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Objectives In clinical reasoning, clinicians need to switch between automatic and effortful reasoning to solve both routine and non‐routine problems. This requires the ability to recognise when a problem is non‐routine and adapt one's reasoning mode accordingly, that is to ‘slow down’ the reasoning process. In the current study, we explored the process of these transitions between automatic and effortful reasoning by radiologists who performed ultrasound examinations during consultations at the polyclinic. Methods Manifestations of slowing down in clinical reasoning were explored in 41 out‐patient consultations performed by five radiologists. Interviews before and after the consultations were combined with observations during the consultations to obtain proactively planned triggers, slowing down manifestations and situationally responsive initiators. Transcripts of the interviews and field notes of the observations were coded. The constant comparative method was used to classify slowing down manifestations. Results In thirteen of the 41 consultations, slowing down moments were observed. Four manifestations of slowing down were identified: shifting, checking, searching and focusing. These manifestations mainly differed in how long radiologists maintained effortful reasoning, varying from very short periods (shifting and checking) to sustained periods (searching and focusing). Unexpected patient statements and ambiguous ultrasound images initiated the slowing down moments. Discussion The results from this study contribute to understanding how clinicians transition from automatic to effortful reasoning. Also, this study revealed two sources of initiators of this transition in radiologists’ consultations: statements made by the patient and conflicting or ambiguous visual information, in this case from ultrasound images. Natural variations in patient statements and visual information can be used as input of what might be meaningful variation in the domain of radiology education to support expertise development., In this paper, Groenier et al. demonstrate how radiologists transition from near‐automatic to effortful reasoning to illustrate how clinicians 'slow down' the reasoning process.

Introduction: Non-adherence medication is found among patients with pulmonary tuberculosis. Various factors influence patient adherence to medication. The purpose of this study was to analyze the relationship between family health tasks to medication adherence among patients with pulmonary tuberculosis. Methods: The design of this study was cross-sectional, with 45 sample size of pulmonary tuberculosis patients at Polyclinic of Pulmonary Disease in Haji General Hospital Surabaya taken by using a purposive sampling technique. Independent variables of this study were family health task which includes five dimensions, recognizing the family member health problem, making decisions for appropriate treatment measures, caring for sick family members, modifying the healthy environment and utilizing the healthcare facilities. The dependent variable was medication adherence. Data were taken using the questionnaires then analyzed by Spearman rho test. Results: There was a relation between tasks of family health: recognizing the family member health problem (p=0.001), taking decisions for appropriate treatment measures (p=0.000), caring for sick family members (p=0.003), modifying the healthy environment (p=0.006), and utilizing the healthcare facilities (p=0.001) with medication adherence in patients with pulmonary tuberculosis. Conclusion: The research of this study suggests the hospital arrange health education for the family and the patient to increase the quality of health services. The family can provide a conducive environment for the patient and further research can develop better research by using other methods such as direct observation, demonstration, and simulation.

Background: Dentistry continues to evolve with the development of restorative materials. Patient satisfaction is an increasingly significant issue in dental practice; therefore, knowledge of the level of patient satisfaction with restorative materials is important. Objectives: The objective was to assess patient satisfaction with composite and amalgam restorations carried out by International Islamic University Malaysia (IIUM) dental students and the criteria that influence satisfaction. Methods: This cross-sectional study involved 42 patients treated by year 4 and 5 dental students of the Kulliyyah of Dentistry, IIUM. Sampling was conducted using a single proportion formula, and patients were reviewed 2 weeks following placement of amalgam and composite restorations. Satisfaction was assessed using a self-administered five-point Likert scale questionnaire previously validated by a pilot study involving ten patients. Data were analyzed using independent sample t-tests and the Chi-square tests. Results: Patients were more satisfied with composite restorations than with amalgam restorations in terms of color and esthetics (P < 0.001). Other criteria, such as operator skills, treatment procedures, and external factors, had no significant effect on patient satisfaction with the restoration (P > 0.05). Overall, patient satisfaction with amalgam (81.0%) and composite restoration (88.1%) did not differ when restorations were placed by IIUM dental students. Conclusion: Most patients were satisfied with the amalgam and composite restorations placed by IIUM dental students. The color and esthetic value were the major criteria affecting patient satisfaction. Treatment procedures, operator skills, and external factors did not significantly influence patient satisfaction. Hence, in terms of satisfaction, amalgam remains a reliable material for use in restorative dentistry.

Introduction: Schizophrenia is a chronic mental illness with symptoms of hallucinations, delusions and inappropriate behavior. Patients require long-term treatment, but many do not adhere to treatment. The purpose of the study was to determine whether there was a relationship between family roles and adherence to medication for schizophrenic patients. Methods: The research design used correlation with a cross-sectional approach. The population of this study was 60 families with schizophrenia who visited the mental polyclinic of Ibnu Sina Hospital on 7-13 July 2019. The sampling technique used accidental sampling with a total sample of 52 respondents. Collecting data on family roles based on Friedman's theory and medication adherence using the Morisky Medication Adherence Scale. The research test used the Spearman rank test SPSS. Ethical Approval by Faculty of Nursing Universitas Airlangga number 1601-KEPK, July 17, 2019. Results: The results of this study showed that the role of the good family was 53.8% and the role of the less family was 46.2%. The medium level of adherence to taking medication was 42.3% and less level of adherence to taking medication was 32.7%. The results of the Spearman test are rho count 0.403 > rho table 0.271, which means that there is a significant relationship. Conclusion: The role of the family is related to medication adherence for schizophrenic patients.

