MODY calculator applied in patients with clinical diagnosis of type 1 diabetes mellitus: Is a higher cutoff needed?

Aim: This study aimed to evaluate the mean post-test probability (PTP) of the Maturity-onset diabetes of the young (MODY) calculator in a multiethnic cohort of patients previously diagnosed with type 1 diabetes (T1DM). Materials and methods: The MODY probability calculator proposed by Shields and colleagues (2012) was applied to 117 patients from a T1DM outpatient clinic at a tertiary hospital in Brazil. Additionally, two exons of the HNF1A gene were sequenced in eight patients who hadn't received insulin treatment within six months after the diagnosis. Results: 17.1 % of patients achieved PTP >10 %; 11.1 % achieved PTP >25 % (and all patients >30 %), and 7.7 % achieved PTP >40 %. Among the patients who were selected for genetic sequencing, 100 % presented PTP >30 %, with 66.6 % achieving PTP >40 % and 41.6 % achieving PTP >75 %. These cutoffs are as suggested for the Brazilian population, according to previous investigations. No mutation was observed in the sequenced exons. Conclusion: Considering that only around 10 % of the evaluated cases achieved PTP >30 %, it is highly probable that the most suitable cutoff to select patients for genetic sequencing in a Brazilian cohort of T1DM is higher than the cutoff used in Caucasian populations.

Disorders of gut-brain interaction are common diagnoses among infants and toddlers in gastroenterology practices in Latin-America.

OBJECTIVES: To assess the relative frequency and associated factors of disorders of gut-brain interaction (DGBIs) in outpatient gastrointestinal (GI) clinics in young children of Latin America. METHODS: Cross-sectional study in 10 pediatric GI outpatient clinics (private and public) in five countries of Latin America (El Salvador, México, Colombia, Panamá, and Nicaragua). Parents of patients 1 month 4 years of age from outpatient clinics complete/d a diagnostic questionnaire for DGBIs per Rome IV criteria (QPGS-IV, Spanish version). We conducted descriptive analysis, two-sample t-tests and chi-square tests, univariate analyses, and logistic regression to evaluate risk factors. RESULTS: We collected data from 783 children. In total, 34.5% had a DGBI. Overall, functional constipation (FC) was the most common diagnosis (23.4%) in children of all ages (infants, 16.1%, 1-4-years-old, 32.7%). In infants, the second most common DGBI was regurgitation (6.6%) and in 1-4-years-old and cyclic vomiting syndrome (4.1%). The diagnosis of a DGBI was significantly associated with a family history of DGBIs (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.61-5.57, p = 0.0001). Patients who identified as black (OR 2.25, 95% CI 1.28-3.92, p = 0.0021) or mixed race (OR 1.76, 95% CI 1.25-2.48, p = 0.0006) were also significantly associated with a higher likelihood of DGBIs. CONCLUSIONS: DGBIs are a common diagnosis in pediatric GI clinics of Latin America. Overall, FC was the most common DGBI.

Preventive care for individuals with deep pressure ulcers in Sweden living at home: A cross-sectional study.

Background and Aims: Several factors exist regarding the risk for, healing and prevention of pressure ulcers (PUs). A mobile PU team with an individualized holistic approach adapted to the home or outpatient clinic setting could be beneficial for the prevention, and management of PUs. Aims: To describe the mobile PU team's interventions among individuals who had deep PUs and were living at home. Another aim was to describe the patients' perceptions of the quality of the care and having a deep PU. Methods: A quantitative study with a cross-sectional design. At an outpatient clinic, a mobile PU team was established to perform and follow up PU prevention interventions and advanced wound care treatment at home and at the outpatient clinic. All adult patients with existing deep category four PUs remitted to the outpatient clinic were asked to participate, and 16 out of 24 individuals consented. Instruments used for data collection were "Quality from the Patient's Perspective," "Wound-Quality of Life," "Modified Norton Scale," and a study developed protocol for the mobile team's PU interventions. Results: The patients chose home visits 20 times and outpatient clinic visits 89 times. In total, 8-13 interventions per participant were performed by the mobile team. The results show that having PUs affected the participants' perceptions of care and general well-being. The PUs did not heal completely but they did improve, six patients underwent flap surgery. Conclusion: When organizing care regarding patient safety for patients with deep PUs, it is important to consider the patient's perspective and well-being and to involve patients in their care plans. Home care is perhaps not the only way of caring; other aspects, in addition to telemedicine, could be an option.

