Iatrogenic Chronic Abdominal Pain in a Geriatric Patient: A Case Report.

Chronic abdominal pain is a challenging problem in clinical practice, with several pathophysiological mechanisms underlying its aetiologies. This case report presents a geriatric patient with multiple comorbidities who had experienced intermittent abdominal pain for over 10 years. Alarming symptoms were ruled out, and a functional gastrointestinal disorder was determined as the most likely cause. The patient's medical history and previous treatments were thoroughly reviewed, revealing that long-term use of metformin and an oral iron supplement was the iatrogenic symptom triggers. The abdominal pain resolved upon discontinuation of these two medications. This case report highlights the significance of reviewing iatrogenic causes and periodically assessing chronic medical conditions to identify potential contributing factors of chronic abdominal pain.

Side Effects of Antihypertensives Induced by Switching to Different Generic Medications: Case Reports.

Generic medication is a product that contains the same active substance and pharmaceutical characteristics as brand-name medications. Generic medications are cost-effective and comparable to brand-name medications in terms of clinical endpoints. However, the use of generic medications instead of brand-name medications is a debatable issue among patients and healthcare providers. Two patients with essential hypertension experienced side effects after switching to different generic antihypertensives (one generic medication to another generic medication). Adverse drug reactions, including, hypersensitivity, side effects, and intolerance, should be identified through present and past medical history and clinical characteristics. The adverse drug reactions in both patients were more likely to be side effects of the medications after switching to different generic antihypertensives produced by different companies (patient 1: enalapril and patient 2: amlodipine). The side effects were possibly caused by the different inactive ingredients or excipients. These two case reports emphasise the importance of monitoring adverse drug reactions throughout the course of treatment and communicating with patients prior to switching to a new generic medication.

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review.

BACKGROUND: Physical activity (PA) counselling is an effective approach to promote PA in primary health care (PHC). Barriers to PA counselling in PHC include time constraints, lack of knowledge and skills of providers, and systemic barriers. Using electronic health (eHealth) has the potential to promote PA. This scoping review aimed to identify usability and utility of eHealth for tailored PA counselling introduced in PHC settings. METHODS: A scoping review included primary research articles. The authors systematically searched six databases (Cochrane Library, CINAHL Complete, Embase, PubMed, Scopus and Web of Science) from the inception of the databases. The search terms consisted of three search components: intervention (PA counselling), platform (eHealth), and setting (PHC). Additional articles were included through reference lists. The inclusion criteria were research or original articles with any study designs in adult participants. RESULTS: Of 2501 articles after duplicate removal, 2471 articles were excluded based on the title and abstract screening and full text review. A total of 30 articles were included for synthesis. The eHealth tools had a wide range of counselling domains as a stand-alone PA domain and multiple health behaviours. The included articles presented mixed findings of usability and utility of eHealth for PA counselling among patients and providers in PHC settings. Technical problems and the complexity of the programmes were highlighted as barriers to usability. The majority of articles reported effective utility, however, several articles stated unfavourable outcomes. CONCLUSIONS: eHealth has the potential to support PA counselling in PHC. Facilitators and barriers to eHealth usability should be considered and adapted to particular settings and contexts. The utility of eHealth for promoting PA among patients should be based on the pragmatic basis to optimise resources.

Can mobile health apps replace GPs? A scoping review of comparisons between mobile apps and GP tasks.

BACKGROUND: Mobile health applications (mHealth apps) are increasingly being used to perform tasks that are conventionally performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and support for health services. This raises an important question: can mobile apps replace GPs? This study aimed to systematically search for and identify mobile apps that can perform GP tasks. METHODS: A scoping review was carried out. The Google Play Store and Apple App Store were searched for mobile apps, using search terms derived from the UK Royal College of General Practitioners (RCGP) guideline on GPs' core capabilities and competencies. A manual search was also performed to identify additional apps. RESULTS: The final analysis included 17 apps from the Google Play Store and Apple App Store, and 21 apps identified by the manual search. mHealth apps were found to have the potential to replace GPs for tasks such as recording medical history and making diagnoses; performing some physical examinations; supporting clinical decision making and management; assisting in urgent, long-term, and disease-specific care; and health promotion. In contrast, mHealth apps were unable to perform medical procedures, appropriately utilise other professionals, and coordinate a team-based approach. CONCLUSIONS: This scoping review highlights the functions of mHealth apps that can potentially replace GP tasks. Future research should focus on assessing the performance and quality of mHealth apps in comparison with that of real doctors.

Communication issues between caregivers and patients with concealment of advanced-stage cancer: A qualitative study.

