Specialist Outpatient Clinics Research Articles

Application of the Chinese Expert Consensus on Diabetes Classification in clinical practice

Objective: To evaluate the diagnostic for classification of newly diagnosed diabetes patients and assess the application of the screening tests recommended by the 2022 Chinese Expert Consensus on Diabetes Classification. Methods: Retrospective case series study. The data from the electronic medical record system of patients with new-onset diabetes mellitus (within 1 year of disease onset) who attending the Diabetes Specialist Outpatient Clinic at the Second Xiangya Hospital of Central South University from January 1, 2018 to December 31, 2021 were collected for the analysis. Based on the consensus, patients were categorized according their age of onset, body mass index (BMI), and suspicion of type 1 diabetes mellitus (T1DM). The chi-square statistic was used to compare key classifier indicators, including C-peptide, islet autoantibodies, and genetic markers, in the subgroups. The diagnosis in suspected T1DM patients was also evaluated. The screening strategy recommended in the consensus was further assessed using a logistic regression model and the area under the receiver-operating curve (AUC). Results: A total of 3 384 patients with new-onset diabetes were included. The average age of disease onset was (46.3±13.9) years, and 61.0% (2 065/3 384) of the patients were male. The proportions of patients who completed C-peptide and glutamic acid decarboxylase antibody (GADA) tests were 36.6% (1 238/3 384) and 37.5% (1 269/3 384), respectively. There were no significant differences in C-peptide test results among the subgroups (all P>0.05). In contrast, the GADA detection rate was higher in patients with young age of onset (<30 years old), in those who were non-obese (BMI<24 kg/m2), and in those clinically suspected of T1DM (all P<0.05). According to the diagnostic pathway proposed by the consensus, only 57.4% (1 941/3 384) of patients could be subtyped. For a definitive diagnosis, the remaining patients needed completion of C-peptide, islet autoantibody, genetic testing, or follow-up. Furthermore, among patients with clinical features of suspected T1DM, the antibody positivity rate was higher than in non-suspected T1DM patients [24.5% (154/628) vs. 7.1% (46/646), P<0.001]. When the clinical features of suspected T1DM defined in the consensus were taken as independent variables and antibody positivity was considered the outcome variable in the logistic regression model, young onset, non-obese onset, and ketosis onset could enter the model. Based on AUC analysis, the accuracy of the diagnostic model was 0.77 (95%CI 0.73-0.81), suggesting that the clinical features of suspected T1DM in the consensus have good clinical diagnostic value for this patient subgroup. Conclusions: There was a significant discrepancy between the clinical practice of diabetes classification and the process recommended by the consensus, which was specifically reflected in the low proportions of both subtyping indicator testing and definitively subtyped diabetes patients. Attention should be pay to the classification diagnosis process proposed in the consensus and the clinical detection rate of key diabetes subtyping indicators such as C-peptide and islet autoantibodies for diabetes classification should be improved. Noteworthy, the screening strategy for T1DM proposed by the consensus showed good clinical application value.

1191 Novel Biomarkers for the Diagnosis of Chronic Pancreatitis: An Exploratory Case-Control Study

Abstract Aim Chronic pancreatitis is a complex inflammatory syndrome with manifestations including abdominal pain, malnutrition, and diabetes. Early recognition is necessary for optimal management; however this remains clinically challenging and there are no established biomarkers for diagnosis. This exploratory study aims to determine the expression of a set of fibrosis-related serum biomarkers in patients with chronic pancreatitis relative to controls. Method Participants were recruited from specialist outpatient clinics at a single centre. Ethical approval was granted via the institutional biobank. Cases were defined as adult patients with a radiological and/or histological diagnosis of chronic pancreatitis. Controls were adult patients with no history of pancreatic disease. Blood samples were collected from each participant and the serum concentrations of candidate biomarkers measured in duplicate by enzyme-linked immunosorbent assays. Results In cases (n = 17; median age 53 years) compared to controls (n = 4; median age 54 years), the mean serum concentration of osteoactivin was 39.32 ng/ml vs. 18.70 ng/ml (2.1 fold); fibronectin was 512.33 μg/ml vs. 328.83 μg/ml (1.6 fold), osteopontin was 8.19 ng/ml vs. 7.47 ng/ml (1.1 fold), vimentin was 637.94 ng/ml vs. 562.14 ng/ml (1.1 fold), TIMP1 was 0.25 μg/ml vs. 0.23 μg/ml (1.0 fold) and osteonectin was 3.8 μg/ml vs. 4.71 μg/ml (0.8 fold). Conclusions This pilot study demonstrated differential expression of several fibrosis-related serum biomarkers in patients with chronic pancreatitis compared to controls. An expanded study will aim to establish the utility of these biomarkers for the early diagnosis of this condition.

