Journal articles on the topic 'Physician and patient Victoria'
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1
Rauw, Jennifer Marie, Sunil Parimi, Helen Anderson, Pamela Hinada, Bethina Abrahams, and Katie Hennessy. "Improving management of hypersensitivity reactions: A BC Cancer-Victoria quality improvement initiative." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 230. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.230.
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230 Background: Hypersensitivity reactions (HSR) are a documented, predictable side effect of multiple chemotherapy agents. Reactions negatively affect the patient experience, increase the amount of chair time, nursing and physician resources, may result in the omission of a potentially effective cancer management tool from a patient’s treatment plan and could potentially result in death. BC Cancer is a Health Care Organization with 6 cancer centres across British Columbia, Canada. Guideline(GL)s have been developed at BC Cancer to support clinicians to manage reactions acutely and reduce the risk of reactions with subsequent cycles. A recent audit identified that the GLs were not always being followed at the Victoria Centre. Our goal was to encourage physician and nursing staff to follow GLs, which we hypothesized would result in decreased rates of HSR. Methods: Our aim was to decrease HSR to < 5% of doses delivered within 1 year at BC Cancer-Victoria. We engaged stakeholders (nursing, physicians, pharmacy, clerical staff and administration). Our change ideas improved adherence to GLs by focusing on: physician attendance and documentation, written orders for rescue medication, and rate of infusion of the chemotherapy drug rechallenge. Our interventions included: two physician-education sessions, one nursing education session, daily huddles, pre-printed order development for management of the reaction (PPOA) and prophylaxis for subsequent cycles (PPOB), and a modified clinic flow. All interventions were introduced and underwent modifications through PDSA cycles. Our family of measures were: Outcome: number of reactions, percent of reactions per dose given. Process: percent of PPO use per reaction, physician attendance and notes dictated per reaction. Balancing: physician and nursing satisfaction. We analyzed the data using quality improvement run charts and control charts. Results: After the start of our initiative, our total number of reactions displayed special cause variation, and a shift in the baseline from a mean of 11.27 HSR per month to 7.526. This change was reflected in the percentage of reactions per doses given which fell from 3.1% to 1.9%. Average percentage of dictated notes per reaction increased from 55% to 64%. Physician attendance per reaction also showed special cause variation with the average increasing from 57% to 90%. PPOA and PPOB use both increased over time. Nursing and Physician satisfaction data will also be presented. Conclusions: Our successful initiative has resulted in HSR management which more closely reflects GLs, including increased physician attendance and notes, and clear consistent written orders detailed on PPO A and B. This has led to decreased HSRs at our site, resulting in decreased resource use and increased patient safety and quality. This has provincial implications as there is the potential to spread this initiative to other BC Cancer sites.
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Urquhart, Christine, and Alexander H. Urquhart. "Commentary on Abrahamson and Rubin (2012) “Discourse structure differences in lay and professional health communication”, Journal of Documentation, Vol. 68 No. 6, pp. 826-851." Journal of Documentation 71, no. 2 (March 9, 2015): 216–23. http://dx.doi.org/10.1108/jd-02-2014-0036.
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Purpose – The purpose of this paper is to criticise the paper by Jennie A. Abrahamson and Victoria L. Rubin (2012) “Discourse structure differences in lay and professional health communication”, Journal of Documentation, Vol. 68 No. 6, pp. 826-851. Design/methodology/approach – The author reviewed the antecedents of Rhetorical Structure Theory (RST) in discourse analysis, and paid close attention to the differences between the original formulation of RST, later formulations of the RST model and the application of RST in this paper. The author also reviewed the literature on physician-patient communication, and patient-patient support to contextualise the findings of Abrahamson and Rubin. Findings – The paper shows evidence of over-simplification of RST since its initial formulation. Next, the Motivation relationship in the original Mann/Thompson formulation of RST appears problematic. This makes the authors’ RST findings that patient-patient (or consumer-consumer) information sharing appear to be more effective than physician-consumer information sharing rather tenuous. An important additional flaw is that there was only one physician participant in this study. A practical limitation to the study is that physicians mostly interact face-to-face with patients and use of consumer advice web sites may not fit well with the current practice of medicine. Research limitations/implications – The author had limited examples in the paper to examine how the authors had categorised the binary unit relationships. Originality/value – RST is promising for discourse analysis of information advice web sites but simplifications in its application can lead to unwarranted claims.
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Bibi, Rabia, Mishal Liaqat, Kalsoom Bibi, Iram Liaqat, and Yasmeen Akhtar. "Rare Periampullary Carcinoma: A Case Report." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 26, 2022): 210–11. http://dx.doi.org/10.53350/pjmhs22165210.
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Periampullary carcinoma is usually used to define a heterogeneous group of neoplasms raised on the head of the pancreas, duodenum, and distal common bile duct. Most of the periampullary growths are adenocarcinomas. Timely diagnosis and successful surgical treatment are dependent on the first physician. A 60 years old male patient was presented to medical outpatients of Bahawal Victoria Hospital Bahawalpur in October 2019 with a rare etiology of unexpected vomiting, nausea, fatigue, weight loss, and abdominal cramps for 12 days continuously. Abdominal ultrasound revealed a hypo-echoic mass with a measurement of 2.6x2.7cm on the head of the pancreasobstructingthe distal common bile duct with mild intrahepatic cholestasis. Based on physical examination signs& symptoms and lab investigations patient was considered of having periampullary cancer and a prompt Whipple plan was prepared. The vigilance of the physician and support of the patient’s family helped to make an early decision of pancreatoduodenectomy of the patient before the multi nodulation of the tumor hence, increased the life expectancy. Keywords: Periampullary, Whipple Plan, Pancreatoduodenectomy, Pancreatic Cancer.
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Samaroo, Bethan. "Assessing Palliative Care Educational Needs of Physicians and Nurses: Results of a Survey." Journal of Palliative Care 12, no. 2 (June 1996): 20–22. http://dx.doi.org/10.1177/082585979601200205.
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The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians’ and nurses’ perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.
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Campbell, Helen, Magee Miller, Janet Stretch, and Rivian Weinerman. "A Quality Improvement Initiative for Depression: Finally, a Model for use in “Real” Family Physician Time." Canadian Journal of Community Mental Health 27, no. 2 (September 1, 2008): 191–99. http://dx.doi.org/10.7870/cjcmh-2008-0028.
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Many patients with mental illness depend on family physicians (FPs) for their physical and mental health care, yet FPs often report dissatisfaction with the quality of mental health care they provide. A 2-year, quality improvement (QI) manual-based initiative was developed to increase FPs' diagnostic, cognitive-behavioural, and interpersonal treatment skills for depression. Two teams, each consisting of a psychiatrist and a mental health therapist, rotated through 18 family practices in Victoria, British Columbia, mentoring the model on-site with physicians and patients. Feedback suggests that this initiative enhanced the ability of FPs to diagnose depression and comorbid disorders, organize problems, and treat depression using non-pharmaceutical approaches.
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Knock, Marion, David Newsome, and Barbara Poole. "The Medical Information Highway: Where is the Access Ramp?" Healthcare Management Forum 8, no. 3 (October 1995): 57–61. http://dx.doi.org/10.1016/s0840-4704(10)60920-9.
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In this article, an analogy is drawn between a health care information system and a freeway transportation system. Unfinished access ramps and disconnected road sections are likened to unlinked computer information systems. It is not until there is “connectivity” between roadways that vehicles can take advantage of the efficiencies of a freeway system or until there are comrehensive, integrated information systems that quality health care can be provided. The Greater Victoria Hospital Society used quality improvement techniques to improve the medical information highway, and theories of change management to encourage physician leaders to “buy into” the information system to produce needed change in the organization and in patient care.
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Silvers, A., A. Licina, and L. Jolevska. "A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria." Anaesthesia and Intensive Care 46, no. 4 (July 2018): 404–13. http://dx.doi.org/10.1177/0310057x1804600410.
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There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.
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Dukelow, A., K. Van Aarsen, C. MacDonald, and V. Dagnone. "P036: Interim analysis of the impact of the emergency department transformation system on flow metrics." CJEM 20, S1 (May 2018): S69. http://dx.doi.org/10.1017/cem.2018.234.
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Introduction: Emergency Department Systems Transformation (EDST) is a bundle of Toyota Production System based interventions implemented in two Canadian tertiary care Emergency Departments (ED) between June 2014 to July 2016. The goals were to improve patient care by increasing value and reducing waste. Longer times to physician initial assessment (PIA), ED length of stays (LOS) and times to inpatient beds are associated with increased patient morbidity and potentially mortality. Some of the 17 primary interventions included computerized physician order entry optimization, staff schedule realignment, physician scorecards and a novel initial assessment process ED access block has limited full implementation of EDST. An interim analysis was conducted to assess impact of interventions implemented to date on flow metrics. Methods: Daily ED visit volumes, boarding at 7am, time to PIA and LOS for non-admitted patients were collected from April 2014 -June 2016. Volume and boarding were compared from first to last quarter using an independent samples median test. Linear regression for each variable versus time was conducted to determine unadjusted relationships. PIA, LOS for non-admitted low acuity (Canadian Triage and Acuity Scale (CTAS) 4,5) and non-admitted high acuity (CTAS 1,2,3) patients were subsequently adjusted for volume and/or boarding to control for these variables using a non-parametric correlation. Results: Overall, median ED boarding decreased at University Hospital (UH) (14.0 vs 6.0, p<0.01) and increased at Victoria Hospital (VH) (17.0 vs 21.0, p<0.01) from first to last quarter. Median ED volume increased significantly at UH from first to last quarter (129.0 vs 142.0, p<0.01) but remained essentially unchanged at VH. 90th percentile LOS for non-admitted low acuity patients significantly decreased at UH (adjusted rs=-0.24, p<0.01) but did not significantly change at VH. For high acuity patients 90th percentile LOS significantly decreased at both hospitals (UH: adjusted rs=-0.23, p<0.01; VH: adjusted rs=-0.21, p<0.01). 90th percentile time to PIA improved slightly but significantly in both EDs (UH: adjusted rs=-0.10, p<0.01; VH: adjusted rs=-0.18, p<0.01). Conclusion: Persistent ED boarding impacted the ability to fully implement the EDST model of care. Partial EDST implementation has resulted in improvement in PIA at both LHSC EDs. At UH where ED boarding decreased, LOS metrics improved significantly even after controlling for boarding.
