Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study

Background Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. Methods A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

Lipid metabolism within the bone micro-environment is closely associated with bone metabolism in physiological and pathophysiological stages

Recent advances in society have resulted in the emergence of both hyperlipidemia and obesity as life-threatening conditions in people with implications for various types of diseases, such as cardiovascular diseases and cancer. This is further complicated by a global rise in the aging population, especially menopausal women, who mostly suffer from overweight and bone loss simultaneously. Interestingly, clinical observations in these women suggest that osteoarthritis may be linked to a higher body mass index (BMI), which has led many to believe that there may be some degree of bone dysfunction associated with conditions such as obesity. It is also common practice in many outpatient settings to encourage patients to control their BMI and lose weight in an attempt to mitigate mechanical stress and thus reduce bone pain and joint dysfunction. Together, studies show that bone is not only a mechanical organ but also a critical component of metabolism, and various endocrine functions, such as calcium metabolism. Numerous studies have demonstrated a relationship between metabolic dysfunction in bone and abnormal lipid metabolism. Previous studies have also regarded obesity as a metabolic disorder. However, the relationship between lipid metabolism and bone metabolism has not been fully elucidated. In this narrative review, the data describing the close relationship between bone and lipid metabolism was summarized and the impact on both the normal physiology and pathophysiology of these tissues was discussed at both the molecular and cellular levels.

Communication Vulnerability within Singapore’s Healthcare Environment

Communication difficulties can, and often do, create barriers between patients and healthcare workers (HCWs). We examined the perceptual differences between patients and caregivers; and HCWs with regards to their perceived communication vulnerabilities and identified communication needs in a tertiary hospital. A survey was conducted in selected outpatient settings among patients, their caregivers and HCWs, in a cross-sectional study. Respondents rated the reasons and frequency of encountering the communication difficulties during a hospital visit. Fifty-four percent of patients and caregivers cited poor hearing in the presence of noise, while HCWs cited patient’s poor vision (87%) as their primary communication barrier that requires improvement. Majority of HCWs (90%) had encountered patients who presented multiple communication barriers a quarter of the time. A third of HCWs felt that such encounters were especially challenging during communication, with very limited strategies available to deal with such communication vulnerable individuals. Patients, caregivers and HCWs universally experience communication challenges, even if their perceived barriers to communication happen to differ. Such perceptual difference between patients and HCWs may lead to inconsistent use of communication strategies by HCWs, potentially compromising patient’s healthcare needs. Nonetheless, the onus is on healthcare providers to bridge this communication gap to improve patient care.

Pathogen profile of urinary tract infections in Nephrology Unit

Introduction. Urinary tract infection (UTI) is one of the most common types of infection in both hospitalized and outpatient settings. The etiology is mostly bacterial, and the typical causative agent is uropathogenic Escherichia coli. There is a noticeable increase in drug resistance of pathogenic microorganisms. The aim of the study was retrospective analyses of etiological agents of UTI and their antibiotic resistance patterns in Nephrology Unit patients. Material and methods. An infection was diagnosed based on the patient’s symptoms and positive results of urine culture, carried out over 26 months. The clinical material was tested by using the VITEK system, the drug susceptibility of the emerged pathogens was identified. Results. The most common etiological agents of UTI were Gram-negative rods: Escherichia coli (51.23%), Klebsiella spp. (19.3%) and Proteus spp. (13.68%). The analysis of drug resistance profiles of these pathogens showed a high percentage of strains resistant to broad-spectrum penicillins and fluoroquinolones. At the same time, it seems that E. coli isolates presented the most favorable pattern of drug susceptibility in this comparison. Conclusions. The alarming tendency of increasing drug resistance among pathogens causing UTIs to antibiotics such as penicillins or fluoroquinolones prompts a careful choice of drugs in empirical therapies. The most appropriate practice in this regard seems to be meticulous control of nosocomial infections and making therapeutic decisions based on the knowledge of local microbiological data.

Study of the Stages of Cardiorehabilitation in Patients with Acute Coronary Syndrome

According to Russian clinical guidelines, there are three main stages of cardiorehabilitation associated with the periodization of the disease. Acute coronary syndrome is one of the most dangerous conditions in the world of modern cardiology, after which patients are at high risk of the appearance and development of chronic pathologies, in particular the development of type 2 diabetes mellitus. According to the latest data, there was a statistically significant increase in the number of new cases of diabetes mellitus after an episode of acute coronary syndrome. Doctors should provide high-quality assistance in the rehabilitation of patients after acute coronary syndrome, especially at the last stage of cardiorehabilitation, which is carried out in outpatient settings.