Objetivo: Compreender a relação de saúde-doença-cuidado de uma pessoa com câncer atendida em um hospital de referência para a macro região de saúde de Sobral a partir da reconstituição do seu itinerário terapêutico à luz do referencial teórico de Arthur Kleinman. Métodos: Estudo exploratório descritivo, com abordagem qualitativa, do tipo estudo de caso com reprodução do itinerário terapêutico de um usuário com câncer atendido em um hospital de referência para a macro região de saúde de Sobral - Ceará. Realizado no período de janeiro de 2021. A coleta das informações foram norteadas por um Formulário com informações Sociodemográficas Clínicas do sujeito, a História de Vida Focal operacionalizada pela entrevista em profundidade. A análise das entrevistas gravadas e transcritas ao longo dos 3 encontros norteada à luz da Análise de Conteúdo Temática. Resultados: Destacou-se ao longo do itinerário buscas recorrentes a serviços públicos e privados para identificação do diagnóstico do câncer. O tratamento teve início tardiamente, repercutindo em sofrimento psíquico no participante, bem como a sua familiar. A rede de apoio acessada foi composta pelos serviços de saúde formais representada pelo posto de saúde, policlínica, clínicas particulares, hospital de referência da região em câncer e Serviço de Atendimento Móvel de Urgência. Quanto ao suporte informal foi composto apenas pela forte relação com a companheira, e alguns familiares. Considerações finais: Ao longo das trajetórias evidenciou-se diversos fatores que atravessaram o processo de cuidado, desde as dificuldades enfrentadas na busca pelo diagnóstico até a garantia de alguns cuidados ao longo do tratamento.

The aim of this cross-sectional pilot survey was to assess patients’ perception and acceptance of a tele(oral)medicine program during the COVID-19 pandemic. We conducted a telephone survey on 84 patients of MoMax ambulatory at the Department of Oral Sciences and Maxillofacial Surgery at “Sapienza” University of Rome, Polyclinic Umberto I. Demographic characteristics of the patients were recorded, and a 24 question-survey was completed. A Chi-square test and an ANOVA test were performed with a significance level of 5% to determine the association between two target questions of the survey (Q22 and Q23) and specific variables such as computer skills, conditions influencing the experience of the conventional visit, and the difficulty in taking intraoral photos. Sixty-two (73.8%) patients declared an interest in the use of a tele(oral)medicine program. Furthermore, 41 (48.8%) participants preferred this type of visit to a conventional odontostomatological visit. Significative statistical associations were found between patients’ interest in a tele(oral)medicine service and computer skills, conditions influencing the experience of the conventional visit, and the difficulty in taking intraoral photos. Our study showed that the tele(oral)medicine program appears to meet the expectations and needs of our patients.

Introduction:many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. Methods:a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. Results:fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). Conclusion:there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.

Hypertension is a condition of elevated abnormal arterial blood pressure that lasts persistently. Some knowledge that should be known by hypertensive patients are such as the meaning of hypertension, the cause of hypertension, the symptoms that come along, and the importance of regular and long term treatment, also knowing the dangers posed if not taking the medication. This study aims to determine the correlation between knowledge and adherence to taking antihypertensive medication in elderly hypertensive patients at the Krian Public Health Center, Sidoarjo Regency. In this study, the population was elderly hypertensive patients who examined themselves or only took control to take medication at the Elderly Polyclinic of Krian Public Health Center in Sidoarjo Regency with 332 populations with 75 samples taken. The result of this research was obtained sig. value = 0,000 (

The number of patient revisits in maternity polyclinic of Surabaya Haji Public Hospital decreased within the period of 2015 – 2016 as much as 24%. In addition, there were several indicators complained by patients in the maternity polyclinic of Surabaya Haji Public Hospital. The purpose of this study was to analyze the effect of service quality to patients’ satisfaction and loyalty in the maternity polyclinic based on Donabedian Theory. It was an observational analytic study, and sampling was taken by simple random sampling technique which in the end obtained a total of 141 respondents. The results of the study indicated that service quality significantly affected patients’ satisfaction. The mean value

Background. Currently, chronic noncommunicable diseases (NCD) cause more than 2/3 of all deaths in the world. Despite the continuous improvement of approaches to drug therapy for chronic low risk infections, they can not be completely cured, and mortality tends to increase. In such conditions, the need for preventive measures comes to the fore. One of the approaches of secondary prevention is to educate patients in Health Schools, the goal of which is to reduce the incidence and progression of complications of NCD, reduce morbidity and mortality. Aim. The goal is to assess the attendance of Schools, the gender and sex composition of patients, the structure of educational activities. Methods. Аssessment of the work of the Health Schools through the analysis of patient case report stored in the clinic’s prevention department. The analysis of the cases was carried out taking into account the age, gender, and results of the patient survey. Results. The data obtained indicate a fairly uniform attendance at Health Schools. The School of Health in hypertension was the most visited (20% of the total attendance), the least - the School of Breast Health (less than 10% of the total attendance). Women visited Health Schools more often than men (71.2%). Men were more interested in the school on the general principles of healthy lifestyles and the School on quitting smoking. The main contingent of Health Schools is the elderly. The average age of the patients of the School for type 2 diabetes and healthy joints was about 65 years, and the School for hypertension - about 73 years. Conclusion. Due to patient education, it is possible to increase adherence to treatment prescribed by a doctor, reduce the effect of FR, help patients lead a healthier lifestyle.

