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Background. Acute cerebrovascular disorders are one of the main causes of severe disability in modern society. Russian and foreign researchers register the emerging trend towards rejuvenation of the patients with stroke, which, in turn, significantly increases the relevance of the treatment and rehabilitation of these patients at various stages.The aim. To study the social and hygienic characteristics of the stroke patients and to determine their need for medical rehabilitation in the early recovery period.Materials and methods. We studied the social and hygienic characteristics of 109 patients who had stroke in 2020 and 2021 and underwent rehabilitation in the specialized rehabilitation department of the Southern District Medical Center of the Federal Medical and Biological Agency, and determined their need for medical rehabilitation using the analytical method, the method of expert assessments and questionnaires.Results. The average portrait of a patient with a stroke in the early recovery period is as follows: this is a man aged 61 to 70 years with a higher or secondary specialized education, unemployed, living in the city. Up to 30 % of stroke survivors were recognized as disabled; among which, the persons with more severe disability (groups I and II) predominate – up to 90 %. Implementation of rehabilitation measures in the acute period in the hospital and in the early recovery period in the outpatient clinic is carried out at a fairly low level. The percentage of patients being examined by a multidisciplinary rehabilitation team ranges from 17.4 to 10.1 %.Conclusion. The availability of medical rehabilitation measures in a specialized rehabilitation center is quite limited; more than half of the surveyed contingent (52.3 %) experienced problems in obtaining a referral to treatment, about half of the respondents (46.8 %) waited up to 6 months for a referral, which indicates the need to expand the network of such institutions at the regional level.

Aims: Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors. Methods: This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE. Results: In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p

In hospitalized COVID-19 patients, myocardial injury and echocardiographic abnormalities have been described. The present study investigates cardiac function in COVID-19 patients 6 weeks post-discharge and evaluates its relation to New York Heart Association (NYHA) class. Furthermore cardiac function post-discharge between the first and second wave COVID-19 patients was compared. We evaluated 146 patients at the outpatient clinic of the Leiden University Medical Centre. NYHA class of II or higher was reported by 53% of patients. Transthoracic echocardiography was used to assess cardiac function. Overall, in 27% of patients reduced left ventricular (LV) ejection fraction was observed and in 29% of patients LV global longitudinal strain was impaired (> − 16%). However no differences were observed in these parameters reflecting LV function between the first and second wave patients. Right ventricular (RV) dysfunction as assessed by tricuspid annular systolic planar excursion (< 17 mm) was present in 14% of patients, this was also not different between the first and second wave patients (15% vs. 12%; p = 0.63); similar results were found for RV fraction area change and RV strain. Reduced LV and RV function were not associated with NYHA class. In COVID-19 patients at 6 weeks post-discharge, mild abnormalities in cardiac function were found. However these were not related to NYHA class and there was no difference in cardiac function between the first and second wave patients. Long term symptoms post-COVID might therefore not be explained by mildly abnormal cardiac function. [ABSTRACT FROM AUTHOR]

This study aimed to guide the efforts to improve the efficiency of healthcare by revealing the demographic data and disease profile of patients applying to a state hospital which was the only secondary healthcare institution in aregion, and which had only one orthopedic specialist. The study included the patients who applied to the Orthopedics and Traumatology outpatient clinic of the state hospital in Kestel District Town of Bursa Province in Turkey in the 1 March 2019-29 February 2020 period. The ages, genders, complaints, diagnoses, involved body partsof the patients admitted during this period as well as treatment modalities used were given in tables and figures. A total of 13,397 patients who applied to the Orthopedics and Traumatology Department with various complaints were included in the present study. Of all patients, 4,469 were men (33.3%) and 8,928 were women (66.6%). It was revealed that 4,984 patients (37.2%) applied to a primary healthcare institution first for theircurrent complaints whereas 8,413 patients (62.8%) used the Orthopedics and Traumatology Outpatient Clinic as a primary healthcare center. The most common complaint to apply the outpatient clinic involved knee (39%) followed by foot-ankle (16%) and hand-wrist (12%). The most common diagnoses made for the patients who applied during the study period were arthritis (30%), tendinopathy/enthesopathy (16.6%), and soft tissue injuries (15.7%). Primary healthcare examinations were requested for most patients, and only a small percentage of patients needed secondary healthcare examinations. A high percentage of patients were treated in our secondary healthcare center and very few of the patients were referred to tertiary healthcare institutions. There is a considerable patient density in health institutions in Turkey. Especially orthopedic physicians in secondary healthcare institutions have a high number and variety of patients. There is a need to improve health policies in this regard. [Med-Science 2020; 9(4.000): 935-8]

Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients.In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped. Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status. Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P

Purpose: Outpatient palliative care clinics are essential for early symptom management in patients with advanced cancer. Few outpatient programs are available in the Middle East. In this prospective study, we examined the symptom changes among cancer patients seen at a palliative care clinic in Jordan.Methods: Patients with advanced cancer who had an outpatient palliative care consultation and not delirious were enrolled. The Edmonton Symptom Assessment System (ESAS), Karnofsky Performance Scale (KPS), and Memorial Delirium Assessment Scale (MDAS) were collected at consultation and follow up visit 14-34 days later. We compared symptom changes using paired t test.Results: Among the 182 enrolled patients, the average age was 53 years, 47 % were females, and 95 % had stage IV cancer. The median duration between the two clinic visits was 21 days (interquartile range 15-28). KPS decreased between visits (mean 68 vs. 66 %, P = 0.004). ESAS pain (5.9 vs. 5.1, P = 0.004) and sleep (4.6 vs. 4.1, P = 0.007) improved significantly over time. The remaining ESAS symptoms decreased in intensity, albeit not statistically significant. Among patients who presented with moderate to severe symptom intensity, pain (7 vs. 6, P < 0.0001), fatigue (7 vs. 6, P = 0.003), nausea (7 vs. 4, P < 0.0001), depression (7 vs. 5, P = 0.0008), anxiety (7 vs. 5, P < 0.0001), drowsiness (6 vs. 5, P < 0.001), appetite (7 vs. 6, P = 0.0007), well-being (7 vs. 6, P < 0.0001), dyspnea (6 vs. 5, P = 0.0006), and sleep (7 vs. 5, P < 0.0001) all improved significantly.Conclusions: Our outpatient palliative care consultation was associated with improvement in ESAS, particularly for patients who presented with moderate to severe symptoms. Further studies are needed to examine predictors of symptom response, longer term outcomes, and how to improve access to outpatient palliative care in the Middle East. [ABSTRACT FROM AUTHOR]

Aims: Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors., Methods: This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE., Results: In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p  < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks., Conclusion: The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated., Competing Interests: There is no conflict of interest for the present manuscript., (© 2023 The Authors.)

Background Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria. Methods This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding. Results Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months. Conclusion Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI initiatives be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Background Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open-access returning traveller clinic. Methods Data were prospectively recorded for all patients attending the open-access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point-of-care test ( POCT) (phase 2). Results A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 ( P < 0.0001). Two new diagnoses of HIV-1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT. Conclusions A nurse-delivered universal point-of-care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low-prevalence country. Caution is required in communicating reactive results in low-prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this research was to compare the Strengths and Difficulties Questionnaire (SDQ) scores and subscale scores in children with high-functioning autism spectrum disorder (HFASD) and attention-deficit/hyperactivity disorder (AD/HD), and also to clarify the differences between parent- and teacher-assessed SDQ scores/subscores in HFASD and AD/HD children. These patients’ total difficulties scores were significantly high compared to the community sample. In the parent rating, HFASD children had significantly higher scores in the subscales of emotional symptoms and peer problems. In the teacher rating, AD/HD children showed significantly higher scores in the subscales of hyperactivity/inattention and conduct problems, whereas peer problems were significantly higher in HFASD. The teacher rating showed significantly greater difficulties than the parent rating on the subscale of prosocial behavior in both the AD/HD and HFASD groups. These results suggest that each subscale may reflect behavioral, emotional, and social characteristics of HFASD and AD/HD. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a highly prevalent problem among women. Our aim was to investigate the prevalence of IPV among patients of an out-patient clinic obstetrics–gynecology, association with level of education, and women's opinion on asking about IPV by physicians. We conducted a survey among women between 18 and 60 years in a waiting room of an out-patient clinic obstetrics–gynecology. We used the Composite Abuse Scale to measure type and severity of IPV. Two hundred women of whom 82 (41%) were pregnant, were included in the study (response 57%). Twenty-three percent of the women ever experienced IPV and 9% currently. IPV is more prevalent among women with a lower educated partner. Four of the pregnant women (5%) experienced current IPV. Seventy-eight percent of the respondents find it important for physicians to ask about IPV. IPV proved to be a highly prevalent problem in an out-patient clinic obstetrics–gynecology with almost one-quarter of the patients ever having been victim of various forms of IPV, and almost one in 10 currently. Awareness of the possibility of IPV and early recognition by physicians might reduce mental and physical sequels and strengthen women's feeling of being supported. [ABSTRACT FROM AUTHOR]