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Vedsted, Peter, David Weller, Alina Zalounina Falborg, Henry Jensen, Jatinderpal Kalsi, David Brewster, Yulan Lin, et al. "Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data." BMJ Open 12, no. 12 (December 2022): e059669. http://dx.doi.org/10.1136/bmjopen-2021-059669.
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ObjectivesA growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.SettingPrimary care in 10 jurisdictions.ParticipantData were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.Primary and secondary outcome measuresPatient, primary care, diagnostic and treatment intervals.ResultsOverall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3–29 (Denmark and Sweden), 0–20 (seven jurisdictions and Ontario) and 8–29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15–39 (Norway, Victoria and Manitoba) and 4–78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).ConclusionsLarge international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.
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Freed, Gary L., and Amy R. Allen. "Outpatient consultant physician service usage in Australia by specialty and state and territory." Australian Health Review 43, no. 2 (2019): 200. http://dx.doi.org/10.1071/ah17125.
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Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.
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Davis, William B. "Music Therapy in Victorian England." Journal of British Music Therapy 2, no. 1 (June 1988): 10–16. http://dx.doi.org/10.1177/135945758800200103.
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The purpose of this article was to trace the growth and development of the Guild of St. Cecilia. This late nineteenth century organisation was founded by Frederick Kill Harford in London to provide music therapy to hospitalised patients. All information was derived from letters written by Harford and editorials that appeared in British medical and music periodicals. Initially, the Guild enjoyed great success and was endorsed by important people such as Florence Nightingale and Sir Richard Quain, physician to Queen Victoria. The Rev. Harford was astute in his observations that the effects of music must be tested to find the most beneficial ways for it to be used as therapy. He envisaged an association that would provide live and transmitted music via telephone to London's hospitals. Ultimately, due to the lack of support from the press, limited financial resources and Harford's ill health the organisation failed to prosper. Despite this, the Guild of St. Cecilia remains important because it kept alive the idea that music could be used therapeutically to benefit physically and mentally ill people.
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Poss, C., C. Fernandes, M. Columbus, and K. Wood. "LO029: Undetected serious medical illness in mental health patients seen in an academic emergency department." CJEM 18, S1 (May 2016): S39—S40. http://dx.doi.org/10.1017/cem.2016.66.
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Introduction: Mental health concerns make up 5-10% of all adult presentations to Canadian emergency departments (ED). One challenge for the emergency physician (EP) is determining if a patient with a mental health concern has concomitant underlying medical illness. We defined “serious medical illness” (SMI) as a pathological condition that requires inpatient treatment on a medical or surgical ward. SMI undetected by emergency physicians in patients presenting with mental health concerns may result in adverse patient outcomes. The aim of this study was to determine the prevalence, timing, and etiology of undetected SMI in the ED among adult patients presenting with mental health concerns. Methods: A retrospective chart review was performed on all patients age 18 and older who presented to the ED at Victoria Hospital, London Health Sciences Centre between October 1, 2014 and April 30, 2015, who were subsequently referred to psychiatry by the EP. The primary outcome was the number of patients transferred to a medicine or surgery inpatient unit for treatment of their SMI within seven days of psychiatry admission from the ED. Results: 1,255 patients were referred to psychiatry during the study period. 803 patients were admitted and 452 were discharged. Of the admitted patients, 14/803 patients (1.7%) met our primary outcome. The mean age of patients in the SMI group (n=14) was 64 years. The mean age in the non-SMI group (n=1,241) was 38. In the SMI group, 3/14 patients died, 2/14 patients required an ICU admission, and 2/14 patients underwent a surgery for their missed SMI. The average length of psychiatry admission prior to transfer was 3.7 days. The average length of medical/surgical admission after transfer from psychiatry was 8.3 days. Undetected diagnoses included NSTEMI, serotonin syndrome, lithium toxicity, thoracic aortic aneurysm, gastrointestinal stromal tumour, forearm abscess, Parkinsonian crisis, and others. Conclusion: This chart review demonstrated a 1.7% rate of undetected serious medical illness in patients who presented to the ED with mental health concerns. Adverse outcomes included death, ICU admissions, and surgeries. This rate is similar to other studies on the topic. The SMI group tended to be older than the non-SMI group. This research may have implications on the appropriate workup and disposition of elderly patients presenting to the ED with mental health concerns.
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Draper, Brian. "Melancholia in late life in New South Wales and Victoria, Australia, 1871–1905: symptoms, behaviours and outcomes." History of Psychiatry 33, no. 4 (November 19, 2022): 467–74. http://dx.doi.org/10.1177/0957154x221117000.
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In the late nineteenth century, the prognosis of late-life melancholia was believed to be poor. The medical casebooks of 40 patients aged 60+years, admitted to two Hospitals for the Insane in New South Wales with melancholia between 1871 and 1905, were examined. Psychosis (87.5%), depressed mood (80%), suicidal behaviour (55%), physical ill health (55%), restlessness (50%) and fears of harm to self (50%) were identified. Main outcomes were discharge (40%) and death (37.5%). Victoria’s Kew Hospital patient register for 1872–88 revealed 669 melancholia admissions with 30 aged 60+. Outcomes worsened significantly with age (chi square = 16.19, df = 4, p < 0.005), mainly due to higher mortality. Nineteenth-century late-life melancholia was a severe disorder despite many cases recovering.
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Cheung, P., I. Schweitzer, V. Tuckwell, and K. C. Crowley. "A Prospective Study of Aggression among Psychiatric Patients in Rehabilitation Wards." Australian & New Zealand Journal of Psychiatry 30, no. 2 (April 1996): 257–62. http://dx.doi.org/10.3109/00048679609076103.
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Objective: The aim of the study was to determine, among patients in rehabilitation wards, the prevalence and nature of aggressive behaviour and the relationship between aggressive behaviour and patient characteristics and ward factors. Method: The aggressive behaviour of all 220 inpatients within the rehabilitation program of a large psychiatric hospital in Victoria was assessed using the Staff Observation Aggression Scale. Results: Physical assaults occurred at a rate of 97.6 per 100 patients per year. About 40% of all incidents appeared to be unprovoked. Most physical incidents involved use of body parts and use of a weapon was uncommon. Aggression was most often directed at a staff member. Serious injury was rare. Aggressive behaviour was correlated with gender and duration of admission for the whole sample; however, there were different correlates of aggressive behaviour for different ward populations and different types of aggression. As for ward variables, time of day but not patient/staffing level was associated with aggressive behaviour. Conclusions: There was a high rate of aggressive behaviour among patients in rehabilitation wards; this should be taken into consideration in the planning of their community placement. The findings also caution against aggregating different ward populations and types of aggressive behaviour for research.
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Votova, K., M. Bibok, R. Balshaw, M. Penn, M. L. Lesperance, M. Nealis, B. Farrell, and A. Penn. "LO87: Use of a clinical prediction rule would lead to more effective CTA utilization for urgent brain imaging of suspected TIA/mild stroke in the emergency department." CJEM 19, S1 (May 2017): S58. http://dx.doi.org/10.1017/cem.2017.149.
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Introduction: Canadian stroke best practice guidelines recommend patients suspected of Acute Cerebrovascular Syndrome (ACVS) receive urgent brain imaging, preferably CTA. Yet, high requisition rates for non-ACVS patients overburdens limited radiological resources. We hypothesize that our clinical prediction rule (CPR) previously developed for diagnosis of ACVS in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization. Methods: Our data consists of records for 1978 ED-referred patients to our TIA clinic in Victoria, BC from 2015-2016. Clinic referral forms captured all data needed for the CPR. For patients who received CTA, orders were placed in the ED or at the TIA clinic upon arrival. We use McNemar’s test to compare the sensitivity (sens) and specificity (spec) of our CPR vs. the baseline CTA orders for identifying ACVS. Results: Our sample (49.5% male, 60.6% ACVS) has a mean age of 70.9±13.6 yrs. Clinicians ordered 1190 CTAs (baseline) for these patients (60%). Where CTA was ordered, 65% of patients (n=768) were diagnosed as ACVS. To evaluate our CPR, predicted probabilities of ACVS were computed using the ED referral data. Those patients with probabilities greater than the decision threshold and presenting with at least one focal neurological deficit clinically symptomatic of ACVS were flagged as would have received a CTA. Our CPR would have ordered 1208 CTAs (vs. 1190 baseline). Where CTA would have been ordered, 74% of patients (n=893) had an ACVS diagnosis. This is a significantly improved performance over baseline (sens 74.5% vs. 64.1%, p<0.001; spec 59.6% vs. 45.9%, p<0.001). Specifically, the CPR would have ordered an additional 18 CTAs over the 2-yr period, while simultaneously increasing the number of imaged-ACVS patients by 125 with imaging 107 fewer non-ACVS patients. Conclusion: Using ED physician referral data, our CPR demonstrates significantly higher sensitivity and specificity for CTA imaging of ACVS patients than baseline CTA utilization. Moreover, our CPR would assist ED physicians to apply and practice the Canadian stroke best practice guidelines. ED physician use of our CPR would increase the number of ACVS patients receiving CTA imaging before ED discharge (rather than later at TIA clinics), and ultimately reduce the burden of false-positives on radiological departments.
