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Dowling, Mitchell J., and Debra J. Rickwood. "Experiences of Counsellors Providing Online Chat Counselling to Young People." Australian Journal of Guidance and Counselling 24, no. 2 (January 20, 2014): 183–96. http://dx.doi.org/10.1017/jgc.2013.28.
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Online counselling is a rapidly growing field and, while there is emerging evidence of its comparative effectiveness, there has been little research into what techniques are being applied in practice and which clients will most likely benefit from this medium. Using a focus group methodology, this study examines the experiences of 19 online clinicians employed by a youth mental health service, investigating their perception of online clients, views on their counsellor roles, the approaches and techniques they employ, and the unique aspects of counselling in an online environment. Overall, online clinicians perceived their clients as presenting with highly complex problems and a high level of psychological distress. They noted online clients would most often use the service once or twice, and that some would use online chat as an adjunct to face-to-face counselling. The online clinicians described various roles, including: assessments, gatekeeping, providing emotional support, and therapeutic interventions. According to the online clinicians, they used a variety of techniques online, but favoured person-centred techniques, as these helped keep the clients engaged with the service. Areas of further research and implications for practice are discussed.
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Kit, Phey Ling, Chua Tee Teo, Meilinda Tan, and Yuhyun Park. "Singapore children’s online counselling experiences on a live chat portal." British Journal of Guidance & Counselling 47, no. 3 (June 13, 2018): 304–16. http://dx.doi.org/10.1080/03069885.2018.1485871.
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Ersahin, Zehra, and Terry Hanley. "Using text-based synchronous chat to offer therapeutic support to students: A systematic review of the research literature." Health Education Journal 76, no. 5 (April 30, 2017): 531–43. http://dx.doi.org/10.1177/0017896917704675.
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Objective: Counselling within educational settings has now become commonplace. As with the advent of the use of new technologies in teaching, such developments are also impacting the broader support structures available to students. One development is the move of schools to offer pupils access to online counselling services. To date, such practices have received little attention, and this paper synthesises the existing empirical research literature in this area. Design: A systematic review of the literature was conducted which focused upon synchronous chat counselling for 11- to 25-year-olds. Method: Key bibliographic databases were searched for relevant papers. These were assessed for relevance and quality prior to being included into the analysis. The final selection of studies was analysed for key themes. Results: In all, 19 papers met the inclusion criteria. The thematic synthesis identified four higher order themes: (1) developing safe and youth-friendly online services, (2) online client characteristics, (3) in-session online processes and (4) session alliance and outcome. Conclusion: These themes outline the varied challenges and opportunities present within this developing practice. Each is initially discussed alongside existing literature related to online counselling before the implications for educational providers are explicitly considered. Ultimately, it is concluded that online counselling for students has much potential, however, those commissioning such services need to be mindful of common pitfalls.
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Mallen, Michael J., Indria M. Jenkins, David L. Vogel, and Susan X. Day. "Online counselling: An initial examination of the process in a synchronous chat environment." Counselling and Psychotherapy Research 11, no. 3 (September 2011): 220–27. http://dx.doi.org/10.1080/14733145.2010.486865.
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Dowling, Mitchell, and Debra Rickwood. "Investigating individual online synchronous chat counselling processes and treatment outcomes for young people." Advances in Mental Health 12, no. 3 (December 2014): 216–24. http://dx.doi.org/10.1080/18374905.2014.11081899.
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Bastiani, Luca, Maurizio Fea, Roberta Potente, Claudia Luppi, Fabio Lucchini, and Sabrina Molinaro. "National Helpline for Problem Gambling: A Profile of Its Users’ Characteristics." Journal of Addiction 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/659731.
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Gambling has seen a significant increase in Italy in the last 10 years and has rapidly become a public health issue, and for these reasons the first National Helpline for Problem Gambling (GR-Helpline) has been established. The aims of this study are to describe the GR-Helpline users’ characteristics and to compare the prevalence rates of the users with those of moderate-risk/problematic gamblers obtained from the national survey (IPSAD 2010-2011). Statistical analysis was performed on data obtained from the counselling sessions (phone/e-mail/chat) carried out on 5,805 users (57.5% gamblers; 42.5% families/friends). This confirms that the problems related to gambling concern not only the gamblers but also their families and friends. Significant differences were found between gamblers and families/friends involving gender (74% of gamblers were male; 76.9% of families/friends were female), as well as age-classes and geographical area. Female gamblers had a higher mean age (47.3 versus 40.2 years) and preferred nonstrategy-based games. Prevalence rates of GR-Helpline users and of moderate risk/problematic gamblers were correlated (Rho = 0.58;p=0.0113). The results highlight the fact that remote access to counselling can be an effective means of promoting treatment for problem gamblers who do not otherwise appeal directly for services.
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Dowling, Mitchell, and Debra Rickwood. "A naturalistic study of the effects of synchronous online chat counselling on young people's psychological distress, life satisfaction and hope." Counselling and Psychotherapy Research 15, no. 4 (July 14, 2015): 274–83. http://dx.doi.org/10.1002/capr.12037.
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Fu, Weifeng. "Application of an Isolated Word Speech Recognition System in the Field of Mental Health Consultation: Development and Usability Study." JMIR Medical Informatics 8, no. 6 (June 3, 2020): e18677. http://dx.doi.org/10.2196/18677.
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Background Speech recognition is a technology that enables machines to understand human language. Objective In this study, speech recognition of isolated words from a small vocabulary was applied to the field of mental health counseling. Methods A software platform was used to establish a human-machine chat for psychological counselling. The software uses voice recognition technology to decode the user's voice information. The software system analyzes and processes the user's voice information according to many internal related databases, and then gives the user accurate feedback. For users who need psychological treatment, the system provides them with psychological education. Results The speech recognition system included features such as speech extraction, endpoint detection, feature value extraction, training data, and speech recognition. Conclusions The Hidden Markov Model was adopted, based on multithread programming under a VC2005 compilation environment, to realize the parallel operation of the algorithm and improve the efficiency of speech recognition. After the design was completed, simulation debugging was performed in the laboratory. The experimental results showed that the designed program met the basic requirements of a speech recognition system.
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Dancet, Eline A. F., Thomas M. D’Hooghe, Felicia Dreischor, Madelon van Wely, Ellen T. M. Laan, Cornelius B. Lambalk, Sjoerd Repping, and Inge M. Custers. "The ‘Pleasure&Pregnancy’ web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial." BMJ Open 9, no. 7 (July 2019): e025845. http://dx.doi.org/10.1136/bmjopen-2018-025845.
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IntroductionMany subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise ‘expectant management (EM)’ for 6–12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The ‘Pleasure&Pregnancy randomised controlled trial (RCT)’ will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM.Methods and analysisA multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat.Ethics and disseminationThis study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications.Trail registration numberNTR5709; Pre-results.
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Wibowo, Nur Cahyo Hendro, Flora Ima Milenia, and Faris Hifzhuddin Azmi. "Rancang Bangun Bimbingan Konseling Online." Walisongo Journal of Information Technology 1, no. 1 (November 8, 2019): 14. http://dx.doi.org/10.21580/wjit.2019.1.1.3924.
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<p>Zaman globalisasi ditandai dengan fenomena teknologi informasi dan telekomunikasi yang menunjang disegala bidang. Fenomena teknologi informasi dan telekomunikasi <em>(Information and Communication technology / ICT)</em> tersebut bagi masyarakat global (dunia) kemudian menciptakan suatu kecenderungan paradigma masyarakat terbuka, yaitu suatu kenyataan dimana tidak ada sekat dan batas yang menghalangi untuk saling berinteraksi. Perkembangan ilmu pengetahuan dan teknologi telah membawa manusia menuju peradaban modern, suatu peradaban yang ditandai dengan banyak dimanfaatkannya teknologi untuk membantu aktifitas manusia.</p>Lebih lanjut dalam Wikipedia, online adalah dimaknai dalam jaringan atau daring atau keadaan saat sesuatu terhubung ke dalam suatu jaringan atau system (umumnya internet atau ethernet). Jadi istilah konseling online dapat dimaknai secara sederhana yaitu proses konseling yang dilakukan dengan alat bantu jaringan sebagai penghubung antara guru bk/konselor dengan kliennya. Hal ini senada dengan yang dikemukakan oleh (Amani, 2007) Konseling Online adalah konseling melalui internet yang secara umum merujuk pada profesi yang berkaitan dengan layanan kesehatan mental melalui teknologi komunikasi internet. Lebih lanjut Fields (2011) menyebutkan bahwa konseling online adalah layanan terapi yang relatif baru. Konseling dikembangkan dengan menggunakan teknologi komunikasi dari yang paling sederhana menggunakan email, sesi dengan chat, sesi dengan telp pc-to-pc sampai penggunaan dengan penggunaan webcam (video live sessions), yang secara jelas menggunakan komputer dan internet. Haberstroh (2011) menjelaskan bahwa konseling online adalah klien dan konselor berkomunikasi dengan menggunakan streaming video dan audio. Capill (tt). Counselling using the computer as the medium of communication between client and counsellor. Dari beberapa pendapat di atas dapat dipahami dan disimpulkan bahwa konseling online adalah usaha membantu (therapeutic) terhadap klien/konseli dilakukan dengan memanfaatkan teknologi informasi, komputer dan internet.
