Journal of Family Medicine and Primary Care最新文献

Background: Psychiatric social workers typically play an important role in the treatment and management of psychosocial issues at different levels, such as individual, family, and community levels. However, despite the field having a long history, there are significantly fewer standardized guidelines for interventions in mental health settings.

Methodology: This study aims to develop guidelines for psychiatric social work interventions in mental health settings. Psychiatric social workers with a degree of M.Phil. in Psychiatric Social Work, 2 years of working experience, and working in mental health settings were selected for this study. Using purposive sampling, 15 psychiatric social workers were selected for this study and were interviewed using a semi-structured interview schedule. The data were analyzed using the qualitative method of content analysis.

Results: There is a high level of satisfaction rate among psychiatric social workers about their work and profession, however, they face challenges because of non-clarity of roles and responsibilities, lack of theories, and difficulties in implementing theories into practice. More training, discussion, supervision, and exposure to different cases help improve the interventions' quality.

Conclusion: Although psychiatric social work interventions are effective in addressing the treatment gap by providing curative, preventive, promotive, and rehabilitative services, there is no uniformity in the interventions, which in turn, explains the need for standardized guidelines for intervention. The study explains the guidelines for psychiatric social work interventions at the community, group, family, and individual levels.

Background: Effective communication between patients and healthcare providers is essential for optimal care outcomes, particularly in the field of ear, nose, and throat (ENT) medicine. Our study aimed to explore patient-centered communication approaches in the context of ENT advancements to bridge the knowledge gap between healthcare providers and patients.

Methods: A mixed-methods approach was employed, including quantitative surveys, qualitative interviews, and medical record reviews for this cross-sectional observational study. A total of 120 patients and 40 ENT clinicians were included in the study, with data collected over a 1-year period. Demographic characteristics, patient understanding, satisfaction with communication, preferences for receiving information, and themes identified from qualitative interviews were analyzed.

Results: The study revealed high levels of patient understanding and satisfaction with communication from ENT providers. Verbal communication was the most preferred method for receiving information, followed by written materials and online resources. Qualitative interviews identified themes emphasizing the importance of clear communication, desire for shared decision-making, and the need for accessible information. The survey among 40 ENT practitioners reveals that 25% utilize multimedia platforms frequently, 50% occasionally, 20% rarely, and 5% never.

Conclusion: In conclusion, the findings of this study highlight the importance of patient-centered communication in enhancing patient understanding, satisfaction, and engagement in ENT healthcare speciality. By prioritizing clear communication, shared decision-making, and accessible information, healthcare providers can influence patients to play an active role in their care and improve healthcare outcomes.

Objective: This study aimed to compare the quality-adjusted life years (QALYs) of patients with gastrointestinal (GI) cancer after receiving palliative and supportive care.

Materials and methods: Conducted at Firoozgar Hospital in Tehran, Iran, this observational study included 500 end-stage gastrointestinal cancer patients. The study divided these patients into two groups: 250 utilized palliative medicine services, while the remaining 250 did not. The study compared the conditions of patients in both groups.

Results: Among those receiving palliative care, only 21% underwent chemotherapy, significantly lower than the 55% in the non-palliative care group (P < 0.001). Hospital mortality rates were considerably reduced in the palliative care group, with 115 patients (46%) compared to 200 patients (80%) in the non-palliative group (P < 0.001). The average hospital stay for patients receiving palliative care was 25.11 ± 5.12 days, significantly shorter than the 96.42 ± 14.15 days in the non-palliative group (P < 0.001). The EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire scores showed that patients in the palliative care group experienced significantly better outcomes in pain and mood symptoms, but no significant difference was observed in physical function compared to the non-palliative group.

Conclusion: Palliative medicine is recommended for gastrointestinal cancer patients as it can significantly reduce unnecessary hospital referrals and length of hospitalization.

