Speed but Not Smoothness of Gait Reacts to Rehabilitation in Multiple Sclerosis

Introduction. Improved gait is one of the leading therapy goals in multiple sclerosis. A plethora of clinical timed trials and state-of-the-art technology-based approaches are available to assess gait performance. Objectives. To examine what aspects of gait react to inpatient rehabilitation in MS and which parameters should be best assessed. Design. In this longitudinal study, we examined the performance of 76 patients with MS to shed further light on factors influencing gait, associations between tests, and the reaction to inpatient rehabilitation during an average time span of 16 d. Setting. Private specialist clinic for inpatient neurorehabilitation. Main Outcome Measures. Clinical walk tests (timed 25-foot walk test at normal pace, maximum pace over 10 m or 6 min) and IMU-based measures of movement smoothness. Results. All gait parameters were strongly intercorrelated (all p < 0.05 ), and a model multiple linear regression for the 6MWT revealed short distance velocity (10 m) and movement smoothness as predictors in a strong model ( R 2 adjusted 0.75, p < 0.01 ). A second model with natural pace on short distance and movement smoothness was almost equally strong ( R 2 adjusted 0.71, p < 0.01 ). Patients improved their walking speed ( p < 0.01 ), but not smoothness ( p = 0.08 – 0.12 ), over the course of rehabilitation. Conclusions. Since we were not able to observe improvements in smoothness of gait, we conclude that rehabilitation programs should be adapted to the patient’s physiological capacities in order to allow for such improvements in smoothness of gait. Externally valid gait capacity (6MWT) could be predicted by a single walk for 10 s at natural pace.

Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: new MBS-telehealth-item and face-to-face psychiatrist office-based services from April–September 2020

Objective: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of telehealth, and face-to-face consultations for April–September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. Method: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April–September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. Results: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April–September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria’s increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April–September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April–September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. Conclusions: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.

Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020

Objective: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July–September), 2020. We compare these to the same quarter in 2019. Method: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July–September), 2019, of face-to-face consultations for the whole of Australia. Results: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15–30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. Conclusions: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.

Granulomatosis with polyangiitis - An oral medicine case book

A 33-year-old female patient presented at a private specialist practice (Periodontics and Oral Medicine) with a main complaint of sore and bleeding gums, fever, headaches and sinus pain. The gingiva became irritated, red and swollen five weeks prior to the first consultation in July 2018. She was referred by her dentist one month after prescribing two consecutive courses of antibiotics and providing oral hygiene instructions to the patient, with no significant improvement. The first prescription was for Augmentin 375mg t.d.s. for 5 days and the second prescription two weeks later was for Amoxycillin 250 mg t.d.s. and Metronidazole 200mg t.d.s. for 5 days. The patient was also using a chlorhexidine mouth rinse.

Correlation of Ultrasonographic Estimation of Fetal Weight with Actual Birth Weight as Seen in a Private Specialist Hospital in South East Nigeria

Background. Ultrasound estimation of fetal weight at term provides vital information for the skilled birth attendants to make decisions on the possible best route of delivery of the fetus. This is more pertinent in a setting where women book late for antenatal care. Aim and Objectives. The study evaluated the accuracy of estimation of fetal weight with ultrasound machine at term. Methods. This was a cross sectional study conducted at a private specialist hospital in Nigeria. A coded questionnaire was used to retrieve relevant information which included the last menstrual period, gestational age, parity, and birth weight. Other information obtained includes Ultrasound-delivery interval, maternal weight, and route of delivery. The ultrasound was used to estimate the fetal weight. The actual birth weight was determined using a digital baby weighing scale. The data were inputted into Microsoft excel and analyzed using STATA version 14. Statistical significance was considered at p-values less than 0.05. Measures of accuracy evaluated in the statistical analysis included mean error, mean absolute error, mean percentage error, and mean absolute percentage error. Pearson correlation was done between the estimated ultrasound fetal weight and the actual birth weight. The proportion of estimates within ±10% of actual birth weight was also determined. Result.A total of 170 pregnant women participated in the study. The mean maternal age was 30.77 years ± 5.54. The mean birth weight was 3.47 kg ± 0.47, while the mean estimated ultrasound weight was 3.43 kg ± 0.8. There was positive correlation between the ultrasound estimated weight and the actual birth weight. The mean ultrasound scan to delivery interval was 0.8 days (with range of 0–2 days). The study recorded a mean error of estimation of 41.17 grams and mean absolute error of 258.22 grams. The mean percentage error was 0.65%, while the mean absolute error of estimation was 7.56%. About 72.54% of the estimated weights were within 10% of the actual birth weight. Conclusion. The ultrasound estimated fetal weight correlated with the actual birth weight. Ultrasound estimation of fetal weight should be done when indicated to aid the clinician in making decisions concerning routes of delivery.

Competitiveness of private specialist medical entities in the opinion of service recipients

Introduction. The phenomenon of competitiveness and pressure of competitors that influence private medical institutions lead to the quest for new solutions on managing and defining determinants, which will provide advance of the institution over competing entities Aim. The purpose of the study was to determine factors influencing competitiveness of a medical institution according to the beneficiaries. Material and methods. The study group comprised 127 patients who used the services of private specialised medical institutions. Results and conclusions. The phenomenon of competitiveness in chosen types of medical services was noticed by 69% (88) of beneficiaries. High quality of services 79% (100), short waiting time for appointments 70% (89) and competitive prices 55% (70) are the main determinants of the competitiveness of those institutions.