Impact on core values of family medicine from a 2-year Master’s programme in Gezira, Sudan: observational study

Abstract Background Training of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master’s programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates’ adherence to some core values of family medicine. Methods This is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians’ attitude towards patient-centeredness. Practice based data from individual patients’ consultations and self-assessment methods were used to assess physicians’ adherence to core values. Results At the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p < 0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients’ medical history (p < 0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007). Conclusions The GFMP Master’s programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.

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Vascular anastomoses in intrauterine growth in monochorionic twins

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0028 ◽

2020 ◽

Vol 48 (6) ◽

pp. 539-543

Author(s):

Michał Lipa ◽

Przemysław Kosinski ◽

Paweł Stanirowski ◽

Mirosław Wielgos ◽

Dorota Bomba-Opon

Keyword(s):

Injection Technique ◽

Digital Analysis ◽

Monochorionic Twins ◽

Intrauterine Growth ◽

Blood Exchange ◽

Sharing Patterns ◽

A Prospective Study ◽

The Impact ◽

Umbilical Cords

AbstractObjectivesTo evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins.MethodsA prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up.ResultsVascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins’ birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31).ConclusionsVascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.

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Feasibility of telemedicine in the management strategy of patients with lymphoma amid the COVID-19 pandemic in Spain, a prospective study (Preprint)

10.2196/preprints.34128 ◽

2021 ◽

Author(s):

Raul Cordoba ◽

Alberto Lopez-Garcia ◽

Daniel Morillo ◽

Maria-Angeles Perez-Saenz ◽

Elham Askari ◽

...

Keyword(s):

Prospective Observational Study ◽

Digital Health ◽

Hematologic Malignancies ◽

Patient Portal ◽

Health Strategy ◽

Potential Risk Factors ◽

Hospital Visits ◽

A Prospective Study ◽

The Impact

BACKGROUND Recurrent hospital visits were potential risk factors for COVID-19 contagion. OBJECTIVE The aims of this prospective observational study was to analyze the consequences of COVID-19 pandemic in the health care of patients with lymphoma and the impact of telemedicine strategies such as the patient portal in their management. METHODS All data were obtained from the electronic medical record (EMR). Variables such as age, sex, matter of the visit, use of patient’s portal, changes in management, impact in clinical trials and suffering from COVID-19 contagion were recorded. RESULTS 290 patients were attended in the lymphoma clinic accomplishing 437 appointments. The median age was 66 years (range 18-94), and 157 (54.13%) were male. Of them, 109 out of 290 (37.58%) were aged older then 70 years. Regarding number of visits, 214 patients (73.79%) had only 1 visit to the hospital. Only 23 patients (7.93%) didn’t have access to patient’s portal. During the follow-up, only 7 patients (2.41%) suffered from COVID-19, with a median age of 66 years (51-80). CONCLUSIONS Telemedicine such as patient’s portal are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to hospital and a very low contagion rate. This experience allowed us to continue with a new digital health strategy in the follow up of patients with hematologic malignancies. CLINICALTRIAL Not registered.

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The impact of meningitis on the motor function of adult survivors in Harare, Zimbabwe

South African Journal of Physiotherapy ◽

10.4102/sajp.v55i1.552 ◽

1999 ◽

Vol 55 (1) ◽

pp. 6-10

Author(s):

Jennifer Jelsma ◽

Helen Lilley ◽

Helen Smith ◽

Jens Mielke ◽

James Hakim ◽

...

Keyword(s):

Functional Disability ◽

Functional Limitation ◽

Adult Survivors ◽

Stepwise Logistic Regression ◽

Motor Impairments ◽

Forward Stepwise ◽

The One ◽

A Prospective Study ◽

The Impact

Objective: The study aimed to document the spectrum of motor impairments and the degree of functional limitation of those who survived adult meningitis and to identify which factors were associated with a poor functional outcome and mortality.Methods: A prospective study was undertaken in the central hospitals in Harare, Zimbabwe. Twenty six adult patients who had survived meningitis were interviewed between one and five months post-admission. Seventeen of these were examined in the clinic for signs of impairment. Nine did not attend the follow-up session and were interviewed at home. The Barthel Activities of Daily Living Index (BI) was administered to all twenty six subjects.Results: Twenty subjects were HIV sero-positive. Eight subjects died in the time period between the one month interview and the final follow-up five months later. The majority of the seventeen examined in the clinic, demonstrated sensory and motor disturbances. Seven of the twenty six subjects scored eighteen or less on the BI. Forward stepwise logistic regression revealed that a low BI was the only variable which significantly predicted mortality (p.<0.01). The odds of a patient with a low BI dying were 63 times the odds of a patient dying who had a normal BI.Discussion and Conclusions: Survivors of meningitis in this study displayed a diversity of impairments and disabilities. Rehabilitation intervention is recommended to provide functional reeducation and support for those with a low BI and to mitigate against the effects of the impairments. A measure of functional disability should be included in the examination of these clients as functional impairment appears to be a predictor of mortality.