Background and aim: Haemolysis due to dapsone as a part of MDT in leprosy patients has been long recognized. However, the frequency and severity of this side effect and factors associated with it have not been well documented. We planned to determine the frequency of dapsone-induced haemolysis in leprosy patients on MDT and various risk factors associated with it.

Materials and methods: This was a hospital-based retrospective analysis, conducted on 36 treatment completed or partially treated or on treatment leprosy patients in a tertiary care centre in Chhattisgarh.

Results: Out of 36 patients, 83.3% showed a fall in haemoglobin from the baseline value (pre-treatment values). Dapsone was stopped in 33.3% of patients with a significant fall in haemoglobin. We found that the mean haemoglobin concentration for all patients fell from 13.05(+/-1.8) g/dl to 11.8(+/-1.9) g/dl (P < 0.05) which was statistically significant. A total of 25% of patients were labelled as confirmed cases of dapsone-induced haemolysis as per our definition.

Conclusion: Our results underline the need to incorporate haematological investigations in leprosy management protocol, especially in primary care settings where the majority of leprosy patients are managed.

The proportion of young individuals that present with acute myocardial infarction is a major problem that keeps increasing. The specific characteristics of premature coronary artery disease and its differences between young and older individuals need to be elucidated. Although risk factors are similar in different age categories, there is a great difference in their prevalence. The vast majority of young patients are males and there is a higher prevalence of cigarette smoking, family history of premature coronary artery disease, lipid disorders, and illicit drug use, while the prevalence of hypertension and diabetes mellitus is lower. Young individuals with acute coronary syndrome usually present either with ST-segment elevation or non-ST-segment elevation myocardial infarction. It is not unusual for young patients to present with atypical symptoms to the office of primary care physicians, leading occasionally to incorrect or delayed diagnosis. Therefore, prompt and correct diagnosis is necessary to implement the specific management as quickly as possible. A literature research of studies was conducted for the last 10 years, regarding the risk factors and prevention of premature myocardial infarction. As databases, we used PubMed and peer reviewed journals. The aim of this review is to raise awareness among family medicine and primary care physicians, regarding the clinical presentation of young patients with acute myocardial infarction, to provide optimal medical attention.

Background: The attitude of nursing students towards their profession is one of the important factors that have many effects on students and their professional future. A positive attitude leads to academic progress, and in the future, nurses with professional commitment will enter the labour market, and on the contrary, a negative attitude can lead to withdrawal from education and job burnout. The aim of the present study was to investigate factors affecting the formation of negative attitudes in undergraduate nursing students towards their profession.

Methodology: This study was conducted with a qualitative research method and with a content analysis approach in 1400 in nursing and midwifery schools in Tehran. In order to collect data, 21 people were selected by purposeful sampling and semi-structured interviews were conducted with them. The interviews were recorded and transcribed on paper and analysed.

Findings: Information in 4 main categories and 11 sub-categories, including defects in the structure of the organisation (including the sub-categories of discrimination, job problems, financial problems, defective organisational management, unfavourable professional communication), inefficient educational system (including the sub-category of defects in clinical education and educational supervision), individual factors (including the sub-classes of lack of interest and low self-esteem), and community beliefs (including the sub-classes of low social value and ignorant society), was included.

Conclusion: Various reasons are involved in the formation of a negative attitude towards the nursing profession, and in most cases, these factors are related to the problems of the profession and the educational problems of the profession, which can be solved by adjusting some factors and paying more attention to the profession from upstream organisations. It has raised the nursing profession and improved the conditions of nurses, and in the future, the attitude towards the nursing profession will be improved and can lead to the improvement of the health of the society.

Background: An aging population ultimately has deprived physiological stores making them vulnerable for development of a syndrome called frailty, which presents with a cumulative decrease in tolerance, immunity, vision, balance, organ functions, health, and independent living. All these result in rising prevalence of frailty and its components, along with burden of disease, dependence, and health care cost. Thus, early estimation and assessment and interventions to correct it mark the mile stone in geriatric medicine. The present study was conducted with an aim to compare and correlate FIRE-MADE (Frailty Index in Rural Elderly - Mental status, Activities of daily living, Depression, and Events) FI (frailty index) with LASA (Longitudinal Aging Study Amsterdam) FI in central rural India's geriatric population.