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Leach, Helen, and Jamie J. Coleman. "Osler Centenary Papers: William Osler in medical education." Postgraduate Medical Journal 95, no. 1130 (November 21, 2019): 642–46. http://dx.doi.org/10.1136/postgradmedj-2018-135890.
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William Osler combined many excellent characteristics of a clinical educator being a scientific scholar, a motivational speaker and writer and a proficient physician. As we celebrate his life a century on, many of his educational ideals are as pertinent today as they were in those Victorian times. Osler’s contributions to modern medicine go beyond his legacy of quotable aphorisms to a doctor, educator and leader whose proponent use of bedside teaching, careful clinical methods, and clinicopathological correlation was a great inspiration for students and junior doctors. He was also a great advocate of patient-centred care—listening to and closely observing his patients, an important message for modern medicine as the reliance on investigations strains modern healthcare systems. This review of Osler’s contribution to medical education summarises his development as an educator and provides reflection on his influences to modern clinical education.
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Schoenmaker, Suzanne G., Lizanne Berkenbosch, Susannah Ahern, and Jamiu O. Busari. "Victorian junior doctors’ perception of their competency and training needs in healthcare management." Australian Health Review 37, no. 4 (2013): 412. http://dx.doi.org/10.1071/ah13015.
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Introduction. Australian medical speciality colleges have adapted and integrated the CanMEDS Physician Competency Framework into their training programs. The role as manager is one of the competencies and is presently thought to receive little attention during training. The objective of our study was to investigate the perceptions of Australian junior doctors regarding their management skills and their perceived need for management education. Methods. In November and December 2011, 1376 junior doctors from eight Victorian metropolitan health services were invited via email to participate in this study. Participating junior doctors received a questionnaire regarding their self- perceived management skills and knowledge and a medical management training needs assessment. Results. The response rate of one of the health centres was too low (6%) and therefore insufficient for credible conclusions to be drawn. Of the other health services, 194 (16%) out of 1213 junior doctors responded to the survey. Overall, the junior doctors rated their perceived competency on a 1–5 Likert scale as moderate (mean 3.45; s.d. 0.42). Of the 194 residents who responded, 71.3% (n = 139) reported a need for management training. Discussion. The junior doctors of Victoria, Australia perceived their knowledge on medical management as moderate. The results of this study showed that there is a perceived need among junior doctors for more management training. This need seems to confirm that management skills are thought to be valuable in medical practice. Our study also suggests that before the development of specific interventions, there is a need for a gap analysis between the perceived and actual management skills desired in medical residents. The attention paid to the role ‘as manager’ should therefore be embedded in training of all junior doctors. What is known about the topic? The CanMEDS 2005 Framework describes the seven key competencies physicians should possess to meet the needs of patients and society, and was developed by The Royal College of Physicians and Surgeons of Canada. One of these competencies is the role as manager. Published studies have shown that medical residents have a need for education in healthcare management in basic and postgraduate medical training. What does this paper add? In this study we discovered that junior doctors in Victorian metropolitan health services have a moderate perception of their competencies as managers. Previous management experience influenced the perceived competence in a positive way. What are the implications for practitioners? We believe that it is necessary that junior doctors continue to build on existing opportunities to develop their management skills. In order to achieve this, awareness of the importance of management competencies and the possibilities to obtain management experience must be raised among junior doctors. Furthermore, they need to be given the opportunity to obtain experience.
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Mansfield, Shawn D., Greg S. Bezanson, and Thomas J. Marrie. "Characterization and cloning of a 37.6-kb plasmid carried byLegionella pneumophilarecovered from patients and hospital water over a 12-year period." Canadian Journal of Microbiology 43, no. 2 (February 1, 1997): 193–97. http://dx.doi.org/10.1139/m97-025.
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For 12 years, strains of Legionella pneumophila serogroup 1 harbouring a 37.6-kb (23 MDa) plasmid have predominated among patient and potable water isolates at the Victoria General Hospital, Halifax, N.S. Plasmid DNA recovered from 24 strains isolated between 1983 and 1995 was digested with the restriction endonucleases EcoRI, HindIII, KpnI, PvuII, XbaI, and BamHI. The distribution of cutting sites indicated that the 23-MDa size group had remained essentially unchanged during this period, suggesting the persistence of a single plasmid type. Further fragmentation pattern analysis permitted the construction of a physical map of the prototype 23-MDA plasmid, pLp4269. Double digestion with BamHI–HindIII enabled the cloning of 94.4% of pLp4269 into pBluescript vector. A 2.1-kb fragment was not clonable. Plasmid pLp4269 is the first of the smaller Legionella extrachromosomal DNAs to be characterized in this way.Key words: Legionella, plasmid, stability, map, cloning.
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Hallinan, Christine Mary, Jane Maree Gunn, and Yvonne Ann Bonomo. "Implementation of medicinal cannabis in Australia: innovation or upheaval? Perspectives from physicians as key informants, a qualitative analysis." BMJ Open 11, no. 10 (October 2021): e054044. http://dx.doi.org/10.1136/bmjopen-2021-054044.
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Objective We sought to explore physician perspectives on the prescribing of cannabinoids to patients to gain a deeper understanding of the issues faced by prescriber and public health advisors in the rollout of medicinal cannabis. Design A thematic qualitative analysis of 21 in-depth interviews was undertaken to explore the narrative on the policy and practice of medicinal cannabis prescribing. The analysis used the Diffusion of Innovations (DoI) theoretical framework to model the conceptualisation of the rollout of medicinal cannabis in the Australian context. Setting Informants from the states and territories of Victoria, New South Wales, Tasmania, Australian Capital Territory, and Queensland in Australia were invited to participate in interviews to explore the policy and practice of medicinal cannabis prescribing. Participants Participants included 21 prescribing and non-prescribing key informants working in the area of neurology, rheumatology, oncology, pain medicine, psychiatry, public health, and general practice. Results There was an agreement among many informants that medicinal cannabis is, indeed, a pharmaceutical innovation. From the analysis of the informant interviews, the factors that facilitate the diffusion of medicinal cannabis into clincal practice include the adoption of appropriate regulation, the use of data to evaluate safety and efficacy, improved prescriber education, and the continuous monitoring of product quality and cost. Most informants asserted the widespread assimilation of medicinal cannabis into practice is impeded by a lack of health system antecedents that are required to facilitate safe, effective, and equitable access to medicinal cannabis as a therapeutic. Conclusions This research highlights the tensions that arise and the factors that influence the rollout of cannabis as an unregistered medicine. Addressing these factors is essential for the safe and effective prescribing in contemporary medical practice. The findings from this research provides important evidence on medicinal cannabis as a therapeutic, and also informs the rollout of potential novel therapeutics in the future.
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Najeeb, Muhammad Naveed, Sadiq Hussain Malik, Sheikh Khurram Salam Sehgal, Ameer Ahmad Malik, and Saqib Mehmood. "46 XY DISORDER." Professional Medical Journal 23, no. 10 (October 10, 2016): 1202–8. http://dx.doi.org/10.29309/tpmj/2016.23.10.1723.
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Objectives: The Disorders of Sex Development are classified as 46, XY DSD,46, XX DSD and Chromosomal DSD according to the chromosomal constitution of the affectedpersons. 46, XY DSD is further classified into Androgen Synthetic Defect, Androgen InsensitivitySyndrome Gonadal Dysgenesis, 5-Alpha Reductase Deficiency, Persistent Mullerian DuctSyndrome and Isolated Hypospadias according to the pathophysiology of the disease. Theaim of present study was to classify 46, XY patients into their subclasses on the basis of theirhormonal profile and physical examination. Study Design: Observational descriptive study.Setting: Biochemistry Department University of Health Sciences for Karyotyping and Geneticassessment, and its allied institution Biochemistry Department Quaid-e-Azam Medical CollegeBahawalpur for hormonal analysis, along with Pediatric Medicine Departments of Quaid-e-AzamMedical College / Bahawal Victoria Hospital Bahawalpur for collection of Sample and clinicalassessments. Period: June 2015 to December 2015. Study Design: Observational descriptivestudy. Material and Methods: 53 patients with 46, XY DSD were recruited. Complete clinicalhistory and data of each patient was recorded in the research proforma. Genitals examinedfor the phallus length and size, position of urinary meatus, palpation of gonads and shape ofthe labioscrotal folds. Ultrasonography examination of each patient was performed to look forundescended testes and for the presence of either male or female internal reproductive organs.Results: Base line levels of serum Testosterone Dihydrotestosterone Luteinizing hormone,Follicle stimulating hormone, 17-OH-Progesteron and Anti-mullerian hormones were measuredby ELISA technique. Testosterone and DHT were measured again after hCG stimulation. Onthe basis of physical examination, ultrasonographic findings and hormonal profile diagnosisof the types of 46, XY DSD was possible in 27 (51%) of patients. Androgen synthesis defect asa cause of 46, XY DSD was diagnosed in 7(13%) patients, Androgen insensitivity syndrome in6(11%) patients, 5-Alpha reductase deficiency in 3(6%) patients, Gonadal Dysgenesis in 3 (6%),Persistent Mullerian Duct Syndrome in 3(6%) and Isolated Hypospadias in 2 (4%) patients.There were 26 (49%) patients which remain undiagnosed with the algorithm of diagnosis usedin the present study.