Introduction: Communication is a key element of palliative care. The concealment of advanced-stage diseases is a communication challenge. This study aimed to explore the patterns and difficulties in communication regarding the concealment of advanced-stage cancer between caregivers and patients. Methods: This qualitative study employed an interpretive phenomenological approach and was conducted at a district hospital in Thailand. Semi-structured in-depth interviews were performed to collect data from caregivers (i.e. family members) of patients regarding the concealment of advanced-stage cancer. The data analysis followed an inductive thematic approach. Results: Ten in-depth interviews were conducted among the caregivers of patients aged 57-97 years. Four themes emerged: (i) reasons for concealing the diagnosis and prognosis (personality of patients and concerns about negative effects), (ii) communication patterns between caregivers and patients (communicating symptoms/signs instead of the diagnosis/prognosis and distorting information), (iii) difficulties and challenges in maintaining concealment (feelings of guilt, hesitation in sharing the information and suspicion of patients' awareness of their diagnosis/prognosis) and (iv) communication support from healthcare professionals (avoiding informing patients about their diagnosis/prognosis, supporting decision-making and disclosing the information). Conclusion: The concealment of advanced-stage cancer is perceived as an appropriate communication approach among some caregivers. Communicating information about advanced-stage cancer is dynamic. Some caregivers and families consider disclosing the information in the future. Healthcare professionals can support communication throughout care. Future studies should focus on decision-making and communication processes for better handling of information concealment or the conspiracy of silence in palliative care.

Health-related issues of people experiencing homelessness in Thailand: a scoping review.

Introduction: Homelessness is a significant global challenge affecting people worldwide. In Thailand, the health-related issues of people experiencing homelessness have not been a major research focus. This scoping review aims to explore the scope of research on health-related issues among people experiencing homelessness in Thailand. Methods: Eight databases (ACI, AMED, Embase, PsycINFO, PubMed, Scopus, TCI, and Web of Science) were searched from inception of each database to August 2022. The search terms consisted of terms related to people experiencing homelessness in Thailand. Research articles published in Thai or English were included. Results: Of 186 articles, 167 were excluded during duplicate removal (n = 45), title and abstract screening (n = 106), seeking for full-text articles (n = 2), and full-text screening (n = 14). Nineteen articles were included for extraction and synthesis. Three topics (health status, causes of homelessness and effects of homelessness on health, healthcare and social services) were summarised. The included studies described mental health (e.g., depression, suicide, alcohol and drug dependence), physical health (e.g., poor self-hygiene, injuries, accidents), and health behaviours (e.g., alcohol drinking, substance use, unsafe sex). Social behaviours and health problems linked to homelessness, and several factors related to health and living conditions (e.g., stigma, discrimination) were reported. People experiencing homelessness had some barriers to access to healthcare and social services (e.g., health insurance, social welfare, financial difficulties). Conclusions: The majority of studies on health-related issues in people experiencing homelessness in Thailand are descriptive studies. Future studies should focus on the interactions and mechanisms between homelessness and health.

Physical Activity with Sports Scientist (PASS) programme to promote physical activity among patients with non-communicable diseases: a pragmatic randomised controlled trial protocol.

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35-70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician's consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3-4: follow-up measurements), visit 3 (months 6-8: end-point measurements) and visit 4 (months 9-12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry. Trial registration number: TCTR20240314001.

Fentanyl transdermal patches induced chemical leucoderma.

Chemical leucoderma is defined as hypopigmentation or vitiligo-like hypomelanosis caused by repeated chemical exposure, and the diagnosis can be made clinically. Chemical leucoderma induced by fentanyl transdermal patches is rare. This case report involves a 53-year-old man with chronic back pain caused by herniated nucleus pulposus at the L4-L5 level. The patient had used fentanyl transdermal patches for about 2 years. Depigmented lesions were observed in the areas where fentanyl transdermal patches had been applied. Chemical leucoderma was the most likely diagnosis. There remains a debate regarding whether there is a fentanyl dose-response relationship and whether the duration of exposure is relevant. Spontaneous repigmentation may occur after discontinuing the chemical exposure, and follow-ups are recommended to monitor whether spontaneous repigmentation occurs. Additionally, several treatment options have been proposed as specific treatments for chemical leucoderma, including psoralens, corticosteroids, calcineurin inhibitors, immunosuppressive agents and phototherapy.