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Kostos, Janette, and Catherine Flynn. "Father Absence: Exploring the Experiences of Young People in Regional Western Australia." Children Australia 37, no. 4 (November 6, 2012): 170–76. http://dx.doi.org/10.1017/cha.2012.38.
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This article describes the experiences of four young people aged 18 to 25 years whose fathers were absent during their adolescent years. The study, located in regional Western Australia, sought to investigate how young people experience father absence, their needs and preferences in regard to any help seeking, and their evaluation of the effectiveness of supports used. Participants were found to share a combination of risk factors which were linked to negative psychosocial outcomes. Problems identified by young people included no one to talk to about problems and a lack of available services. Participants disclosed involvement in substance use, school misconduct and anti-social behaviour, and all reported early home leaving. Male and female participants reported using similar coping styles and a hierarchy of preference in help-seeking was found with friends and family preferred over counselling. Counselling was considered helpful when offered online or via drop-in services not requiring an appointment. Ethical constraints, however, were found to limit young people's participation in research.
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McVeigh, Mary Jo, and Susan Heward-Belle. "Necessary and good: a literature review exploring ethical issues for online counselling with children and young people who have experienced maltreatment." Children Australia 45, no. 4 (December 2020): 266–78. http://dx.doi.org/10.1017/cha.2020.59.
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AbstractThe World Health Organization categorised the Corona virus as a public health emergency of international concern. As a result of this declaration, a raft of procedures to stem the spread of the virus to safeguard the health and safety of its citizens was enacted by the Australian Government. The promotion of social isolation and distancing were among these measures. The governmental social distancing measures put in place in Australia resulted in a curtailing of face-to-face work and moving to online service delivery for many agencies who provide counselling for children/young people who have experienced maltreatment. This article presents the findings of a review of the literature on the pertinent ethical issues in relation to online counselling. The results of the review highlighted common ethical issues discussed across the literature, with a major gap in the literature focusing on issues for children and young people and a continued privileging of the adult voice over children and young people’s needs.
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Costa, Deborah A. "Transforming Traumatised Children within NSW Department of Education Schools: One School Counsellor's Model for Practise – REWIRE." Children Australia 42, no. 2 (June 2017): 113–26. http://dx.doi.org/10.1017/cha.2017.14.
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Adequately supporting the needs of maltreated and traumatised children within New South Wales (NSW) public education system schools is often frustrated by poor perception of the impact of developmental trauma on children's school-based functioning and the need for additional, specialist support; the push for, and provision of, behaviour diagnoses for these children to fund basic assistance and supervision; competing demands on an overextended School Counselling resource impacting capacity for school-based trauma informed psychological services, and seemingly stretched capacity of government/non-government agencies to reliably provide effective support. This is accompanied by a lack of understanding of behavioural signals of distress children display and underreporting to agencies; persistent, simplistic behaviourist views of children's behaviours within schools and low-level collaboration between schools and external agencies. Facilitating a trauma sensitive environment within NSW schools can ameliorate these frustrations and attend to these inadequacies in a pragmatic, achievable way. This practice paper presents a School Counsellor-led model (REWIRE) for achieving this.
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Assal, Angela, Janine Malcolm, Heather Lochnan, and Erin Keely. "Preconception counselling for women with acromegaly: More questions than answers." Obstetric Medicine 9, no. 1 (September 1, 2015): 9–14. http://dx.doi.org/10.1177/1753495x15598699.
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Background and aims Approximately 174 pregnancies in acromegaly have been reported. Our objectives were to identify the key challenges of preconception counselling in this population. Methods Case series of three acromegalic women with desire for pregnancy. Issues were identified from chart review and discussion with attending physicians. Literature review of acromegaly and pregnancy was conducted. Results Important issues identified included: impact of acromegaly on fertility, management of acromegaly in the peripartum period, screening for associated conditions, risk of progression of acromegaly/tumour growth during pregnancy, impact of acromegaly on pregnancy outcomes, surveillance during pregnancy, method of delivery and impact on neonatal outcomes and breastfeeding. Conclusions Pregnancy can be safely achieved in patients with acromegaly. There is little evidence to guide recommendations around conception and pregnancy surveillance. Patients can be reassured that in most situations, pregnancy proceeds without complication and that medical treatment can be used during pregnancy if necessary.
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Hansen, Patricia, and Frank Ainsworth. "Examining child protection practice in New South Wales: Non-accidental injury and the principle of strict liability." Children Australia 45, no. 1 (March 2020): 8–13. http://dx.doi.org/10.1017/cha.2020.5.
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AbstractThis article examines child protection practice when the Department of Communities and Justice in New South Wales takes the view that an injury to a child is non-accidental. The position taken in this paper is that once a child protection caseworker takes the position that an injury is non-accidental, then a strict liability or absolute liability approach is adopted. In effect, any of the child’s parents or caregivers are identified as persons who may have caused the injury or harm. What follows is the decision that a child must never be restored to the parents or caregivers, unless a person confesses to causing the harm and completes specific child protection counselling. Our concern is with the process of investigation, the reliance on one medical opinion in a context where the parents or caregivers are not in a financial position to obtain a second opinion, the failure to observe the rules of evidence when considering medical opinion, and the manner of substantiation of the non-accidental injury. In addition, we argue that there is a lack of knowledge about the factors that influence a paediatrician’s decision-making and that the guidelines for judicial decision-making derived from case law need to be examined further.
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Fatima, Sana, Ayesha Siddiqui, Saniya Kauser, Syeda Ayesha Maimoona Naba, Mirza Misba Ali Baig, and Ahrar Ahmed Feroz. "EDUCATION (COUNSELLING AND DIGITAL UPDATE) BY CLINICAL PHARMACIST IN PATIENTS WITH POLYPHARMACY IN CHRONIC DISEASES IN THE DEPARTMENT OF GENERAL MEDICINE." International Journal of Advanced Research 9, no. 07 (July 31, 2021): 813–23. http://dx.doi.org/10.21474/ijar01/13181.
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Background: As chronic diseases require treatment with an expanding number of medications, the issue of polypharmacy is getting more significant. Polypharmacy can lead to the danger of adverse events, drug interactions and medication non adherence. Objective: To improve patient medication compliance, check whether all the drugs prescribed are safe and appropriate to use, improve the knowledge about their medical state and poly-pharmacy and to check whether there is any drug-drug interaction. Materials And Methods: A prospective observational study was carried in 200 patients. The collected data was investigated for poly-pharmacy and analyzed for factors and consequences associated with poly-pharmacy. Patient information and relevant data is collected in data collection form directly by clinical pharmacist by interviewing the patient and the patient follow-up is done by digital counseling provided to the patient using various sources such as chats, calls, videos. Result: This study was designed to educate patients in poly-pharmacy for chronic diseases through digital counselling means. During the six months study period, a total of 200 patients among which Patients suffering from several diseases have been consumed multiple medicines (8.52±3.58) compared to patients with two types (8.15±4.05) or single type of disease (7.29±3.10), p 0.08. Knowledge assessment score was improved after education (counseling and digital update) by clinical pharmacist (2.75±1.21 7.15±0.94, p value 0.02). Morrisky medication Adherence scale (MMAS-8) score was significantly increased after education (counseling and digital update) by clinical pharmacist (2.83±1.79 7.60±0.66, p value 0.001). Quality of lifeED-5D-5L score was improved after education (counseling and digital update) by clinical pharmacist (1.01±0.78 2.94±1.25, p vale 0.003). We performed Pearson correlation coefficient test to analyze the correlation between poly-pharmacy and quality of life (QOL), We observed that, individuals who consumed poly pharmacy were found with decreased quality of life (r = -0.72 p value = 0.003). This might be due to adverse side effects caused by multiple medications. Among the 200 patients digital counselling by WHATSAPP along with Call and E-mail was done to 16% of patients, WHATASPP and Call was done to 44% of patients, WHATSAPP and E-mail was done to 2% of patients, WHATSAPP was done to 17% of patients, Call was done to 21% of the patients. Patient satisfaction score with clinical pharmacist by Direct counseling 42% (9.02±3.90) and Digital counseling58% (12.29±3.83). Conclusion: The utilization of digital counselling has become an inexorably well-known mode for giving counselling. Nonetheless, little is thought about its effectiveness.This study is an initial effectiveness study on digital counselling. Participants who had gotten digital counselling from a phone evaluated the viability of digital counselling and the quality of their counselling relationship. Generally, respondents showed that digital counselling was useful and that the participants were happy with the counselling they got. There was an improvement found in the quality of life of participants and their knowledge with respect to chronic condition and polypharmacy. The participants understood the significance of medication adherence for polypharmacy in chronic diseases. Participants were made mindful of the suspected adverse drug reactions, drug-to-drug interaction, medication errors, medication redundancy, and so on.
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Shukoor, Jabrulla. "Trauma and Children: A Refugee Perspective." Children Australia 40, no. 3 (July 21, 2015): 188–94. http://dx.doi.org/10.1017/cha.2015.25.