To determine the frequency of Fibromyalgia syndrome (FMS) in accordance with the American College of Rheumatology (ACR) 1990 and ACR 2010 FMS classification criteria, also to assess the pain intensity, functional and emotional status of patients whoare admitted to the cardiology clinic with a complaint of chest pain without a cardiologic pathology. 107 female patients with chest pain, who admitted to cardiology polyclinic after discarding cardiac chest pain, directed to Physical Medicine and Rehabilitation polyclinic, were included to the study. All patients were assessed in terms of age, height, weight, body mass index (BMI), chronic pain duration, Visual Analog Scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI), Symptom Severity Scale (SS) and Back Anxiety Depression Scale (BADS). The ACR was assessed according to the 1990 and 2010 FMS classification criteria. It was found that 3(2.8%) of these patients met only the 1990 criteria, 3(2.8%) only met the 2010 criteria and 16(15%) met both the 1990 and 2010 criteria, but 85(79.4) did not meet any of the criteria. The number of tender points, WPI, SS and FIQ values of the clinical and functional evaluation parameters of FMS were higher in the FMS group and this result was statistically significant (p [Med-Science 2019; 8(1.000): 58-62]

This is the first of two papers concerning our study into an integrated approach to psychotic disorders, conducted at the University of Palermo's Psychiatry Unit Polyclinic over approximately 15 years. Here we will explore and reflect upon the acute psychotic condition mainly from a theoretical and conceptual perspective, while in the second paper we will explore the clinical perspective. From the point of view of psychopathology, and in the light of C.G. Jung's conceptualization of analytical psychology, as well as calling on contributions from other authors from the systemic-relational and post-psychoanalytic field, we will clarify the ideas developed over these last few years by our team. From a more speculative perspective we will advance new interpretive hypotheses in an attempt to thoroughly understand the nature of the psychotic condition, both on a psychodynamic relational and a neuroscientific level. The paper describes how we revised our understanding of psychosis from a brain disease to a process aimed at the rearrangement of psychic functioning, as anticipated by John Weir Perry nearly 40 years ago.Ceci est le premier de deux articles au sujet d’une étude sur une approche intégrée des troubles psychotiques. Cette étude a été conduite sur une quinzaine d’années à l’Université de Palerme, dans le service de Polyclinique en Psychiatrie. Dans ce premier article nous explorerons la condition psychiatrique aigue à partir d’un point de vue principalement théorique et conceptuel. Dans le deuxième article nous explorerons la perspective clinique. Du point de vue de la psychopathologie, à la lumière des conceptualisations de la psychologie analytique de C.G. Jung et en s’appuyant également sur l’apport d’autres auteurs du champ systémique-relationnel et post-psychanalytique, nous clarifierons les idées développées par notre équipe dans les dernières années. D’un point de vue plus spéculatif, nous proposerons de nouvelles hypothèses interprétatives pour tenter de comprendre pleinement la nature de la condition psychiatrique, à la fois sur le plan psychodynamique et relationnel et sur le plan des neurosciences. L’article décrit comment nous avons révisé notre compréhension de la psychose, la considérant au départ comme une maladie du cerveau, puis finalement comme un processus visant le réaménagement du fonctionnement psychique, comme John Weir Perry l’avait anticipé il y a presque 40 ans.Dieser ist der erste von zwei Artikeln über unsere Studie über einen integrierten Ansatz bezüglich psychotischer Störungen, die über einen Zeitraum von ungefähr 15 Jahren an der Poliklinik für Psychiatrie der Universität Palermo durchgeführt wurde. Hier werden wir den akuten psychotischen Zustand hauptsächlich aus theoretischer und konzeptioneller Sicht untersuchen und darüber reflektieren. Im zweiten Artikel werden wir die klinische Perspektive untersuchen. Aus psychopathologischer Sicht und im Lichte von C.G. Jungs Konzeptualisierung der Analytischen Psychologie sowie unter Heranziehung der Beiträge anderer Autoren aus dem systemisch-relationalen und postpsychoanalytischen Bereich werden wir die Vorstellungen erläutern, die unser Team in den letzten Jahren entwickelt hat. Aus einer spekulativeren Perspektive heraus werden wir neue interpretierende Hypothesen aufstellen, um die Natur des psychotischen Zustands sowohl auf psychodynamisch-relationaler als auch auf neurowissenschaftlicher Ebene gründlich zu verstehen. Der Text beschreibt, wie wir unser Verständnis von Psychose von einer Gehirnkrankheit zu einem Prozeß, der auf die Neuordnung der psychischen Funktionen abzielt, überarbeitet haben, wie es John Weir Perry vor fast 40 Jahren vorausgesehen hatte.Questo è il primo di due articoli riguardanti il nostro lavoro sui disordini psicotici condotto con un approccio integrato, portato avanti presso l’Unità Operativa di Psichiatria del Policlinico Universitario di Palermo. In queste pagine esploreremo e rifletteremo sulla condizione psicotica acuta principalmente da una prospettiva teoretica e concettuale mentre nel secondo articolo ci occuperemo dell’aspetto clinico. Da un punto di vista psicopatologico, ed alla luce della concezione della Psicologia Analitica di Jung, ricorrendo anche all’aiuto di autori provenienti da territori differenti quali la teoria sistemico-relazionale e la post-psicoanalisi, proveremo a chiarire le idee sviluppate dal nostro gruppo di lavoro nel corso degli anni. Da una prospettiva maggiormente speculativa invece, proporremo nuove ipotesi interpretative nel tentativo di comprendere più a fondo la natura della condizione psicotica, sia sul versante psicodinamico e relazionale che neuro-scientifico. L’articolo descrive come si è modificata nel corso del tempo la nostra idea della psicosi, da malattia del cervello a processo finalizzato alla riorganizzazione del funzionamento psichico, così come venne ipotizzato da J.W. Perry circa quarant’anni fa.Это первая из двух статей, в которых описано наше исследование интегрированного подхода к психотическим расстройствам. Исследование проводилось в университете Палермо в отделении психиатрии в течение 15 лет. Мы предлагаем поразмышлять об остром психотическом состоянии преимущественно с теоретической и концептуальной позиции. Во второй статье рассмотрим клинический взгляд. С точки зрения психопатологии, а также в свете представлений К. Г. Юнга, теории системных отношений и пост-психоаналитических работ, мы объясним идеи, которые развивает наша команда в последние годы. Мы выдвинем новые объясняющие гипотезы, чтобы более точно понять природу психотического состояния на психодинамически-реляционном и нейронаучном уровне. Статья описывает пересмотр нашего понимания психоза: мы перешли от взглядов на психоз как на заболевание головного мозга к его пониманию как процесса, нацеленного на перестройку психического функционирования. Джон Веир Перри предвидел этот сдвиг еще 40 лет назад.Este es el primero de dos ensayos acerca de nuestro estudio sobre un abordaje integrado de los trastornos psicóticos, conducido en la Unidad Policlínica Psiquiátrica de la Universidad de Palermo durante 15 años aproximadamente. Aquí vamos a explorar y reflexionar sobre la condición psicótica aguda desde una perspectiva teórica y conceptual. En el segundo trabajo exploraremos la perspectiva clínica. Desde el punto de vista de la psicopatología, y a la luz de la conceptualización de C.G. Jung de la psicología analítica, así como también tomando las contribuciones de otros autores del campo sistémico-relacional y pos-psicoanalítico, clarificaremos las ideas desarrolladas por nuestro equipo durante los últimos años. Desde una perspectiva más especulativa ofreceremos nuevas hipótesis interpretativas en un intento de comprender cabalmente la naturaleza de la condición psicótica, desde ambos niveles, psicodinámico relacional, y neurocientífico. El trabajo describe el modo en que hemos revisado nuestra comprensión de la psicosis, desde ser considerada una enfermedad cerebral hasta ser un proceso destinado a la reorganización del funcionamiento psíquico, tal como lo anticipó John Weir Perry hace aproximadamente 40 años.精神病, 象征, 易感性1-通过分析心理学来看发病机制及治疗 这是两篇论文的第一篇, 涉及我们在巴勒莫大学精神病学联合诊所15年以来, 关于精神紊乱的整合取向研究。在此我们将主要在理论和概念角度对严重的精神病进行探索和反思。第二篇论文我们将探索临床的视角。我们将介绍团队在过去几年发展出来的一些观点, 这些观点整合了心理病理学的角度, 荣格分析心理学概念化的观点, 以及整合了其他包括系统-关系和后现代精神分析领域作者的贡献。我们会进一步从一个推测性的角度提出解释性的假设, 试图更彻底地理解精神状况的本质, 这些假设来自心理动力的关系和神经科学的层面。文章描述了我们如何从把精神病看作大脑的疾病, 转变为认识到这是一个心理功能重置的尝试过程, 这正是John Weir Perry四十年前曾预期的。.