Not all questions are created equal: the weight of the Oxford Knee Scores questions in a multicentric validation study

BackgroundThe Oxford Knee Score (OKS) has been designed for patients with knee osteoarthritis and has a widespread use. It has 12 questions, with each question having the same weight for the overall score. Some authors have observed a significant ceiling effect, especially when distinguishing slight postoperative differences. We hypothesized that each questions’ weight will depend significantly on the patient’s sociodemographic data and lifestyle.MethodsIn this international multicentric prospective study, we included patients attending a specialist outpatient knee clinic. Each patient filled out 3 questionnaires: (a) demographic data and data pertaining to the OKS, (b) the standard OKS, and (c) the patient gave a mark on the weight of the importance of each question, using a 5-point Likert scale (G OKS). Linear regression models were used for the analysis.ResultsIn total 203 patients (106 female and 97 male) with a mean age of 64.5 (±12.7) years and a mean body mass index (BMI) of 29.34 (±5.45) kg/m2 were included. The most important questions for the patients were the questions for pain, washing, night pain, stability, and walking stairs with a median of 5. In the regression models, age, gender, and driving ability were the most important factors for the weight of each of the question.ConclusionThe questions in the OKS differ significantly in weight for each patient, based on sociodemographic data, such as age, self-use of a car, and employment. With these differences, the Oxford Knee Score might be limited as an outcome measure. Adjustment of the OKS that incorporates the demographic differences into the final score might be useful if the ceiling effect is to be mitigated.Level of Evidence: Level II prospective prognostic study

Experiences of Health Service Access and Use for People Living with Parkinson’s Disease in Ireland: A National Survey

Background. Despite the growing prevalence of Parkinson’s disease (PD) and the need to plan for future health service provision, little is known in the Irish context about PD patients’ experiences of service access/use. Methods. A cross-sectional survey, with multiple formats, i.e., online, pen-and-paper, and telephone. Data were collected from May 2020 to July 2021 using a multipronged recruitment strategy. The survey was completed by people with PD alone or with the support of a carer/support person. Results. A total of 1402 responses were included. Over half (53%) were male. Approx. 10% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a generic or specialist outpatient clinic. Almost 1-in-5 reported it took more than 12 months to obtain the diagnosis. Most were diagnosed by neurologists (84%), followed by GPs (8%) and geriatricians (7%); 1% indicated “other.” Of those diagnosed privately, 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Access to the range of health and social care professionals, including PD nurse specialists and clinical therapies is universally poor. Conclusions. A number of significant gaps in PD care are discussed, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level. Specifically, more PD nurse specialists are needed within the public health system.

Body-Focused Repetitive Behavior Disorders in Children and Adolescents: Clinical Characteristics and Treatment Outcomes in a Naturalistic Setting