Lessons learned: drive-through COVID-19 clinic testing during an adaptive epidemic response and a point-of-care test assessment of a computer-read rapid lateral flow immunoassay with fluorescence-based detection.

Background. The COVID-19 pandemic demonstrated a need for robust SARS-CoV-2 test evaluation infrastructure to underpin biosecurity and protect the population during a pandemic health emergency.Gap statement. The first generation of rapid antigen tests was less accurate than molecular methods due to their inherent sensitivity and specificity shortfalls, compounded by the consequences of self-testing. This created a need for more accurate point-of-care SARS-CoV-2 detection methods.Aim. Here we present the lessons-learned during the COVID-19 emergency response in Western Australia including the detailed set-up, evaluation and operation of rapid antigen test in a state-run drive-through sample collection service during the COVID-19 pandemic after the strict border shutdown ended.Methods. We report a conformity assessment of a novel, second-generation rapid antigen test (Virulizer) comprising a technician-operated rapid lateral flow immunoassay with fluorescence-based detection.Results. The Virulizer rapid antigen test demonstrated up to 100% sensitivity (95% CI: 61.0-100%), 91.94% specificity (95% CI: 82.5-96.5%) and 92.65% accuracy when compared to a commercial PCR assay method. Wide confidence intervals in our series reflect the limits of small sample size. Nevertheless, the Virulizer assay performance was well-suited to point-of-care screening for SARS-CoV-2 in a drive-through clinic setting.Conclusion. The adaptive evaluation process necessary under changing pandemic conditions enabled assessment of a simple sample collection and point-of-care testing process, and showed how this system could be rapidly deployed for SARS-CoV-2 testing, including to regional and remote settings.

Pharmacist E-script transcription service initiated nicotine replacement therapy uptake in pre-admission clinic: A pilot study.

BACKGROUND: Pharmacist-led smoking cessation programs in pre-admission clinics (PAC) have shown to increase quit attempts and achieve abstinence by the day of surgery (DOS). AIMS: To evaluate the feasibility of Pharmacist E-script Transcription Service (PETS) initiated nicotine replacement therapy (NRT) in PAC, including smoking cessation on DOS. METHODS: A single centre, pre and post-intervention pilot study conducted at an Australian public hospital PAC. In a two-month intervention period, PAC nursing staff invited smokers (≥1 cigarette/day) to see a smoking cessation PET pharmacist. Pharmacist-initiated NRT and Quitline© referrals were offered. Cessation outcomes were compared with the preceding two-month control period. PRIMARY OUTCOME: feasibility of intervention. SECONDARY OUTCOMES: DOS smoking abstinence rates and three-months post-surgery. RESULTS: PAC nurses identified 112 smokers over 4 months; 53 during pre-intervention period, and 59 during intervention period. Twenty-two intervention patients (37%) accepted seeing the pharmacist, with 16 subsequent Quitline© referrals (73%) and 11 NRT prescriptions (50%) written. The median nursing smoking status documentation time increased in the intervention period (1 min vs. 4, p < .001). The intervention did not impact pharmacist's workload. Verified abstinence increased from 8.5% (4/47) pre-intervention to 9.4% (5/53) post-intervention, p =1.00. Relapse rates in the intervention period increased (20% vs. 50%) at three-months post-surgery. CONCLUSION: A PETS-initiated NRT program in PAC is feasible and increased preoperative use of NRT and Quitline© with minimal impact on smoking cessation. SO WHAT?: This study has highlighted the importance of implementing a multidisciplinary smoking cessation program in PAC however, larger studies are needed to determine the true impact of the program on smoking cessations.