Objective: Pneumoconiosis is a fatal, irreversible interstitial lung disease caused by various inorganic dust and chemicals. The disease is radiologically characterized by micronodules, pleural plaques, emphysema, mediastinal and hilar lymphadenopathies (HL). There are hypotheses that fibrotic lymph nodes increase the dust load of the lungs in patients with pneumoconiosis. Our aim is to determine the frequency of HL and related factors in pneumoconiosis patients admitted to our unit in the light of current data. Material and Methods: 76 patients diagnosed with pneumoconiosis who applied to our unit between November, 2015 and October, 2020 were retrospectively screened. Sociodemographic characteristics, radiological, laboratory and clinical findings were evaluated. The frequency of HL and related factors were analyzed. Results: We found the rate of HL as 29,3%. The average age was 43,78 ± 7,54. There was no significant age difference between patients with and without HL (44,41±8,90 / 43,34±6,93 p=0,578). All of the patients were male. As the ILO (International Labor Organization) category rose, we saw an increase in the number of HL. 59,1% of the patients with HL had at least one active complaint (dyspnea, cough or sputum). The most common complaint was dyspnea (50%). We found a statistically significant increase in NLR (Neutrophil to Lymphocyte Ratio) and TLR (Thrombocyte to Lymphocyte Ratio) values in patients with HL compared to those without (2,38±0,70; 1,97±0,59 p=0,016 and 133,79±39,06; 109,03±29,00 p=0,005). Another important finding was that the albumin values of patients with HL were found to be statistically significantly lower (4.42 ± 0.41; 4.67 ± 0.29 p = 0.008). Conclusion: 29.3% of patients had HL. We found significant increase in NLR and TLR in pneumoconiosis patients with HL and decrease in serum albumin levels. We think that these markers may have prognostic value in pneumoconiosis patients with lymphadenopathy.