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Postma, Maarten, Stephen I. Pelton, Victoria Divino, Joaquin F. Mould-Quevedo, Drishti Shah, Mitchell DeKoven, and Girishanthy Krishnarajah. "29. Impact of Enhanced Influenza Vaccines on Direct Healthcare Costs for the U.S. Elderly: A Comprehensive Real-World Evaluation of Adjuvanted Trivalent Influenza Vaccine Compared to Trivalent High-Dose Influenza Vaccine for the 2018–19 Influenza Season." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S38—S39. http://dx.doi.org/10.1093/ofid/ofaa439.074.
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Abstract Background Influenza generates a substantial economic burden ($3.2B in the U.S. annually) due to direct medical costs such as physician office visits or hospitalizations, especially among the elderly. Recent published literature for the 2018–19 influenza season has demonstrated similar clinical effectiveness between adjuvanted trivalent influenza vaccine (aTIV) and trivalent high dose influenza vaccine (TIV-HD). This research aimed to assess the annualized mean all-cause and influenza-related healthcare costs among subjects 65+ years vaccinated with aTIV or TIV-HD during the 2018–19 influenza season. Methods A retrospective cohort analysis was conducted using professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, region, Charlson Comorbidity Index, comorbidities, indicators of frail health status, and pre-index hospitalization rates. Treatment selection bias was adjusted through 1:1 propensity score matching (PSM). Economic outcomes included annualized mean all-cause costs and influenza-related costs, which comprised influenza-related hospitalizations, emergency room (ER) visits, and physician office visits costs. Mean costs were compared using paired t-test. Adjusted analyses were conducted using generalized estimating equation (GEE) models, with two-part models for influenza-related costs. With the GEEs, adjustment for outliers (99th percentile) were addressed and predicted healthcare costs were obtained through bootstrapping (500 replications). Results During the 2018–19 influenza season, the PSM sample comprised 561,243 recipients of aTIV and 561,243 recipients of TIV-HD. Following GEE adjustment, predicted mean annualized all-cause and influenza-related costs per patient were statistically similar between aTIV and TIV-HD (US$9,676 vs. US$9,625 and US$23.75 vs. US$21.79, respectively). Both aTIV and TIV-HD were comparable in terms of predicted mean annualized costs for influenza-related hospitalizations (US$20.28 vs. US$18.13) and influenza-related office visits (US$1.29 vs. US$1.34). Conclusion In adjusted analyses, total all-cause and influenza-related healthcare costs were comparable among elderly subjects vaccinated with either aTIV or TIV-HD. Disclosures Maarten Postma, Dr., IQVIA (Consultant) Stephen I. Pelton, MD, Merck vaccine (Consultant, Grant/Research Support)Pfizer (Consultant, Grant/Research Support)Sanofi Pasteur (Consultant, Other Financial or Material Support, DSMB)Seqirus Vaccine Ltd. (Consultant) Victoria Divino, PhD, Seiqrus Vaccines Ltd. (Consultant) Joaquin F. Mould-Quevedo, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder) Drishti Shah, PhD, Seqirus Vaccines Ltd. (Consultant) Mitchell DeKoven, PhD, Seqirus Vaccines Ltd. (Consultant) Girishanthy Krishnarajah, PhD, Seqirus Vaccines Ltd. (Employee, Shareholder)
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Hameed, Fawad, Javeria Afzal, Ahmad Rafique, M. Khurram Jameel, Khurram Niaz, Humiara Alam, and Muhammad Shoaib. "The Importance of Clinical Data & Prevalence of Breast Tumors in South Punjab, Pakistan." Pakistan Journal of Medical and Health Sciences 16, no. 11 (December 1, 2022): 21–24. http://dx.doi.org/10.53350/pjmhs2022161121.
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Background: In Western countries, middle-aged women are more vulnerable to breast cancer. Globally, almost a million new cases were identified in 1998. One in 12 women in England and Wales will get the disease at some point.1 Even 5,000 years after it was first reported, the etiology of breast cancer is still unclear, and effective preventative measures are even further off. Aim: To characterize the varied ways in which breast cancer has presented itself among patients at Bahawal Victoria Hospital in Bahawalpur. Methods: This investigation employed a descriptive case series research design. This research was conducted at Bahawal Victoria Hospital's Surgery Department in Bahawalpur (Pakistan). From March 13th, 2020 through March 12th, 2021, the study was conducted (12 months). With their assent, 100 women with definite cases of breast cancer were enrolled in the study. Results: Cancer of the breast most commonly affected women between the ages of 31 and 50 (59%). Seventy-six patients arrived from the outlying rural areas of Bahawalpur and the neighboring districts. Only 18 patients had completed high school after 10 years and 5 patients were discovered to be college graduates. The single rate was 12%, with 12 patients. Eighty-one percent of patients reported having a breast lump. 56% of breast cancers involve the left breast, while 43% involve the right. One patient alone had breast cancer that had spread to both of her breasts. Illness duration varied from 1 month to 5 years. Stage III was the most prevalent presentation, with 46 instances, and Stage IV was the least common, with 16 patients. Practical implication Community based effective awareness and prompt screening programme will improve better outcomes in breast cancer management. Conclusion: Breast cancer is very common cancer in the females, and most commonly it presented as a lump in the breast, because of some social aspects, lack of awareness, poverty, no proper screening programs and above all the fear of diagnosis, females try to hide this problem and often it presented at late and more advance stage. Keywords: Breast, Nipple, Cancer, Lump, Surgery, Tumor
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Philip, Jennifer, Gregory Crawford, Caroline Brand, Michelle Gold, Belinda Miller, Peter Hudson, Natasha Smallwood, Rosalind Lau, and Vijaya Sundararajan. "A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease." Palliative and Supportive Care 16, no. 4 (May 31, 2017): 452–60. http://dx.doi.org/10.1017/s147895151700044x.
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ABSTRACTBackground:Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns.Objective:Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers.Method:Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia.Results:A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as “usual” care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death.Significance of results:Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.
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Carson, Luke, Christopher Kui, Gemma Smith, and Anand K. Dixit. "The Effect of the 2019 Novel Coronavirus Pandemic on Stroke and TIA Patient Admissions: Perspectives and Risk Factors." Journal of Clinical Medicine 10, no. 7 (March 25, 2021): 1357. http://dx.doi.org/10.3390/jcm10071357.
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Background: The 2019 novel coronavirus pandemic has generated concern from stroke specialist centres across the globe. Reductions in stroke admissions have been reported, despite many expecting an increase due to the pro-thrombotic nature of 2019 novel coronavirus. Aims: To assess the impact of the pandemic and subsequent lockdown on stroke admissions and transient ischaemic attack referrals at the Royal Victoria Infirmary, Newcastle-Upon-Tyne, and additionally on patient behaviours affecting modifiable risk factors or perspectives related to accessing healthcare. Methods: A single-centre retrospective data analysis was carried out on a “lockdown” cohort of suspected stroke patients admitted between 11 March to 26 May 2020 and a “pre-lockdown” cohort admitted in 2019. Differences in weekly admissions, weekly referrals, onset-to-presentation time and weekly thrombolysis cases were examined. Further analysis interrogated these cohorts separated by Bamford classification and stroke mimics (such as seizure/hemiplegic migraine/functional neurology). A binary-format questionnaire was separately administered to admitted patients from 15 April to 5 June 2020. Results: Significant reductions in weekly posterior circulation infarct (−43%, p = 0.017) and stroke-mimic (−47%, p < 0.001) admissions and weekly referrals diagnosed as non-transient ischaemic attack (−55%, p = 0.002) were observed in the lockdown cohort, with no differences in onset-to-presentation time. Over 25% of questionnaire respondents reported less physical activity, increased isolation and delaying their presentation due to the pandemic. Conclusions: This study provides evidence of reduced stroke-mimic and posterior circulation infarct admissions. Questionnaire findings suggest that patients need to be informed to ensure they appropriately seek medical advice. Significant communication at the stroke-primary care interface is needed to support referral pathways and management of modifiable risk factors.
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Mandell, Harvey N. "Physician-Patient, Physician-Patient's Physician." Postgraduate Medicine 82, no. 6 (November 1987): 40–44. http://dx.doi.org/10.1080/00325481.1987.11700025.
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Koritsas, Stella, Malcolm Boyle, and Jan Coles. "Factors Associated with Workplace Violence in Paramedics." Prehospital and Disaster Medicine 24, no. 5 (October 2009): 417–21. http://dx.doi.org/10.1017/s1049023x0000724x.
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AbstractIntroduction:The majority of research that has explored workplace violence has focused on establishing the prevalence of violence in different settings. In general, there is a paucity of research that explores factors that may predict or increase the risk of experiencing violence in the workplace.Objective:The aim of this research was to determine predictors of violence for paramedics.Methods:A questionnaire was developed that focused on paramedics' experi-ences with six forms of violence: verbal abuse, property damage/theft, intimi-dation, physical abuse, sexual harassment, and sexual assault.The questionnaire was distributed randomly to paramedics throughout rural Victoria and metropolitan South Australia, and completed and returned anonymously.Results:Predictors emerged for verbal abuse, intimidation, sexual harassment, and sexual abuse. Specifically, gender was the only predictor of intimidation, sexual harassment, and sexual assault. Paramedic qualifications, how they responded to a call-out, and hours per week in direct patient contact emerged as a predictor of verbal abuse.Conclusions:Certain factors predict or predispose paramedics to workplace violence. The need for workplace violence education and training is impera-tive for the prevention of violence, as well as for its management.