Bibliometric Analysis of Literature on Physical Activity and COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic induced a sudden surge in COVID-19 related publications. This bibliometric analysis aimed to analyze literature on physical activity and COVID-19 published in the PubMed database. The search terms ((physical activity [MeSH Terms] OR physical inactivity [MeSH Terms]) AND COVID-19 [MeSH Terms]) were applied to obtain publications from the inception of PubMed to February 2022. The analyses included the year of publication, type of publication, and origin of publication by country, region, and country income. The research areas were analyzed for research articles and systematic reviews. Of 1268 articles, 143 articles were excluded, and 1125 articles were analyzed. A total of 709 articles (63.02%) were published in 2021. A majority of publications were research articles (n = 678, 60.27%). The USA (n = 176, 15.64%), countries in the European Region (n = 496, 44.09%), and high-income countries (n = 861, 76.53%) were dominant publishing countries. Of 699 research articles and systematic reviews, surveillance and trends of physical activity were the main research area, followed by health outcomes, and correlates and determinants of physical activity. There is a wide gap in publication productivity in the field of physical activity and health during the pandemic among different countries' economic statuses.

Self-Care Practices of Patients with Non-Communicable Diseases during the COVID-19 Pandemic: A Qualitative Study.

Individuals with chronic non-communicable diseases (NCDs) have a higher risk of morbidity and mortality. This study explores the lived experience of patients with NCDs during the COVID-19 pandemic and the impact of COVID-19 on their self-care. An interpretive phenomenological analysis approach was used that involved in-depth interviews with patients who received medical services from a family medicine clinic, along with caregivers who responded on their behalf. An inductive thematic approach was utilized to analyze the data. Interview respondents included 17 patients with NCDs and four caregivers. The patients had a mean age of 65.7 ± 11.3 years and were diagnosed with an NCD, a mean of 4.8 ± 1.1 years previously. Self-care practices used during the pandemic were classified as therapeutic or preventive. Patients responded to changes in healthcare services by seeking in-person services for their acute illnesses and accepting remote services for underlying chronic conditions. The COVID-19 pandemic influenced the self-care practices of patients with NCDs. Most patients paid more attention to self-care during this time, while some became more concerned with other aspects of their life.

Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care.

The new World Health Organization (WHO) 2020 guidelines on physical activity (PA) and sedentary behavior include recommendations for adults with chronic conditions. The guidelines provide adaptable and general recommendations for people living with chronic medical conditions. This article summarizes the content and provides suggestions for the application of the guidelines for patients with essential hypertension in primary care. The WHO 2020 PA guidelines recommend broad advice for adults and older adults with chronic conditions. The key recommendations are consistent with other hypertension guidelines. A systemic approach to promote PA in primary care (i.e., PA assessment, safety considerations, PA prescription, behavioral counseling, and referral) along with applying the WHO guidelines is required. Health risk assessment and safety issues related to hypertension (e.g., current PA levels, level of blood pressure, treatment plans, comorbidities) should be concerned. The FITT Pro (frequency, intensity, time, type, and progression) can be adopted as a framework to break down the guidelines into specific PA prescription. The WHO 2020 PA guidelines address the importance of PA in clinical populations. The guidelines can be adapted for patients with hypertension in primary care settings.

Overview of Physical Activity Counseling in Primary Care.

Physical inactivity is a global health burden. Promoting physical activity in primary care through physical activity counseling is an effective intervention. This article provides an overview of and perspectives on physical activity counseling in primary care. The identification of physical inactivity as a health problem may increase the awareness of physical inactivity among patients and primary care providers, which will lead to an action plan. The contents of physical activity counseling should be based on evidence-based recommendations. Safety issues should be evaluated appropriately to optimize the utilization of primary care services. Physical activity counseling methods should be "tailored" for an individual using appropriate counseling methods and setting-specific resources. Multilevel barriers to physical activity counseling in primary care (i.e., healthcare providers, patients, and systems) must be addressed. Setting-specific strategies to overcome these barriers should be implemented to maximize the effectiveness of physical activity counseling in primary care.

Prognostic disclosure and quality of life in palliative care: a systematic review.