Studies regarding the caring relationship in out-patient clinics are few. The aim was to illuminate the caring relationship's appearance in encounters between patients with long-term illness and nurses in an out-patient clinic, and their experiences of this phenomenon. An interpretive phenomenological method was used; data were collected using participant observation and interviews, which were then interpreted. The findings illuminate the caring relationship's appearance in encounters, as well as patients' and nurses' experiences. Findings are understood as balancing between vulnerability and dignity, which reflects opportunities for realizing a holistic view in decreasing vulnerability and maintaining dignity. [ABSTRACT FROM AUTHOR]

Objective: To describe the demographic and clinical characteristics of consecutive referrals to an out-patient liaison psychiatry clinic in a large university hospital in the UK. Method: We studied 900 patients using a standardized proforma. Assessments of functional capacity were made using the Global Assessment of Functioning (GAF) scale, and each patient was assigned a psychiatric diagnosis using ICD-10 criteria. Results: Four of five of all referrals presented with somatic complaints, and 41% had a concurrent physical illness. The most common psychiatric diagnoses were somatoform disorders (55%) and neurasthenia (11%). Although more than half (59%) had no previous psychiatric history, a surprisingly high number (35%) had significant functional impairment (scores of < 50 on the GAF scale). The lack of adequate psychological treatment services often provided a barrier to optimal management of some of the more disabled patients. Conclusion: The general hospital liaison psychiatry clinic provides an acceptable setting in which to assess and manage patients referred from non-psychiatric colleagues. [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the benefit and inconvenience to cancer patients of receiving a copy of the medical record following a visit to the out-patient clinic of the Department of Oncology, University Hospital of Tromsø, Norway. Between January and December 1998, after their attendance at the clinic a printout of the record made after the consultation was mailed to each of 199 patients seen by the same medical oncologist. A 15-item questionnaire was later mailed to 178 survivors in March 1999. The questionnaire had items on the use made of the copy report, side effects it might have occasioned, such as anxiety, worries and fear, and patients' general opinion of this procedure. There were 119 responders (67%), and 93 acknowledged receipt of the record. Most (96%) replied that the report had been beneficial; 78% had shown it to family members or friends; and 27% had shown it to other doctors. Only 9% had taken it with them when travelling. Such side effects as anxiety and worries were mentioned by only a few patients. Some 20% (mostly men) stated that medical terms had caused difficulties. Most patients in the study group (93%) recommended that the study practice should be introduced as standard procedure. Patients who considered receipt of the copy report of little value experienced the highest level of anxiety. In conclusion, cancer patients should be offered a copy of the medical record following an out-patient visit. [ABSTRACT FROM AUTHOR]

Objective To determine the most efficient method to follow patients after transurethral prostatectomy (TURP) such that only those patients suffering significant post-operative problems are reviewed. Patients and methods The study comprised two parts: (1) a retrospective review of the case notes of 100 consecutive patients who underwent TURP under one consultant to determine whether any factors could be identified pre- or post-operatively by which those patients most likely to require clinic review could be selected and; (2) a prospective review of the succeeding 100 patients undergoing TURP, using a telephone 'screening' call made by the urological research nurse 3 months after the operation. Patients who requested follow-up and those patients with malignancy or admitted in high-pressure chronic retention were reviewed in the out-patient department. Results In the first part, 17 patients (17%) required an out-patient review for malignancy. Only nine patients (11%) with benign histology required further treatment after TURP; this subgroup could not be identified on the basis of their pre- or post-operative symptoms. In the second part, 23 patients were not reviewed by telephone; 14 had carcinoma of the prostate, eight had no telephone and one could not be contacted after seven attempts. Of the remaining 77 contacted by 'phone, 61 (79%) declined further clinic review and 16 (21%) requested follow-up for persistent problems. A mean of two calls was made per patient and the mean duration of each call was 6.3 min. Conclusions Based on pre- or post-operative symptoms at the time of discharge, there is no reliable method of identifying those patients who have a poor result after TURP. Telephone screening of patients at 3 months identified successfully those patients who required an out-patient review and enabled resources to be targeted towards this difficult group of patients. [ABSTRACT FROM AUTHOR]