Body-focused repetitive behavior disorders, including trichotillomania (hair-pulling disorder) and excoriation (skin picking) disorder, typically emerge in early adolescence, but little is known about the clinical characteristics and treatment outcomes of these disorders in young people, particularly in real-world clinical settings. Participants were 63 children and adolescents (51 girls; age range 9–17) with a diagnosis of trichotillomania (n = 33) and/or skin-picking disorder (n = 33) attending a specialist outpatient clinic in Stockholm, Sweden. Demographic and clinical characteristics were gathered at the initial assessment. Of the 63 assessed youths, 56 received manual-based behavior therapy mainly focusing on habit reversal training, which was combined with medication when deemed appropriate. The mean clinician-reported trichotillomania and skin-picking disorder symptom severity at baseline (n = 63) was in the moderate range. We observed high rates of psychiatric comorbidity (63.5%) and use of psychiatric medication (54.8%). For the 56 individuals undertaking treatment at the clinic, mixed-effects regression models showed a significant decrease in symptom severity from baseline to posttreatment, with gains maintained up to the 12-month follow-up. Substantial and durable improvements were also seen on self-reported symptoms, self-reported depression, and global functioning. Specialist care should be made more widely available to improve the prognosis and quality of life of young people with trichotillomania and skin-picking disorder.

Predictors of specialist somatic healthcare utilization among older people with intellectual disability and their age-peers in the general population: a national register study

ObjectivesTo compare somatic healthcare usage among older people with intellectual disabilities (ID) to that of their age-peers in the general population, taking into account health and demographic factors, and to...

Increasing advance care planning referrals for chronic obstructive pulmonary disease patients in the emergency department

In Singapore General Hospital (SGH), patients with chronic obstructive pulmonary disease (COPD) are referred for advance care planning (ACP) at the specialist outpatient clinics with about 50 cases referred a year and a completion rate of 10%. One of the commonly cited reasons by patients is that they are feeling well currently and do not need to talk about ACP at that moment. The Emergency Department (ED) saw about 240 COPD patients of P2 or P3 acuity yearly and might be a strategic place for ACP advocacy to take place for COPD patients who are triaged as P2 or P3 acuity. While the memory of the recent exacerbation remains fresh, it could be an opportune moment to start an ACP conversation with such patients in the ED. A quality improvement project (QIP) led by both ED nurses and doctors was executed to increase the number of ACP referrals for COPD patients from the ED. A total of 16 COPD ACP referrals were made, up from the previous baseline of zero. Of note, two of the 16 referrals (12.5%) completed the ACP process. Four more (25%) are still in midst of ACP completion at time of project conclusion.

Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult patients with type 2 diabetes from specialist outpatient clinics of a tertiary hospital: A cohort study

AimTo evaluate the association between trajectories of glycated haemoglobin (HbA1c) and potentially avoidable hospitalisations (PAH). MethodsWe performed a cohort study in a tertiary hospital in Singapore among adult type 2 diabetes patients with ≥ 3 HbA1c tests over two years. Then, we followed up for one year after the last HbA1c reading to determine the PAH outcome. Glycaemic control was analysed by (1) HbA1c trajectories through group-based trajectory modelling, and (2) mean HbA1c. PAH was defined using the Agency of Healthcare Research and Quality criteria, categorising as overall, diabetes, acute, and chronic-composites. ResultsA total of 14,923 patients (mean age: 62.9 ± 12.8 years; 55.2% men) were included. Four HbA1c trajectories were observed; low-stable (n = 9854, 66.0%), moderate-stable (n = 3125, 20.9%), high-decrease (n = 1017, 6.8%) and high-persistent (n = 927, 6.2%). Compared to the low-stable trajectory, one-year risk ratio (RR) and 95% confidence interval (CI), respectively for moderate-stable, high-decrease and high-persistent trajectories were as follows: (1) overall PAH: 1.15 (1.00–1.31), 1.53 (1.31–1.80), 1.96 (1.58–2.43); (2) diabetes PAH: 1.30 (1.04–1.64), 1.98 (1.55–2.53), 2.24 (1.59–3.15); (3) acute PAH: 1.14 (0.90–1.44), 1.29 (0.95–1.77), 1.75 (1.17–2.62); and (4) chronic PAH: 1.21 (1.02–1.43), 1.62 (1.34–1.97), 2.14 (1.67–2.75). Mean HbA1c was significantly associated with overall and chronic-composites of PAH whilst evidence of a non-linear relationship with diabetes-composite of PAH was noted. ConclusionPatients with high-decrease trajectory had a risk lower than those with persistently-high HbA1c, highlighting that a greater risk of hospitalisation conferred by poor glycaemic control is potentially reversible. Determining HbA1c trajectories could help to identify the high-risk individuals for targeted and intensive management to improve care and reduce hospitalisations.