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Post-traumatic stress affects both the mental and physical health of individuals, giving rise to various psychological disturbances. The neurological effects of these disturbances are similar across age groups, irrespective of race or culture. However, the perception of psychological disturbances differs from culture to culture depending on issues such as the stigma that attaches to mental illness and the ability or willingness to seek assistance. While much research has been undertaken on the impact of trauma on both adults and children, research to explore the effect of trauma on people in the context of their various cultures, especially people of refugee background, remains at an early stage. Mental health professionals working with refugees encounter various challenges. They range from dealing with resistance by individuals to the notion of counselling itself, to barriers such as the perceived stigma that prevents some individuals from acknowledging mental health problems. Other challenges in providing mental health services in such cases are contributed to by government policies and the limited resources available. All this exacerbates the mental health of traumatised parents and caregivers, and has a ripple effect on their children, who exhibit the effects of trauma in their own ways. This paper aims to highlight and discuss these issues through the presentation of two case studies, suggest a workable recovery model, possible ways to deal with the challenges, and to propose recommendations for working with non-Western children and their families.
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Jahan, Musarrat, Akhtar Ali, and Rabia Bahoo. "Identification of the Remedial Strategies to Improve Low Academic Achievements of Students at Higher Secondary Level." Global Regional Review V, no. II (June 30, 2020): 71–79. http://dx.doi.org/10.31703/grr.2020(v-ii).08.
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The present qualitative study was aimed to identify and develop strategies to improve students' low academic achievements at the higher secondary level. For this interviewee, were selected purposively. Individually semi-structured interviews were conducted with thirty interviewees and were audio-recorded. Thematic analysis was applied, and the following themes based on teachers' suggestions were identified: The establishment of the career counselling center, Standardized class size, Enhance academic session, Ban overnight internet package and awareness program, Focus on a mother tongue to clear concepts rather than rote learning, Revisit curriculum and subject combination, Revise evaluation system, Enhance time management skills. This study concluded and proposed a flow chart of remedial strategies to implement. This study is an effort to save the dark future of our future leaders and helpful for policymakers, educationists, psychologists, and principals to practically implement the proposed strategies to overcome this situation.
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Kim, Sungha, Kyungsun Han, Ojin Kwon, Wongu Lee, Chulsang Yoon, and Jun-Hwan Lee. "Effect of Korean Medicine Treatment Including Korean Medicine Counselling on Weight Loss in Patients with Morbid Obesity: A Retrospective Chart Review." Journal of Korean Medicine for Obesity Research 21, no. 1 (June 30, 2021): 22–31. http://dx.doi.org/10.15429/jkomor.2021.21.1.22.
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Lilley, Andrew. "ASSESSING THE BENEFITS THAT COMMUNITY PHARMACIES CAN HAVE ON CHILDHOOD ASTHMA OUTCOMES." Archives of Disease in Childhood 101, no. 9 (August 17, 2016): e2.48-e2. http://dx.doi.org/10.1136/archdischild-2016-311535.52.
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IntroductionThe local Clinical Commissioning Group has funded an innovative one-year pilot project to assess the value of providing specialist paediatric pharmacist and physiotherapist support direct to families and health care professionals (GP's, community pharmacists, practice nurses etc.) regarding asthma in the primary care setting. Community pharmacies are the one service that asthmatic children come in contact with in order to pick up their medications it was decided to encourage staff to provide interventions at the point of collection.Methods22 large chain, small chain and independent community pharmacy branches were included in the pilot (out of 152 within CCG area) with a total of 31 pharmacists and 67 assistants trained to provide the service. The plan was to provide ‘back to basics’ leaflets on collection of prescription to help improve education on the medications being used; provide inhaler technique counselling on the collection of all prescriptions for children; encourage pharmacist's to perform medicines use reviews and the new medicines service in asthmatic children of high school age (for which they could collect the standard NHS fee). In order to assess the benefits of this, the pharmacist or assistant would first perform the standard asthma control test, marked out of 25 with the parent/patient completing an online version one month later to assess any improvement in symptom management. In order to trace the number of MURs, NMS, inhaler counselling sessions and leaflets given out a tally chart was completed each month by the branches involved.ResultsUnfortunately of the 22 branches that signed up to the pilot only 15 returned tally charts to the team. Over a six month period 23 MUR's, 3 NMS and 32 inhaler technique sessions were performed with 67 leaflets distributed. Of a possible 55 asthma control tests (MURs and inhaler technique counselling sessions) only 23 patients completed the four week post intervention online form. Of those completed the average asthma control test score increased by 7 points (30% increase). In particular feedback from the pharmacists involved was that the inhaler counselling sessions were of particular benefit to parents/patients.Feedback from the pharmacy teams in general was positive with many stating it was good to be more involved in the care of children's conditions; however many stated in order for the service to roll out to a wider audience the scheme would have to provide a financial incentive for the large chains to take part.ConclusionsIt is clear that interventions performed by the community pharmacy teams can help improve symptom control in asthmatic children. In particular ensuring patients are using their medications correctly appears to be key to symptom control. Encouraging pharmacists to provide child friendly MURs should be investigated further to prove the benefit of this service further. It should be noted that ensuring patients are using their medications correctly is already part of the essential service contract for pharmacies.
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Dietrich, Fine Michèle, Kurt E. Hersberger, and Isabelle Arnet. "Benefits of medication charts provided at transitions of care: a narrative systematic review." BMJ Open 10, no. 10 (October 2020): e037668. http://dx.doi.org/10.1136/bmjopen-2020-037668.
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ObjectivesParticularly at transitions of care points information concerning current medication tends to be incomplete. A medication chart that contains all essential information on current therapy is likely to be a helpful tool for patients and healthcare providers. We aimed to investigate any type of benefits associated with medication charts provided at transition points.MethodsA systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Two databases, two online journals and two association websites dedicated to biomedicine and pharmacy issues were consulted to identify studies for the review using the search term ‘medication chart’ and synonyms. We run our search from database inception up to March 2019. Studies of any study design, intervention and population which examined the effect of paper-based medication charts were included. We extracted study results narratively and coded and classified them by themes and categories inductively by using the ‘framework method’ with content analysis. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool.ResultsFrom the 846 retrieved articles, 30 studies met the inclusion criteria, mostly from Germany (18 studies) and the USA (5 studies). Thirteen studies reported a statistically significant result. In the ‘patient theme’, the most obvious benefits were an increase in medication knowledge, a reduction of medication errors and higher medication adherence. In the ‘interdisciplinary theme’, a medication chart represented a helpful tool to increase communication and inter-sectoral cooperation between healthcare providers. In the ‘theme of terms and conditions’, accuracy and currency of data are prerequisites for any positive effect. The quality of the studies was classified predominantly weak mainly due to unmet good quality criteria (no randomised controlled trials study design, no reported dropouts).ConclusionOverall, the reviewed studies suggested some benefits when using medication charts. Healthcare providers could consider using medication charts in their counselling practice. However, it is unknown whether the reported benefits lead to measurable improvement in clinical outcomes.PROSPERO registration number
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McFarlane, Graham, Karmugi Balaratnam, Peter Selby, Shabbir Alibbhai, M. Catherine Brown, Jennifer M. Jones, Doris Howell, et al. "Palliative versus nonpalliative patients’ perceptions of the effect of alcohol consumption on clinical outcomes." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 199. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.199.
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199 Background: Little is known about the perceptions of palliative patients on the impact of continued alcohol consumption after a cancer diagnosis and whether they are similar to the perceptions of patients who are considered potentially curative. Methods: Patients with diverse cancer subtypes were surveyed at a comprehensive cancer centre, cross-sectionally. Specifically, palliative and non-palliative cancer patients were asked about their perceptions on the benefits/harms of continued drinking on cancer-related quality of life, fatigue, and overall survival, and whether they had received information on their alcohol consumption from their health care providers. Palliative status was established by chart review. Results: Of 1049 patients, 48% were male, with median age of 58 (18-98) years; cancer sites included gastrointestinal, genitourinary, breast, thoracic, hematologic, and others; 16% were classified as being palliative at the time of survey; and 14% reported receiving counselling information on alcohol use sometime after their cancer diagnosis. Compared to curative patients, palliative patients were more likely to perceive continued alcohol consumption as harmful to their fatigue (OR=1.39, P=0.05) and survival (OR=1.45, P=0.03), but less so on quality of life (OR=1.16, P=0.35). When compared to those who had not been counselled, informed patients were twice as likely (OR=2.01, P<0.01) to perceive continued drinking as harmful to their levels of fatigue, although there was less of a difference in their perception of quality of life (OR =1.39, P=0.20) and survival (OR=1.40, P=0.19). Conclusions: Palliative patients are more likely to perceive continued alcohol consumption as harmful to their fatigue and overall survival, when compared to non-palliative patients, especially after receiving counselling. Given the lack of data on the benefits or harm of mild-moderate alcohol use and a strong emphasis on quality of life, future research should focus on effects of alcohol in palliative patients, and there should be improved education to both providers and patients on regarding the current lack of information.
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van Karnebeek, Clara, Tyler Murphy, Wynona Giannasi, Marion Thomas, Mary Connolly, and Sylvia Stockler-Ipsiroglu. "Diagnostic Value of a Multidisciplinary Clinic for Intellectual Disability." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 41, no. 3 (May 2014): 333–45. http://dx.doi.org/10.1017/s0317167100017273.