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Liu, Alice J., Alison Wells, Jeffrey Presneill, and Caroline Marshall. "Common microbial isolates in an adult intensive care unit before and after its relocation and expansion." Critical Care and Resuscitation 24, no. 1 (March 7, 2022): 50–60. http://dx.doi.org/10.51893/2022.1.oa7.
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OBJECTIVE: To describe the prevalence of common and clinically relevant microbial isolates before and after the migration of a 24-bed, open plan, adult intensive care unit (ICU) to a new extended design of 32 single rooms, supporting an expanded clinical oncology casemix while continuing all existing clinical services. DESIGN: Retrospective, observational descriptive analysis covering the period 5 May 2014 to 4 May 2018 — the 2 years before and after the ICU relocation on 5 May 2016. SETTING: A university-associated, tertiary teaching hospital and state trauma centre in Victoria, Australia. PATIENTS: Adult ICU patients. MAIN OUTCOME MEASURES: Bacterial isolate frequency and incident rate ratios (IRRs) during the study period. RESULTS: When compared with the old ICU, the incidence rates per 1000 occupied bed-days in the new ICU were lower for bacterial isolates overall (IRR, 0.88; 95% CI, 0.83–0.93), for coagulase-negative staphylococci (IRR, 0.64; 95% CI, 0.55–0.75) and for vancomycin-resistant enterococci (IRR, 0.50; 95% CI, 0.32–0.80). The incidence rates per 1000 occupied bed-days between ICU locations were unchanged for Staphylococcus aureus (IRR, 1.1; 95% CI, 0.91–1.3), extended-spectrum beta-lactamase-producing organisms (IRR, 1.4; 95% CI, 0.78–2.6) and carbapenemase-producing Enterobacterales (IRR, 0.85; 95% CI, 0.11–6.4). CONCLUSION: Within the limits of a before–after design and clinically directed sampling, relocation to a new ICU with single rooms and a growing oncological patient casemix was accompanied by no overall change in the apparent prevalence of the nosocomial pathogens S. aureus, extended-spectrum beta-lactamase-producing organisms or carbapenemase-producing Enterobacterales. These finding suggest that advanced physical infrastructure, including patient accommodation in single rooms, may play a role in overall safe delivery of critical care.
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Ruíz, Sofía, Bella Pajares, Maria-Jose Bermejo-Perez, Cristina Roldán Jiménez, Antonio Cuesta Vargas, and Emilio Alba Conejo. "Effect of tailored and supervised therapeutic exercise in metastatic breast cancer patients: A prospective study." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e13075-e13075. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e13075.
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e13075 Background: The safety, feasibility and benefit of physical activity is robust in adjuvant breast cancer, but as far as we know, there is little information on the feasibility and benefit of exercise in women with advanced breast cancer. The objective of our study is to analyze the feasibility and impact on fatigue, quality of life and functionality of an individualized, prospective and supervised exercise program in a group of patients with metastatic breast cancer. Methods: A prospective study on 30 metastatic breast cancer patients who were recruited as volunteers between February 2018 and April 2019 by Medical Oncologists from the Medical Oncology Unit at University Clinical Hospital Virgen de la Victoria (Malaga, Spain). Participants included in this study were patients aged between 34 and 71 years old and all had metastatic breast cancer, not amenable to curative treatment. The intervention was a twelve-week Therapeutic Exercise and Education Programme delivered by a physiotherapist. The intervention was preceded by a physical assessment of the musculoskeletal system. The outcomes were cancer-related fatigue, quality of life and functional outcomes (patient- reported and other measured by investigators). Results: Of the 30 patients initially recruited, only 11 of them completed the program with an attendance greater or equal to 17 sessions (75% of assistance). Most of patients who dropped (19), did it because of personal matters, not related to disease progression. Regarding patients who completed the completion of physical activity program (n = 11), the majority were treated on first line of treatment with hormonal receptors positive tumors and bone metastasis. After the intervention, no major changes were observed in cancer-related fatigue, quality of life and several patients-reported outcomes, although an improvement in functionality was observed, in investigator-measured parameters (30-STS and adapted burpees). Conclusions: Our study shows that a supervised and individualized tailored physical activity program in metastatic breast cancer patients is safe and feasible, although more studies are needed to analyse its impact on improving functional parameters, fatigue and quality of life.
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Iglesias Campos, Marcos, Bella Pajares, Cristina Roldán Jiménez, Begona Jimenez, Emilio Alba, and Antonio Cuesta Vargas. "Feasibility and patient perception of a web-based exercise program during COVID pandemic in breast and ovarian cancer patients." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13623-e13623. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13623.
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e13623 Background: Current literature shows us that therapeutic exercise has multiple benefits in oncology patients, such as improvement in quality of life or a reduction in cancer-related fatigue. Furthermore, given the risk of obesity, both exercise and diet play a key role in recovery from cancer. As a consequence of the COVID-19 pandemic, oncology patients present more difficulties to attend programs as they are considered a risk population, so new online exercise programs should be developed to ensure that patients take advantage of them in the post-COVID era. The main objective was to study patient´s perspectives and the feasibility of a web-based tailored and supervised therapeutic exercise program during COVID pandemic. Methods: A prospective study was performance on patients recruited from the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. Participants were between 18 and 65 years old and diagnosed of early resected breast cancer after finishing chemotherapy (CT) or metastatic ovarian (MOC) or breast cancer (MBC) with or without active treatment. Patients had had a good performance status (PS) with no prior cardiovascular history, and they were excluded if they were not used to online technologies. The duration of the program was 3 months, twice a week, delivered by a physiotherapist and a nutritionist. At the end of the program, women were asked 9 questions about their perspectives on the program. All of them signed informed consent. Results: 17 breast cancer survivor (BCS), 10 MBC and 3 MOC patients were initially recruited. From 30 patients recruited, 5 BCS did not started the program because of clinical contraindication and 5 patients left due to personal issues. 15 out of the remaining 20 completed the survey. All of patients reported that the program had contributed to improve their mood during the pandemic due to issues such functional ability, feeling better or less asthenia, and serving as improvement and encouragement in their lives. 86,7% reported having met their objectives and 100% reported going to continue doing some type of exercise or physical activity on a regular basis after the program is finished. Regarding advantages of online format compared to the face-to-face one, they reported avoiding displacement and lower risk of contagion. Lately, if they could participate again, 50% reported they would prefer online, while the remining 50% would prefer traditional modality. Conclusions: At the light of these results, the tele-exercise program contributed to improve the mood and fatigue of patients during the pandemic. The web-based program seems to be feasible and allow patients to meet their objectives after program completion and encourage them to keep doing some type of physical activity.
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Segal, Steven P., Leena Badran, and Lachlan Rimes. "Accessing acute medical care to protect health: the utility of community treatment orders." General Psychiatry 35, no. 6 (December 2022): e100858. http://dx.doi.org/10.1136/gpsych-2022-100858.
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BackgroundThe conclusion that people with severe mental illness require involuntary care to protect their health (including threats due to physical—non-psychiatric—illness) is challenged by findings indicating that they often lack access to general healthcare and the assertion that they would access such care voluntarily if available and effective. Victoria, Australia’s single-payer healthcare system provides accessible medical treatment; therefore, it is an excellent context in which to test these challenges.AimsThis study replicates a previous investigation in considering whether, in Australia’s easy-access single-payer healthcare system, patients placed on community treatment orders, specifically involuntary community treatment, are more likely to access acute medical care addressing potentially life-threatening physical illnesses than voluntary patients with and without severe mental illness.MethodsReplicating methods used in 2000–2010, for the years 2010–2017, this study compared the acute medical care access of three new cohorts: 7826 hospitalised patients with severe mental illness who received a post-hospitalisation, community treatment order; 13 896 patients with severe mental illness released from the hospital without a community treatment order and 12 101 outpatients who were never psychiatrically hospitalised (individuals with less morbidity risk who were not considered to have severe mental illness) during periods when they were under versus outside community mental health supervision. Logistic regression was used to determine the influence of community-based community mental health supervision and the type of community mental health supervision (community treatment order vs non-community treatment order) on the likelihood of receiving an initial diagnosis of a life-threatening physical illness requiring acute care.ResultsValidating their shared elevated morbidity risk, 43.7% and 46.7%, respectively, of each hospitalised cohort (community treatment order and non-community treatment order patients) accessed an initial acute-care diagnosis for a life-threatening condition vs 26.3% of outpatients. Outside community mental health supervision, the likelihood that a community treatment order patient would receive a diagnosis of physical illness was 36% lower than non-community treatment order patients—1.30 times that of outpatients. Under community mental health supervision, their likelihood was two times greater than that of non-community treatment order patients and 6.6 times that of outpatients. Each community treatment order episode was associated with a 14.6% increase in the likelihood of a community treatment order patient receiving a diagnosis. The results replicate those found in an independent 2000–2010 cohort comparison.ConclusionsCommunity mental health supervision, notably community treatment order supervision, in two independent investigations over two decades appeared to facilitate access to physical healthcare in acute care settings for patients with severe mental illness who were refusing treatment—a group that has been subject to excess morbidity and mortality.
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Traianos, E., B. Dibnah, D. Lendrem, Y. Clark, V. Macrae, V. Slater, K. Wood, et al. "AB0051 THE EFFECTS OF NON-INVASIVE VAGUS NERVE STIMULATION ON IMMUNOLOGICAL RESPONSES AND PATIENT REPORTED OUTCOME MEASURES OF FATIGUE IN PATIENTS WITH CHRONIC FATIGUE SYNDROME, FIBROMYALGIA, AND RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1057.3–1058. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1999.
