Quality in Clinical Consultations: A Cross-Sectional Study.
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ABSTRACT:
SUBMITTER: Graf A
PROVIDER: S-EPMC9326638 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these agents in this and other LMIC. A cross-sectional retrospective study was designed and 2,266 handwritten veterinary records from 2017 were sampled from 23 animal health premises (AHPs) to estimate individual and an overall proportion of consultations that resulted in an antibiotic prescription. The frequency of antibiotic prescription per species, type of AHP, and according to WHO's AWaRe index and OIE list of priority antimicrobials were also explored. It was estimated that 31% (95% confidence interval: 29-33%; intracluster correlation: 0.03) of the veterinary consultations resulted in an antibiotic prescription. The incidence of antibiotic prescription was highest in consultations of poultry across AHP. Across species, diarrhea and wounds were frequently treated with broad-spectrum antibiotics including sulfonamides, tetracyclines, trimethoprim + sulfa, and penicillin. Between 45% and 70% antibiotics prescribed correspond to AWaRe's access group and up to 25% to AWaRe's watch group. Over 70% of antibiotics dispensed in veterinary consultations for any species correspond to the OIE's veterinary critically important antimicrobial agents. Overall, the study demonstrated positive features of veterinary antimicrobial stewardship in Bhutan, given the conservative proportion of consultation that results in this type of prescription and the type of antibiotic prescribed. Although the veterinary service closely follows the Bhutanese Standard Treatment Guidelines, the prescription of antibiotics to key species should be closely monitored. Our study suggests that further improvements of antibiotic stewardship can be achieved through standardisation of antibiotic prescription to some species, a revision of the guidelines toward reducing the prescription of antibiotics of high relevance for human medicine, and by including details of clinical investigation, use of tests, and treatment outcomes in veterinary consultation records.
| S-EPMC8194083 | biostudies-literature
Project description:IntroductionAccess to contraceptive consultations and the content of these consultations are important to achieve a safe and satisfying sexual life and successful reproduction when desired. The aim of this study was to investigate Norwegian women's experiences of and opinions on contraceptive consultations.MethodsWe conducted a cross-sectional study with a questionnaire distributed via Facebook with 1917 respondents of age ≥15 years. Descriptive analyses were used.ResultsFew women found it hard to access consultations (5%). Across all age groups, side effects were the most common topic that women (69%) wanted more information about. Concern about side effects was also the most frequent reason given (27%) for not using hormonal contraceptives. Among women aged 25-34 years, 54% wanted to know more about different available contraceptives. The majority of women deemed issues of sexual wellbeing important to address during a contraceptive consultation. Few women reported that these topics had been raised. Just under half of the women found it appropriate to see a midwife for contraceptive/sexual health consultations. Only one-third knew that midwives can prescribe and administer long-acting reversible contraceptives (LARCs).ConclusionsWomen want contraceptive consultations to include more information on side effects and available hormonal contraceptives. Women want to be asked about their sexual health and wellbeing during contraceptive consultations. Women should be made aware that midwives can provide contraceptive services including LARCs.
| S-EPMC7839094 | biostudies-literature
Project description:ObjectiveTo analyse the spectrum, vaccination needs and pretravel advice complexity of travellers presenting at a travel medicine clinic in Santiago, Chile.DesignCross-sectional study.SettingPretravel consultations in a private healthcare centre in Chile, an 'emerging market' country in South America.ParticipantsTravellers (n=1341) seeking pretravel advice at the Travel Medicine Program of Clínica Alemana, Santiago, from April 2016 to March 2018.Primary and secondary outcome measuresDemographical and travel characteristics, indications for travel vaccines and malaria prophylaxis, and complexity of travel consultations.ResultsOf 1341 travellers, 51% were female; the median age was 33 years. Most frequent travel reasons were tourism (67%) and business (20%). Median travel duration and time to departure were 21 days and 28 days, respectively. Most destinations were located in America (41%), followed by Asia (36%) and Africa (26%); 96% visited less developed countries, mostly in tropical regions, with risk of arboviral infections (94%) and malaria (69%). The indicated vaccine indications comprised hepatitis A (84%), yellow fever (58%), typhoid fever (51%), rabies (29%), polio (8%), Japanese encephalitis (6%) and meningococcal meningitis (5%). More than 60% of consultations were classified as complex.ConclusionThe studied population mostly visited less developed tropical regions, resulting in a high requirement of yellow fever and other travel-related vaccinations. Most consultations were complex and required a comprehensive knowledge and training in travel medicine.