[Supporting care teams as a lever for improving practices]. / L'accompagnement des équipes de soins comme levier à l'amélioration des pratiques.

Thanks to their guidance and coaching skills, advanced practice nurses (APNs) support teams on a daily basis in improving their practices and developing their reflexivity. Their leadership enables caregivers to question themselves, exchange ideas and think about care from a different angle. Situational analysis sessions provide a space for them to step back, debate and innovate. This meaningful support enabled a newly-qualified IPA to find her place among the teams. Here's a testimonial.

Effect of PSMA PET/CT on the Use of Bone Scintigraphy for Prostate Cancer at a University Hospital System.

We observed at our university-based imaging centers that when prostate-specific membrane antigen (PSMA) PET/CT became available for staging and restaging prostate cancer, the volume of bone scanning on patients with prostate cancer (BS-P) markedly decreased. We aimed to study use patterns of PSMA PET/CT and BS-P at our imaging centers during the 4-y period around U.S. Food and Drug Administration approval of PSMA PET/CT in December 2020. We tested the hypothesis that the rate of decline of BS-P accelerated after U.S. Food and Drug Administration approval, as physicians planned for use of PSMA PET/CT in their patients. Methods: Our clinical report system was searched for BS-P and PSMA PET/CT scans from January 2019 through June 2023. Numbers of scans were tabulated by quarter and year. Quantitative and statistical analyses were performed. Results: Annualized average monthly BS-P peaked at 53.7 scans/mo in 2021 and then decreased over time. There were 552 BS-Ps performed in 2019, 503 in 2020, 614 in 2021, 481 in 2022, and 152 in the first half of 2023. BS-P monthly averages declined by 22% from 2021 to 2022 and by 36% from 2022 to 2023, whereas monthly PSMA PET/CT scan averages increased by 1,416% from 2021 to 2022 and by 69% from 2022 to 2023. There was a significantly greater decline in BS-Ps from 2022 to 2023 than from 2021 to 2022 (36% vs. 22%, P < 0.0001). There were 30 PSMA PET/CT scans performed in 2021, 455 in 2022, and 384 in the first half of 2023. The greatest quarterly increase in these scans (400%) occurred at the outset of PSMA PET/CT implementation in quarter 4 of 2021. In quarter 2 of 2023, the percentage of total studies was higher for PSMA PET/CT than for BS-P (74% vs. 26%, P < 0.0001). Conclusion: At our university-based imaging centers, use of BS-P has declined in correlation with the timing of U.S. Food and Drug Administration approval and implementation of PSMA PET/CT. This study illustrates one instance of workflow changes that occur in the nuclear medicine clinic when new agents are introduced and affect clinical management options.

A cross-sectional study measuring the magnitude of depression and associated factors among patients attending orthopedic outpatient clinic at Ambo University Referral Hospital, Ambo Town, Oromia, Ethiopia, 2023.

