Traditional and complementary medicine (TCM) usage and its association with Patient Assessment of Chronic Illness Care (PACIC) among individuals with metabolic syndrome in primary care

Background Traditional and Complementary Medicine (TCM) is widely used particularly among patients with chronic diseases in primary care. However, evidence is lacking regarding TCM use among patients with Metabolic Syndrome (MetS) and its association with patients’ experience on chronic disease conventional care that they receive. Therefore, this study aims to determine the prevalence and pattern of TCM use, compare the patients’ experience of chronic disease care using the Patient Assessment of Chronic Illness Care - Malay version (PACIC-M) questionnaire between TCM users and non-users and determine the factors associated with TCM use among patients with MetS in primary care. Methodology A cross-sectional study was conducted at a university primary care clinic. Patients aged 18 to 80 years old with MetS were recruited. Socio-demographic characteristic, clinical characteristics and information on TCM use and its pattern were recorded in a proforma. Patient’s experience of chronic disease conventional care was measured using PACIC-M questionnaire. The comparison of PACIC-M mean score between TCM users and non-users was measured using independent t-test. The factors associated with TCM use were determined by simple logistic regression (SLogR), followed by multiple logistic regression (MLogR). Results Out of 394 participants, 381 (96.7%) were included in the final analysis. Of the 381 participants, 255 (66.9%) were TCM users (95% CI 62.7, 71.7). Only 36.9% of users disclosed about TCM use to their health care providers (HCP). The overall mean PACIC-M score was 2.91 (SD ± 0.04). TCM users had significantly higher mean PACIC-M score compared to non-users (2.98 ± 0.74 vs 2.75 ± 0.72, p = 0.01). The independent factors associated with TCM use were being female (Adj. OR 2.50, 95% CI 1.55, 4.06), having high education level (Adj. OR 2.16, 95% CI 1.37, 3.41) and having high overall PACIC-M mean score (Adj. OR 1.49, 95% CI 1.10, 2.03). Conclusion TCM use was highly prevalent in this primary care clinic. However, the disclosure rate of TCM use to HCP was low. Females, those with high education and high PACIC-M mean score were more likely to use TCM. Further research should explore the reasons for their TCM use, despite having good experience in conventional chronic disease care.

THE DIAGNOSIS AND ASSESSMENT OF THE QUALITY OF LIFE IN TINNITUS PATIENTS. A LITERATURE REVIEW

Highlight:1. Assessment of the patient’s quality of life is used to establish the diagnosis of tinnitus.2. The assessment is performed using several types of questionnaires: Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). 3. THI is the questionnaire that has been translated into Indonesian so that it is easier to use in Indonesia.Background: Tinnitus is a symptom with many different causes that can interfere with daily life. The diagnosis of tinnitus can be carried out, starting by examining the history, physical examination, and audiology, and assessing the quality of life of the patient. Assessment of the patient’s quality of life and the severity of tinnitus was carried out using a questionnaire. Objective: This study aimed to explain the frequency of use of several questionnaires to assess the quality of life of patients with tinnitus, including Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). Discussion: The use of THI as a research tool has been recommended for assessing the severity of tinnitus functional, emotional, and catastrophic responses. THS is used as a screening instrument to evaluate tinnitus complaints because of a hearing problem and how frequently it happens. TFI was used for identifying the functional impact on tinnitus patients, to evaluate how tinnitus affects a person’s life, while TPFQ was applied as it is a new questionnaire designed specifically for this objective. Conclusion: Many questionnaires can be used as an assessment of the quality of life of patients with tinnitus. Each questionnaire can be used and has its advantages. THI is a questionnaire that has been translated into Indonesian so that it is easier to assess.

A Telecare System for Use in Traditional Persian Medicine

Background: In Persian Medicine (PM), measuring the wrist temperature/humidity and pulse is one of the main methods for determining a person's health status and temperament. An important problem is the dependence of the diagnosis on the physician's interpretation of the above-mentioned criteria. Perhaps this is one reason why this method has yet to be combined with modern medical methods. Also, sometimes there is a need to use PM to diagnose patients remotely, especially during a pandemic. This brings up the question of how to implement PM into a telecare system. This study addresses these concerns and outlines a system for measuring pulse signals and temperament detection based on PM. Methods: A system was designed and clinically implemented based on PM that uses data from recorded thermal distribution, a temperament questionnaire, and a customized device that logs the pulse waves on the wrist. This system was used for patient care via telecare. Results: The temperaments of 34 participants were assessed by a PM specialist using the standardized Mojahedi Mizaj Questionnaire (MMQ). Thermal images of the wrist in the supine position (named Malmas in PM), the back of the hand, and the entire face were also recorded under the supervision of the physician. Also, the wrist pulse waves were evaluated by a customized pulse measurement device. Finally, the collected data could be sent to a physician via a telecare system for further interpretation and prescription of medications. Conclusion: This preliminary study focused on the implementation of a combinational hardware-software system for patient assessment based on PM. It appears that the design and construction of a customized device that can measure the pulse waves, and some other criteria, according to PM, is possible and can decrease the dependency of the diagnostic to PM specialists. Thus, it can be incorporated into a telemedicine system.