| S-EPMC7473631 | biostudies-literature
Project description:BackgroundTo mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic.ObjectiveThis study aimed to evaluate whether differences exist in physicians' attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic.MethodsThis survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician's attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians' sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians' characteristics with the perceived outcomes of the web-based consultation.ResultsCompared to audio consultations, video consultations were significantly associated with physicians' confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians' confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008).ConclusionsThese results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services.
| S-EPMC8171285 | biostudies-literature
Project description:Genetic and environmental risk factors contribute to periodontal disease, but the underlying susceptibility pathways are not fully understood. Epigenetic mechanisms are malleable regulators of gene function that can change in response to genetic and environmental stimuli, thereby providing a potential mechanism mediating risk effects in periodontitis. The aim of this study is to identify epigenetic changes across tissues that are associated with periodontal disease.
2018-11-25 | GSE121633 | GEO
Project description:Few data exist to support the observation that general practitioners (GPs) occupy many important positions in our communities or to characterize which GPs devote more of their time to such activities. We sought to characterize community-based complementary medical activities performed by GPs in the canton Vaud, Switzerland.All GPs in a region were invited to participate in a cross-sectional study (n?=?600) examining engagement in complementary activities beyond standard ambulatory consultations. Categories included teaching, care giving in specific structures, roles as medical experts or company doctors, community care giving, and others completed by the GP. GPs were asked the number of hours devoted monthly to each activity and whether or not they are remunerated for this work.One hundred and sixty-eight GPs responded (28%), with 149 (92%) reporting that they were engaged in at least one activity beyond their in-office consultations, including 117 (72%) in community care-giving (ex: care for addictions or refugees). Altogether, GPs spend on average 5.8 h a week on these activities. One-hundred and twenty-three GPs (82%) were remunerated for at least one of their complementary engagements. Predictors of participation in a larger number of complementary activities were working in a rural area (IRR 1.29, 95% CI 1.05 to 1.57) and having a higher weekly workload (IRR 1.01 for each additional hour, 95% CI 1.01 to 1.02).The vast majority of GPs engage in activities beyond their standard clinic tasks and they are typically reimbursed. GPs in rural areas and those who work more hours per week are more likely to engage in complementary activities.
| S-EPMC5934800 | biostudies-other
Project description:Low-grade, chronic inflammation during ageing (“inflammageing”) is suggested to be involved in the development of frailty in older age. However, studies on the association between frailty, using the frailty index definition, and inflammatory markers are limited. The aim of this study was to investigate the relationship between inflammatory markers and frailty index (FI) in older, home-dwelling adults. Home-dwelling men and women aged ≥ 70 years old, living in South-East Norway were recruited and included in a cross-sectional study. The FI used in the current study was developed according to Rockwood’s frailty index and included 38 variables, resulting in an FI score between 0 and 1 for each participant. Circulating inflammatory markers (IL-6, CRP, IGF-1, cystatin C, cathepsin S, and glycoprotein Acetyls) were analyzed from non-fasting blood samples using ELISA. Whole-genome PBMC transcriptomics was used to study the association between FI score and inflammation. The present study was a cross-sectional study that included home-dwelling men and women aged ≥ 70 years old, living in the Skedsmo area, South-East Norway. The study was conducted in 2014/2015 and has been described previously [Ottestad I, Ulven SM, Øyri LKL, Sandvei KS, Gjevestad GO, Bye A, et al. Reduced plasma concentration of branched-chain amino acids in sarcopenic older subjects: a cross-sectional study. Br J Nutr. 2018;120(4):445-53]. The participants were recruited by the National Register and received an invitation letter by mail. Briefly, a total of 2820 subjects were invited, and 437 subjects participated in the study. The participants met for a single study visit, and data was collected on dietary intake, body weight and composition, physical performance, medical history, cognitive function, risk of malnutrition, anthropometric measurements, blood pressure, heart rate, and quality of life. Non-fasting blood samples were also collected.