Modern challenges have increased attention to the effective operation of medical institutions of various types. At first glance, the tools for achieving the goals of medical organizations have been studied and tested. However, the scientific description and research of the doctors’ KPIs of a polyclinic medical organization within in goal-setting sustainable development in the context of a changing situation with a pandemic has not been sufficiently clarified. The paper presents the current forms and systems of remuneration, KPIs for employees of polyclinic medical organization, as well as a study of the motivational components of the doctors at the Clinical Diagnostic Center (CDC) of Immanuel Kant Baltic Federal University (IKBFU), functional expectations (requirements) from the CDC management with subsequent development of innovative KPIs for doctors as a key category of employees of the research object. The results of the study make it possible to develop a methodology for calculating the integral indicator of KPIs with options for the concept of remuneration for doctors in CDC. The research includes a content analysis of the sources characterizing the current scientific and practical state of the formation and application of doctors’ KPIs. The basis of the study implies a comparison of the formulated tasks of CDC with the tasks of the doctors and their motivational components, followed by the formulation of indicators of doctors’ performance in the context of current forms and systems of remuneration of doctors in Russia and abroad. The continuation of the research in a practical aspect will be associated with developing and implementing the integral indicator of doctors’ KPIs in the approbation process. Future theoretical research is related to the formation of a methodological tool for a flexible system of remuneration for doctors based on changing challenges in goal-setting sustainable development

Background Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P Conclusions Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.

Objective: To report the experience of undergraduate nursing students at the Universidade Federal Fluminense (UFF) on the organization of the work process in the bandage sector in primary care. Methodology: Research of the type of experience report based on the experience of nursing students at a Public University about the work process of nurses in the bandage sector of a Regional Polyclinic in the city of Niteroi-RJ. The practice took place in the first half of 2019. The object, agents, instruments, purpose, methods and products, components of the work process were taken into account. Results and discussion: It was observed that the completion of each stage of the work process is carried out by nursing professionals in the hospital sector, in search of the best clinic and patient safety as the final product. The sector is run by a nurse, whose work includes planning, communication, qualified assistance, teaching, research and ethical relationships. Therefore, it is emphasized that good nursing-technical, nursing-patient communication, a practice that comprehensively addresses each step of the work process and is based on evidence, ensures differentiated, assertive care and the final product is patient safety. Final considerations: The present study contributed to the formation of the learning of the academics involved with regard to the work and management process. The performance of the nurse manager is directly related to the good functioning of a sector, given its autonomy and qualification for the work performed, and this object of study in its formation.

The COVID-19 pandemic has affected nearly every country worldwide and all African countries. The issue of healthcare workers (HCWs) contracting the disease is a growing concern in Ghana, because of the risk of spreading infections amongst themselves and to vulnerable patients in their care. This article illustrates how 14 staff at the Korle Bu Polyclinic/Family Medicine Department were incidentally found to be Covid-19 positive with most of them being asymptomatic. This observation led to a modification of the personal protective equipment (PPE) used by clinical staff when attending to patients. Furthermore, this finding suggests that a different criteria or guideline may be needed for testing of HCWs during a pandemic where a significant proportion of infected people are asymptomatic. We conclude that in the primary care setting HCWs must be ready to see all the following cases safely: routine patients, asymptomatic COVID-19 patients and suspected COVID-19 patients.

The mission of Undaan Eye Hospital is to provide high quality and affordable eye health service. However, some problems which indicate customer’s dissatisfaction are still found, including the amount of customer complaints which hasn’t reached the target set by hospital which is zero complaint. Based on Customer Complaint Report of Undaan Eye Hospital, most complaints are caused by communication problem. The aim of this study is to analyze the interpersonal quality of Polyclinic of Outpatient Clinic of Undaan Eye Hospital which consists of respect, confidentiality, courtesy, responsiveness, dan empathy. This study is using descriptive and cross-sectional design and conducted to 82 people who are representing the outpatients and proceeded using simple random sampling method. The data were obtained by interviewing respondents using questionnaire. The data is analyzed using quantitative method and presented in tables. The result of the study shows that most of the respondents which includes 63,41% respondents feeling a little satisfied with interpersonal quality in Polyclinic of Outpatient Clinic of Undaan Eye Hospital. The result of the study shows that most of respondents feeling satisfied with respect, courtesy, confidentiality, and empathy of the service, however they are feeling a little satisfied with responsiveness of the service. Therefore, the hospital needs to improve their quality especially in responsiveness aspect by reducing patient wait times, and maintaining the quality of the aspects which have good ratings of patient satisfaction.Keywords: interpersonal quality, outpatient clinic, patient satisfaction

BACKGROUND: Cognitive, motoric, and language development in a human immunodeficiency virus (HIV)-infected child is an important issue that affects developmental milestone and quality of life. The effect of HIV infection on cognitive function must be detected early to prevent delayed cognitive, motoric, and language function. AIM: This study aimed to assess the correlation of cognitive scores with CD4 count among HIV-infected children in pediatrics polyclinic Sanglah Hospital, Bali. METHODS: This cross-sectional study recruited 68 HIV-infected children age 0–36 months old as participants. Cognitive score was assessed using Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) scores and HIV status, and CD4 count was obtained from the medical record. RESULTS: The result showed that mean of CD4 count among subject was 29.85 cells/mm3, there was positive correlation between CAT scores with CD4 count (r = 0.33, p = 0.006) and also between CLAMS scores with CD4 count (r = 0.307, p = 0.01). CONCLUSION: It can be concluded that CD4 count correlated with Capute scores on HIV-infected children.