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Background:Fatigue is reported as a common symptom among autoimmune and other chronic diseases such as fibromyalgia (FM), a long-term condition with uncertain pathophysiology. Previous studies from our group suggest that non-invasive vagus nerve stimulation (nVNS) may contribute to the improvement of patient reported outcome measures (PROMs) of fatigue in patients with primary Sjögren’s Syndrome (1).Objectives:This follow-up study uses the gammaCore device (electroCore) to assess the effect of nVNS on PROMs of fatigue and immune responses in chronic fatigue syndrome (CFS), FM and rheumatoid arthritis (RA).Methods:The study included thirteen CFS, fourteen FM and fifteen RA patients who used the gammaCore nVNS device twice daily over a 26-day period. Pre- and post- nVNS bloods were drawn at baseline and final visits. Whole blood samples were stimulated with 2 ng/mL lipopolysaccharide (LPS) and the IL-6 and TNF-α cytokine concentrations were quantified at 24 hours. In addition, the epidermal growth factor (EGF), IFN-γ, IL-6, IP-10, MIP-1α, and TNF-α levels were measured in ‘pre-nVNS’ serum and flow cytometric profiles of whole blood immune cells were analysed. The patient reported outcome measures (PROMs) recorded at each visit were the Visual Analogue Scale (VAS) (0-100 cm) of abnormal fatigue, Hospital Anxiety and Depression (HAD) Scale, Orthostatic Grading Scale, Epworth Sleepiness Scale (daytime sleepiness), and Profile of fatigue (PRO-F) for Physical and Mental fatigue. Paired t-tests were performed to assess for changes in PROMs, cytokine levels, and cell subset distribution and associations of cytokine response with PROMs were investigated by correlation analyses.Results:Eleven CFS, twelve FM and fourteen RA patients completed the study. There was a significant reduction in daytime sleepiness in CFS (p =0.0321) and FM (p =0.0294) patients between the final and baseline visits and a significant reduction in HAD depression (p =0.0413) in FM (Fig.1). Improvement in VAS for abnormal fatigue, HAD-Anxiety, HAD-Depression, PRO-F Physical and Mental fatigue was observed in all three groups over the study period with a reduction in VAS fatigue in 64% of CFS, 67% of FM and 62% of RA patients. There were no significant changes in the immune cell subsets or in cytokine response. Finally, higher baseline pre-nVNS supernatant IL-6 levels were predictive of an improvement in VAS fatigue (p =0.0006), Daytime Sleepiness (p =0.0466) and PRO-F Physical fatigue (p =0.0196) in RA, while higher baseline TNF-α levels were predictive of an improvement in VAS fatigue (p =0.0003), Daytime Sleepiness (p =0.0380), Orthostatic (p =0.0281) and PRO-F Physical fatigue (p =0.0007) in FM.Conclusion:Our findings suggest that nVNS may contribute to the improvement of PROMs of fatigue in CFS, FM and RA. NVNS led to significant reductions in daytime sleepiness in CFS and FM, and depression in FM. Further studies and a larger sample size are needed to investigate the potential effects of nVNS on diseases characterised by persistent fatigue.References:[1]Tarn J, Legg S, Mitchell S, Simon B, Ng WF. The Effects of Noninvasive Vagus Nerve Stimulation on Fatigue and Immune Responses in Patients With Primary Sjögren’s Syndrome. Neuromodulation Technol Neural Interface. 2018;22(5):580–5.Figure 1.VAS for abnormal fatigue and PROMs recorded at baseline and final visits in patients with chronic fatigue syndrome (CFS), fibromyalgia (FM) and rheumatoid arthritis (RA). Boxplots show the median, upper, and lower quartiles for PROMs at visit 1 and visit 3 in each disease group. Paired-t tests revealed a significant reduction in daytime sleepiness in CFS and FM (B), and a significant reduction in HAD depression in FM (E). Improvement trends were observed in VAS for abnormal fatigue, HAD-Anxiety, HAD-Depression, PRO-F Physical fatigue and PRO-F Mental fatigue in all three groups over the 26-day study period.Acknowledgements:This study received infrastructural support from the National Institute of Health Research (NIHR) Newcastle Biomedical Research Centre at Newcastle Hospitals Foundation Trust and Newcastle University.Disclosure of Interests:Emmanuella Traianos: None declared, Bethany Dibnah: None declared, Dennis Lendrem: None declared, Yasmin Clark: None declared, Victoria Macrae: None declared, Victoria Slater: None declared, Karl Wood: None declared, David Storey: None declared, Bruce Simon Shareholder of: Bruce Simon is an employee and shareholder of electroCore., Employee of: electroCore, Inc., Justyna Blake Shareholder of: Justyna Blake is an employee of electroCore, and receives stock ownership., Employee of: electroCore, Inc., Jessica Tarn: None declared, Wan Fai Ng: None declared
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Cortés Vieco, Francisco José. "Unravelling the Body/Mind Reverberations of Secrets Woven into Charlotte Brontë’s Villette." Prague Journal of English Studies 4, no. 1 (July 1, 2015): 25–45. http://dx.doi.org/10.1515/pjes-2015-0002.
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Abstract The pervasive psychological realism of Charlotte Brontë’s Villette (1853) challenges scholarly assumptions based on her biography or her indoctrination to Victorian medical discourses, as it explores dysfunctional body/mind interrelations, particularly those evidencing patriarchal pressures and prejudices against women. Under the guise of her heroine Lucy, the author becomes both the physician and the patient suffering from a female malady of unnamed origin. This article intends to prove that, instead of narratively unravelling her creature’s past trauma with healing purposes, the author conceals its nature to protect her intimacy and she focuses on the periphery of her crisis aftermath to demonstrate its severity by means of the psychosomatic disorders that persistently haunt her life: depression, anorexia nervosa and suicidal behavior. Brontë’s literary guerrilla of secrecy aims, simultaneously, to veil and unveil the core of Lucy’s clinical case with an unequivocal diagnosis: a harmful, mysterious event from her childhood/adolescence, whose reverberations repeatedly erupt during her adulthood and endanger her survival. Unreliable but “lucid”, this heroine becomes the daguerreotype of her creator to portray life as a sad, exhausting journey, where professional self-realisation - not love or marriage - turns into the ultimate recovery therapy from past ordeals, never successfully confirmed in the case of Lucy, who epitomises a paradigm of femininity in Victorian England: the impoverished, solitary, middle-class woman
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Iglesias Campos, Marcos, Bella Pajares, Cristina Roldán Jiménez, Maria-Jose Bermejo-Perez, Emilio Alba, and Antonio Cuesta Vargas. "Functional status of patients suffering from ovarian cancer: A cross-sectional study." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e17556-e17556. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e17556.
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e17556 Background: Physical activity displays multiple benefits in oncology patients, with the strongest evidence related to breast cancer. But there is little information about patient with ovarian cancer, even less in those who are metastatic. The main objective of this study was to assess and describe the performance´s in patients suffering from ovarian cancer in terms of function and cancer-related fatigue (CRF). Methods: Patients willing to join therapeutic exercise program (TEP) were at the Medical Oncology Unit of the Hospital Virgen de la Victoria, Malaga. A physiotherapist carried out an interview and a baseline assessment. The following outcomes were recorded: number of repetitions (n) performed in 30 seconds sit-to-stand test (30-STS), handgrip strength (Kg), cancer related fatigue (CRF) measured by Piper Fatigue Scale (0-10), upper and lower limb function measured by Upper Limb Functional Index (ULFI) and Lower Upper Limb Functional Index (LLFI), respectively (%). Results: Patients recruited had a diagnosed of an advanced ovarian cancer receiving or not active treatment. All participants had a good performance status (PS) and signed informed consent. 8 women were included, with a mean age of 52.66 (9.53) years and a mean BMI of 27.22 (4.56) kg/m2. Women performed 22 (4.24) repetitions of 30-STS test. Handgrip strength was 22 (2.7) Kg and CRF 5.43 (2.91) points. Patients reported 64.81% (34.65) and 66.83% (37.91) in ULFI and LLFI questionnaires, respectively. Conclusions: At the light of these preliminary results, ovarian cancer patients present a good level of function measured by 30-STS and a good grip strength. However, they report a moderate level of CRF and affected upper and lower limbs function. In additions, patients measured had function enough to participate in a therapeutic exercise program. Given the heterogeneity of the sample and its low number of participants, future studies with a wider sample should be carried out.
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Hardman, Ruth, Stephen Begg, and Evelien Spelten. "Multimorbidity and its effect on perceived burden, capacity and the ability to self-manage in a low-income rural primary care population: A qualitative study." PLOS ONE 16, no. 8 (August 9, 2021): e0255802. http://dx.doi.org/10.1371/journal.pone.0255802.