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Background:Identification of the underlying cause of intellectual disability (ID) is important as it improves genetic counselling, management, adaptation; yet its etiologic heterogeneity is challenging and often leads to an expensive work-up.Methods:To improve this diagnostic trajectory, the multidisciplinary Complex Diagnostic Clinic (CDC) was established for ID patients with unexplained complex systemic and/or neurologic features that were referred to the CDC and evaluated by three medical specialists followed by multi-disciplinary rounds. Analyses included surveys and interviews, (retrospective) chart review, costs calculations and comparison.Results:24 children (9 male) were evaluated during seven clinics held over 16 months. The average patient age was 7 years 11 months (range 9 months-18 years). All the children had previously been seen by 2–10 specialist services. The diagnostic yield of the CDC was higher than expected with confirmed and working diagnoses in 11 (46%) and 9 (38%) children respectively. Cost-savings included fewer trips to hospital and fewer tests via more streamlined evaluations. Positive feedback was received from both families and medical professionals.Conclusions:The CDC represents an innovative model of personalized care. Specialist collaboration in the interpretation of relevant clinical, biochemical and genomic data resulted in diagnoses, where none had previously been possible.
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Frau, Giuseppe N., William M. Luxford, William W. M. LO, Karen I. Berliner, and Fred F. Telischi. "High-resolution computed tomography in evaluation of cochlear patency in implant candidates: a comparison with surgical findings." Journal of Laryngology & Otology 108, no. 9 (September 1994): 743–48. http://dx.doi.org/10.1017/s0022215100128002.
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AbstractHigh-resolution computed tomography (HRCT) is important in the evaluation of cochlear implant candidates. This study examines the accuracy of radiological assessment of cochlear patency in relation to findings at the time of surgery. Older and newer HRCT methods and attending and senior radiologist interpretations are compared in a large series of cochlear implant patients.Subjects were 50 adults (22 to 74 years) and 31 children (2.4 to 11.7 years) who received either a 3M/House or a Nucleus 22-channel cochlear implant. Attending radiologist reports were obtained by chart review and the scans were re-reviewed for this study by a senior radiologist. Accuracy in detecting cochlear ossification ranged from 86.4 per cent for attending radiologists, with all HRCT scans, to 94.7 per cent for the senior radiologist with newer HRCT scans. False positives were rare, but false negatives did occur. Overall, best results were obtained with newer HRCT scans and a senior radiologist.Knowledge of the presence and extent of cochlear ossification is important to the implant surgeon and for patient counselling. Technical guidelines and a check list for interpretation of results are presented.
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Petersen, Angela, Suraya Jabaiah, Timothy Chen, Neal Doran, and Mark Myers. "Predicting Engagement in Smoking Cessation Treatment Following a Brief Telephone Evaluation and Referral Session." Journal of Smoking Cessation 14, no. 2 (July 11, 2018): 125–31. http://dx.doi.org/10.1017/jsc.2018.24.
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Introduction: Smoking cessation treatment combining medication and counselling yields the best outcomes; however, few smokers employ both modalities.Aims: The purpose of this study was to examine variables predicting treatment attendance.Methods: This was a chart review of US military Veterans (N = 340; 89% male, 59% non-Hispanic white) referred for smoking cessation, who completed a telephone call to encourage treatment utilization. Treatment engagement was defined as attending a smoking cessation session within 30 days following telephone contact. A logistic regression analysis examined predictors (demographics, smoking variables, and psychiatric diagnoses) of treatment engagement.Results/Findings: Greater age (Odds Ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.06), more cigarettes (OR = 1.03, 95% CI 1.00–1.06), and higher perceived importance of quitting (OR = 1.11, 95% CI 1.00–1.23) predicted engaging in treatment within 30 days (all p values < 0.05).Conclusion: Veterans who attended treatment were older, smoked more cigarettes, and perceived quitting as more important than those who did not attend. These findings are consistent with prior studies examining factors associated with treatment utilization. Results highlight the need to identify strategies for engaging into treatment smokers who are younger, smoke fewer cigarettes, and view quitting as less important.
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Biradar, Siddaruda Malleshappa, Dhanavanti Gelada, MV Mounika, P. Meghana, M. Bharathi, Anand P. Ambali, P. Mallinath, M. Vinod, and NV Kalyane. "ASSESSMENT OF CLINICAL PROFILE AND TREATMENT CHART REVIEW FOR ALCOHOLIC LIVER DISEASE (ALD) PATIENTS: A PROSPECTIVE AND OBSERVATIONAL STUDY." Journal of Drug Delivery and Therapeutics 8, no. 5 (September 12, 2018): 437–41. http://dx.doi.org/10.22270/jddt.v8i5.1945.
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Background/Aim: Alcohol remains one of most common cause of liver disease in India, hence the present study was undertaken to assess the clinical profile and treatment chart review of alcoholic liver disease (ALD) patients.
Materials and Methods: Hospital based prospective and observational study was carried out for a period of nine months in a tertiary care hospital of south India. All the patients of either gender diagnosed with ALD were enrolled in the study and patient consent was taken, the data related to the patients of ALD were documented in a structured patient data collection form and analyzed carefully.
Results: ALD was mainly affected in male with age group of 41-50 years.Out of 130 patients 43.8% patients were suffered from Fatty Liver disease while 23.1% were suffered from Alcoholic Hepatitis and 33.1% were suffered from Cirrhosis of Liver. The secondary developments to ALD were portal hypertension (13.8%) followed by Ascities (10.8%) and Hepatitis (10%). The major risk factors involved in ALD was alcohol per se (52.3%) and, alcohol and smoking exaggerate the disease condition. The Periodic (61.5%) and regular basis (38.5%) of alcoholism for chronic period of time may land up with ALD. Polypharmacy is essential for the treatment of ALD as it inoved multiple secondary development to ALD. The patients were intervened and counselled on their individual basis for ALD consequences, and motivated for cessation of alcohol and smoking.
Conclusion: The study enlightens that the early diagnosis and its beneficial outcomes that can exponentially curtail the mortality rate of ALD. Similarly the optimal drug therapy regimen and patient counseling may improve the patient’s quality of life.
Keywords: Alcoholic Liver Disease; Optimal Drug Therapy; Patient Counselling; Improved Quality of Life
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Wong, Mildred, Enza Gucciardi, Louisa Li, and Sherry L. Grace. "Gender and Nutrition Management in Type 2 Diabetes." Canadian Journal of Dietetic Practice and Research 66, no. 4 (December 2005): 215–20. http://dx.doi.org/10.3148/66.4.2005.215.
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Purpose: The literature suggests that adherence to dietary recommendations may differ between women and men with type 2 diabetes due to family obligations and spousal support. Methods: To assess division of household labour between spouses, retrospective chart review of 561 individuals who attended the Diabetes Education Centre at the Toronto Western Hospital was performed. Qualitative interviews were also performed with 12 married clients (six female and six male) and seven spouses of clients (three female, four male) to understand how the sharing of household labour influences adherence to nutrition guidelines in type 2 diabetes. Results: Results indicate a significant gender difference in responsibility for meal preparation (χ2(3)=140.64, p<.001) and grocery shopping (χ2(3)=88.24, p<0.001), with women more often engaging in these household activities than men. Male clients are more likely to be actively supported by their wives in the form of meal preparation and verbal encouragement, while female clients are only passively supported by their husbands. Conclusions: The results suggest that diabetes educators should recognize gender differences in household labour and support when counselling their clients to ensure that both men and women have the help they need to successfully manage their diabetes.
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Agarwal, Gina, Janusz Kaczorowski, and Steve Hanna. "Care for Patients with Type 2 Diabetes in a Random Sample of Community Family Practices in Ontario, Canada." International Journal of Family Medicine 2012 (July 18, 2012): 1–7. http://dx.doi.org/10.1155/2012/734202.
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Objective. Diabetes care is an important part of family practice. Previous work indicates that diabetes management is variable. This study aimed to examine diabetes care according to best practices in one part of Ontario. Design and Participants. A retrospective chart audit of 96 charts from 18 physicians was conducted to examine charts regarding diabetes care during a one-year period. Setting. Grimsby, Ontario. Main Outcome Measures. Glycemic screening, control and management strategies, documentation and counselling for lifestyle habits, prevalence of comorbidities, screening for hypertension, hyperlipidemia, and use of appropriate recommended preventive medications in the charts were examined. Results. Mean A1c was within target (less than or equal to 7.00) in 76% of patients (ICC = −0.02), at least 4 readings per annum were taken in 75% of patients (ICC = 0.006). Nearly 2/3 of patients had been counselled about diet, more than 1/2 on exercise, and nearly all (90%) were on medication. Nearly all patients had a documented blood pressure reading and lipid profile. Over half (60%) had a record of their weight and/or BMI. Conclusion. Although room for improvement exists, diabetes targets were mainly reached according to recognized best practices, in keeping with international data on attainment of diabetes targets.
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Lingesh Kumar V and Anuradha Krishnan P. "Screening of Colour Vision in Paediatric Population." International Journal of Research in Pharmaceutical Sciences 11, SPL4 (December 21, 2020): 1753–57. http://dx.doi.org/10.26452/ijrps.v11ispl4.4367.