Background. Hepatitis B virus (HBV) infection has been suggested to play a role in various adverse birth outcomes. The study determined the prevalence as well as knowledge of hepatitis B virus infection among pregnant women in the Ningo-Prampram District of the Greater Accra Region of Ghana.Materials and Methods. A cross-sectional study using simple random sampling technique was used to recruit 213 pregnant women receiving antenatal care in three different health facilities (Prampram Polyclinic (PPC), Dangme Community Hospital (DCH), and Old Ningo Health Center (ONHC)) in the Ningo-Prampram District of Ghana from November 2018 to January 2019. A semi-structured questionnaire was used to collect data which included participants’ HBsAg test results, sociodemographic and gynaecological characteristics, and their level of knowledge on HBV infection. Knowledge of the participants on HBV infection was classified as either excellent, good, or poor based on their cumulative percentage scores from the questionnaire according to Al Rubaish system of classification.Results. Overall low-intermediate prevalence of HBV infection was 3.3%; however, PPC recorded the highest prevalence of 4.0% while DCH and ONHC recorded 2.82% and 2.50%, respectively. Statistically significant association was observed between HBV infection and the health facility. Majority (77.40%) of the study participants had poor knowledge on HBV infection while only 14 (6.57%) had excellent knowledge on HBV. Regarding excellent knowledge, 8 (11.0%) among the participants were demonstrated by the majority of those who received antenatal care from DCH. Generally, knowledge on HBV and the infection was poor among the study participants. Knowledge on HBV infection was found to be associated with residential status (p=0.006), educational level (p<0.001), occupation (p<0.001), and gestational period (p<0.001). Participant’s knowledge was also significantly associated with the health facility (p=0.027).Conclusion. HBV infection among pregnant women is prevalent in the Ningo-Prampram District even though the prevalence is not very high. The majority of pregnant women in the Ningo-Prampram District inadequate knowledge on HBV infection and it mode of transmission. Intensive public health education on the HBV infection is required in the district to help prevent and manage future transmissions as well as inform the population about the negative side effects of the virus and the need to prevent it by way of vaccination.

Background This study addresses an important field within HIV research, the impact of socioeconomic factors on the healthcare costs of people living with HIV/AIDS (PLHIV). We aimed to understand how different socioeconomic factors could create diverse healthcare costs for PLHIV in Turkey. Methods Data were collected between January 2017 and December 2017. HIV-positive people attending the clinic who had been referred to the national ART programme from January 1992 until December 2017 were surveyed. The questionnaire collected socioeconomic data. The cost data for the same patients was taken from the electronic database Probel Hospital Information Management System (PHIMS) for the same period. The PHIMS data include costs for medication (highly active antiretroviral therapy or HAART), laboratory, pathology, radiology, polyclinic, examination and consultation, hospitalisation, surgery and intervention, blood and blood products, supplies and other costs. Data were analysed using STATA 14.2 to estimate the generalised linear model (GLM). Results The findings of our GLM indicate that age, gender, marital and parental status, time since diagnosis, employment, wealth status, illicit drug use and CD4 cell count are the factors significantly related to the healthcare cost of patients. We found that compared with people who have AIDS (CD4 cells 3), people who have a normal range of CD4 cells (≥ 500 cells/mm3) have $1046 less in expenditures on average. Compared to younger people (19–39 years), older people (≥ 55) have $1934 higher expenditures on average. Costs are $644 higher on average for married people and $401 higher on average for people who have children. Healthcare costs are $518 and $651 higher on average for patients who are addicted to drugs and who use psychiatric drug(s), respectively. Compared to people who were recently diagnosed with HIV, people who were diagnosed ≥10 years ago have $743 lower expenditures on average. Conclusion Our results suggest that in addition to immunological status, socioeconomic factors play a substantial role in the healthcare costs of PLHIV. The key factors influencing the healthcare costs of PLHIV are also critical for public policy makers, healthcare workers, health ministries and employment community programs.

The study was conducted to investigate the relationship between the insomnia-fatigue levels of the mothers with infants and their depression and maternal attachment status. The universe of this descriptive study consisted of the mothers with infants who applied to a state hospital in the north of Turkey with the mothers admitted to the pediatric polyclinic. The sample comprised 194 mothers who were selected by a simple random sampling method and who agreed to participate in the study. In the G power analysis, the sample calculation was performed based on the relationship between two means. As a result of the analysis, the sample was calculated as 178 people. This number was increased to 194 to improve the power of the research. As data collection tools, a Mother Introductory Information Form for descriptive features, Brief Fatigue Form, Sleep Status Rating Scale for Mothers, Beck Depression Scale and Maternal Attachment Scale were used. In the statistical analysis, arithmetic means, standard deviations and percentages were used for descriptive variables. Spearman correlation analysis was used to examine the relationships between the quantitative variables. The average age of the mothers was found as 29.28±5.52 and 52.7% of them were primary school graduates. 86.1% had planned pregnancy and 64.9% had a cesarean section. 68.7% of the mothers stated that they could take their baby on their laps more than one hour and 45.6% were breastfeeding them. It was determined that the mean fatigue scores of the mothers were 4.33±2.56, the mean insomnia score was 4.23±1.24, the Beck depression score was 14.01±11.06 and the maternal attachment score was 99.22±6.74. In our study, there was a significant weak relationship in the positive direction between maternal fatigue and insomnia levels and depression status (p 0.05). It was determined that there was a weak correlation in the positive direction between the fatigue-insomnia levels and the depression status of the mothers. In the light of these results, by identifying the factors that cause fatigue and insomnia, it could be suggested to prevent the maternal depression and to strengthen maternal attachment of the mothers with infants aged 2-6 months through social support provided by health professionals. [Med-Science 2018; 7(4.000): 728-32]

