International journal of clinical practice
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Int. J. Clin. Pract. · Sep 2021
Inadequate post-partum screening for type 2 diabetes in women with previous gestation diabetes mellitus: a retrospective audit of practice over 17 years.
Women with gestational diabetes (GDM) are at greatly increased risk of type 2 diabetes (T2DM). The UK guidance recommends screening for T2DM at around 6-week postpartum and annually thereafter. We evaluated conformity to this guidance in two separate time periods. ⋯ Despite high profile guidelines and a clear clinical rationale to screen women with a past diagnosis of GDM, many women did not receive adequate screening for T2DM both in the short term and long term. This suggests that alternative approaches are needed to ensure effective follow-up of this high-risk group. To have an impact, interventions need to be tailored to a young, generally healthy group in which traditional approaches to follow-up may not be best suited.
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Int. J. Clin. Pract. · Sep 2021
Patient-centered digital healthcare for patients undergoing breast surgery - A cross-sectional questionnaire study.
The potential of digital health services has become apparent in recent years, more so now following the coronavirus disease outbreak. However, despite majority of UK population integrating digital-based platforms into their everyday life, there is low engagement with NHS digital services, citing lack of patient-centered approaches to the design of such services. As such, this cross-sectional questionnaire aims to understand the patient perspective pertaining the utility of web-based information in aiding their breast cancer pathway at a large volume tertiary breast institute. ⋯ Patients welcome the breast services' website, but we need to improve awareness of this resource and include more holistic information, relating not only to their diagnosis and treatment but also to practical/support services they can access to make their patient journey smoother.
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Int. J. Clin. Pract. · Sep 2021
Advanced counseling using training device and smartphone application on inhalation technique from metered-dose inhaler with spacer equipped with different interfaces in asthmatic children.
Spacers are equipped with either facemask or mouthpiece as an interface through which patient inhale their dose. The present study aimed to evaluate the effect of advanced counselling using training devices and smartphone applications on inhalation techniques from the metered-dose inhaler (MDI) with a spacer equipped with different interfaces. ⋯ The Flo-Tone with its positive reinforcement whistle and the Trainhaler smartphone application significantly improved the inhalation technique by decreasing the total number of mistakes especially in important steps eg, shaking MDI, maintaining slow inhalation rate, breath-holding after inhalation and appropriate facemask fitting. Also, they increased the duration of inhalation of asthmatic children from MDI with a spacer. Both spacer interfaces are easy to handle once taught well.
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Int. J. Clin. Pract. · Sep 2021
Importance of Emergency Department Waiting Period in Fournier's Gangrene; 10 Years of Experience.
Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED. ⋯ FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be.
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Int. J. Clin. Pract. · Sep 2021
Comparing cost of intravenous infusion and subcutaneous biologics in COVID-19 pandemic care pathways for Rheumatoid Arthritis and Inflammatory Bowel Disease - A brief UK stakeholder survey.
One important group of people at higher risk from the SARS-CoV-2(COVID-19) pandemic are those with autoimmune conditions including rheumatoid arthritis/inflammatory bowel disease. To minimise infection risk, many people have been switched from intravenous to subcutaneous biologics including biosimilars. ⋯ Switching from infusion to subcutaneous routes is currently driven by the COVID-19 pandemic in many services. A case for biologics (infusion vs subcutaneous) must be made on accurate real-world economic analysis. In an analysis of direct/indirect costs, excluding medicine acquisition costs, subcutaneous administration appears to be the more cost saving option for many patients even without the benefit of industry funded home-care. What's known One important group of people at high risk in COVID-19 pandemic are those with autoimmune conditions, including those with rheumatoid arthritis and inflammatory bowel disease. Depending on the complexity of their condition, some of the patients in this group may be receiving intravenous biologic infusion therapy which under normal circumstances is administered within a hospital or day hospital setting. The National Institute for Health and Care Excellence has published new guidance to ensure that patients having intravenous treatment are assessed for possible switching to the same treatment in subcutaneous form. What's new A cost analysis showed that administration costs for subcutananous routes are 50% lower than for infusion routes, with most patients administering subcutaneous medicines themselves. Other indirect benefits to this route included less pressure on infusion unit waiting times and reduced risk of COVID-19 infection, along with reduced patient costs. Cost savings were partly offset by increased pressure on home-care and community/primary care services.