Background: Depression is a leading cause of major public health problems globally, and its frequency has been increasing, particularly in low-income and middle-income countries. The prevalence of depression in sub-Saharan Africa ranges from 15 to 30%. In Ethiopia, depression is found to be the seventh leading cause of disease burden, yet no study was done in West Shewa, Ethiopia. Therefore, this study aimed to assess the magnitude of depression and associated factors among adult orthopedic outpatients getting treatment at Ambo University Referral Hospital, West Shewa, Oromia, Ethiopia, in 2023. Methods: An institution-based cross-sectional study was conducted among 391 adult orthopedic patients from January 1-30, 2023. A systematic random sampling technique was used to select the study subjects. The data were collected by using a structured questionnaire and checklist through face-to-face interviews and chart review techniques. The collected data were entered into Epi-data, version 4.6, and then exported to SPSS, version 26.0, for statistical analysis. The binary logistic regression model was fitted, and both bivariable and multivariable logistic regression analyses were employed. Result: The magnitude of depression was found to be 38.9% (95% CI: 34.5%, 43.9%), being female [adjusted odds ratio (AOR)=2.41; 95% confidence interval (CI): 1.45-4.00], chewing chat (AOR=2.39; 95% CI: 1.29-4.43), and no disorder on the lower limb (AOR=0.24; 95% CI: 0.07-0.85), had ligament injury (AOR=2.62; 95% CI: 1.23-5.59), had no complication (AOR=0.07; 95% CI: 0.01-0.52), and had amputation (AOR=3.83; 95% CI: 2.09-7.00) were significantly associated with depression. Conclusion and recommendation: The study found that the prevalence of depression among orthopedic patients was considerable; nearly half of the participants developed depression at Ambo University Referral Hospital, and being female, chewing chat, having no disorder on the lower limb, having a ligament injury, having a complication, and being amputated were significantly associated with depression. Therefore, due attention is needed from concerned bodies in order to tackle this problem.

Environmental bacterial load during surgical and ultrasound procedures in a Swedish small animal hospital.

BACKGROUND: Environmental bacteria in animal healthcare facilities may constitute a risk for healthcare-associated infections (HAI). Knowledge of the bacterial microflora composition and factors influencing the environmental bacterial load can support tailored interventions to lower the risk for HAI. The aims of this study were to: (1) quantify and identify environmental bacteria in one operating room (OR) and one ultrasound room (UR) in a small animal hospital, (2) compare the bacterial load to threshold values suggested for use in human healthcare facilities, (3) characterise the genetic relationship between selected bacterial species to assess clonal dissemination, and (4) investigate factors associated with bacterial load during surgery. Settle plates were used for passive air sampling and dip slides for surface sampling. Bacteria were identified by Matrix Assisted Laser Desorption-Time Of Flight. Antimicrobial susceptibility was determined by broth microdilution. Single nucleotide polymorphism-analysis was performed to identify genetically related isolates. Linear regression was performed to analyse associations between observed explanatory factors and bacterial load. RESULTS: The bacterial load on settle plates and dip slides were low both in the OR and the UR, most of the samples were below threshold values suggested for use in human healthcare facilities. All settle plates sampled during surgery were below the threshold values suggested for use in human clean surgical procedures. Staphylococcus spp. and Micrococcus spp. were the dominating species. There was no indication of clonal relationship among the sequenced isolates. Bacteria carrying genes conveying resistance to disinfectants were revealed. Air change and compliance with hygiene routines were sufficient in the OR. No other factors possibly associated with the bacterial load were identified. CONCLUSIONS: This study presents a generally low bacterial load in the studied OR and UR, indicating a low risk of transmission of infectious agents from the clinical environment. The results show that it is possible to achieve bacterial loads below threshold values suggested for use in human healthcare facilities in ORs in small animal hospitals and thus posing a reduced risk of HAI. Bacteria carrying genes conveying resistance to disinfectants indicates that resistant bacteria can persist in the clinical environment, with increased risk for HAI.

Examining the Cycle of Physical Frailty in Falls Clinic Attendees Through Structural Equation Modeling.

