EVALUATION OF CLINICAL AWARENESS OF DIABETIC MELLITUS AMONG RAKMHSU MEDICAL STUDENTS- A QUESTIONNAIRE SURVEY

Introduction: The number of patients with diabetes are increasing in rapid phase and the present medical students will encounter with such patients in the future very often. It was essential to understand and update their knowledge through education and awareness programs. Materials and methods: The cross-sectional questionnaire survey has been conducted in RAK Medical and Health Sciences University (RAKMHSU) with due approval from research ethics committee. After going through various indexed articles related to our topic, a pre designed pre validated questionnaire was prepared. The questionnaire assessed the knowledge about symptoms, investigations, treatment and complications. This was applied after validation to second, third, fourth and fifth year medical students. Results: The study showed the majority in both groups 93.5% and 89.2% agreed that they will be involved in taking care of diabetic patients in their future practice. The study also found that 65.2% group A agreed that excessive thirst and urination is a indicative of low blood sugar when compared with 31.7% from group B. With regard to symptoms majority in both groups agreed itchy skin is not a symptom of DM. When asked about insulin misuse, only 36.8% and 55.4% students agreed that blood glucose will go below 50mg/dl. Discussion and conclusion: Our study correlated with various studies which showed many students had problems in treatment aspects. But we also had positive results which correlated with other study showing they have good knowledge about symptoms. We also found our students had good knowledge about diabetic ketoacidosis. In conclusion, there is a need for conducting regular workshops, seminars, conferences in medical colleges to upgrade the knowledge of students and make them a competent general physician. Key words: Diabetes, Keto acidosis, Education, Knowledge, Risk factors

The Antecedents of Psychological Empowerment and Its Impact towards General Physician Job Performance

BACKGROUND: The emergence of new infectious diseases such as SARS-CoV-2 (Coronavirus Disease 19) creates a burden to the healthcare system especially to the front liners such as medical doctors. The job performance of the general practitioners related to quality of care to SARS-CoV2 patients. AIM: ​​The purpose of this study is to analyze the antecedents of psychological empowerment towards job performance, mediated by service orientation. These antecedents could be seen in hospital perspectives and professional life. METHODS: This is a quantitative survey study using a cross-sectional approach. 185 samples purposively obtained from the general practitioners who work at SARS-CoV-2 Reference Private Hospital in Jakarta and surrounding area. Data collection using online questionnaires and analyzed by SmartPLS 3.3.3™ . RESULTS: There are nine hypotheses that are supported in this research. The strongest predictor of psychological empowerment is the training opportunities, followed by relationships with fellow doctors and autonomy at work. Psychological empowerment has been proven to have a direct impact on job performance, while service orientation has been found as a mediation in this relationship. CONCLUSION: Psychological empowerment has been proven as an important construct to predict job performance, therefore hospital management has to pay more attention to psychological empowerment for GPs during the pandemic. Training opportunities should be prioritized by the board of directors of the hospitals, they should allocate time and the resources to facilitate the training opportunity. KEYWORDS: Psychological empowerment, service orientation, job performance, general practitioner, SARS-CoV-2 referral private hospital.

116. Impact of an Antimicrobial Stewardship Program in the First Year of Pandemic 2020 in a Large,Academic, Public Network Hospitals in Bogotá,Colombia

Background Antimicrobial resistance is a major public health threat internationally but, particularly in Colombia. High and increasing rates of carbapenemases are challenging. Implementing antimicrobial stewardship programs (AMSs) in a large, academic, public network hospitals in Bogotá, Colombia.will help curb inappropriate antibiotic use. Adherence to AMS Program 2020. Subred Integrada de Servicios de Salud Sur Occidente E.S.E Bogotá, Colombia. Impact of an Antimicrobial Use Optimization Program in the First Year of Pandemic 2020 in a Large, Academic, Public Network Hospitals in Bogota Colombia Methods AMS was established in April 2020 consisting of an administrative champion, Infectious Diseases staff, nurse, General Physician, microbiologist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The AMS tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with AMS recommendations. Defined daily dose (DDD) of drugs and health economics evaluations of antimicrobials (April-December 2020). Recommendations are placed in the electronic medical record as a progress note. Results From April to December 2020, 1013 patients were evaluated by means of a prospective methodology. Unnecessary 689 days of hospitalization and 4420 days of antibiotic therapy were avoided. Among the top antibiotics discontinued were piperacillin tazobactam for the months of July, August, November and December, while for September and October was meropenem. The intensive care unit was the most frequently intervened service (52%), followed by hospitalization (43%) and the emergency department (5%).Over the course of the year, there was significant adherence to the program, with 100% in July, followed by 93.3% in April, 87% in December, 86.6% in May and June, 83% in November, 80% in September, 73.3% in August and 57% in October. The AMS program was able to save &47.409US in antibiotics and &55.529US in hospitalization, and 11% decrease in nephrotoxicity events (14 renal failures were avoided), which also saved additionally & 23.503 US for a total of an estimated cost saving for the network public hospitals of & 126.441 US by 2020. Conclusion Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, academic, public network hospitals in Bogotá, Colombia demonstrated feasibility and economic benefits even in a Covid19 pandemic situation. Disclosures All Authors: No reported disclosures