Improving the treatment of functional seizures through a public specialist outpatient clinic

ObjectivesWe performed an audit of the first 12 months of clinical operations to assess the feasibility of a newly established public outpatient clinic for the assessment and treatment of functional (psychogenic nonepileptic) seizures (FS). MethodClinical notes for the first 12 months of the FSclinic weresystematicallyreviewed with data compiled onreferral pathways, clinic attendance, clinical features, treatments, and outcomes. ResultsOf eighty-two new FS patients referred to the clinic, over 90% attended. Patients were diagnosed with FS after comprehensive epileptological and neuropsychiatric review, mostly with typical seizure-like episodes captured during video-EEG monitoring, and most accepted the diagnosis. Most had FS at least weekly, with little sense of control and significant impairment. The majority of individuals had significant psychiatric and medical comorbidity. Predisposing, precipitating, and perpetuating factors were readily identified in >90% of cases. Of 52 patients with follow-up data within12 months, 88% were either stable or improved in terms of the control of their FS. ConclusionThe Alfred functional seizure clinic model, the first dedicated public outpatient clinic for FS in Australia, provides a feasible and potentially effective treatment pathway for this underserved and disabled patient group.

COVID Stress Scales: A Cross-sectional Study of its Psychometric Properties among Africans with Chronic, Stable Medical Conditions

Background: The coronavirus 2019 pandemic (COVID-19) elicited in various populations, diverse psycho-behavioral responses. The COVID Stress Scales (CSS) was developed and validated in the general population, among US and Canadian adults, in response to the COVID-19 pandemic. Expectedly, population-specific variations in response are likely, hence, the need to validate psychometrically sound instruments across cultures and diverse populations.&#x0D; Aim: To determine the factor structure and reliability estimates of the CSS among participants with chronic, stable medical conditions in a Nigerian Tertiary Hospital.&#x0D; Methods: The cross-sectional study, involved 1047 consenting adults with chronic, stable medical conditions attending the out-patient specialist clinics of a foremost tertiary hospital in Nigeria. The participants were enrolled consecutively over a four-month period straddling the first and second waves of the COVID-19 pandemic. The CSS was administered to participants who fulfilled the study criteria. Exploratory Factor Analyses (EFA) using Principal Component Analysis and Oblimin rotation with Kaiser Normalization, was used to extract the factors. &#x0D; Results: A six-factor structure emerged: COVID-19-related socio-economic consequences; contamination; xenophobia; traumatic stress; compulsive checking and reassurance seeking; and danger. The internal consistency within items of each domain was acceptable (Cronbach alpha 0.85 and above) and correlation between the domains was moderate to strong.&#x0D; Conclusion: The CSS maintained a six-factor structure, corresponding to the six scales, among Nigerian participants with chronic, stable medical conditions. It has acceptable reliability estimates and can be used to assess COVID-19-related anxiety in this population. The inter-correlation of the various domains is a strong evidence for the existence of COVID stress syndrome.

Assessment of Hypertension Complications and Health Service Use 5 Years After Implementation of a Multicomponent Intervention