In 1998, Fried and Walston introduced the Cycle of Frailty (CF) as a foundational concept for defining the physical frailty phenotype (FP). While the FP has been extensively validated, the CF hypothesis lacks equivalent support. This study aimed to internally validate the CF using structural equation modeling (SEM) in a clinical dataset of adults aged 50 or older attending an outpatient falls clinic. Measures included: age, morbidity, nutrition, sarcopenia by bioelectrical impedance, VO2max, handgrip strength, basal metabolic rate (BMR), 5-times chair stand test (5CST), physical activity, and total energy expenditure (TEE). The SEM, incorporating CF hypothesized causal pathways, was tested using IBM® SPSS® Amos 27.0.0 (maximum likelihood method) with a sample of 102 adults (mean age 69.8 years, 58.8% women). Overall, the SEM was supported by the data (χ2 = 44.4, df = 37, p = 0.189), with significant (p < 0.05) regression weights for morbidity→sarcopenia, age→sarcopenia, sarcopenia→VO2max, sarcopenia→handgrip strength, handgrip strength→5CST, physical activity→TEE, TEE→nutrition, and BMR→TEE. However, nutrition→sarcopenia, sarcopenia→BMR, VO2max→5CST, and 5CST→physical activity were not significant. Although the SEM was limited by inclusion of surrogate CF measures (e.g., 5CST instead of gait speed, VO2max based on age-predicted maximal/resting heart rate), it provided some internal support for the CF hypothesis.

Impact of virtual reality on peri-interventional pain, anxiety and distress in a pediatric oncology outpatient clinic: a randomized controlled trial.

PURPOSE: Pain and anxiety-inducing interventions have a major impact on pediatric patients. Pain reduction by virtual reality (VR) during port and vein punctures is well studied. This study investigates peri-interventional reduction of pain, anxiety and distress using VR compared to the standard of care (SOC) in a pediatric oncology outpatient clinic. METHODS: In a randomized, controlled cross-over design, patients aged 6-18 years experience potentially painful interventions accompanied by VR. Observational instruments include NRS, FPS-r, BAADS, mYPAS-SF, PedsQL and SSKJ3-8R. All patients undergo two observations: SOC (A) and VR (B) in a randomized order. In addition, parents and staff are interviewed. Specific conditions for VR in an outpatient clinic setting derived from interprofessional focus group discussion are being explored. RESULTS: Between July 2021 and December 2022 57 eligible patients were included and randomized to the orders A/B (n = 28) and B/A (n = 29). Thirty-eight patients completed both observations. Characteristics in both groups did not differ significantly. More than half of the patients had no previous experience with VR, 5% decided to discontinue VR prematurely. Peri-interventional pain, anxiety and distress were significantly reduced by VR compared with SOC. 71% of patients and 76% of parents perceived punctures with VR to be more relaxed than previous ones. 95% of patients perceived fun with VR goggles. Detailed questionnaires on individual stress and anxiety were returned from 26 of 38 patients. Focus group discussion with staff yielded evidence for successful implementation of VR in an outpatient clinic. CONCLUSIONS: The present study shows that VR can be used for peri-interventional reduction of pain, anxiety, and distress in the special environment of a pediatric outpatient clinic. Specific conditions must be met for successful implementation. Further studies are needed to identify particularly susceptible patients and to illuminate alternatives for distraction that are feasible to implement with limited resources. TRIAL REGISTRATION NUMBER: (ClinicalTrials.gov ID): NCT06235723; 01/02/2024; retrospectively registered. This study adheres to the standard checklist of CONSORT guidelines.

