Regularity Of Follow-up Research Articles

A Descriptive Study to Assess the Nursing Care Needs of Schizophrenia Patients Attending OPD in Tertiary Care Mental Health Institute

Background: Schizophrenia is a serious and persistent neurobiological brain disease. It is characterized by disturbances in thought, perception, affect, verbal & motor behaviors, and relationship to the external world. According to WHO, schizophrenia has been estimated that approximately 7 individuals per 1000 will develop during their lifetime. Objectives: The study objectives were to assess the socio-demographic profile and clinical profile, to assess the nursing care needs and to find out the association between selected socio-demographic profile and clinical profile with nursing care needs among Schizophrenia patients. Materials and Methods: Quantitative research approach was used, and descriptive design was adopted. 60 OPD patients were selected by using purposive sampling technique. Self-structured checklist to assess Nursing Care Needs, Assessment of Mental Status and Scale for the Assessment of Negative Symptoms (SANS) were used. Results: Out of 60 participants, 32 were male & 28 were female. 33.3% (f=20) were on occasional follow-up, 20.0% (f=12) were on regular, 31.7% (f=19) were on irregular and 15.0% (f=9) were never went for follow-up care & 58.3% (f=35) were not maintaining regular medication compliance. The findings of nursing care needs assessment showed majority i.e., 50% (f=30) participants had Moderate nursing care needs, 20% (f=12) had High nursing care needs and 30% (f=18) had No significant nursing care need with immediate interventions. Conclusion: The result showed that there was significant association between Nursing care needs of Schizophrenia patients who attending OPD with their age, regularity of follow-up and medication compliance.

A qualitative study on perceptions and practices of diabetes prevention and management in rural south India

Abstract Aims: The purpose of this study is to explore the perceptions and practices of diabetes management through focus group discussions (FGDs) among adults with diabetes in rural Tamil Nadu. Materials and Methods: A qualitative study was conducted among individuals with diabetes who were part of the Telemedicine pRoject for screENing Diabetes and its complications in rural Tamil Nadu (TREND). A total of 16 FGDs were conducted using a semi-structured FGD guide that elicited perceptions of the different aspects of diabetes management and knowledge about diabetes prevention. The sample size was based on the attainment of thematic saturation. All FGDs were audio-recorded and transcribed verbatim. The textual data was then coded into meaning units and grouped into themes. Data were analyzed using NVIVO software version 10.0. Results: There were varied responses with respect to diet, medication adherence, regularity of follow-up, knowledge about diabetes, and diabetes prevention. Most participants had limited knowledge of the disease and did not have regular hospital visits. Several participants were unable to adhere to the diet prescribed by healthcare providers, as they lived alone or were dependent on someone in the family for dietary needs. Most participants were unaware that diabetes could be prevented. Some participants were interested in serving as “Diabetes ambassadors” to educate rural societies about diabetes. Conclusions: Understanding the perceptions and practices about diabetes management and prevention strategies could help primary healthcare workers effectively treat, manage, and prevent diabetes in underserved rural populations.

Contemporary challenges in clubfoot treatment: A quantitative study among Indian parents

PurposeThe studies conducted a decade ago showed that the Ponseti method, suffers from many execution-related issues-particularly in low and middle-income countries including poverty, physical distance, lack of transportation etc. The society has undergone many changes, including improvements in literacy, connectivity (both transport and digital), etc., in the last decade. Therefore, this study is designed to identify the contemporary apprehensions, concerns, and challenges of parents seeking CTEV treatment for their child through the Ponseti Method in India. MethodsA descriptive cross-sectional study of 200 parents of the children undergoing treatment at a multi-specialty hospital is carried out using an interview guide. The semi-structured interviews were conducted telephonically and recorded. ResultsThe statistical analysis shows that a male child is presented late than a female child. The physical distance is associated with child discomfort during the casting and bracing phase, with the travel method affecting the follow-up. The increase in travel time may result in increased casts due to a lack of regular follow-up. Parents' income level is also strongly associated with regularity of follow-up and child discomfort during treatment. ConclusionsThe patients traveling long distances in public transport are the most vulnerable group regardless of gender. The children in such cases are more likely to experience discomfort during the casting and bracing phase with a lack of regular follow-up. Expert doctors and brace unavailability in the local area remain vital challenges for the parents.

Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center.

Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146-1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012-1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619-0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002-1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047-1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033-1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972-0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543-0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.

Dterminants of medication adherence in Moroccan schzophrenic patients

Abstract Introduction Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management. Objectives To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia. Methods This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%. Results A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p < 0.001), insight (p < 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082). Conclusions Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients. Key messages Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.

Geographic influence on postoperative complications in children with complicated appendicitis: a single center study

BackgroundAcute appendicitis is one of the most common abdominal emergencies in children. Complicated appendicitis is much more common in pediatric age group than in adults due to probability of delay in diagnosis or misdiagnosis. Geographic status has an influence on the clinical course of such surgical cases. This prospective comparative study was conducted at the pediatric surgery department in our hospital in Egypt during the period from December 2018 to August 2019, aiming to find the relation between residence of patients and occurrence of post-operative complications among patients in Sharkia Governorate, Egypt. Patients were divided into two groups: rural and urban. Data recorded included demographic data, preoperative assessment, operative findings, postoperative course, postoperative complications, and follow-up.ResultsSixty patients were included in the study, 32 of them were from rural areas, and 28 were from urban areas. There was no significant difference between them regarding demographics. Duration of symptoms was significantly longer with rural group (3.7 ± 1.4 vs. 3.07 ± 0.92 days). Length of hospital stay was significantly longer with the rural group (4.7 ± 1.7 vs. 4.7 ± 1.7 days). The rate of wound infection was significantly higher with the rural group (34.37% vs. 10.7%), while other postoperative complications were increased with rural group, but that was not statistically significant. The regularity of follow-up was higher with the urban group.ConclusionsChildren with complicated appendicitis from rural areas are at higher risk for occurrence of postoperative complications and poor outcome, with less regularity in follow-up. This is because of many obstacles they faced, including difficulties of transportation, insufficient medical services, and low socioeconomic and educational statuses.

Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia

To read the full abstract: J Pediatr Endocrinol Metab 2020; 33(2): 295–304. doi: 10.1515/jpem-2019-0345

Assessment of health-related quality of life in Egyptian children and adolescents with congenital adrenal hyperplasia

Background Congenital adrenal hyperplasia (CAH) is a chronic disorder causing adrenal insufficiency and hyperandrogenism affecting the quality of life (QOL). The objective of the study was to assess the health-related QOL (HRQOL) in Egyptian children and adolescents with CAH and to identify factors affecting it. Methods This cross-sectional study included 200 CAH patients (with 21-hydroxylase deficiency [21-OHD]) who were assessed according to their age, sex, clinical phenotype, timing of genitoplasty, hospital admissions within the last year, compliance to treatment, regularity of follow-up, presence of complications and hormonal control. HRQOL was assessed using the World Health Organization (WHO)QOL-BREF questionnaire with four domains analyzed independently including physical, psychological, social and environmental domains, with higher scores indicating better QOL. Results The study included 140 females and 60 males with a mean age of 6.6 ± 4.5 years, and 88% were salt-wasting (SW). Older patients had significantly lower QOL scores (r = - 0.151, p = 0.033). The physical domain correlated significantly with the degree of virilization (r = - 0.491, p = 0.001) and frequency of hospitalization (r = - 0.495, p < 0.001). The psychological domain was affected by age (r = - 0.157, p = 0.026) and timing of genitoplasty (r = - 0.326, p = 0.001), while the social domain was affected by age (r = -0.277, p < 0.005) and pubertal stage (r = - 0.195, p = 0.006). Females had lower scores at the psychological domain (p < 0.001), whereas males had lower scores at the physical domain (p = 0.003). Salt-losing patients had lower scores at the physical domain (p = 0.001). Patients with good hormonal control had higher scores at the physical domain (p = 0.03). Genitoplasty affected both psychological and social domains (p = 0.003 and 0.01, respectively). Patients with hypertension and hirsutism had lower QOL scores (p < 0.05). Conclusions HRQOL was relatively more affected in CAH patients with older age, poor hormonal control, high frequency of hospital admissions and those who developed complications.

Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study.

To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9years at a tertiary diabetes center in India. We compared glycemic burden [cumulative time spent above a HbA1c of 53mmol/mol (7%)] and incidence of diabetes complications (retinopathy, neuropathy, nephropathy, peripheral arterial disease, coronary heart disease) between 1,783 T2DM patients with "regular follow-up" (minimum of three visits and two HbA1c tests every year from 2003 to 2012), and 1,798 patients with "irregular follow-up" (two visits or less and one HbA1c or less per year during the same time period), retrospectively identified from medical records. Cox proportional hazards models were used to estimate risk associated with diabetes complications. Compared to those with regular follow-up, the irregular follow-up group had significantly higher mean fasting and postprandial plasma glucose, HbA1c, glycemic burden, total and LDL cholesterol, and triglycerides at every time point during the 9years of follow-up. Those with irregular follow-up had double the total and mean monthly glycemic burden and 1.98 times higher risk of retinopathy (95% CI 1.62, 2.42) and 2.11 times higher risk of nephropathy (95% CI 1.73, 2.58) compared to those with regular follow-up, even after adjusting for time-varying confounding variables. Complications tended to develop significantly earlier and were more severe in those with irregular follow-up. Among patients with type 2 diabetes, regular follow-up was associated with significantly lower glycemic burden and lower incidence of retinopathy and nephropathy over a 9-year period.

Continuidad de cuidados, innovación y redefinición de papeles profesionales en la atención a pacientes crónicos y terminales. Informe SESPAS 2012

Continuity of care is essential to address the multiple needs of the chronically and terminally ill. To achieve this aim, the organizational barriers of the different levels of care must be overcome by establishing appropriate coordination mechanisms. Interest in finding effective solutions to the problems that threaten continuity of care is increasing, favoring the continued development of professional and institutional strategies to improve coordination. The present article explores some of the proposals to improve the coordination of care in primary care settings, from the point of view of nursing, social work and palliative care. Due to the increase in patients with chronic and complex needs and multimorbidity, the number and quality of home visits should be increased. The effectiveness of home care depends on the regularity of follow-up and the stability of the healthcare programs, rather than on the service responsible for monitoring the patient or the professional responsible for home visits.

The need for cardiac follow-up in adults with mild congenital cardiac disease

To discuss the need for continuing cardiac surveillance in adults with hemodynamically insignificant congenital cardiac disease. In 82 patients with mild congenital cardiac malformations, aged from 17 to 32 years, we investigated the subjective health status, the health-related quality of life, any difficulties encountered in daily life, the regularity of follow-up, current diagnosis, and antibiotic prophylaxis. The subjective health status, and the health-related quality of life, did not differ from those of the general population. Nevertheless, patients experienced unnecessary difficulties with choice of sport, obtaining insurance cover, and education. After clinical re-evaluation, diagnosis and antibiotic regimes had to be changed in 9 patients (11%). Patients with a mild congenital cardiac malformation consider themselves to be in good health. So as to fine tune the diagnosis, and update the information supplied to the patients, we suggest that at least a cardiological assessment be carried out at the age of 16 to 18 years. In this way, patients might be protected from unnecessary difficulties, such as restrictions for sport or the charging of unjustifiably high rates for insurance.