Rede de apoio social ap��s o transplante renal: estudo qualitativo na perspectiva dos pacientes, profissionais e gestores

Objetivo: Descrever as perspectivas de receptores de transplante renal, profissionais da saǧde e gestores sobre a rede de apoio social. MǸtodo: Estudo qualitativo realizado com transplantados renais, profissionais e gestores. Os dados coletados foram entrevistas individuais gravadas em ǭudio a partir de dois instrumentos que compuseram perguntas por meio das escalas Assessment for Chronic Illness Care (ACIC) e Patient Assessment of Chronic Illness Care (PACIC), adaptadas para a cultura brasileira. Resultados: Os dados revelaram a participa��ǜo das entidades nǜo-governamentais e dos profissionais de saǧde e o v��nculo que estabelecem com os receptores de transplante renal, sobretudo, com o profissional mǸdico, com a enfermagem, alǸm de outras categoriais profissionais. TambǸm, outros dados trazidos foi o parecer dos profissionais de saǧde sobre o v��nculo que estabelecem com a fam��lia da pessoa. Conclusǜo: O v��nculo estabelecido continua forte mesmo ap��s o transplante renal, o que demonstra o sucesso no estabelecimento de v��nculos emocionais pela equipe multiprofissional, incluindo a enfermagem.

Predictors and Assessment of Hospice Use for End-Stage Renal Disease Patients in Taiwan

Objectives: Hospice and early palliative care are generally considered as an alternative and supportive care to offer symptoms relief and optimize the quality of life among end-stage renal disease (ESRD) patients, but hospice care remains underutilized. This study aimed to examine patient and health system characteristics and develop a patient assessment scale to evaluate ESRD patients for hospice care after the implementation of non-cancer hospice care reimbursement policy in 2009 in Taiwan. Method: We conducted a retrospective cohort study using nationwide population-based datasets. Adult long-term dialysis patients between 2009 and 2012 were included. Multivariable logistic regression and the Firth penalized likelihood estimation were used to estimate the likelihood of receiving hospice care. A receiver operating characteristic curve (ROC) analysis and C-statistic were calculated to determine the optimal models for a patient assessment of hospice use. Results: Patients who were older, comorbid with anemia (odds ratio [OR] 3.53, 95% CI 1.43-8.70) or sepsis (OR 1.62, 95% CI 1.08–2.44), with longer dialysis durations, more hospitalizations (OR 4.68, 95% CI 2.56–8.55), or primary provider care with hospice (OR 5.15, 95% CI 2.80–9.45) were more likely to receive hospice care. The total score of the patient assessment scale of hospice care was 0–28 with a cut-off value of 19 based on the results of the receiver operating characteristic curve. Conclusion: Given the “Patient Right to Autonomy Act” implemented in Taiwan in 2019 to promote the concept of a “good quality of death”, this patient assessment scale may help health professionals target ESRD patients for hospice care and engage in shared decision making and the advance care planning process.

Considerations on out-of-hospital pain assessment of a diverse population

Nearly all medical emergency calls are related to someone experiencing some form of discomfort—either due to trauma or pain. Initial pain assessment may be undertaken over the telephone by an emergency medical dispatcher, without seeing the patient; however, the next key moment in pain assessment is completed patient-side by the paramedic. This inquiry is detailed and guides the paramedic in the formation of a differential diagnosis and provision of appropriate pain management. The research team recently conducted and published a study on pain assessment which raised concerns on the subjectivity of pain scoring. The work presented was in the context of a very multicultural environment. The aim of this commentary article is to further explore this topic and encourage health professionals to reflect on this aspect of patient assessment.

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.

Complications in Fracture Healing-A Review

Complications are a reality in healing fractures. Most can be stopped or reduced by being aware of their pathophysiology. Others, though, are inevitable, but their Early diagnosis and effective treatment can help recovery. Significant complications Are Osteomyelitis, delayed union, non-union, malunion, premature union, which were a result of fracture repair. Keeping these complications into consideration Presurgical patient assessment as well as postoperative treatment should be taken into account. The goal of fracture repair is to ascertain rigid fixation and perfect alignment of the bone to permit each timely and maximized come to perform in the affected space. The particular injury, species and breed conformation, age, general health, concomitant malady processes, nutrition, and medications all play a job in healing and, therefore, response to the repair. However, these factors don't seem to be the sole determinants of outcome. the strategy of repair and surgical technique each play a vital role within the outcome of fracture management. For this reason, it's vitally necessary that the practitioner be aware of potential complications of fracture repair and take steps to stop them. This review centers on how these complications can be prevented, understood and handled.