Diabetes Self-Efficacy on Glycemic Control and Well-Being of Patients With Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus is a major, chronic, and progressive lifestyle disease. It adversely affects patients' quality of life, effectiveness, and well-being. Self-care practices are universally recognized as imperative to keep the illness under control and prevent complications. Self-efficacy is one of the factors involved in the successful self-care of diabetic patients. The primary objective of the study was to estimate the proportion of diabetes self-efficacy and to assess the correlation of diabetes self-efficacy with glycemic control, and the well-being of patients with type 2 diabetes mellitus (T2DM). The secondary objective was to assess the factors associated with diabetes self-efficacy. METHODS: An analytical cross-sectional study was conducted among T2DM patients attending the non-communicable disease clinic in the outreach centers of Government Medical College, Thiruvananthapuram, Kerala, India. Four hundred patients with T2DM were included in the study. Diabetes self-efficacy was assessed by the Stanford Diabetes Self-Efficacy Scale and the WHO-5 index scale was used to assess wellbeing. Glycemic control was determined by HbA1C estimation, with ≤7% as good control. RESULTS: Among 400 patients with T2DM, 51.25 % (95% CI: 46.2-56.2) had high diabetes self-efficacy. A significantly negative correlation was found between HbA1C and self-efficacy (r =- 0.208, p = 0.01), and a positive correlation was shown between well-being and self-efficacy (r = 0.418, p = 0.01). Logistic regression analysis found that factors associated with diabetes self-efficacy were upper socioeconomic status (OR = 8.53, 95% CI: 3.06-13.82), family support (OR = 1.97, 95% CI: 1.10-3.54), participation in diabetes education classes (OR = 1.95, 95% CI: 1.10-3.54), diet compliance (OR = 4.74, 95% CI: 2.80-8.01), glycemic control (OR = 1.69, 95% CI: 1.01-2.84), and overall wellbeing (OR = 6.7, 95% CI: 3.84-11.64). CONCLUSION: The proportion of high diabetes self-efficacy was 51.25% (95% CI: 46.2-56.2). The factors associated with diabetes self-efficacy were family support, participation in diabetes education classes, high socioeconomic status, absence of complications, good glycemic control, and well-being. The study findings depicted that high self-efficacy was significantly correlated with good glycemic control and well-being of patients with T2DM.

Efficacy of transarterial chemoembolization treatment with 30-60-µm microspheres in patients with hepatocellular carcinoma.

BACKGROUND: Chemoembolization with small drug-eluting microspheres is widely used in the treatment of hepatocellular carcinoma (HCC). OBJECTIVES: This study aimed to evaluate the efficacy and safety of transarterial chemoembolization with doxorubicin-eluting 30-60-µm microspheres (DEB-TACE) in patients with Barcelona Clinic Liver Cancer (BCLC) stage A and B HCC. MATERIALS AND METHODS: In this single-center study, 88 patients with HCC (BCLC A/B: 15.9%/84.1%) who underwent 137 DEB-TACE sessions between January 2015 and December 2020 were retrospectively assessed. Response to treatment was assessed 4-8 weeks after each DEB-TACE procedure according to mRECIST (Modified Response Evaluation Criteria in Solid Tumors) criteria. Progression-free survival (PFS), time to progression (TTP), overall survival (OS), and adverse events were recorded. RESULTS: In 88 patients (84.1% males; median age, 66.0 years; range, 22-83), the median follow-up was 17 months (range, 2-64). Eight patients (9.1%) had a complete response, 42 (47.8%) had partial regression, 10 (11.3%) had stable disease, and 28 (31.8%) had progressive disease. There was a statistically significant difference between serum alpha-fetoprotein (AFP) levels before and after DEB-TACE treatment (p < 0.001). The median OS was 17 months (95% confidence interval [CI], 10.3-23.7). Cox regression analyses found that preprocedural serum AFP level (400+ vs. < 400; p = 0.024), Child Pugh classification (B vs. A; p = 0.019), and number of DEB-TACE sessions (1 vs. > 1; p = 0.003) were independent risk factors affecting OS. The median PFS was 8 months (95% CI, 5.8-10.2) and TTP was 6 months (1-14 months). CONCLUSION: Chemoembolization with 30-60-µm microspheres is an effective and safe treatment for HCC. The number of DEB-TACE sessions is also one of the factors affecting OS.

Exploring the key elements for the successful management of primary otolaryngologic clinics in Taiwan.