Yoga therapy in the world of nursing is known as the term complementary therapy. To avoid stress, one of the most efficient and has been done for centuries is to do yoga. The efficacy of yoga in helping to relieve stress is no doubt. Yoga helps keep people away from stress. According to Hawari (2008), the high incidence of stress in Indonesia is also the reason why stress should be prioritized handling because in 2008 recorded about 10% of the total population of Indonesia experiencing mental disorders or stress. The high level of stress is generally caused by economic pressures or poverty (Ministry of Health, 2009). General Purpose of this study To determine the influence of complementary therapies of yoga meditation on stress patients in Soul Polyclinic of Special Hospital Area of South Sulawesi Province. True Experiment Design True Experimental Design. Population in this study all stress patients who came to visit in Soul Polyclinic of Special Hospital Area of South Sulawesi Province amounted to 60 respondents consisting of 30 respondents in the group without intervention 30 people for the intervention group (Sugiono, 2011). The statistical test used: Mann Whey test and Wilcoxon test. The result of analysis test using Mann Whitney got data that value The result shows that Ha rejected and Ho accepted which mean there is no difference of the average of stress level in the group without intervention and intervention group during pre-test . The results of the test The results show that Ha accepted and Ho rejected which means there is a difference in the average level of stress in the group without intervention and intervention group at post-test . The above statistical test results give us an illustration that there are two groups in this study, that is the group of respondents treated only with pharmacology therapy, and one group of respondents treated with pharmacology therapy and complementary therapies of yoga meditation. The results showed that the group gave pharmacological therapy and complementary therapies had a higher cure rate than the group of respondents who received only pharmacological therapy

Stroke fase rehabilitasi dapat mengakibatkan perubahan fisik dan psikologis sehingga mempengaruhi kualitas hidup pasien yang kemudian menyebabkan masalah psikosial berupa cemas dan depresi. Cemas dan depresi ini memiliki korelasi terhadap kesejahteraan spiritual. Tujuan dari penelitian ini adalah untuk mengidentifikasi tingkat kesejahteraan spiritual pada pasien pasca stroke di poliklinik RSUD Al Ihsan Provinsi Jawa Barat. Penelitian ini merupakan penelitian deskriptif kuantitatif dengan menggunakan instrumen SIWB. Penarikan sampel menggunakan metode purposive sampling dengan kriteria insklusi pasien stroke fase rehabilitasi yang mempunyai nilai Mini Mental State Examination (MMSE) normal 24-30, dan didapatkan 105 responden. Data disajikan dalam bentuk distribusi frekuensi. Hasil penelitian ini menunjukkan tingkat kesejahteraan spiritual tinggi sebanyak 57 responden (54,3%) dan tingkat kesejahteraan spiritual rendah sebanyak 48 responden (45,7%). Karakteristik responden paling banyak pada rentang usia lansia akhir yaitu berjumlah 41 responden (39,0%), dengan lama stroke > 12 bulan 58 responden (55,2%), memiliki penyakit penyerta 82 responden (78,1%), dan mengalami serangan stroke 1x sebanyak 54 responden (51,4%). Pada penelitian ini, antara tingkat kesejahteraan spiritual tinggi dan rendah tidak jauh berbeda persentasenya. Sehingga masih diperlukan upaya untuk meningkatakan kesejahteraan spiritual melalui perbaikan sarana dan prasaran ibadah ,mengoptimalkan spiritual care, mengadakan seminar-seminar dan pelatihan spiritual care, melakukan berdo’a bersama sebelum pemeriksaan dimulai, menciptakan lingkungan yang nyaman, aman, dan damai, serta mengadakan peer group khusus pasien stroke. ABSRTACTStroke rehabilitation phase can lead to physical and psychological changes. It has an impact on the quality of life of patients that later caused psychosocial problems such as anxiety and depression. These anxiety and depression have a correlation to the spiritual well-being. The purpose of this study was to identify the level of spiritual well-being in post-stroke patients in polyclinic RSUD Al Ihsan West Java Province. This research was a quantitative descriptive research using SIWB instruments. It used a purposive sampling method with the inclusion criteria of rehabilitation phase stroke patients who had 24-30 as the normal score of Million Minimum State Examination (MMSE) and obtained 105 respondents. The data presented in the form of the frequency distribution. The results of this study indicated that the respondent’s amount who reached the high level of spiritual well-being was 57 respondents (54.3%) and low level of spiritual well-being was 48 respondents (45.7%). The most respondents’ characteristic were respondents with age range of elderly as of 41 respondents (39.0%), with stroke length more than 12 months as of 58 respondents (55.2%), had comorbid disease as of 82 respondents (78.1%), and suffered once stroke attack as of 54 respondents (51.4%). The research revealed that the percentage level of spiritual well-being between high and low was nearly similar. As the consequences, it is necessary to increase the spiritual well-being through the improvement of religious facilities and infrastructure, optimizing spiritual care, conducting seminars and spiritual care training, praying together before the medical check-up or treatment, creating a comfortable, safe and peaceful environment, and establish the peer group for stroke patients.