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The descriptive cross-sectional study was done to screen the children attending paediatric OPD of Saveetha Medical College and Hospital for colour vision deficiency and to find out the overall prevalence of CVD and compare the prevalence rate among males and females. One hundred seventy-five children in the age group 4 – 12 years attending paediatric OPD of Saveetha Medical College and Hospital were taken up for the study. Visual acuity and colour vision test using the Ishihara chart was conducted for all the children. Results were tabulated and statistically analysed. It was noted that 7 (4.14%) children were found to be colour deficient. Out of which 6 (7.68%) and 1 (1.10%) were Male and Female children respectively, Considering the religion, the higher prevalence of colour vision deficiency was found among Muslim children 4(14.8%) as compared to Hindu 2 (2.1%) and Christian 1 (2.1%) children. Early diagnosis of this defect helps them in minimising the potential problems they face in their everyday life, and enable them to make adaptive strategies to improve the quality of life and most importantly helps them in choosing appropriate professional choice in their career and creating awareness through education. Medical counselling will improve to reduce the occurrence of Colour Vision disorder.
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Ciuro, Jordan Alana, Samira Ahsan, Alisha Beyer, and Nancy Jackson. "Healthcare disparities and the demand for expanding hereditary breast cancer screening guidelines in African Americans." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e13636-e13636. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e13636.
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e13636 Background: The role of predictive genetic testing on cancer care continues to rise in the healthcare community due to increased development, high demand and utilization of multi-panel testing and genome sequencing. BRCA1 and BRCA2 (BRCA1/2) mutations constitute some of the most common, targetable and clinically important markers in breast cancer. Individuals who harbor BRCA1/2 mutation have a substantially increased risk of developing a multitude of cancers, including breast and ovarian cancer. Early detection of these mutations leads to genetic and prevention counselling. The National Comprehensive Cancer Network (NCCN) guidelines recommend BRCA1/2 screening in high risk individuals however has not incorporated differences within ethnic cohorts. Methods: This study reviewed data collected from a genetics clinic in a tertiary community hospital from 2008 to 2018 to analyze the prevalence of BRCA1/2 mutations in various ethnicities as well as identify high risk personal characteristics and family history. A retrospective chart analysis was conducted on 1090 high risk patients seen for genetic counselling for hereditary breast and ovarian cancer syndrome. Results: Among cases, BRCA1/2 mutations were significantly more common in African American when compared to non-Ashkenazi Jewish Caucasians (8.1% vs 3.6%, p = 0.020). African Americans were more likely to have a personal history of any cancer compared to non-Ashkenazi Jewish Caucasians (90.4% vs 84.5 %, p = 0.048). African Americans were also more likely to have personal history of breast cancer compared to non-Ashkenazi Jewish Caucasians (86.4% vs 79.6%, p = 0.048). Regarding family history, there was no significant difference in the prevalence of cancer. Conclusions: In conclusion, we observed a significantly higher rate of BRCA1/2 in the African American population when compared to non-Ashkenazi Jewish Caucasians. Given the documented social barriers such as insurance and lack of knowledge of family history, the prevalence of BRCA1/2 might be underrepresented in literature. It is critical for healthcare providers to assess probability of BRCA1/2 mutations in the African American population and consequently order genetic testing when appropriate. Future studies are needed in this ethnic cohort to establish if a more tailored approach would help identify higher risk individuals.
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., Praveena, Ashok Kumar, Rashmi Ranjan Barik, and Pradeep Kumar Tiwari. "Prevalence of visual impairment and associated vision related quality of life among older adults in an urbanized village in Delhi." International Journal Of Community Medicine And Public Health 7, no. 12 (November 25, 2020): 5068. http://dx.doi.org/10.18203/2394-6040.ijcmph20205186.
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Background: Vision impairment (VI) is a public health problem, of which the greatest burden is shared by older adults. This study was done to find out the prevalence of VI among older adults and its association with sociodemographic variables and vision related quality of life.Methods: This cross-sectional study was done in an urbanized village in east Delhi from May to December 2019. 224 participants were selected by house to house visit by simple random sampling. A pre-tested, semi-structured tool was used to collect information regarding socio-demography. Visual acuity was measured by Snellen’s chart. Vision-related quality of life was assessed using Indian Vision function questionnaire-33 (IND-VFQ-33) in all three domains.Results: About 20.1% of participants were found having VI. It was found more among those who were not working {age adjusted odds ratio (AOR)=22.3, 95% confidence interval (CI)=3.2-152.2}, and those who were past chewer (AOR=5.54, 95% CI=1.75-17.4). The mean total visual function score was found 108.40 (5.10) among visually impaired participants. The mean and median of these scores were found higher among participants with VI.Conclusions: One out of every 5 older adults are suffering from VI. It affects quality of life significantly. Early screening, counselling and timely referral along with accessible and affordable quality eye care service should be promoted.
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Hawrylyshyn, Krista, Shelley L. McLeod, Jackie Thomas, and Catherine Varner. "Ectopic pregnancy outcomes in patients discharged from the emergency department." CJEM 21, no. 1 (March 4, 2018): 71–74. http://dx.doi.org/10.1017/cem.2018.13.
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AbstractObjectiveThe objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the emergency department (ED) where ectopic pregnancy had not yet been excluded.MethodsThis was a retrospective chart review of pregnant (<12-week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule-out ectopic pregnancy, or pregnancy of unknown location over a 7-year period.ResultsOf the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes, and 71 (12.9%) had other outcomes that included therapeutic abortion, molar pregnancy, or resolution of βHCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal ultrasound during their index ED visit, and 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy.ConclusionThese results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.
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Hawrylyshyn, K., S. McLeod, J. Thomas, and C. Varner. "P067: Ectopic pregnancy outcomes in patients discharged from the emergency department." CJEM 20, S1 (May 2018): S80—S81. http://dx.doi.org/10.1017/cem.2018.265.
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Introduction: The objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the ED where ectopic pregnancy had not yet been excluded. Methods: This was a retrospective chart review of pregnant (<12 week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes and 71 (12.9%) had other outcomes which included therapeutic abortion, molar pregnancy or resolution of HCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal US during their index ED visit, 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy. Conclusion: These results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.
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Al-Obaidly, Sawsan, Jis Thomas, Mahmoud Abu Jubara, Abdullah Al Ibrahim, Mariam Al-Belushi, Najah Saleh, Zeena Al-Mansouri, and Najat Khenyab. "Anencephaly and obstetric outcome beyond the age of viability." Journal of Perinatal Medicine 46, no. 8 (October 25, 2018): 885–88. http://dx.doi.org/10.1515/jpm-2017-0363.
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AbstractObjectiveTo review the obstetric impact and natural history of anencephalic pregnancies beyond the age of viability.Study designA retrospective chart review of all cases with a prenatal diagnosis of anencephaly who delivered after 24 weeks’ gestation during the period 1990 until 2016. Obstetric outcomes including mode of delivery, live births, shoulder dystocia, antepartum haemorrhage (APH), postpartum haemorrhage (PPH) and uterine rupture were studied.ResultsA total of 42 cases were studied. The average gestational age at diagnosis was 22 weeks (range 10–41). The average gestational age at birth was 36 weeks (range 25–44 weeks). Induction of labour was performed in 55% (23/42) of the cases. Livebirths were documented in 40% (17/42) of the cases. The average birth weight was 1597±746 g. The rate of vaginal birth was 69% (29/42), the overall rate of caesarean section was 31% (13/42), with a primary caesarean section in 31% (4/13) and a repeat caesarean section in 69% (9/13) of the patients. There were two cases of shoulder dystocia. No other complications were encountered.ConclusionOverall, anencephaly is not associated with an increased risk of obstetric complications; however, there is a tendency towards delivery via repeated caesarean section in women with a previous uterine scar and anencephaly. The prenatal counselling of potential obstetric outcomes could be of robust value for parents who opt to continue with anencephalic pregnancies.
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Tutunji, Laila, Fida Thekrallah, Asma Basha, Bushra Awaysheh, Shorouq Amer, Lina Khatib, Lubna Hamdan, et al. "Prenatal detection of fetal heart disease at Jordan University Hospital: early experience in a developing country." Cardiology in the Young 29, no. 8 (July 9, 2019): 1072–77. http://dx.doi.org/10.1017/s1047951119001550.
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AbstractObjective:To report on the first 5 years of establishment of fetal echocardiographic services at the Jordan University Hospital with emphasis on diagnosis and outcome.Methods:A retrospective chart review was conducted on all fetal echocardiographic studies performed between January 2011 and December 2015. Data collected included maternal demographics, referral indications, fetal cardiac diagnosis, correlation to post-natal diagnosis, outcome of pregnancy including pre-mature delivery and perinatal mortality. Basic statistical analysis was performed including demographic analysis, and calculation of fetal echocardiographic sensitivity and specificity.Results:A total of 208 fetuses underwent fetal echocardiographic evaluation at a mean gestational age of 26.5 (±5) weeks. The most common referral indication was a suspicion of CHD during the obstetric ultrasound (44.2%), followed by cardiac dysfunction (18.2%), and a family history of CHD (14.9%). Fetal echocardiography showed CHD in 71 fetuses (34%), heart failure in 26 (12.5%), arrhythmia in 9 (4.3%), and intracardiac masses in 2. In the remaining 100 fetuses (48%), fetal echocardiography showed normal evaluation. For detecting CHD, fetal echocardiography had a sensitivity and specificity of 91.7% and 95.4%, respectively. Perinatal mortality including termination of pregnancy, intrauterine fetal death, and neonatal mortality was highest in heart failure (77%), and was 41% for CHD.Conclusion:The fetal cardiac diagnostic services at the Jordan University Hospital have encouraging initial results with a relatively high sensitivity and specificity. The services further positively impacted the quality of counselling offered and facilitated pre- and post-natal management.