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Introduction Multimorbidity is increasing in prevalence, especially in low-income settings. Despite this, chronic conditions are often managed in isolation, potentially leading to burden-capacity imbalance and reduced treatment adherence. We aimed to explore, in a low-income population with common comorbidities, how the specific demands of multimorbidity affect burden and capacity as defined by the Cumulative Complexity Model. Materials and methods Qualitative interviews with thirteen rural community health centre patients in Victoria, Australia. Participants were aged between 47–72 years and reported 3–10 chronic conditions. We asked about perceived capacity and burden in managing health. The Theory of Patient Capacity was used to analyse capacity and Normalisation Process Theory to analyse burden. All data specifically associated with the experience of multimorbidity was extracted from each burden and capacity domain. Results The capacity domains of biography, resource mobilisation and work realisation were important in relation to multimorbidity. Conditions causing functional impairment (e.g. chronic pain, depression) interacted with physical, psychological and financial capacity, leading to biographical disruption and an inability to realise treatment and life work. Despite this, few people had a treatment plan for these conditions. Participants reported that multimorbidity affected all burden domains. Coherence and appraisal were especially challenging due to condition interactions, with clinicians providing little guidance. Discussion The capacity and burden deficits highlighted by participants were not associated with any specific diagnosis, but were due to condition interactions, coupled with the lack of health provider support to navigate interactions. Physical, psychological and financial capacities were inseparable, but rarely addressed or understood holistically. Understanding and managing condition and treatment interactions was a key burden task for patients but was often difficult, isolating and overwhelming. This suggests that clinicians should become more aware of linkages between conditions, and include generic, synergistic or cross-disciplinary approaches, to build capacity, reduce burden and encourage integrated chronic condition management.
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Garrido-Cumbrera, M., D. Poddubnyy, C. Bundy, L. Christen, R. Mahapatra, S. Makri, C. J. Delgado-Domínguez, D. Gálvez-Ruiz, P. Plazuelo-Ramos, and V. Navarro-Compán. "POS0990 FACTORS ASSOCIATED WITH ENGAGING IN PHYSICAL ACTIVITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 763.1–763. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2469.
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Background:Physical activity is an essential component in axial spondyloarthritis (axSpA) care, improving physical and mental well-being.Objectives:This analysis aims to identify factors associated with engaging in physical activity among axSpA patients.Methods:Data from 2,424 unselected patients participating in EMAS (N=2,846), a cross-sectional study (2017-2018) across 13 European countries, were analysed. Engaging in physical activity was assessed by the following item: “Do you do any physical or sporting activity?” for which participants could report at least 1 physical activity or that they did not do any physical activity. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health using General Health Questionnaire GHQ-12 (0-12) were assessed. Mann-Whitney and Pearson’s χ2 tests were used to analyse relationships between engaging in physical activity and sociodemographic factors, patient-reported outcomes, employment, lifestyle and comorbidities. Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining engagement in physical activity.Results:Mean age was 43.9±12.3 years, 61.3% were female, 48.1% had a university degree and 67.9% were married. 81.8% (n= 2,329) engaged in at least one kind of physical activity. Those physically active were typically male (85.3% vs 79.7% female, p<0.001), university educated (86.0% vs 78.0%, p<0.001), married (83.1% vs 79.2% unmarried, p=0.046), and members of a patient organisation (86.4% vs 78.9% non-member, p<0.001). 25.1% of obese patients (n=533) did not engage in physical exercise (v. 16.6% not obese, p<0.001). Those not engaging in physical activity reported greater disease activity (6.0 vs 5.4 BASDAI, p<0.001), functional limitation (21.6 vs 20.2, p=0.010), spinal stiffness (8.3 vs 7.6, p<0.001), and poorer mental health (5.9 vs 4.8 GHQ-12, p<0.001). Furthermore, 83.9% of those employed (n=1,457) were physically active, versus 73.7% unemployed (n=205; p<0.001). In the multivariable binary logistic regression, the qualitative variables associated with engaging in physical activity were belonging to a patient organisation (OR= 1.91), not being obese (OR= 1.58), being university educated (OR= 1.54), and being male (OR= 1.39). The quantitative variables associated with engaging in physical activity were lower spinal stiffness (OR=0.90), better mental health (OR=0.96), and one-year age increase (OR=1.02). (Table 1).Table 1.Regression analysis for variables explaining engagement in physical activity (n=2,424)Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI7OR95% CI7Gender. Male11.481.21, 1.811.391.06, 1.82Educational level. University21.731.42, 2.111.541.18, 2.00Marital Status. Married31.731.06, 1.581.180.91, 1.54Patient organization. Member41.71)1.39, 2.101.911.43, 2.55Body Mass Index. Not Obese51.691.35, 2.121.581.17, 2.13Employment status. Employed61.281.06, 1.561.000.76, 1.32Quantitative variablesOR95% CI7OR95% CI7Age1.011.00, 1.021.021.01, 1.03BASDAI (0-10)0.860.82, 0.910.960.89, 1.04GHQ-12 (0-12)0.940.92, 0.960.960.93, 0.99Functional Limitation (0-54)0.990.99, 1.001.000.99, 1.01Spinal Stiffness (3-12)0.900.86, 0.940.900.84, 0.95Proportion of life with axSpA (0-1)2.831.50, 5.352.000.91, 4.391Male vs Female; 2University vs no university; 3Married vs unmarried; 4Member vs not; 5Not obese (underweight, normal and overweight) vs obese; 6Employed vs not (unemployed, sick leave, retirement, housework and student).795% CI for test H0: OR=1Conclusion:These results show that increasing age, being male, university educated, member of a patient organisation, not obese, having lower spinal stiffness, and better mental health increase the probability of engaging in physical activity. Physical activity is an important part of axSpA care and patient organizations play a critical role in enhancing access to and participation in physical activity.Acknowledgements:This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
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SHABBIR, ASIYA, TARIQ MAHMOOD REHAN, SHAHID Hussain Jaffery, and Muhammad Ubaidullah Baig. "GYNAECOMASTIA." Professional Medical Journal 17, no. 02 (June 10, 2010): 205–10. http://dx.doi.org/10.29309/tpmj/2010.17.02.2345.
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Objectives: To determine the causative factors and management of Gynaecomastia. Study Design: Observational case series study. Place and Duration of Study: Surgical Unit-1 Bahawal Victoria Hospital Bahawalpur, from 1st January 200 till 31st December 2007. Patient and Methods: Thirty male patients having breast swelling were included in this study. Relevant history was obtained. Appropriate physical examination was performed. Necessary investigations were done and after making a diagnosis appropriate treatment was done. A total of 30 patients were studied in the study period of 18 months. Those male patients who were having breast lesion other than benign enlargement (e.g. Ca. Breast, Breast/Abscess) were not included in the study. Necessary investigations were done. Subcutaneous Mastectomy was performed. Results: The most common age group developing gynaecomastia was of 20-30 years (60%). Bilateral gynaecomastia was observed in 76.66% and unilateral gynaecomastia in 23.33%. Idiopathic gynaecomastia was observed in 73.33% cases. Medical treatment was given with tamoxifen 10mg twice a day for the period of three months in 6 case (20%) and this remained effective in 5 case (83.33%). Subcutaneous mastectomy was performed in 17 cases (56.66%). Post-operative complications were seen in 4 cases (23.52%), the most common complication being wound hematoma in 2 cases (11.76%). Most of the patients (88.9%) were fully satisfied with the results of subcutaneous mastectomy. Conclusion: Gynaecomastia is the most common benign lesion of the male breast. As far as physiological gynaecomastia is concerned, patients should be observed for at least 2 years from the onset of their condition. In most of the cases spontaneous resolution occurs. Surgical treatment should be planned in whom spontaneous resolution does not occur. Surgery remains the mainstay of therapy and is frequently indicated for psychological and cosmetic reasons.
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Ma, M., A. Santosa, K. O. Kong, C. Xu, J. T. G. Xiang, G. G. Teng, A. Mak, et al. "POS0200 POST-mRNA VACCINE FLARES IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES: INTERIM RESULTS FROM THE CORONAVIRUS NATIONAL VACCINE REGISTRY FOR IMMUNE DISEASES SINGAPORE (CONVIN-SING)." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 333–34. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1787.