There is a lack of information regarding the impact of implementing a protocol-driven, team-based, multicomponent intervention in public primary care settings on hypertension-related complications and health care burden over the long term. To compare hypertension-related complications and health service use at 5 years among patients managed with Risk Assessment and Management Program for Hypertension (RAMP-HT) vs usual care. In this population-based prospective matched cohort study, patients were followed up until the date of all-cause mortality, an outcome event, or last follow-up appointment before October 2017, whichever occurred first. Participants included 212 707 adults with uncomplicated hypertension managed at 73 public general outpatient clinics in Hong Kong between 2011 and 2013. RAMP-HT participants were matched to patients receiving usual care using propensity score fine stratification weightings. Statistical analysis was conducted from January 2019 to March 2023. Nurse-led risk assessment linked to electronic action reminder system, nurse intervention, and specialist consultation (as necessary), in addition to usual care. Hypertension-related complications (cardiovascular diseases, end-stage kidney disease), all-cause mortality, public health service use (overnight hospitalization, attendances at accident and emergency department, specialist outpatient clinic, and general outpatient clinic). A total of 108 045 RAMP-HT participants (mean [SD] age: 66.3 [12.3] years; 62 277 [57.6%] female) and 104 662 patients receiving usual care (mean [SD] age 66.3 [13.5] years; 60 497 [57.8%] female) were included. After a median (IQR) follow-up of 5.4 (4.5-5.8) years, RAMP-HT participants had 8.0% absolute risk reduction in cardiovascular diseases, 1.6% absolute risk reduction in end-stage kidney disease, and 10.0% absolute risk reduction in all-cause mortality. After adjusting for baseline covariates, the RAMP-HT group was associated with lower risk of cardiovascular diseases (hazard ratio [HR], 0.62; 95% CI, 0.61-0.64), end-stage kidney disease (HR, 0.54; 95% CI, 0.50-0.59), and all-cause mortality (HR, 0.52; 95% CI, 0.50-0.54) compared with the usual care group. The number needed to treat to prevent 1 cardiovascular disease event, end-stage kidney disease, and all-cause mortality was 16, 106, and 17, respectively. RAMP-HT participants had lower hospital-based health service use (incidence rate ratios ranging from 0.60 to 0.87) but more general outpatient clinic attendances (IRR, 1.06; 95% CI, 1.06-1.06) compared with usual care patients. In this prospective matched cohort study involving 212 707 primary care patients with hypertension, participation in RAMP-HT was associated with statistically significant reductions in all-cause mortality, hypertension-related complications, and hospital-based health service use after 5 years.

Motives behind low-acuity geriatric emergency medicine attenders: a picture from free healthcare system.

Current evidence about the low-acuity ED visits of old patients has been generated in various healthcare systems; however, this is not a well-researched area in middle-income countries by patients' perspectives. A study of 231 patients attending the ED of a tertiary public hospital was conducted using a structured questionnaire from June to August 2021. Eligible patients were community-dwelling, aged > 65years, who presented with lower clinical urgency. The questionnaire tool was developed using questions from available studies on health service utilization. Additional commentary was obtained from the patients regarding on the reasons for attending the ED and was administered on weekdays between 8:00am and 5:30pm. The study included 221 patients over 65years of age, with a mean age of 72.21 ± 4.2. A total of 58.4% of the patients thought that they should be examined urgently, 15.4% had symptoms that had lasted more than one month, and 59% requested emergency imaging. Patients preferred the ED via treatment, imaging, transportation opportunities of emergency department, past negative experiences, and access problems with family medicines or appointment problems with specialist outpatient clinics with expectations of continuity of care. Old individuals have unique healthcare needs, and the motives behind this group of patients with low-acuity problems to apply to the ED is complex. As one of the key objectives of healthcare policies is to make sure that patients are assessed at proper time and place, studies that consider patient perspectives might lead to accurate conclusions for this aim.

Out-of-pocket fees for health care in Australia: implications for equity.

Out-of-pocket fees for health care in Australia: implications for equity.

A painless fracture of a phalanx of the left hand in a patient with type 1 diabetes – case report

The aim of our study is to present a case report of a patient who, due to advanced symmetrical peripheral diabetic polyneuropathy, was unaware of the fracture of the fifth finger of the left hand and even tried to restore it to its previous position. The 53-year-old patient with type 1 diabetes at the age of 9, who, due to non-compliance with medical recommendations and poor metabolic control (over the last 15 years, HbA1c has never fallen below 8.1%, reaching 11.1% in May 2017), developed complications such as: ischemic heart disease, diabetic retinopathy, nephropathy and peripheral neuropathy. In February 2019, in the morning, when unscrewing the fuel filler cap in the car, the patient suffered a finger fracture. He remained unaware of this fact all day due to the lack of any pain symptoms. It was only in the evening that he noticed the wrong placement of the fifth finger on his left hand. On the next day, there was a slight soreness with pressure, and the swelling deepened, which prompted him to visit the emergency room. An X-ray examination was performed there, which showed a fracture of the shaft of the proximal phalanx of the fifth finger of the left hand with angular setting of the fragments. The finger was immobilized in a plaster cast and the patient was referred for further check-up in a specialist outpatient clinic. Fortunately, the attempt to set the finger on his own did not cause any significant complications, and after removing the plaster cast, the patient regained the use of the broken finger. A recent electromyographic study confirmed the existence of a very advanced peripheral neuropathy. In summary, improperly treated, poorly controlled type 1 diabetes has serious consequences. It is very important that people suffering from it conduct regular self-monitoring of blood glucose levels and lead a healthy lifestyle.