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Sanatani, Michael S., Maan Kattan, and Dwight E. Moulin. "Initial Pain Management Plans in Response to Severe Pain Indicators on Oncology Clinic Previsit Questionnaires." Pain Research and Management 19, no. 6 (2014): 309–12. http://dx.doi.org/10.1155/2014/180212.
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BACKGROUND: The issue of how to address patient pain in the outpatient setting remains challenging. At the London Regional Cancer Program (London, Ontario), patients complete the Edmonton Symptom Assessment System (ESAS) before most visits.OBJECTIVES:To perform a chart review assessing the frequency and, if applicable, the type of a clinical care plan that was developed if a patient indicated pain ≥7 on a 10-point scaleMETHODS: The charts of 100 eligible sequential outpatient visits were reviewed and the initial pain management approaches were documented.RESULTS: Between December 2011 and May 2012, visits by 7265 unique patients included 100 eligible visits (pain ≥7 of 10). In 83 cases, active pain management plans, ranging from counselling to hospital admission, were proposed. Active pain management plans were more likely if the cause was believed to be cancer/treatment related: 63 of 65 (96.9%) versus 20 of 35 (57.1%, noncancer/unknown pain cause); P<0.001. There were no differences depending on cancer treatment intent or medical service.CONCLUSIONS: Active pain management plans were documented in 83% of visits. However, patients who reported severe pain that was assessed as benign or unknown in etiology received intervention less frequently, perhaps indicating that oncologists either consider themselves less responsible for noncancer pain, or believe that pain chronicity may lead to a higher ESAS pain score without indicating a need for acute intervention. Further study is needed to determine the subsequent effect of the care plans on patient-reported ESAS pain scores at future clinic visits.
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Weiss, Zoe Freeman, Sara Gore, and Andrew Foderaro. "Pneumomediastinum in marijuana users: a retrospective review of 14 cases." BMJ Open Respiratory Research 6, no. 1 (February 2019): e000391. http://dx.doi.org/10.1136/bmjresp-2018-000391.
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IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.MethodsWe performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.ResultsWe identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).DiscussionInhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.
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Kishore, Jugal, Tanu Anand, and Sneha Kumari. "Essential Skills in Postgraduate Medical Curriculum of Community Medicine." Annals of the National Academy of Medical Sciences (India) 53, no. 01 (January 2017): 021–29. http://dx.doi.org/10.1055/s-0040-1712741.
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ABSTRACT Introduction: Community-based education has been considered a suitable approach for health promotion and for requisite skill development regarding primary health care. In the current perspective, public health training and research, being two important aspects require immediate attention. Objective: To assess the skills of Postgraduate Students in the Department of Community Medicine in four Medical Colleges of Delhi. Materials and Methods: It was a cross-sectional study conducted among 70 Postgraduate Medical Students of 4 Medical Colleges in Delhi. The data were collected through a self administered, pretested questionnaire containing items assessing socio-demographic profile and skills essential for Postgraduate Students of Community Medicine. Results: There were 58.6% male and 29% female students. A large proportion of participants were having age range between 25-29 years. Ability 'to resolve conflict among the nurse at Primary Health Centre (PHC)', 'generate community participation', 'making thick and thin smear in case of fever', 'making a chart showing month-wise distribution of CuT', and 'calculating Chi-square of data', were found to significantly higher in 2nd and 3rd year PG students than first year PG students (p<0.01). Only 27.1% of students felt that they could test water sample for microbiological aspects while only 47.1% said that they could examine an industrial worker for pre-placement examination. Conclusions: PG students assessed themselves to possess necessary skills on communication, counselling and health education. However, many students lacked skills pertaining to occupational health and epidemiology.
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Havatza, K., K. Togia, S. Flouda, A. Pieta, O. Gioti, D. Nikolopoulos, N. Kapsala, et al. "FRI0170 THERAPEUTIC ΤARGETS AND QUALITY INDICATORS IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), DEFINED ACCORDING TO THE 2019 UPDATE OF THE EULAR RECOMMENDATIONS: DATA FROM THE “ATTIKON“ LUPUS COHORT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 669.2–670. http://dx.doi.org/10.1136/annrheumdis-2020-eular.6255.
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Background:Targets of therapy and quality of care are receiving increased attention in the management of SLE, as outlined in the 2019 update of the EULAR recommendations for SLE treatment.Objectives:To assess compliance with quality indicators and attainment of treatment targets, according to recent EULAR recommendations, in the SLE cohort of “Attikon” Rheumatology Unit.Methods:100 consecutive SLE patients followed for at least one year were. A 30 item Quality Indicator Set (QIS) was developed, according to the 2019 EULAR recommendations for SLE, to include laboratory tests for diagnosis and monitoring, evaluation of disease activity and damage using validated indices, use of patient-reported outcomes, counselling for women’s health and reproduction issues, attainment of targets of therapy [remission or low disease activity state (LLDAS) with low-dose glucocorticoids (GC, ≤7.5mg/day prednizone) and hydroxychloroquine (HCQ dose≤5mg/kg/day)], prevention of disease flares and prevention and management of co-morbidities. Chart review and patient interview was performed to assess the degree of compliance with each item of the QIS and achievement of treatment targets.Results:Disease activity was monitored by means of validated indices in 31% and antiphospholipid antibody testing during the first 6 months from diagnosis was performed in 58.8% of patients. Sustained remission (defined as remission of a sustained period of 12 months) or LLDAS was achieved by only 3% and 22% respectively; in contrast, other targets of therapy, such as ≤1 minor flares during last year, were achieved by 85% (43% had complete absence of flares), with 90.2% of patients receiving low-dose GC and 81.8% corrected HCQ dose. Fertility and pregnancy counselling were offered in 40% (12/30 eligible women) and 63.3% (19/30) of patients, respectively, while 65.4% had a Pap Test and only 3 of 32 eligible patients had received the HPV vaccine. Annual lipid status was assessed in 43% and counselling for smoking cessation in 44.6%. Flu vaccination was performed in 77%, while pneumococcal (including both of the pneumococcal vaccines) and herpes-zoster vaccination, were given in 32.7% and 2% (1/44 eligible patients) respectively.Conclusion:Our real-life data suggest low vaccination rates (excluding flu) and suboptimal management of cardiovascular risk factors in lupus patients. While the majority of patients received the suggested doses of GC and HCQ, only one quarter of patients achieved remission or LLDAS. There is an unmet need for new therapies in SLE to improve therapy targets.References:[1]Arora S, Sequeira W, Yazdany J, Jolly M, “Does Systemic Lupus Erythematosus Care Provided in a Lupus Clinic Result in Higher Quality of Care Than That Provided in a General Rheumatology Clinic?”, Arthritis Care Res. 2018 Dec;70(12):1771-1777. doi: 10.1002/acr.23569. Epub 2018 Nov 10.Disclosure of Interests:KATERINA HAVATZA: None declared, KONSTANTINA TOGIA: None declared, Sofia Flouda: None declared, Antigoni Pieta: None declared, Ourania Gioti: None declared, Dionysis Nikolopoulos: None declared, Noemin Kapsala: None declared, Aliki Ntourou: None declared, Panagiota Rapsomaniki: None declared, Thaleia Gerogianni: None declared, Dimitrios Tseronis: None declared, Michail Aggelakos: None declared, Theofanis Karageorgas: None declared, PELAGIA KATSIMPRI: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Konstantinos Thomas: None declared, DIMITRIOS BOUMPAS Grant/research support from: Unrestricted grant support from various pharmaceutical companies, Antonis Fanouriakis Paid instructor for: Paid instructor for Enorasis, Amgen, Speakers bureau: Paid speaker for Roche, Genesis Pharma, Mylan
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Chan, Alvita Justine, Stephanie Gomer, Eleni V. Dimaraki, Lorraine Lucille Lipscombe, and Geetha Mukerji. "Improving Care Delivery for Young Adults With Type 1 Diabetes via a Multi-Faceted Quality Improvement Interdisciplinary Intervention." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A459—A460. http://dx.doi.org/10.1210/jendso/bvab048.938.