INTRODUCTION: Prognostic disclosure is an important component of communication in palliative care. Disclosing information on poor prognosis may affect quality of life (QoL) of palliative care patients. However, the effects of prognostic disclosure on QoL across different cultures and countries are unclear. OBJECTIVE: To review the effects of prognostic disclosure on QoL of palliative care patients. METHODS: A systematic review was conducted across seven databases (AMED, CINAHL plus, Cochrane Library, Medline (via the PubMed interface), Embase, Scopus and Web of Science). All primary studies, of any design, that explored the effects of prognostic disclosure on QoL of adult palliative care patients were eligible. RESULTS: A total of 1926 records were screened for eligibility. Twenty-five articles were included (11 cross-sectional, 10 cohort, 3 mixed methods and 1 qualitative study). Studies were conducted in 11 countries. Five studies reported the sources of prognostic disclosure, while 20 studies did not. Emotional QoL was the most reported domain among the studies. The effects of prognostic disclosure on emotional aspects, overall QoL and other domains, including symptoms, physical functions, role functions, social functions and cognitive functions, were inconsistent. CONCLUSIONS: The effects of prognostic disclosure on QoL across cultures and countries are inconsistent. Cultural differences are not sufficient to explain the effects. Future research is needed to explore the association between prognostic disclosure and QoL, and develop tools to support clinicians to share prognostic information in the most sensitive and supportive way.

Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qualitative Study.

INTRODUCTION: A mobile health (mHealth) technology has the potential to facilitate personalized physical activity (PA) counselling. We aimed to explore the feasibility and challenges of implementing a newly developed mHealth application (PAC app) for personalized PA counselling. MATERIAL AND METHODS: A qualitative design employed a descriptive phenomenology approach. Data were collected through focus group discussions (FGDs) with primary health care (PHC) providers and were analyzed using a deductive thematic approach. RESULTS: A total of 16 participants participated in four FGDs. Four major themes were found: application for personalized PA counselling, barriers to the use of the application by providers, patient involvement, and impact on PHC services. DISCUSSION: The results showed that the new mHealth application can potentially facilitate PA counselling. However, its use in PHC settings requires an understanding of the context of service delivery; the challenges faced by providers and patients and effects on services must be considered. CONCLUSION: Future research should focus on the long-term use of PAC app and its impact on behavioral and health outcomes.

Primary Health Care Providers' Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study.

PURPOSE: Physical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers' perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings. METHODS: This qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data. RESULTS: Three physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15-100 patients/day (median 40) and spent 2-20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients' limitations. CONCLUSION: A well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.

Purple urine bag syndrome in palliative care.

Purple urine bag syndrome (PUBS) is a rare condition characterised by urine discolouration. The management of PUBS remains controversial. Four females (mean age 84.5±9.7 years) with palliative conditions (two cancer and two non-cancer cases) presenting PUBS were identified. Urine bags were changed in all cases. Urinary catheters were changed in three cases. Oral antibiotics were prescribed in two cases and used in one case. Urine discolouration was resolved in all cases. One patient (without antibiotic treatment) died on day 5 after presentation of PUBS. Three patients (one out of three cases used oral antibiotics) were clinically stable after the management of PUBS. There was no recurrence of PUBS. Caring for patients with PUBS should be based on clinical decisions, patient status and the goals of care. Palliative care teams should focus on the prevention of PUBS by shortening the duration of catheterisation and minimising modifiable risk factors for this condition.

Developing a training programme in physical activity counselling for undergraduate medical curricula: a nationwide Delphi study.

OBJECTIVES: To identify the essential content and approaches for developing a training programme in physical activity (PA) counselling for undergraduate medical curricula. DESIGN: A three-round Delphi survey was conducted to investigate four key topics: (1) contents of PA counselling in medical education; (2) teaching and learning methods; (3) medical school collaboration and (4) educational policy implementation. Round 1 collected opinions from the participants. Round 2 focused on scoring the opinions. Round 3 summarised the expert opinions. A mean score of 4 or above identified as an important item. SETTING: All 23 medical schools in Thailand. PARTICIPANTS: Academic staff who were experts or in charge of medical schools in the fields of PA, health promotion or medical education. RESULTS: A total of 20 representatives from 18 of the 23 Thai medical schools participated in the study (for a response rate of 78.2%). The top three most important indicators of knowledge were (1) the definition and types of PA (4.75±0.55), (2) the FITT principle (frequency, intensity, time and type) (4.75±0.55) and (3) the benefits of PA (4.65±0.67). The most important component of the training involved general communication skills (4.55±0.60). An extracurricular module (4.05±0.76) was preferable to an intracurricular module (3.95±0.94). Collaborations with medical education centres and teaching hospitals (4.45±0.78) and supporting policies to increase medical students' PA (4.40±0.73) were considered to be important. CONCLUSION: Knowledge and counselling skills are important for PA counselling. Building collaborations between medical education and health institutions, as well as implementing effective educational policies, are key approaches to the integration of PA counselling into medical education. Future research should focus on investigating the effects of training in PA counselling on the learning outcomes of medical students and the clinical outcomes of patients.