2023-09-01 | GSE236927 | GEO
Project description:We quantified gene expression in three different strains of the short-lived killifish Nothobranchius furzeri during aging.
2023-10-24 | GSE207748 | GEO
Project description:BACKGROUND:Seborrheic dermatitis (SD) is a common, chronic, inflammatory skin disorder, yet few studies have reported its clinical characteristics, or addressed its effect on quality of life (QoL). This study assesses the clinical characteristics and QoL of SD patients in China. It also identifies the clinical, demographic and environmental factors that may influence QoL. METHODS:Three hundred twelve SD outpatients from 9 hospitals completed a survey. QoL was measured with the dermatology-specific instrument Skindex-29. We collected social demographic characteristics and disease severity, and conducted logistic regression to determine the factors associated with QoL impairment. RESULTS:67.3% of the patients were females. The mean Skindex-29 overall score was 33.97 (SD?=?20.55). The breakdown was 40.79 (SD?=?24.24) for emotions, 32.83 (SD?=?19.84) for symptoms and 28.3 (SD?=?23.24) for functioning. 48.1% had severe emotional problems. Logistic regression analysis showed that BMI less than 25 (OR?=?0.223; 95% CI: 0.072-0.692; P?=?0.009), skin disease-related hospitalization (OR?=?6.882; 95% CI:1.767-26.795; P?=?0.005), environmental PM 10 levels above 120??g/m3 (OR?=?3.386; 95% CI: 1.253-9.15; P?=?0.016) and severe disease conditions (OR?=?4.438; 95% CI:1.26-15.626; P?=?0.02) were risk factors for severe emotional impairment. Moreover, skin disease-related hospitalization (OR?=?6.057; 95% CI:1.351-27.149; P?=?0.019), environmental PM 10 levels between 70 and 120??g/m3 (OR?=?6.317; 94% CI: 1.704-23.42; P?=?0.006), moderate (OR?=?2.388; 95% CI: 1.272-4.487; P?=?0.007) and severe disease conditions (OR?=?5.732; 95% CI: 1.838-17.88; P?=?0.003) were each risk factors for overall severe impairment. CONCLUSION:In China, nearly half of SD patients had severely emotional problems. Disease severity, BMI, dermatologic hospitalization, and ambient PM 10 levels are each risk factors for QoL impairment in SD patients. These implications are alarming, and warrant public health attention in SD disease management.
| S-EPMC7493366 | biostudies-literature
Project description:BackgroundHealth-related quality of life (HRQoL) impairment is common in pulmonary hypertension (PH), but its clinical predictors are not well established. This study aims to characterize the HRQoL of patients with pulmonary arterial hypertension (PAH) and other precapillary forms of PH (pcPH) and to explore its clinical correlates.Materials and MethodsA cross-sectional, observational study of patients with documented PAH and other forms of pcPH. Patients completed two patient-reported outcome measures (PROM): Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) and Nottingham Health Profile (NHP). Clinical characteristics were retrieved from electronic medical records.ResultsMean CAMPHOR and NHP scores for the study population were indicative of a moderate HRQoL impairment. Patients in World Health Organisation Functional Classes (WHO FC) III/IV showed significantly worse HRQoL. The main clinical correlates of HRQoL were WHO FC, 6-minute walking distance (6MWD), and Borg dyspnoea index. Overall quality of life (QoL), assessed through CAMPHOR's QoL domain, showed patterns comparable to HRQoL measured by both instruments.ConclusionsHRQoL, measured by two different PROMs, is impaired in Portuguese patients with PAH and other forms of pcPH, particularly in patients with increased disease severity. WHO FC, 6MWD, and Borg dyspnoea index are highly correlated with HRQoL and QoL.
| S-EPMC5884279 | biostudies-literature