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Abstract Background: The transition from pediatric to adult type 1 diabetes (TID) care represents a vulnerable period for young adults (YA), and many are eventually lost to follow up. This can result in lost opportunities for patient education, worsened glycemic control and increased rates of acute diabetes complications. To address this, a multi-faceted quality improvement (QI) intervention was implemented at a YA T1D program with the goal of improving patient attendance and care delivery amongst YA with T1D. Methods: The intervention consisted of three main components: a transitional navigator, an interdisciplinary diabetes assessment flowsheet and virtual care via phone or video conference. These components were implemented at the YA T1D program using a stepwise approach beginning in 2019. The attendance of all patients seen between January 2017 and August 2020 were tracked monthly on a run chart to identify any shifts after each component was implemented. A pre-post analysis was also performed in new patients with a minimum follow up period of 12 months to compare secondary outcomes including A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations, incidence of severe hypoglycemia and psychosocial counselling rates. Results: A total of 2240 scheduled appointments was included in the primary analysis. Patient attendance improved from 59% to 79% (p<0.01) with virtual care, demonstrated by a shift in attendance sustained over 6 months after its implementation. Virtual care was utilized in 81.3% of appointments in the post-intervention period. Subgroup analysis showed the improvement in attendance was significant in follow up appointments (80% vs 59%, p<0.01), but there was no difference in attendance for initial consultations (67% vs 58%, p=0.45). Forty-two patients were included in the pre-post analysis (n=27 in the pre-intervention and n=15 in the post-intervention period). There were with no significant difference in baseline characteristics of the two groups. Mean patient age was 20.2±2.9 years. Males comprised of 28.5% of the study population. Mean duration of diabetes was 11.1±5.3 years, and baseline average A1c was 8.6±1.7%. Preliminary analysis demonstrated there was significant improvement in preconception counselling rate (76% vs 100%, p=0.048) following the intervention. There was no significant difference in A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations or incidence of severe hypoglycemia. Conclusion: Virtual care was effective in improving attendance for follow up appointments at a YA T1D clinic. Further data analysis for patients assessed in September to December 2020 is currently underway.
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Goldenberg, Paula C., Betsy J. Adler, Ashley Parrott, Julia Anixt, Karen Mason, Jannel Phillips, David S. Cooper, Stephanie M. Ware, and Bradley S. Marino. "High burden of genetic conditions diagnosed in a cardiac neurodevelopmental clinic." Cardiology in the Young 27, no. 3 (September 19, 2016): 459–66. http://dx.doi.org/10.1017/s104795111600072x.
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AbstractBackgroundThere is a known high prevalence of genetic and clinical syndrome diagnoses in the paediatric cardiac population. These disorders often have multisystem effects, which may have an important impact on neurodevelopmental outcomes. Taken together, these facts suggest that patients and families may benefit from consultation by genetic specialists in a cardiac neurodevelopmental clinic.ObjectiveThis study assessed the burden of genetic disorders and utility of genetics evaluation in a cardiac neurodevelopmental clinic.MethodsA retrospective chart review was conducted of patients evaluated in a cardiac neurodevelopmental clinic from 6 December, 2011 to 16 April, 2013. All patients were seen by a cardiovascular geneticist with genetic counselling support.ResultsA total of 214 patients were included in this study; 64 of these patients had a pre-existing genetic or syndromic diagnosis. Following genetics evaluation, an additional 19 were given a new clinical or laboratory-confirmed genetic diagnosis including environmental such as teratogenic exposures, malformation associations, chromosomal disorders, and single-gene disorders. Genetic testing was recommended for 112 patients; radiological imaging to screen for congenital anomalies for 17 patients; subspecialist medical referrals for 73 patients; and non-genetic clinical laboratory testing for 14 patients. Syndrome-specific guidelines were available and followed for 25 patients with known diagnosis. American Academy of Pediatrics Red Book asplenia guideline recommendations were given for five heterotaxy patients, and family-based cardiac screening was recommended for 23 families affected by left ventricular outflow tract obstruction.ConclusionGenetics involvement in a cardiac neurodevelopmental clinic is helpful in identifying new unifying diagnoses and providing syndrome-specific care, which may impact the patient’s overall health status and neurodevelopmental outcome.
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Cremin, Carol M., Linlea Armstrong, Sharlene Gill, David Huntsman, and Chris Bajdik. "The Identification of Lynch Syndrome in British Columbia." Canadian Journal of Gastroenterology 23, no. 11 (2009): 761–67. http://dx.doi.org/10.1155/2009/620518.
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OBJECTIVE: To determine the prevalence of Lynch syndrome mutations in a Canadian hereditary cancer clinic population, and to determine the effectiveness of the program’s referral criteria and testing algorithm.METHODS: A retrospective chart review of all patients who were referred for and received genetic counselling at the BC Cancer Agency’s Hereditary Cancer Program for a family history of colon cancer from August 1, 2004, to September 1, 2006, was performed. Charts were reviewed for referral criteria met, cancer history, whether testing was offered and the outcome of testing.RESULTS: Lynch syndrome was confirmed or highly suspected in 14.3% of index test patients (eight of 56) by the identification of a deleterious mutation or variant likely to be deleterious in either of thehMLH1orhMSH2mismatch repair genes. In the program, the two most effective criteria were a personal diagnosis of two or more primary Lynch syndrome-related cancers (one diagnosed at younger than 50 years of age) or two first-degree relatives with a Lynch syndrome-related cancer (both diagnosed at younger than 50 years of age). The respective positive predictive values of these two criteria were calculated to be 66.7% (95% CI 40% to 93%) and 58.3% (95% CI 30.4% to 86.2%).CONCLUSIONS: The Hereditary Cancer Program developed and successfully implemented an approach that selected individuals at risk for Lynch syndrome with a significant pretest probability of mutation of 14.3%. Improved ascertainment of families with Lynch syndrome will require greater physician awareness of referral criteria, program advances in the testing algorithm and a population-based approach to screening incident colon cancers.
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Harvey, C. E. "35. OUT OF THE SPOTLIGHT: AN AUDIT OF FIVE YEARS OF IMPLANON® USE IN QUEENSLAND." Sexual Health 4, no. 4 (2007): 298. http://dx.doi.org/10.1071/shv4n4ab35.
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The progestogen contraceptive implant -Implanon� was launched into the Australian marketplace in May 2001, with intense marketing and extensive training programs for doctors. However, negative media focused on removal problems and unexpected pregnancies, followed by increased medical indemnity requirements for providers, resulted in restricted access for Australian women as many GPs ceased providing insertions. To date there is no published data on the use of this contraceptive implant in Australia. To identify trends in usage, continuation rates, side effects and acceptability of this method, a retrospective chart audit of clients attending Family Planning Queensland (FPQ) clinics for implant insertion and/or removal over a 5 year period was conducted. The audit examined1800 implant users from the two busiest FPQ clinics, one in a regional setting. Preliminary results from the audit indicate:- All age groups across the reproductive years are represented in the group. The major reason for removal is unacceptable bleeding patterns Many women have the device removed because they no longer require contraception. There have been no pregnancies identified with implants The last 2 years have seen significant numbers of women presenting for implant replacement, with these women providing valuable information on factors contributing to longer term acceptability of the method. This presentation will provide an analysis of the audit findings, particularly in relation to duration of use and implications for client acceptability of this contraceptive method. The information about Implanon� use in a clinical setting will be used to make recommendations on improvements in the appropriate selection and counselling of women considering this contraceptive method.
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Saka, S. A., and O. T. Fajemirokun. "The effects of National Health Insurance Scheme on equity and quality of diabetes care in secondary healthcare facilities in SouthWest Nigeria." Journal of Medical and Biomedical Sciences 7, no. 1 (June 1, 2018): 11–21. http://dx.doi.org/10.4314/jmbs.v7i1.2.
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There have been concerns about the influence of the National Health Insurance Scheme (NHIS) on equity and quality of diabetes care in many healthcare settings. This study aimed to assess the effects of NHIS onequity and quality of diabetes care (DC) in Nigeria. A prospective cross-sectional study was carried out among 110 (insured n=42, uninsured=68) consenting type 2-diabetics. Diabetic outpatients on oral hypoglycemic drugs, with at least 4 clinic visits prior to the time of the study were consecutively selected at two NHIS accredited public hospitals in Southwest, Nigeria. Patients’ perceptions of equity and quality of DC were assessed using a validated 27 items questionnaire. The medical care and pharmaceutical care in diabetes were independently assessed using medical chart review and a direct observation of dispensing pharmacists’ activities respectively. Chi-squared test was used to determine associations between variables. Majority (61.8%) of the study participants were uninsured. Females (50.9%) were more than the males (49.1%), 40.0% had post-secondary qualifications. The mean ages for the insured and uninsured were 52.02±11.6 and 58.97± 9.3years respectively. The insured and the uninsured differ in their perceptions of drug availability (p<0.001). The pharmacists’ counselling time (p<0.001) differs between the groups. The quality of medical care provided to the diabetics was generally low. The NHIS did not influence the quality of DC, though it may have engendered inequity in pharmaceutical care in the facilities.Journal of Medical and Biomedical Sciences (2018) 7(1), 11 - 21
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Sreedharan, Sadhishaan, Steven Gray, and Frank Bruscino-Raiola. "Osseointegrated prostheses for lower limb amputees." Australasian Journal of Plastic Surgery 4, no. 1 (March 30, 2021): 56–62. http://dx.doi.org/10.34239/ajops.v4n1.199.