Enhancing Safety via Medication Self-Management and Timely Reporting

Medication errors have been a major threat to patient safety. Current research on medication errors is largely dependent on in-hospital reports. With the rapid shift of health care to chronic condition management, there is an urgent need to investigate medication errors in the community. In this paper, we discuss that the model of medication self-management developed for outpatient settings may be used to guide the development of prevention strategies for medication errors beyond hospitals. Further, timely reporting medication errors from patients in the communities may be helpful in mitigating the severity of side effects and reducing preventable safety events.

Respiratory Viruses Among Ethnic Nicobarese During COVID-19 Pandemic

Background: Acute respiratory infections (ARIs) and severe acute respiratory illness (SARI) are public health burdens globally. The percentage of non-SARS CoV-2 respiratory viruses among patients having ARI and SARI who visit Car Nicobar's hospital settings is undocumented. Changes in the epidemiology of other respiratory viruses during COVID19 pandemic is being reported worldwide.Methods: Inpatient and outpatient settings at BJR hospital, Car Nicobar Island, India, were used to conduct prospective monitoring for ARI and SARI among Nicobarese tribal members. The patients with ARI and SARI were enlisted in BJR hospital from June 2019 to May 2021. At the ICMR-NIV in Pune, duplex qRTPCR assays were used to test the presence of respiratory viruses. The prevalence of non- SARS CoV-2 respiratory viruses was measured by comparing here between pandemic and pre-pandemic periods.Results: During the COVID19 pandemic, Influenza A (H3N2) (55.7%), and rhinovirus (12.5%) were predominantly reported non-SARS CoV-2 respiratory viruses while Human metapneumovirus (48.1%) and influenza A (H1N1)pdm09 (18.5%) were most commonly reported in the prepandemic period. This result indicates the altered circulation of non-SARS CoV-2 during pandemic.Conclusions: A considerable proportion of respiratory infection was correlated with respiratory viruses. Prevalence of non-SARS CoV-2 respiratory viruses was high at the time of infection when compared with pre-pandemic period, at Car Nicobar Island. This study enlightened the change in circulation of other respiratory viruses among the indigenous Nicobarese tribes. Clinicians and allied medical staff should be more prudent of these respiratory infections.

Case Series: Superficial Sonography in Urgent Care

Sonography is an essential imaging modality, known for its real-time capabilities, relative low cost, and multiple diagnostic applications. Although there are protocols which are well-established for specific examinations, there are not clear guidelines for sonographic examinations of soft tissues. Many sonographers have to establish their own imaging protocols when completing a soft tissue examination. This case series details five soft tissue examinations that represent just a few of the clinical requests generated in an Urgent Care (UC) facility. Since UC usage has increased over the past several years, it appears likely that any sonographer working in such outpatient settings will benefit from as much exposure to soft tissue examinations as possible.

The Outpatient Prescribing Pattern of Olopatadine in Al Saih

Aim: This study was conducted to demonstrate the prescribing pattern of olopatadine eye drops in Al Saih. Methodology: This is a retrospective study includes evaluating outpatient prescribing of olopatadine eye drops from 1st of January 2018 to 30th of June 2018 in a public hospital in Alkharj. Results: More than half of the patients who used olopatadine eye drops were females (56.00%). The age of 28.00% of them was between 50 and 59 and the age of 26.67% of them was between 40 to 49 years. More than half of the patients received olopatadine eye drops for 1 month (54.67%). Most of the prescriptions were written by ophthalmology department (96.00%). Conclusion: Olopatadine eye drops prescribing was infrequent in Al Saih due to the availability of other alternatives. Further studies are needed to investigate the prescribing of olopatadine eye drops and its alternatives by the outpatient settings.

Some aspects of the treatment of patients with paracolostomy fistulas in outpatient settings

The analysis of the results of treatment of 15 patients with paracolostomy fistulas treated on an outpatient basis with the use of the sorbent "Celoform" was carried out. The use of modern drugs for the local treatment of wounds at all stages of complex treatment makes it possible to shorten the time of systemic antimicrobial therapy, avoid the development of side effects, and significantly reduce the cost of expensive antibacterial drugs. Key words: colostomy, paracolostomy fistula, sorbent "Coeloform, quality of life.