Spinocerebellar Ataxia Type 35 Caused by a New TGM6 Variant: Video Documentation of a German Family.

Spinocerebellar Ataxia Type 35 Caused by a New TGM6 Variant: Video Documentation of a German Family.

Health outcomes of patients with type 2 diabetes following bariatric surgery: Results from a publicly funded initiative.

Bariatric surgery is an effective treatment for type 2 diabetes and morbid obesity. This paper analyses the clinical and patient-reported outcomes of patients treated through the Bariatric Surgery Initiative, a health system collaboration providing bariatric surgery as a state-wide public service in Queensland, Australia. A longitudinal prospective cohort study was undertaken. Eligible patients had type 2 diabetes and morbid obesity (BMI ≥ 35 kg/m2). Following referral by specialist outpatient clinics, 212 patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Outcomes were tracked for a follow-up of 12-months and included body weight, BMI, HbA1c, comorbidities, health-related quality of life, eating behaviour, and patient satisfaction. Following surgery, patients' average body weight decreased by 23.6%. Average HbA1c improved by 24.4% and 48.8% of patients were able to discontinue diabetes-related treatment. The incidence of hypertension, non-alcoholic steatohepatitis, and renal impairment decreased by 37.1%, 66.4%, and 62.3%, respectively. Patients' emotional eating scores, uncontrolled eating and cognitive restraint improved by 32.5%, 20.7%, and 6.9%, respectively. Quality of life increased by 18.8% and patients' overall satisfaction with the treatment remained above 97.5% throughout the recovery period. This study confirmed previous work demonstrating the efficacy of publicly funded bariatric surgery in treating obesity, type 2 diabetes and related comorbidities, and improving patients' quality of life and eating behaviour. Despite the short follow-up period, the results bode well for future weight maintenance in this cohort.

A pilot study to validate AMTAS in a specialist outpatient clinic at a public restructured hospital in Singapore

Background The prevalence of age-related hearing loss is expected to increase with the ageing population in Singapore resulting in increased demand for pure tone audiometry (PTA). One way of meeting the increased demand for PTA is the Automated Method of Testing Auditory Sensitivity (AMTAS). Nonetheless, before AMTAS may be implemented, it is important to validate its results by comparing them against those of conventional PTA for the diverse Singaporean population. Methods 100 participants were recruited from the Otorhinolaryngology clinic at a public hospital. PTA was conducted for participants via the conventional method and AMTAS. The hearing thresholds obtained via the two methods were then compared. A feedback questionnaire on the use of AMTAS was also completed by all participants. Results Air and bone conduction threshold results from 80 participants were analysed. The absolute mean difference in air conduction thresholds obtained via the two methods ranged from 3.30 to 9.62 dB. The absolute mean difference in bone conduction thresholds obtained via the two methods ranged from 8.16 to 9.38 dB. Most participants indicated that the machine was easy to use. Other feedback collected indicated that the AMTAS testing environment was noisy and that testing was fast. Conclusion This study finds that despite differences in hearing thresholds obtained via AMTAS and manual PTA, these differences are within the acceptable 10 dB test-retest variation. Nonetheless, existing issues related to the AMTAS software and noise levels in the testing environment will need to be addressed before it can be used in the clinic.