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The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

The Moldovan Medical Journal ◽

10.52418/moldovan-med-j.64-5.21.03 ◽

2021 ◽

Vol 64 (5) ◽

pp. 16-20

Author(s):

Alina Malic ◽

◽

Evelina Lesnic ◽

Keyword(s):

Diabetes Mellitus ◽

Prospective Study ◽

Treatment Effectiveness ◽

Similar Rate ◽

Control Group ◽

Diabetic Patients ◽

A Prospective Study ◽

Prospective Longitudinal ◽

The Impact

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

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Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors

PLoS ONE ◽

10.1371/journal.pone.0243804 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0243804

Author(s):

Anne Sverdrup Efjestad ◽

Hege Ihle-Hansen ◽

Vidar Hjellvik ◽

Knut Engedal ◽

Hege Salvesen Blix

Keyword(s):

Age Groups ◽

Acetylcholinesterase Inhibitors ◽

Prescription Database ◽

Prescription Pattern ◽

Before And After ◽

Norwegian Prescription Database ◽

Total Prescription ◽

A Prospective Study ◽

The Impact

Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

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5 Years Mortality of Severe Traumatic Brain Injury during the Establishment of Closed System Neurocritical Care Unit in a Resource Constrained Developing Country

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v24i1.416 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

SYED SHAHZAD HUSSAIN ◽

USMAN AHAMD KAMBOH ◽

ASIF RAZA ◽

HUSNAIN RAZA ◽

RABIA RAZZAQ ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Closed System ◽

Neurocritical Care ◽

Patient Centered ◽

Severe Tbi ◽

A Prospective Study ◽

Age Range ◽

The Impact

Background & Objectives: Severe traumatic brain injury is one of the leading causes of mortality and morbidity.Efficient management of severe traumatic brain injury demands a specialty driven focused intensive care. We developed our model of closed ICU driven by Neurosurgical Neurointensivist and the corollary to thiscommitment is a TBI patient centered Neurocritical care with the capacity and capability to deal with most of the neurological illnesses.Materials & Methods: A prospective study was conducted to find out the impact of the establishment of closed system of neurocritical care on 5 year mortality of severe TBI. Total 1288 patients met the inclusion criteria, which were enrolled. Tabulation was done for gender, age range, Glasgow outcome scale and mortality.Results: It was observed that mortality reduced from 47% to 35% over a span of five years. The most common age range was 30-40 years, which is the most productive group of any population. Bed sore incidence is always on rise in any ICU. After the implementation of SOPs based management and increase in nursing staff theincidence of bedsore also showed a detrimental pattern from 35 % to 19%.Conclusion: Neurocritical care unit is proven to be an integral part of any neurosurgical unit and this closed system of NCC unit provide best SOP based care with significant reduction in mortality of patients with STBI.

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The Role of Growth Hormone and IGF-1 in Retinopathy: A Prospective Study of Retinopathy in Patients with Acromegaly and Impaired Fasting Glucose

10.21203/rs.3.rs-530165/v1 ◽

2021 ◽

Author(s):

Tzu-En Wu ◽

Harn-Shen Chen

Keyword(s):

Blood Pressure ◽

Impaired Fasting Glucose ◽

Odds Ratio ◽

Diabetes Management ◽

Fasting Glucose ◽

Proliferative Retinopathy ◽

National Guidelines ◽

A Prospective Study

Abstract We hypothesized that elevated insulin-like growth factor 1 (IGF-1) could accelerate the progress of non-proliferative retinopathy into proliferative retinopathy. We recruited 91 patients with acromegaly and 123 subjects with impaired fasting glucose (IFG) between 2008 and 2016 to examine the incidence and prevalence of retinopathy. Patients attended follow-ups in our clinics and underwent examinations according to the national guidelines for diabetes management. Both cohorts attended follow-ups until June 2019. Both groups had similar HbA1c, cholesterol, and blood pressure levels. However, patients with acromegaly had higher GH (8.05±16.18 vs. 0.78±1.25 ng/mL) and IGF-1 (547.0±342.1 vs. 146.7±51.4 ng/mL) levels than in subjects with IFG. During the follow-up period, eight patients (8.8%) with acromegaly and 12 patients (9.8%) with IFG developed some degree of retinopathy. Three patients with acromegaly and two with IFG progressed to proliferative retinopathy. Patients with acromegaly had the same incidence of non-proliferative retinopathy (odds ratio [OR]: 0.830; 95% CI: 0.318–2.164) and a non-statistically significantly higher incidence of proliferative retinopathy (OR: 2.461; 95% CI: 0.404–14.988). The data reveals that GH and IGF-1 might play a crucial role in the development of proliferative retinopathy and influence its progression. Therefore, we suggest screening patients with acromegaly should be similar to diabetes patients.

