Patient- oriented approach to management of patients with hepatic cirrhosis

Aim of the study: Optimization of medical care to patients with liver cirrhosis (LC) based on using of patient- oriented approach in real clinic practiceMaterials and methods: The reviews of 734 medical histories of patients treated in polyclinics and in-patient facilities of general specialization (surgery, therapy) and died from HL in 2015–2019 years in Krasnodar region were analyzed. The experience of regular medical check-up of 85 patients with LC who underwent mini-invasive surgeries was summarized.Results: The number of mistakes in treatment tactics of patients with LC was revealed. The experience of regular medical check-up and schools for patients with LC was summarized.Conclusion: Regular medical check-up of patients with LC in multi- disciplinary clinic with practice in mini-invasive surgeries and liver transplantation, attendance of schools for patients improves stabilization and in some cases treatment course of disease.

User-Operated Audiometry Project (UAud) – Introducing an Automated User-Operated System for Audiometric Testing Into Everyday Clinic Practice

Hearing loss is the third leading cause of years lived with disability. It is estimated that 430 million people worldwide are affected, and the number of cases is expected to increase in the future. There is therefore increased pressure on hearing health systems around the world to improve efficiency and reduce costs to ensure increased access to quality hearing health care. Here, we describe the User-Operated Audiometry project, the goal of which is to introduce an automated system for user-operated audiometric testing into everyday clinic practice as a means to relieve part of this pressure. The alternative to the existing referral route is presented in which examination is executed via the user-operated system. This route is conceptualized as an interaction between the patient, the system, and the hearing care professional (HCP). Technological requirements of the system and challenges that are related to the interaction between patients, the user-operated system, and the HCPs within the specific medical setting are discussed. Lastly, a strategy for the development and implementation of user-operated audiometry is presented, which includes initial investigations, a validation study, and implementation in a real-life clinical situation.

The Versatile Roles of Cancer-Associated Fibroblasts in Colorectal Cancer and Therapeutic Implications

The tumor microenvironment (TME) is populated by abundant cancer-associated fibroblasts (CAFs) that radically influence the disease progression across many cancers, including the colorectal cancer (CRC). In theory, targeting CAFs holds great potential in optimizing CRC treatment. However, attempts to translate the therapeutic benefit of CAFs into clinic practice face many obstacles, largely due to our limited understanding of the heterogeneity in their origins, functions, and mechanisms. In recent years, accumulating evidence has uncovered some cellular precursors and molecular markers of CAFs and also revealed their versatility in impacting various hallmarks of CRC, together helping us to better define the population of CAFs and also paving the way toward their future therapeutic targeting for CRC treatment. In this review, we outline the emerging concept of CAFs in CRC, with an emphasis on their origins, biomarkers, prognostic significance, as well as their functional roles and underlying mechanisms in CRC biology. At last, we discuss the prospect of harnessing CAFs as promising therapeutic targets for the treatment of patients with CRC.

Nodular malignant melanoma in vulvar skin without pigmentation: a case report

Background Polypoid nodule growing without apparent pigmentation on the vulvar skin usually reminds us of the diagnostic pitfall, which is commonly and mistakenly diagnosed as other types of tumors. Although there are several manifestations of amelanotic melanoma are known, these malignancies are usually pigmented because they are derived from melanocytes containing melanin. However, amelanotic melanomas are easily misdiagnosed or their diagnoses were commonly delayed due to lack of pigmentation. Therefore, a solitary polypoid nodule is worth noting and further reporting. Particularly, the clinical characteristics and outcomes of the solitary polypoid nodule are rare in Asian patients. Case presentation We presented an interesting case of a 33-year-old female with a solitary polypoid nodule without apparent pigmentation on her vulvar skin. Her medical history was unclear, no ulcer was seen in the lesion area, and dermatoscopy was indicated a possible tumorous change, which has caught the attention of clinicians, and then further examined by the pathologist. The final diagnosis was nodular malignant melanoma (NM) (Breslow thickness 9.5mm, Clark level 4). Conclusions Hence, though reviewing this case record, the relevant literature and NM-related materials, we suggest that the combination of skin imaging technology and histopathological examination could provide us a better understanding and reduce the possibility of misdiagnosis in clinic practice.

Vexing visits: Variables correlating with physician perceptions of patients as “difficult” and overall enjoyment of their delivery of primary ambulatory care