AIM: This study aims to investigate the key elements for successful operation and management of primary otolaryngologic clinics in Taiwan amidst a declining birth rate and increasing competition among clinics. It employs the Innovation Through Tradition (ITT) theory as a theoretical framework to develop an operational model for effective management strategies. METHODS: This research utilized the triangulation method to identify key elements crucial for the operation and management of primary otolaryngologic clinics. Five key elements were identified, namely service attitude, medication efficacy, diagnostic and treatment procedures, treatment costs, and operating hours. Outpatient satisfaction was analyzed using Donabedian's structure-process-outcomes model to assess the impact of these elements on patient experience. RESULTS: Analysis revealed that service attitude significantly influences outpatient visits, indicating its paramount importance in clinic management. Patient satisfaction was highest in the service outcome dimension, emphasizing the significance of effective treatment outcomes. However, satisfaction was lowest in the service structure dimension, indicating potential areas for improvement in clinic infrastructure and organization. CONCLUSION: Understanding these key elements and enhancing outpatient satisfaction can drive improvements in the quality of medical services, contributing to the overall success of primary otolaryngologic clinics.

Prioritising Appointments by Telephone Interview: Duration from Symptom Onset to Appointment Request Predicts Likelihood of Inflammatory Rheumatic Disease.

Background: This study aims to determine the rate of inflammatory rheumatic diseases (IRDs) in a cohort of initial referrals and the efficacy of prioritising appointments to the early arthritis clinic (EAC) based on symptom duration. Methods: In the present study, we used algorithm-based telephone triage to assign routine care appointments according to the time between symptom onset and request for an appointment (cut-off criterion: 6 months). This retrospective, monocentric analysis evaluated the effectiveness of our triage in identifying patients with IRDs as a function of the assigned appointment category (elective, EAC, or emergency appointment). Results: A total of 1407 patients were included in the study (34.7% male; 65.3% female). Of the 1407 patients evaluated, 361 (25.7%) presented with IRD. There were significant differences in the frequency of inflammatory diagnoses between appointment categories (p < 0.001): elective 13.8%, EAC 32.9%, and emergency 45.9%. The sample without the emergency category included a total of 1222 patients. The classification into "inflammatory" or "non-inflammatory" in this subsample was as follows: Sensitivity was 37.7%, and specificity was 92.6%. The positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 83.6%. Overall, 80.2% of patients were correctly assigned using the appointment category and C-reactive protein (CRP). Conclusions: The algorithm-based triage system presented here, which focuses on the time between symptom onset and request for an appointment, allows for the prioritisation of appointments in favour of patients with IRDs and thus earlier initiation of therapy.

Mycoplasma genitalium Incidence, Coinfection, and Antibiotic Resistance: A Prospective Study at a Walk-In Clinic in Los Angeles County, CA.

Among 98 participants with penile discharge symptoms of Chlamydia trachomatis or Neisseria gonorrhoeae at a walk-in sexual health clinic, 11 were diagnosed with Mycoplasma genitalium, 10 had antibiotic resistance, and 6 were incorrectly presumptively treated. Our findings highlight the importance of public health strategies and research to curb M genitalium.

The extent of interruptions to primary care medical officers' consultations in the Western Cape.

BACKGROUND:  Administrative tasks are an increasing burden for primary care doctors globally and linked to burnout. Many tasks occur during consultations. They cause interruptions with possible effects on patients' and doctors' experiences and care. The burden and typology of interruptions of doctors in primary care consultations have not been studied in South Africa. Given the link between administrative loads and burnout, describing the extent of these interruptions would help. This study's aim was to assess the extent of interruptions on primary care doctors in the Western Cape. METHODS:  This was a descriptive cross-sectional survey. Doctors from rural and urban primary care clinics in the Western Cape answered an online self-administered survey on the types of interruptions experienced during consultations. Interruptions were categorised and their prevalence calculated. Clinical and non-clinical interruption categories were compared. RESULTS:  There were 201 consultations from 30 doctors. Most interruptions were from retrieving and recording the current patient's information (93.0%), paperwork for other patients (50.7%), and telephone calls about the current patient (41.8%). Other prevalent interruptions were for emergencies (39.8%) and acquiring consumables (37.3%). The median (interquartile range [IQR]) of four (2-4) interruption types per consultation was higher than global settings. CONCLUSION:  Doctors experienced many interruptions during consultations. Their wide range included interruptions unrelated to the current patient.Contribution: This study adds insights from the global south on clinicians' administrative burden. It elaborates on the types of activities that interrupt consultations in an upper-middle income primary care setting. Exploration of interventions to decrease this burden is suggested.