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BackgroundPublished data suggest no increased rate of flare of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination; however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys).ObjectivesTo study flares of AIIRD within three months of the first dose of an anti-SARS-COV2 mRNA vaccine.MethodsA retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfizer/BioNTech or Moderna) vaccine. Data were censored at the first post-vaccine clinic visit when the patient had flared or if ≥ three months had elapsed since the first dose of the vaccine, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis and time to flare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1).Figure 1.Nelson-Aalen curve of flares over timeResults2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfizer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/ targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection.Table 1.Patient characteristicsBaseline characteristicsNo flares(n = 1887, %)Flares within 0—3 months of 1st vaccine dose (n= 272, %)Flares outside of 0 – 3 months after 1st vaccine dose (n = 180, %)Age (median years, IQR)64 (53, 71)61 (50, 69)65 (55, 71)RaceChinese1386 (73)206 (76)129 (72)Malay193 (10)28 (10)20 (11)Indian195 (10)27 (10)26 (14)GenderFemale1367 (72)200 (74)117 (65)Vaccine typePfizer/BioNTech1713 (92)239 (90)160 (90)Moderna149 (8)28 (10)18 (10)DiagnosisRheumatoid Arthritis831 (44)139 (51)93 (52)Systemic Lupus Erythematosus269 (14)20 (7)9 (5)Psoriatic Arthritis225 (12)42 (15)29 (16)Spondyloarthropathies141 (7)21 (7)17 (9)Sjogren’s Syndrome114 (6)15 (6)8 (4)Systemic sclerosis94 (5)4 (1)6 (3)Baseline Physician Disease ActivityRemission1007 (53)99 (36)63 (35)Low Disease Activity731 (39)128 (47)97 (54)Moderate Disease Activity134 (7)40 (15)20 (11)High Disease Activity15 (1)5 (2)0452 (19%) flares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients flared within the 3-month period of interest and 180 (7.7%) flared outside of the 3-month period (Table 1). Median (IQR) time-to-flare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who flared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine.On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to flare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with inflammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to flare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively]ConclusionThere was a moderately high rate of AIIRD flares after mRNA vaccination; however, there was no clustering of flares in the immediate post-vaccine period to suggest causality. Older patients were less likely to flare, while those with inflammatory arthritis and active disease at baseline were more likely to flare.Disclosure of InterestsMargaret Ma Grant/research support from: Support grant from multiple companies for the Singapore Biologics registry, Amelia Santosa Speakers bureau: Amgen Talk, Consultant of: Pfizer ad board, Kok Ooi Kong: None declared, Chuanhui Xu: None declared, Johnston Tang Gin Xiang: None declared, Gim Gee Teng Speakers bureau: Boehringer Ingleheim, Anselm Mak Speakers bureau: J&J and GSK, Grant/research support from: GSK - the supported studies programme, Sen Hee Tay: None declared, Victoria Wei Wen Ng: None declared, Joshua Zhi En Koh: None declared, Warren Fong Speakers bureau: speaker for Abbvie, DKSH, GSK, Novartis, Li-Ching Chew Speakers bureau: pfizer and Abbvie, Consultant of: Pfizer and Abbvie Advisory Board meeting, Grant/research support from: Abbvie educational grant for ultrasound conference, Andrea Low Speakers bureau: Boehringer Ingeilheim, Consultant of: Consultant/steering group committee for BI and J&J, annie law: None declared, Yih Jia Poh: None declared, Siaw Ing Yeo Grant/research support from: Multiple pharmaceutical companies for the support of the National Biologics Registry, Ying Ying Leung Speakers bureau: Abbvie, DKSH, Jassen, Novartis and Pfizer, Wei-Rui Goh: None declared, Chuah Tyng Yu: None declared, Nur Emillia Roslan: None declared, Stanley Angkodjojo Speakers bureau: Boehringer Ingeilheim, Consultant of: Abbvie and DKSH, Kee Fong Phang: None declared, Thaschawee Arkachaisri: None declared, Melonie Sriranganathan: None declared, Teck Choon TAN: None declared, Peter Cheung Consultant of: Ad board for Boehringer Ingleheim, novartis, janssen and abbvie, Grant/research support from: Novartis, Manjari Lahiri Speakers bureau: J&J, DSKH, Consultant of: DSKH, Gilead, Grant/research support from: Multiple pharma companies contributed to the Singapore Biologics registryNovartis
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Wilson, C., G. Skaczkowski, P. Sanderson, M. Shand, and A. Byrne. "Triaging for Supportive Care Services: Do People Want and Accept Referral?" Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 117s. http://dx.doi.org/10.1200/jgo.18.10300.
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Background: Distress is the 6th vital sign in cancer yet it is only assessed in an ad hoc way in most cancer services. The Distress Thermometer (DT) and the associated Problem Checklist (PC) are the most widely available tools although few studies report on how they are used to effectively triage services. Aim: To explore the link between distress assessment, problem identification, referral to specific supportive care services by staff, and service uptake by cancer patients and survivors among a sample of people attending a major cancer hospital in Victoria Australia. Methods: A secondary analysis of quality assurance audit data were undertaken using data collected from patient medical records between January 2013 and June 2014. Data extracted were; age, sex, post code, language spoken, disease and treatment information, distress as measured by the DT and problems as identified by the PC. For the current study the focus was on the number of referrals offered and the number accepted or declined. The type of services referred to was also examined. Results: Data were collected for 877 patients although missing data resulted in a final sample size of 853. Only data associated with the first DT of each patient are presented. 729 patients (86%) participated in distress screening. The distress threshold of 4 was reported by 50% of participants, highlighting the prevalence of distress requiring support. This 50% reported an average of 9 problems on the PC, many of which came from the physical domain, with 91% reporting at least 1 physical problem. Other problems reported were emotional (74% of the sample); practical (24%), family (14%) and spiritual (2%). Referral data, which was available for 614 people, indicated that over 60% (372) were offered at least one referral. Referral offer was significantly predicted by DT score, and number of problems reported. Acceptance was significantly related to total number of problems, treatment type, and type of referral; referral for physical treatment was most likely to be accepted (87%) whereas referral for emotional support was least likely (53%). Conclusion: Routine distress screening and problem identification are critical to triaging to supportive care services. In a tertiary care setting, not all people will be screened or will want to be screened; not all people will be referred to services; and not all people will accept referral. Nonetheless, problems are extensive with most survivors reporting experiencing several problems. Despite a focus on the physical, these problems extend to other domains, including the emotional, and it is important that services are available to support these needs.
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Garrido-Cumbrera, M., E. Collantes-Estevez, V. Navarro-Compán, P. Zarco-Montejo, J. Correa-Fernández, C. Sastré, P. Plazuelo-Ramos, and J. Gratacos-Masmitja. "POS0993 THE IMPORTANCE OF PHYSICAL ACTIVITY IN RELATION TO BEING OVERWEIGHT/OBESE WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE SPANISH ATLAS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 765.1–765. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2545.
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Background:Evidence on the negative effects of being overweight/obese on the health outcomes of patients with axial spondyloarthritis (axSpA) is increasing.Objectives:This study aimed to identify associations between Body Mass Index (BMI) categories and disease activity, functioning, quality of life, and mental health in a large sample of axSpA patients.Methods:In 2016, a sample of 680 unselected patients with axSpA participated in the Atlas of Axial Spondyloarthritis in Spain through an online survey. The sample was divided in two groups: 1) Patients with a BMI of 18.5 to <25 Kg/m2 (normal weight), and 2) Patients with a BMI of ≥ 25 Kg/m2 (overweight/obesity), excluding the underweight category (BMI <18.5 Kg/m2). The Mann-Whitney and Pearson’s chi-square tests were used to analyse possible relationships between independent sociodemographic characteristics, employment, lifestyle, patient-reported outcomes, and comorbidity variables with those who are overweight/obese. Univariate and multivariate binary logistic regression was used to determine the association of the possible factors with those who are overweight/obese.Results:Of the 663 patients analysed, the mean age was 45.9 years, 51.4% were female, 37.0% had a university degree, and 72.5% were married. The prevalence of overweight/obese patients was 53.4% compared to 46.6% who were of a normal weight. The patients with the highest prevalence of being overweight/obese were older (49.3 vs 42.0, p<0.001), with no university education (59.8% vs 42.4% of university, p<0.001), often widowers (75.0% vs 30.8% of single people, p<0.001), and reported membership of patient organisations (61.7% vs 46.6%, p<0.001). With respect to patients of normal weight, those who were overweight/obese presented greater spinal stiffness (8.2 vs 6.6, p<0.001) and a longer diagnostic delay (9.2 vs 7.8, p=0.005). In addition, patients who were overweight/obese were more likely physically inactive (63.7% vs 36.3%, p=0.007). In the multivariable binary logistic regression analysis, the qualitative factors associated with the presence of being overweight/obese were physical inactivity (OR= 2.40) and males (OR= 1.81), while the quantitative factor most associated with the presence of being overweight/obese were greater spinal stiffness (B= 0.121) and older in age (B= 0.052) (Table 1).Table 1.Logistic regression to analyses factor associated with being overweight/obese (N= 469)Univariate logistic analysisMultivariate logistic analysisORp-value1ORp-value1Qualitative factorsGender. Male2.376<0.0011.8110.005Educational level. No university2.018<0.0011.1880.422Marital Status. Widowed2.6470.235NANAMember of PAGs. Yes1.851<0.0011.0950.680Employment. Retired / early retirement4.414<0.0011.7320.195Physical activity. No1.7030.0072.4000.038Quantitative factorsBp-value2Bp-value2Age0.070<0.0010.052<0.001Spinal Stiffness (3-12)0.220<0.0010.1210.004Diagnostic Delay0.0240.0350.0080.5681p-value for test H0: OR = 1 2p-value for test H0: B = 0.Conclusion:Being overweight/obese is a common comorbidity among patients with axSpA. The lack of physical activity, male gender, higher spinal stiffness, and older age increase the probability of prevalence of being overweight/obese. Physicians should encourage physical activity in patients with axSpA, especially among men and older people to prevent the factors of being overweight/obese.Acknowledgements:This study was supported by Novartis Spain. The authors would like to thank all patients who participated in the study.Disclosure of Interests:Marco Garrido-Cumbrera: None declared, Eduardo Collantes-Estevez Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Pedro Zarco-Montejo: None declared, José Correa-Fernández: None declared, Carlos Sastré Employee of: Novartis Farmacéutica Spain, Pedro Plazuelo-Ramos: None declared, Jordi Gratacos-Masmitja Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
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Mariotti, Aderbal. "Physician-patient relationship." Residência Pediátrica 6, s1 (2016): 24–25. http://dx.doi.org/10.25060/residpediatr-2016.v6s1-07.
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Silva Filho, Carlindo. "Physician–patient relationship." Residência Pediátrica 8, no. 3 (2018): 154–55. http://dx.doi.org/10.25060/residpediatr-2018.v8n3-11.
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Mandell, David E., and Harvey N. Mandell. "Physician-Patient-Attorney." Postgraduate Medicine 81, no. 5 (April 1987): 26–30. http://dx.doi.org/10.1080/00325481.1987.11699777.
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LEVINSON, WENDY, DEBRA ROTER, JOHN P. MULLOOLY, VALERIE T. DULL, RICHARD M. FRANKEL, and William D. B. Pope. "Physician-Patient Communication." Survey of Anesthesiology 41, no. 6 (December 1997): 376. http://dx.doi.org/10.1097/00132586-199712000-00064.
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Choudhuri, Gourdas. "Patient physician interaction." Hepatitis B Annual 7, no. 1 (2010): 86. http://dx.doi.org/10.4103/0972-9747.162158.
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