All physicians experience some patients described as “difficult.” Their prevalence negatively impacts work satisfaction. Prior research identified factors present when physicians perceive patients as difficult. Numerous variables are unrelated to vexing patient visits. Three additive patient characteristics predict difficult encounters: 1) depressive or anxiety comorbidity, 2) polysymptomatic patients, and 3) high symptom severity. The sole physician variable was their score on the Physician Belief Scale (PBS) which quantifies negative attitudes towards psychosocial problems. When all three patient predictors exist, high PBS scorers judge twice as many patients as difficult. Five clinic milieu variables correlated weakly with clinic satisfaction among primary care residents. They are: 1) minimal role conflict, 2) autonomy, 3) collegiality, 4) encouragement of professional growth, and 5) work group loyalty. “Positive affect” was among the strongest physician variables but the author labeled it a confounding variable. Finally, a small “n” QI study conducted in this author’s residency explored the role of physician affectivity and identified additional physician characteristics and clinic milieu factors correlating with overall enjoyment of ambulatory clinic practice. Surprisingly, none of the five previously identified clinic milieu variables correlated directly with resident clinic satisfaction. “Supportive staff cohesion” was one milieu variable that correlated significantly with clinic satisfaction. Resident affective characteristics that significantly reduced clinic satisfaction were “hostility” and “negative affectivity.” “Joviality” was positively related to clinic satisfaction. While patient variables are uncontrollable, it is plausible that by physicians changing their beliefs and affectivity the percentage of vexing visits could be cut in half improving work satisfaction.

The Role of Clinical Instructor in Nursing Clinic Practice

The rapid development of technology in the field work does not only require that college graduates have extensive knowledge, but also have professional skills that are ready to be used in the job field. The achievement of student skills in clinical practice cannot be separated from the role of clinical instructor. Clinical instructors have a responsibility to ensure students learn and gain clinical skills experience. The nurses who are appointed as clinical instructor have a dual role. They are not only as clinical instructor, but also carrying out roles as team leaders, room manager and implementing nurses. This can have an impact on the implementation of the role as clinical instructor. This research aims to determine the role of clinical instructor at St. Elizabeth Hospital Semarang. This type of research is qualitative research. The main informants in this study are clinical instructor, while the triangulation informants are students who carry out clinical practice at St. Elisabeth Hospital Semarang. Informants were taken by using purposive sampling technique. Data collection was carried out by in-depth interviews. The research resulted in 2 themes, the role as an educator and as a motivator.

A Real-World Single-Centre Study of Patients with Diabetic Macular Oedema Who Wore a Home-Use Sleep Mask (Noctura 400) for One Year

A “Real-World” single-centre observational study was carried out to analyse the effects of enhanced patient interaction with the use of the Noctura 400 sleep mask on a group of 26 diabetics displaying diabetic retinopathy (DR) and diabetic macular oedema (DMO), of which 24 completed the study. We hoped to find if patient compliance could be maintained and to determine the anatomical and functional consequences of consistent mask wear. While this study was ongoing, COVID-19 impacted on normal eye clinic practice, allowing an unexpected analysis of the effects of this disruption to the clinical system on mask wear and disease progress. Throughout the whole study, outcomes were positive, with a high level of consistent patient use of the mask, above 74% up to and beyond 1 year. Even during the COVID-19 1st lockdown in England, the patients maintained a 65% nightly light mask compliance. Statistically significant improvements in maculopathy, including cyst reduction (56.4% of eyes with cysts exhibited cyst shrinkage), and visual acuity (VA) improvement (42/48 eyes gained 5 letters or more) were observed and maintained to the end of the study. Anatomical improvement or stability was recorded in all but one study eye. This investigation shows that given that there is appropriate interaction with patients who are self-treating in home environment, a high level of patient compliance can be maintained, even while there are disruptions to the normal hospital clinic setup.

Pilot project: easy read psychiatry clinic appointment outcome letters

AimsTo improve communication with patients and carers by sharing information in an easily comprehensible manner.BackgroundAccording to the department of health guidelines, there is legal requirement to provide copies all clinical correspondence to the patients. Therefore, after any clinic review, letters summarizing the consultation are sent out to GP and patients are copied in. However, these are not very meaningful for patients with special needs, as they struggle to comprehend information. Previous studies have shown that patients with learning disability would prefer letters in a simple language and would also like to participate in the decision making process. According to Accessible Information Standard, we have a legal obligation to deliver information to our service users in an easily understandable manner. We undertook a quality improvement pilot project of easy read templates to improve the understanding of patients and their carers/families.MethodA standard easy read template was co-produced after collecting feedback from different service users and clinicians. Pictures were incorporated into the questionnaire to facilitate understanding. We collected reviews over a period of 2 months from Nov 2019- Dec 2019. This proforma did not replace the routine clinic letter send out to the GP and the patients. This easy read template began with the introduction of the doctor (with photograph) and it encompassed mental health, physical health, current medication (and the benefits and side effects if any) and changes of medication. It also included epilepsy and the risks (risks to self and to others), vulnerability, behaviours of concern and the day-to-day activities that a service user engages in and finally about the plan formulated at the end of the consultation. At the same time, there was a separate form (with self-explanatory pictures), which collected feedback about the above mentioned appointment outcome review form.ResultTemplates were handed out to 65 patients and carers, and 60 completed the form. All patients found the template useful and helpful, mainly because it was easily comprehensible, with pictures, and also “provided instant updates”.ConclusionThis easy read template improves patients’ understanding and participation in the clinic review. This contributes to greater patient satisfaction. As Specialist Learning Disability services, we need to ensure that information is imparted to the patients and the carers in an easily understandable manner and this easy read template should be incorporated in the routine clinic practice.