The correlation between obesity and other cardiovascular disease risk factors among adult patients attending a specialist clinic in Kumasi. Ghana

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Background&lt;/title&gt; &lt;p&gt;Obesity is a complex and multifactorial disease marker, which has become a major threat to cardiovascular health. We sought to assess the correlation of obesity and other cardio-metabolic risk factors in patients seen at the outpatient specialist clinic in Ghana.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;A prospective cross-sectional study was conducted on 395 patients at Precise Specialist Clinic in Kumasi, Ghana. A standardized questionnaire was used to obtain demographic, anthropometric and clinical data of patients. Fisher's exact test for statistical significance at a 95% confidence interval was used to evaluate associations between categorical variables. The associations between obesity indices and cardiovascular disease risk factors were analyzed by Pearson's correlation.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;Of the 395 participants, 187 were males and 208 were females. The mean (± standard deviation) age of study participants was 59.29 (± 13.93); more than half of the participants were between 50 and 69 years. The mean BMI of male participants was significantly lower than the mean BMI of female participants (28.18 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 31.16 kg/m&lt;sup&gt;2&lt;/sup&gt;, &lt;italic&gt;P-value&lt;/italic&gt; &amp;lt; 0.0001). Gender was significantly associated with the weight categories (&lt;italic&gt;P&lt;/italic&gt; = 0.0144). Obesity was seen more in females (49.0%) than in males (35.8%). The Pearson correlation analysis also showed a significant positive correlation between obesity, increasing systolic blood pressure (&lt;italic&gt;r&lt;/italic&gt; = 0.1568, &lt;italic&gt;P-value&lt;/italic&gt; = 0.0018) and increasing diastolic blood pressure (&lt;italic&gt;r&lt;/italic&gt; = 0.2570, &lt;italic&gt;P-value&lt;/italic&gt; &amp;lt; 0.0001).&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusions&lt;/title&gt; &lt;p&gt;Obesity was found to be significantly associated with female gender, increasing age, increasing systolic blood pressure, and increasing diastolic blood pressure. Efforts to step-up preventive measures to reduce the increasing prevalence of obesity in Ghana are highly recommended.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Impact of altering referral threshold from out-of-hours primary care to hospital on patient safety and further health service use: a cohort study

ObjectivesTo estimate the impact of altering referral thresholds from out-of-hours services on older patients’ further use of health services and risk of death.DesignCohort study using patient data from primary and...

Effect of Insulin Injection Techniques on Glycemic Control Among Patients with Diabetes.

Previous studies have shown that healthcare professionals rarely instruct patients about proper insulin injection techniques. This study aimed to assess the practices of insulin injection techniques among patients with diabetes treated and assess the effect of these practices on glycemic control. This cross-sectional study was conducted between November 2020 and February 2021. A random systematic sampling technique was used to recruit study subjects at specialist outpatient clinics. Subjects with type 1 or 2 diabetes mellitus who had been using insulin injections for at least a year were included in this study. A total of 298 subjects with type 1 diabetes and 553 with type 2 diabetes participated in this study. The mean age of patients with type 1 diabetes was 20.1 ± 10.4 years. The mean age of patients with type 2 diabetes was 58.6 ± 9.5 years. The median type 1 diabetes duration was 6.0 years, and median type 2 diabetes duration was 15.0 years. About 66.8% of patients with type 1 diabetes and 69.4% of patients with type 2 diabetes were rotating insulin injection sites. Almost 36.6% of patients with type 1 diabetes and 50.5% of patients with type 2 diabetes reported using the same insulin needle more than three times. The prevalence of lipohypertrophy was 57.0% among patients with type 1 diabetes and 55.5% among patients with type 2 diabetes. The absence of lipohypertrophy, rotation of insulin injection site, and total daily insulin dose ≤50 units were all independently significantly associated with better glycemic control. Insulin injection techniques were suboptimal among significant proportion of patients with diabetes in Jordan. Improper insulin injection technique, especially the rotation of injection sites and lipohypertrophy formation, was associated with uncontrolled blood glucose levels. Educational interventions that focus on insulin injection techniques among Jordanian patients with diabetes are strongly recommended.