Evaluating the feasibility of a tele-diagnostic auditory brainstem response service in a rural context.

BACKGROUND:  There is a noticeable gap in access to audiology services in South Africa, and the gap is intensified in rural areas. Often, primary healthcare (PHC) facilities have an unequal ratio of audiologists to patients in need. Telehealth can expand the range of hearing healthcare services. OBJECTIVES:  This study aimed to determine whether, for infants, tele-diagnostic Auditory Brainstem Response (ABR) assessment results conducted within a mobile clinic van are comparable to face-to-face diagnostic ABR results in rural Winterveldt, Pretoria North, South Africa. METHOD:  The study utilised a quantitative, prospective cross-sectional comparative within-subject design. Each participant received both face-to-face and mobile tele-diagnostic ABR tests, which were then compared to evaluate the feasibility of mobile tele-diagnostic ABR testing. The Student's t-test was used to determine whether there was a difference between face-to-face and tele-diagnostic tests, and Bland -Altman plots were used to assess the level of agreement between the ABR testing results. RESULTS:  There was a strong correlation (p  0.001) between face-to-face and mobile tele-diagnostic ABR test results for both neurological and audiological ABR tests. The study found that there was no statistical significance between face-to-face and tele-diagnostic ABR measures; additionally, the results were within clinically acceptable and normative measures. CONCLUSION:  Tele-diagnostic ABR offered within a mobile clinic van is feasible as it produces similar and clinically acceptable results when compared to the traditional assessment method.Contribution: This feasibility study is a positive indicator that tele-diagnostic ABR testing through a mobile clinic van may be considered to accelerate the delivery of hearing healthcare services to the infant population in rural communities.

Empowerment-based Teddy Bear Clinic for Pre-school Children: A Student-led Educational Project.

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3-5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children.

A Quality Improvement Study to Identify Deterrents and Improve Voice Patient Compliance with Follow-Up.

OBJECTIVE: Evaluation and treatment for voice disorders may optimally involve multiple treatment modalities. However, even in multispecialty clinics, patients may be less likely to comply with follow-up compared to patients seen for other otolaryngologic complaints. We investigated the factors contributing to noncompliance and then implemented quality improvement metrics aimed at improving our clinical noncompliance rates. METHODS: Noncompliant patients were identified as those who had been seen in our multispecialty voice care clinic and instructed to follow-up but had not returned within 6months. Patients were telephoned for a brief survey. Surveys were completed in two rounds, pre- and post-quality improvement efforts. RESULTS: On the initial round of surveys, the most frequently cited reason for discontinuing care was financial (38.5%), some (30.8%) did not like the clinic location, and some felt follow-up would not be helpful (46.2%). The clinic location was subsequently moved outside of the downtown metropolitan area, and multidisciplinary care team approaches were implemented within this same, larger office space. A second round of surveys was then administered, wherein significantly fewer patients endorsed financial concerns as a reason for care discontinuation of care (Chi2 =8.689, P = 0.003). While fewer patients (22.6%) disliked the clinic location, this difference was not significant. A significantly greater number of patients endorsed feeling better as their reason for not following up (Chi2 =5.551, P = 0.018). CONCLUSIONS: This study reports quality improvement efforts aimed at identifying and addressing factors that contribute to voice care noncompliance. Ease of clinic access and affordability appear to be substantial factors. Optimizing clinic location, emphasizing the importance of continuity of care, and offering comprehensive approaches may improve patient adherence to voice care recommendations. LEVEL OF EVIDENCE: 2b.