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Background: Traditional socket-based prostheses are an important rehabilitation tool in lower limb amputation, however, patients often experience skin-related problems, pain, stump volume fluctuations and poor suspension. Osseointegration offers a suitable alternative by providing direct skeletal attachment for limb prosthesis. This study aims to review the complications following osseointegration for lower limb amputation, with attention to mechanical abutment failure. Method: A retrospective chart review was undertaken of all patients who underwent transfemoral osseointegration between January 2000 and June 2019 through the osseointegration and targeted muscle reinnervation surgical and rehabilitation program at The Alfred in Victoria, Australia. Ethics approval was obtained through The Alfred’s ethics committee (414/16). In 2016 this program was redesigned and in 2017 the osseointegration implant system was modified. Patients underwent a two-stage surgical procedure followed by a rehabilitation protocol that gradually increased their activity. Results: A total of 19 limbs were osseointegrated in 18 patients during the study period. Two patients had their implant removed due to failure of osseointegration. The most common complication was a mechanical abutment failure, occurring 46 times in 11 patients. Patients who suffered an abutment failure reported higher levels of postoperative activity. Soft-tissue infections occurred in five patients: three superficial skin infections and two collections. There were no mechanical abutment failures noted in the updated program.Conclusion: Osseointegration is a good option for patients who may have difficulties with traditional socket prosthesis. However, complications such as abutment fracture can occur, and appropriate patient selection and counselling are required
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Yandi, Satria, Intan Batura Endo Mahata, and Elen Anggraini. "Oral hygiene index-simplified sebelum dan setelah penyuluhan menyikat gigi menggunakan media PowerPoint dan media flip chartOral hygiene index-simplified before and after tooth brushing counselling using PowerPoint and flip chart media." Padjadjaran Journal of Dental Researchers and Students 4, no. 2 (October 31, 2020): 141. http://dx.doi.org/10.24198/pjdrs.v4i2.28882.
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Villa-Roel, C., M. Bhutani, S. R. Majumdar, R. Leigh, B. Borgundvaag, E. Lang, A. Senthilselvan, R. J. Rosychuk, and B. H. Rowe. "LO65: Outpatient care gaps in subjects presenting to emergency departments with acute asthma." CJEM 19, S1 (May 2017): S50. http://dx.doi.org/10.1017/cem.2017.127.
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Introduction: Many patients presenting to Emergency Departments (EDs) with acute asthma have limited or no access to health care providers, medications and preventive resources. This study explored outpatient care gaps among subjects presenting to the ED for acute asthma, before being discharged. Methods: Cross-sectional analysis of data obtained in a comparative effectiveness trial conducted in six EDs in Alberta (NCT01079000). Data were collected through patient interviews and chart reviews at ED presentation. Two clinician-investigators independently reviewed and adjudicated the following preventive actions: use of spacer devices, written asthma action plans (AAPs) and asthma medication; influenza immunization, cigarette smoking, and referral to asthma education. Agreement between adjudicators was calculated based on kappa (k) statistics. Results: The median age of the study population (n=367) was 28 years and 64% were women. Overall, 26% of patients reported not having a regular family physician. Agreement between reviewers was excellent (k=0.96). More than half (59%) reported not using spacer devices despite being indicated and 3% reported having a written AAP. Following the recommendations of the current asthma guidelines, 38% of the patients required the initiation of inhaled corticosteroids (ICS), 11% required the addition of ICS/long-acting β-agonists combination agents and 39% required reinforcement of adherence with preventer medications. Finally, 37% reported receiving influenza vaccination in the past year, 7% had been referred to asthma education in the last 10 years, and 31% were still smoking, suggesting that cessation counselling was indicated. Conclusion: The ED encounter for patients with acute asthma represents a unique opportunity to establish important partnerships across the continuum of asthma care (e.g., link them with a family doctor). This study provided a robust assessment of the outpatient care gaps in this patient population, which identified many areas for targeted interventions. The method of delivery and type of messaging needs further study.
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Alyami, Fahad A., Zhoobin Heidari Bateni, Raken Odeh, Walid A. Farhat, and Martin Koyle. "Routine histopathological examination of the foreskin after circumcision for clinically suspected lichen sclerosus in children: Is it a waste of resources?" Canadian Urological Association Journal 12, no. 5 (February 2, 2018): E231–3. http://dx.doi.org/10.5489/cuaj.4331.
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Introduction: Circumcision is one of the most widely performed procedures in the world. One of the indications for circumcision is lichen sclerosis (LS). The natural history of LS in children is not as well-documented as in adult patients. Surgeons use the appearance of the foreskin or meatus to predict the diagnosis of LS.1 Indeed, if the diagnosis of LS is made in childhood, does it change management in the long-term? Pathological analysis of the excised foreskin is routinely done if there is suspicion of LS. Our aim is to assess the concordance between the clinical and pathological diagnosis of suspected LS and to assess the need for sending the foreskin for pathological examination.Methods: We conducted a retrospective chart review of 64 of 420 boys who underwent circumcision in a tertiary children’s hospital from June 2005 to June 2014, and who had their foreskin sent for pathology due to the clinical suspicion of LS. Demographics, presenting symptoms, presumed clinical diagnosis, pathological findings, and followup data were collected and analyzed. Results: Over the review period, 64 patients underwent circumcision for presumed LS. The mean age of the children was 9.7 years (range 3‒16.5). All the children who had circumcision for presumed LS diagnosis were symptomatic. LS was confirmed in 47 of 64 foreskins (73.5%). Balanitis xerotica obliterans (BXO) was clinically suspected in 40 (85%) of the 47 patients. The mean followup was 10 months (range 1–15), with seven recurrences (15%) during that period. The recurrences required revision surgery in two patients and five were managed with steroids only. Conclusions: In our series, the clinical diagnosis correlated with the pathological diagnosis in most cases. A clinical suspicion of LS without routine foreskin pathological assessment will reduces the overall cost to the healthcare system. Appropriate counselling of the patient/parents and their primary caregiver is imperative, as recurrence is common.
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Hossain, Mohammad, Ami Amin, Anju Paul, Huzaif Qaisar, Monika Akula, Alireza Amirpour, Shreya Gor, et al. "Recognizing Obesity in Adult Hospitalized Patients: A Retrospective Cohort Study Assessing Rates of Documentation and Prevalence of Obesity." Journal of Clinical Medicine 7, no. 8 (August 7, 2018): 203. http://dx.doi.org/10.3390/jcm7080203.
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Background: While obesity is a chronic condition that predisposes patients to other more serious disorders, the prevalence and the documentation of obesity as diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. Method: IRB approval was obtained for this retrospective study. Body mass index (BMI) as per CDC, admission and discharge diagnosis of obesity and common comorbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart disease, chronic kidney disease and chronic obstructive pulmonary disease) were recorded. The length of stay in the hospital was also calculated. We also investigated whether counselling was provided to the obese patients for weight loss. Results: A total of 540 consecutive patients were reviewed with a mean age was 66 ± 6 years. Out of 540 patients only 182 (34%) had normal weight, 188 (35%) of the patients were overweight and 170 (31%) patients were obese. Of the obese group, 55% were female and 45% were male.100 (59%) had class I obesity, 43 (25%) had class II obesity and 27 (16%) class III obesity. Of the obese patients 40/170 (23.5%) patients had obesity documented on the admission problem list and only 21 (12%) had obesity documented as a discharge diagnosis. Only 3 (2%) patients were given appropriate counseling and referral for obesity management during the hospitalization. Comorbidities and their prevalence included, hypertension (68%), diabetes mellitus (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar for all three groups (4.5 ± 0.5 days). Conclusion: A significant number of hospitalized patients were overweight and obese. An overwhelming percentage never had weight status documented. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.
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Brubacher, J. R., C. Renschler, B. Huang, W. C. Lee, A. M. Gomez, H. Chan, S. Erdelyi, and R. Purssell. "P024: Physician reporting of medically unfit drivers: knowledge, attitudes, and practice." CJEM 19, S1 (May 2017): S85—S86. http://dx.doi.org/10.1017/cem.2017.226.
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Introduction: Medical conditions that impair perception, cognition or motor skills may make people unfit to drive. Reporting unfit drivers to licensing authorities is seen by many as a public health obligation. This study investigates physician knowledge, attitudes and practice around the management of medically unfit drivers. Methods: We used an online survey to explore physician knowledge of fitness to drive issues and their attitudes and practice with regard to counselling and reporting unfit drivers. Email invitations to participate in the survey were sent to all physicians in BC through DoctorsofBC and to all emergency physicians (EPs) in the UBC Department of Emergency Medicine. Results: We received responses from 242 physicians (47% EPs, 40% GPs, 13% others). The majority (78%) reported little/no knowledge on determining driver fitness and 94% had little/no training around guidelines, reporting, and laws involving fitness to drive. Most (88%) agreed that physicians should be obligated to advise medically unfit patients not to drive, and 74% reported that they often warn patients not to drive. The majority of physicians also chart their opinion of patients’ fitness to drive (67% do so more than twice per year). Most respondents (70%) indicated that it is “always appropriate” to report definitely unfit drivers whereas only 25% indicated that it is “always appropriate” to report potentially unfit drivers. However, in practice physicians see far more unfit drivers than they report to licensing authority: 67% of physicians encounter definitely unfit drivers more than twice per year but only 19% report definitely unfit drivers more than twice per year and 34% never report definitely unfit drivers. Compared to other physicians, EPs reported less knowledge and training about criteria for determining fitness to drive, were more likely to feel that reporting unfit drivers was not their responsibility, and were less likely to report unfit drivers to licensing authorities. Conclusion: Our findings indicate a need for more education and information resources to help physicians, particularly EPs, identify and manage medically unfit drivers. Although most physicians warn unfit drivers not to drive and document this in medical records, many medically unfit drivers are not reported to licensing authorities, a potential public health problem that should be further investigated.