Background Incentive spirometry (IS) is the mainstay of care in postoperative patients that has been heavily studied in the inpatient setting. Studies have shown that the utilization of IS improves lung volumes and reduces the rate of pneumonia in post-surgical patients. However, the literature is ambiguous on its benefit as many studies also demonstrate no significant benefit, especially in comparison to early ambulation. Our study sought to determine whether a consistent IS regimen can improve lung function in an outpatient setting. Methods This prospective cohort study included patients in a physical medicine and rehabilitation clinic setting during the COVID pandemic. Patients with severe respiratory disease, baseline cough, those unable to perform deep breathing, fever greater than 100.4 F due to non-pulmonary on initial evaluation, or inability to fill out the forms and complete the study were excluded. Each participant was given the IS along with hands-on instruction on how to use the device and accurately record measurements. Patients were asked to lie down and inhale and exhale through the tube ten times. They were asked to mark the highest volume during their 10 breaths. Patients were instructed to complete this exercise three times a day for 30 days. Patients were also asked to perform light exercises or walking for 20 minutes per day three times a week and postural drainage. Patients were instructed to call their primary care physician if a 20% or more decrease from their baseline was noted or if they experienced any new coughs, fever, or shortness of breath during the 30 days of exercise. Results A total of 48 patients enrolled in the study with a (median) age of 58.0 years (SD 10.2 years), 21 females and 27 males. Baseline maximal inspiration for study participants was 1885.4 mL prior to exercise, with a subsequent increase in lung capacity observed for all participants enrolled in the study. At the end of the study period, week four, the average maximal inspiratory volume was 2235.4 mL. Paired t-test showed a significant difference between baseline (1885.4) and maximum (2235.4) volumes (t=-4.59, p<0.0001). Analysis of variance (ANOVA) showed no significant difference among Week 1-4 averages (F=1.08, p=0.36). None of the participants reported any symptoms (fever, coughing, shortness of breath) or COVID-19 infection during the 30-days period. None of the participants reported contacting primary care physicians.  Conclusion When prescribed daily breathing exercises with an incentive spirometer, study participants experienced a 16% increase in maximal inspiratory volume over a span of 30 days and did not need to contact their primary care physician during the study period., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Toor et al.)

Background: Short-term follow-up of COVID-19 patients reveals pulmonary dysfunction, myocardial damage and severe psychological distress. Little is known of the burden of these sequelae, and there are no clear recommendations for follow-up of COVID-19 patients.In this multi-disciplinary evaluation, cardiopulmonary function and psychological impairment after hospitalization for COVID-19 are mapped., Methods: We evaluated patients at our outpatient clinic 6 weeks after discharge. Cardiopulmonary function was measured by echocardiography, 24-hours ECG monitoring and pulmonary function testing. Psychological adjustment was measured using questionnaires and semi-structured clinical interviews. A comparison was made between patients admitted to the general ward and Intensive care unit (ICU), and between patients with a high versus low functional status., Findings: Eighty-one patients were included of whom 34 (41%) had been admitted to the ICU. New York Heart Association class II-III was present in 62% of the patients. Left ventricular function was normal in 78% of patients. ICU patients had a lower diffusion capacity (mean difference 12,5% P  = 0.01), lower forced expiratory volume in one second and forced vital capacity (mean difference 14.9%; P <0.001; 15.4%; P <0.001; respectively). Risk of depression, anxiety and PTSD were 17%, 5% and 10% respectively and similar for both ICU and non-ICU patients., Interpretation: Overall, most patients suffered from functional limitations. Dyspnea on exertion was most frequently reported, possibly related to decreased DLCOc. This could be caused by pulmonary fibrosis, which should be investigated in long-term follow-up. In addition, mechanical ventilation, deconditioning, or pulmonary embolism may play an important role., Competing Interests: There is no conflict of interest for the present manuscript., (© 2021 The Author(s).)

The out-patient renal clinic (ORC) represents an important part of the nephrology service in general hospitals. The majority of renal diseases are chronic and patients need a systematic follow-up according to the severity and progression of kidney failure. The most important clinical manifestation is chronic renal failure (CRF) or chronic renal disease (CKD) The management of CKD, apart from medical and nursing services, also involves a number of community structures and financial resources. CRF treatment is costly and is a serious problem for the health systems in the western world. Effective treatment in the early stages aims to decrease the progression of kidney damage and, therefore, to prolong kidney function. Patients with renal failure can be managed as out-patients. The increased number of patients and the complexity of kidney diseases demand the collaboration of other out-patient clinics. The ORC may play an important role in this process. In this article. we present a literature review of the role of ORCs in the management of renal diseases around the world and we also present data based on our experience in our ORC.