Santorso Hospital and San Martino Hospital from September 2012 to March 2014. The patients were asked to indicate whether or not they experienced any of the 19 symptoms listed in the questionnaire during the day; if one or more of these referred symptoms relating to PD improved after taking an additional dose of levodopa; and, if these variations were present routinely. Furthermore, we also evaluated the possible correlation between the presence of motor and non-motor symptoms that were listed in the WOQ 19 with the motor impairment assessed by the Hoehn and Yahr stage (HY) and the Unified Parkinson's Disease Rating Scale (UPDRS) part III motor section, in the whole patient cohort as well as in different subgroups undergoing therapy. Among the 73 patients, 22% were receiving levodopa (a mean daily dose of 300 ± 121.3 mg), 38.3% levodopa and dopamine agonists, 12.3% levodopa/rasagiline, 8.2% levodopa/selegiline, and 19.2% a combination of levodopa/dopamine agonists (DA)/monoamine oxidase inhibitors (MAOI). The most prevalent symptoms were the non-motor symptoms included in the WOQ-19. A significant correlation between the scores obtained on the different motor and non-motor items recorded by the WOQ-19 and the UPDRS motor section and HY scores was found. The therapeutic benefit was especially related to the motor symptoms. In clinical practice, this simple and easily administered questionnaire may be useful for the early detection of fluctuations in symptomatology in patients with PD. It will, therefore, help to improve the quality of the global care of patients with PD detected in various stages of the disease.

Evaluation of the knowledge and behavior of patients at a university hospital outpatient clinic regarding blood donation

Aim: This study aims to determine the knowledge, and behavior of patients at a university hospital’s family practice outpatient clinic regarding blood donation. Material and method: In this cross-sectional study, the authors administered a questionnaire to patients (400 people) at the university hospital’s family practice outpatient clinic for three months. The study data were entered into the SPSS package program, and the author performed the statistical analyses using this program. Results: The mean age of the participants was 28.70±10.81. Of them, 86% knew their blood type, and 53.8% had a document showing their blood type. Only 21.8% of the participants had previously donated blood. Blood donation was evaluated according to gender; men had offered to donate blood more than women; when evaluated according to marital status those who were married were found to donate blood more than singles. 63.3% of the participants who donated blood said they did so to help other people. Of those who did not donate blood before, 29.1% now consider donating?? In response to the question, how much a person is supposed to weigh in order to donate blood, 47.0% said a person should weigh at least 50 kilograms. When asked how often you could donate blood, 23.8% said every three months. Conclusion: The participants’ attitudes and behavior regarding blood donation were positive. Knowledge of participants is not enough. They are moderately well informed about this issue. People should be continuously provided with training about blood donation to increase their awareness.