Children's feelings and attitude towards medical contacts

Introduction and purpose Medical procedures can be physically harmful and cause psychological trauma among young children, possibly resulting in certain lifelong aversion. The aim of the study was to evaluate children's feelings while undergoing minor medical procedures depending on age, gender and previous experience and to compare it with university students. Material and methods We conducted a survey among 382 primary school children, as well as 334 university students. Questions concerned the frame of mind at the moment of examination, during dentist and general physician appointment, vaccination, hospitalization and condition of sore throat. Results The experience of hospital stay resulted in better feelings about possible future hospitalization in both groups, and about dentist appointment in the group of children. Girls and women declared lower mood during general physician appointment. Interestingly, in the group of children boys felt worse at the moment of survey, while in the group of students women felt so. The current frame of mind correlated with an appraisal of all other situations among students, whereas only with physician appointment and vaccination among children. All of above were statistically significant. For both groups, the most unpleasant condition was sore throat. However, in regards to medical procedures exclusively, vaccination appeared to be the most traumatic for children and hospitalization for students. Conclusion Earlier experience and gender of children can affect their feelings about medical procedures. Presented analysis suggests that every medical should do their best to provide pleasant atmosphere for every child during medical contacts.

A real-world assessment of treatment patterns in patients with atherosclerotic cardiovascular disease with hypercholesterolemia: a retrospective database analysis in Germany

Background The European Society of Cardiology (ESC) guidelines suggest that greater absolute reduction in low-density lipoprotein cholesterol (LDL-C) leads to greater cardiovascular risk reduction. Several lipid-lowering treatments (LLTs) are available in Germany; however, the research on treatment patterns and LDL-C outcomes among patients (pts) receiving LLTs in real-world setting is limited. Purpose To characterize the pts characteristics, treatment patterns and LDL-C outcomes of pts with atherosclerotic cardiovascular disease (ASCVD) with hypercholesterolemia (ASCVD-H) in Germany. Methods This is a descriptive, non-interventional, retrospective cohort study of ASCVD-H pts identified from general physician (GP) practices available in the electronic medical record (EMR) database Disease Analyzer (January 1992-June 2020) in Germany. ASCVD-H pts were included if they had a recorded diagnosis, were prescribed LLTs or had LDL-C levels of ≥55 mg/dL anytime within 6 months before and 3 months after the index date (ID), as per the data recorded by the participating physician. The first encounter of ASCVD after hypercholesterolemia during the identification period (1/07/2015–30/06/2019) was considered as the ID. Persistence was measured as the duration (in days) with allowed gap of 60 days and adherence as proportion of days covered (PDC) within 12 and 24 months after ID. Results We included 147,905 pts with ASCVD-H (57.2% male; mean age: 70.6 yrs; ≥75 yrs-old: 43.3%; mean BMI: 29.0 kg/m2). Coronary artery disease was the most common index diagnosis (73.2%), followed by cerebrovascular disease (31.7%) and peripheral vascular disease (21.5%). Hypertension (83.5%) and diabetes (27.6%) were the most common comorbidities among these pts. At ID, statin monotherapy (58.6%) was the most commonly prescribed LLT, with simvastatin being the most common drug (36.4%). The use of PCSK9 inhibitors, ezetimibe and fibrates was very limited (<1%; Table 1). Of note, LDL-C measurements (6 months prior and 3 months post index) were available for 50.7% of pts. In pts with uncontrolled LDL-C (≥55 mg/dL), 47.9% were receiving statin monotherapy (28.6% were on simvastatin), whereas there was no LLT prescribed in 48.0% of pts. The mean (SD) persistence and adherence to statins monotherapy within 24 months follow-up was 522 (260) days and 0.721 (0.345), respectively, with 60% of pts being adherent (PDC ≥0.80) to statins monotherapy. Conclusions Pts with ASCVD-H in Germany treated by GPs are elderly pts with multiple cardiovascular comorbidities. LDL-C was measured in nearly half of the pts, and almost all had LDL-C ≥55 mg/dL at ID. Findings indicate low prescription of LLTs in GP setting, particularly non-statin LLTs. The mean adherence (PDC) to statin monotherapy was 72% within the 24-month after ID. Data suggest the need for newer therapies with potential to control LDL-C levels. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma AG, Basel, Switzerland.

Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. Methods This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.

Projecting the Shortages and Surpluses of General Practitioners in Iran

Introduction: Due to the necessity of careful planning in the human capital of health and the effect of imbalance of general physician supply on economy and health status, this study aimed to estimate general practitioners' (GPs) demand and predict general practitioners’ shortage and surplus in Iran. Method: This study was an analytical and applied study conducted at the national level for Iran in 2019 using ARIMA (5,1,1) method for projecting supply and Vector Error Correction (VEC) models for projecting demand with Gross Domestic Product (GDP), out-of-pocket, aging and hospital beds variables. Data were annual time series from 1991 to 2017, extracted from the statistical yearbooks issued by the Statistical Center of Iran and the World Bank database. The required models and tests were estimated by Eviews 10 software at a 0.05 significance level. Results: The general practitioners’ elasticity to GDP, aging, and out-of-pocket were 0.33, 1.77, and -0.81, respectively. GDP per capita (0.11), aging (0.14), and the number of hospital beds (0.0007) had a positive impact, and out-of-pocket payments (-0.0001) had a negative impact on demand for GPs in Iran. Also, from 2018 to 2030, the mean GPs demand (0.23) was higher than the mean supply (0.20), and there was a shortage of GPs in these years (0.03). Conclusion: Iran is facing a shortage of GPs by 2030. Therefore, there are suggested policies for increasing the admissions capacity at medical universities, maintaining and preventing the migration of physicians with appropriate incentives, establishing rules, and providing job satisfaction for physicians.

The red eye

The red eye is one of the most common cause encountered in ophthalmic practice but a red eye is not always related to eye diseases, instead, it may be a clinical sign of several systemic diseases which may the alarmin signal of sight-threatening or life-threatening condition. Frequently, GPs, pediatricians, immunologists, and rheumatologists are the first landing of patients with a “red eye.” This paper is addressed to non-ophthalmic specialists who may be faced with patients having a red eye. Inspection of the external eye under standard office lighting or with a bright light can be easily and accurately made by a general practitioner. Three major caveats should alert the GPs to promptly refer the patient to the ophthalmologist: the presence of pain; the loss of the natural corneal transparency and specular reflex; and any patient-described reduction of visual acuity. In most cases, a red eye is due to occasional and mild ocular surface reaction as consequence of exposure of the external eye to irritants and naturally occurring environmental agents. In these cases washing the eye with a tear lubricant may help in relief of symptoms. If this treatment fails within a few days, a consultation with an ophthalmologist is suggested. The role of the general physician is crucial in the decision making to judge the severity of the ocular condition. Managing a red eye often requires the support of other specialists. Our goal is not only to preserve vision but to globally cure the patient health.

Physiotherapists’ perspectives on barriers to implementation of direct access of physiotherapy services in the United Arab Emirates: A cross-sectional study

Background There are two primary ways of accessing physiotherapy for service users around the world. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. Despite these benefits, several countries including the UAE, do not allow direct access to physiotherapists. This study aims to understand the level of awareness among practicing physiotherapists in the United Arab Emirates (UAE) about direct access and to determine whether any of their demographic variables influence the way they perceive the concept. Further, the study sought to explore the perceived barriers and benefits of direct access according to the participating physiotherapists. Subjects and methods An observational cross-sectional study was employed. The questionnaire survey developed by Bury and Stokes in 2013 was adapted and employed in this study. The instrument had six sections with close-ended items using a Likert five-point scale to rate them. Two hundred and sixty-four physiotherapists answered the questionnaire shared with them through a web link. Finally, MANOVA was employed to explore any influence of demographic variables on the opinions of the respondents. Results The findings showed that 70% of participants were aware about direct access while nearly 30% were completely unaware. Younger physiotherapists were more willing to endorse the practice whereas older ones were more apprehensive of the barriers. The main barriers reported were the limited support from the physicians and policy makers, professional autonomy, and the limited scope of practice for the physiotherapists, as well as evidence-based practice. The impact of demographic variables on direct access indicated that physiotherapists under the age of 23 endorsed direct access more strongly than other age groups. Conclusion More efforts are needed to implement direct access in the UAE, considering the benefits of improved professional status, cost savings, patient satisfaction, and higher efficiency. This study recommends leadership support, professional autonomy, and mentorship as possible ways to achieve this goal.