Methodology: A cross-sectional study for assessment of frailty in the geriatric population of central rural India, reporting to the medicine department of a tertiary hospital, situated at Wardha district, by using FIRE-MADE and LASA FI was undertaken. Their scores were compared. The efficiency of FIRE-MADE FI in comparison with LASA FI was calculated. A frailty threshold of ≥ 0.25 is considered for diagnosing frailty. Standard descriptive and inferential statistics were used to evaluate all parametric and non-parametric data.

Results: Out of 250 geriatric people, 224 (89.6%) were frail according to LASA FI and 204 (81.6%) were frail according to FIRE-MADE FI. As compared to LASA FI, FIRE-MADE FI was 91.07% sensitive and 73.08% specific, with a positive predictive value of 96.68% and a diagnostic accuracy of 89.20%.

Conclusion: The Indian rural population of central India has high prevalence of frailty. FIRE-MADE FI can be used as a potential, effective, and validated tool for early diagnosing and management of frailty. Among the parameters of FIRE-MADE FI, IHD was the most important contributing factor for development of frailty, followed by cognitive impairment, polypharmacy, and remaining factors mentioned in FIRE-MADE FI.

Background: Different clinical manifestations were revealed by the distinct waves of the coronavirus. The pandemic had a multifaceted impact on mental health, sleep patterns, and associated fear.

Materials and methods: It was an observational online survey using by using Google Forms in the city of Chandigarh between April 2020 and April 2021 across three waves of the coronavirus outbreak (first wave from March 2020 to May 2020, second wave from June 2020 to January 2021, and third wave from February 2021 to April 2021). Fear of coronavirus disease (COVID), preventive behaviors, insomnia-related problems, and impact of the event were assessed by using standardized scales.

Results: The participants who were infected during the first phase exhibited significantly higher levels of distress, loss of control over their reactions, increased fear of coronavirus and sleep problems, and also greater adherence to preventive behaviors compared to those who were infected during the second and third waves. A tendency to emerge post-traumatic stress disorder (PTSD) was seen in 68 (58.1%) of the participants (Peritraumatic Distress Inventory (PDI) score >14) and 34 (29.1%) of all the participants (PDI score >23). Overall, 66 (56.4%) participants reported having insomnia. About 24 people (20.5%) had clinical concerns about PTSD, 20 people (17.1%) had probable PTSD diagnoses, and 16 people (13.7%) experienced a severe coronavirus disease 2019 (COVID-19) pandemic impact on their lives.

Conclusion: The first wave of COVID-19 had a greater psychological impact than subsequent waves. Further research must fill important gaps in our knowledge of the clinical range and long-term effects.

Informal care, provided unpaid by family members or friends is a crucial source for providing care at home due to chronic illnesses, disability, or long-lasting health issues. An increasing burden on informal carers largely determines the already proven negative mental and physical health effects. General practitioners are usually responsible for recognizing the effects of persistent burdens on informal carers at an early stage to maintain a functional caring relationship by providing individual support. A scoping review was conducted in four databases (PubMed, LIVIVO, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) until July 31, 2023, to identify studies describing the actual use of tools to identify informal care and measure the burden due to informal care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed to select studies. A total of 5.686 references were identified, and 59 potentially eligible articles were assessed for inclusion, resulting in the inclusion of five studies published between 2009 and 2019. Instruments were primarily used to measure burden after an intervention; only one study focused on instruments to identify carers in general practice. This review highlights the need for a tool to identify informal carers in general practice, but it is important to consider practice-specific processes and settings. Future research should take a proactive approach to testing, modifying, and implementing an assessment and optimizing framework conditions. A follow-up project should be initiated to evaluate the effectiveness of an adapted identification tool on the burden and health of family carers.