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Impact of changes to national guidelines on hypertension related workload

British Journal of General Practice ◽

10.3399/bjgp21x714281 ◽

2020 ◽

pp. bjgp21X714281

Author(s):

Sarah Lay-Flurrie ◽

James Sheppard ◽

Richard J Stevens ◽

Christian Mallen ◽

Carl Heneghan ◽

...

Keyword(s):

Interrupted Time Series ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Interrupted Time Series Analysis ◽

National Guidelines ◽

Nice Guidelines ◽

Face To Face ◽

General Practices ◽

The Impact

Background: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. Aim: To assess the impact of guideline change on rates of hypertension-related consultation in general practice. Design and Setting: Cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1/4/2006 and 31/3/2017. Method: The primary outcome was the rate of face-to-face, telephone and visit consultations related to hypertension with a GP or nurse. Age and sex standardized rates were analysed using interrupted time-series analysis. Results: In 3,937,191 adults (median follow-up = 4.2 years) there were 12,253,836 hypertension related consultations. The rate of hypertension related consultation was 71.0 per 100 person-years (95% CI 67.8 to 74.2) in April 2006, which remained flat prior to 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend = -3.60 per 100 person-years, 95% CI -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis and persisted when accounting for wider trends in all consultations. Conclusion: Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.

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SP5.1.1 The harsh reality of a long waiting list for bariatric surgery, a prospective study regarding health-related quality of life (HRQoL) among morbid obese patients following bariatric surgery versus those on a waiting list, a two-year follow-up study

British Journal of Surgery ◽

10.1093/bjs/znab361.112 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Jose Rodicio ◽

María Moreno ◽

Tamara Vico ◽

Emilio Negrete ◽

Covadonga Valdés ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Bariatric Surgery ◽

Bodily Pain ◽

Waiting List ◽

Emotional Role ◽

A Prospective Study ◽

The Impact

Abstract Aims The aims of this study were to assess the changes in HRQoL during the 2 years follow-up between patients who underwent surgery and those on a long waiting list . Methods Between January to December 2017, 70 surgical patients and 69 patients on the waiting list were interviewed at baseline, 12-month and 24-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL) questionnaires. Socio-demographics, clinical, and surgical-related variables were collected. Results 139 patients were analyzed, with similar baseline characteristics. Analyzing the entire sample: the higher the BMI, the worse the scores in the IWQoL. Performing more qualified work improves several aspects of the SF-12v2. In contrast, patients with depression tended to score worse on all dimensions of both questionnaires, women scored worse on the Self-Esteem domain and men improved on the Mental Health one. At 12 and 24-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P<.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically differences among Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary domains (P<.05) at 12 months, but differences were not found at 24 months. Conclusions The quality of life of patients undergoing bariatric surgery is normalized one year after surgery, while patients on the waiting list get worse. Knowing the benefits of bariatric surgery, working on programs with long waiting lists should move us to fight against an unfair and unacceptable situation.

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A global picture of family medicine: the view from a WONCA Storybooth

BMC Family Practice ◽

10.1186/s12875-019-1017-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Vincent K. Cubaka ◽

Clayton Dyck ◽

Russell Dawe ◽

Baraa Alghalyini ◽

Molly Whalen-Browne ◽

...

Keyword(s):

Family Medicine ◽

Value Added ◽

Care Patient ◽

Patient Centeredness ◽

Family Doctors ◽

Inquiry Approach ◽

The World ◽

Shared Stories ◽

World Organization ◽

The Impact

Abstract Background Family Medicine is a novel discipline in many countries, where the motivation for training and value added to communities is not well-described. Our purpose was to understand the reason behind the choice of Family Medicine as a profession, the impact of Family Medicine on communities, and Family Medicine’s characterizing qualities, as perceived by family doctors around the world. Methods One-question video interviews were conducted using an appreciative inquiry approach, with volunteer participants at the 2016 World Organization of Family Doctors conference in Rio de Janeiro. Qualitative data analysis applied the thematic, framework method. Results 135 family doctors from 55 countries participated in this study. Three overarching themes emerged: 1) key attributes of Family Medicine, 2) core Family Medicine values and 3) shared traits of family doctors. Family Medicine attributes and values were the key expressed motivators to join Family Medicine as a profession and were also among expressed factors that contributed to the impact of Family Medicine globally. Major sub-themes included the principles of comprehensive care, holistic care, continuity of care, patient centeredness, and the patient-provider relationship. Participants emphasized the importance of universal care, human rights, social justice and health equity. Conclusion Family doctors around the world shared stories about their profession, presenting a heterogeneous picture of global Family Medicine unified by its attributes and values. These stories may inspire and serve as positive examples for Family Medicine programs, prospective students, advocates and other stakeholders.

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