Objective: This study was conducted to investigate lead exposure awareness of families with children aged 0-6, who applied to a district polyclinic. Method: The research was carried out in Hüseyin Savaş district clinic between the 11th-21st of October, 2016. Amongst all the parents who applied to the polyclinic over the given time period, a questionnaire was administered to 101 parents who volunteered to participate. The questionnaire was created by using the literature and was administered through the face-to-face survey application technique. Results: It was determined that 86.1% of the participants did not have sufficient knowledge of lead poisoning. The mean score on the lead poisoning prevention awareness scale was lower for mothers with a high school education, when compared to those with university degrees. Furthermore, the mean score for prevention awareness was higher for respondents living in the centre of the province, compared to those from peripheral villages and towns. In addition, participants with higher economic status perceptions were found to be more knowledgeable than those with moderate perceptions. Conclusion: More education for parents, caregivers and children about lead exposure will raise awareness about the issue.

WOS: 000428055700002, PubMed ID: 29588577, Objective: The purpose of this study was to reveal the treatment outlook, usage habits, and factors affecting these habits, in addition to providing suggestions for solutions for patients who are frequently recommended the use of compression stockings as treatment for conditions such as chronic venous insufficiency, deep vein thrombosis, lymphedema, and pregnancy. Methods: The study was conducted as a face-to-face questionnaire session with 1,004 patients who had previously registered at the cardiovascular surgeon's polyclinic of Sivas Numune Hospital between March 29, 2017, and October 31, 2017. In the study, basic criteria such as the patients' history, physical examination findings, and the use of compression stockings were evaluated. The survey was conducted in patients who were recommended compression stockings treatment for conditions such as chronic venous insufficiency, deep vein thrombosis, lymphedema, or pregnancy. The patients were asked about their demographics, characteristics of the compression stockings, whether compression stockings were used or not, and doctor evaluations related to the diagnosis. Results: At the end of the study, it was found that 20.5% of the patients who were recommended compression stockings never bought them and only 11.5% of the patients regularly used them. Another surprising detail was that only 54.7% of the patients thought that the compression stockings were part of the treatment and 44.0% of the patients thought that they would benefit from using them. Conclusion: In many guidelines, use of compression stockings is the cornerstone of treatment of venous diseases. However, when the treatment incompatibility of the patients is taken into account, many duties fall to the doctors. The first of these is to inform the patient about the treatment and to answer any questions from the patients. In addition, the socioeconomic and sociocultural status of patients should be considered by the doctors.

Introduction. An important role in health care management was taken by the service of managing the volume of medical care for this population group and the progressive development of the opportunities of the district doctor and GP for most of the population which requires only general medical assistance while maintaining all the possibilities for the consultant to get this patient’s advice. Materials and methods. An expert assessment of the organization’s problems, prospects for development and the main directions for optimizing the outpatient care were conducted among the heads of health authorities, state outpatient clinics and the oblast’s top specialists (111 experts). Results. An expert assessment of the problems and perspectives of the organization of out-patient and polyclinic care in the territorial polyclinics obtained the following results. At present, the health of the population is monitored by: citizens themselves – 23,1%; District doctors – 7,9%, medical specialists – 1,2%, no one follows – 67,8%. At the same time, according to experts, citizens themselves should monitor citizens’ health – 81,3% and district doctors – 18,7%. With a deterioration in health status or an exacerbation of the disease, patients most often turn to: the district doctor – 84,1%; The average medical worker working on the site – 2,7% and the specialist doctor – 13,2%. At the same time, according to experts, patients with worsening health or exacerbation of the disease most often need to contact the local doctor – 88,3% and the average medical worker working on the site – 11,7%. The share of unreasonable visits is: a district doctor – 28,1%, house calls – 56,4%, doctors-specialists – 37,3%. Thus, according to experts’ estimates, the share of unjustified visits of district doctors is 28,1%, of the doctor’s call at home – 56,4%, and of specialist doctors – 37,3%, which indicates a low level of organization of work of polyclinics. The proportion of visits by patients to district doctors that could be resolved: on pre-hospital admission, is 24,7%, by telephone consultation, is 24,5%. Thus, the share of visits to district doctors, which could be resolved at a pre-hospital reception and by telephone consultation, is almost half (49,2%). The proportion of visits by patients to medical specialists that could be resolved by telephone consultation: between the district doctor and medical specialists is 11,2%, the number of patients by telephone by medical specialists is 12,4%. Thus, the share of visits by specialist doctors, which could be resolved by telephone consultation between the district doctor and specialist doctors and patient consultations by telephone by specialist doctors, is almost a quarter of all visits (23,6%). Discussion. The data obtained are in some ways consistent with the results of a number of authors who are optimizing outpatient care in terms of the unreasonableness of visits, the possibility of transferring part of the functions of primary general medical reception to specially trained middle medical personnel, using telephone consultations between patients and between doctors, etc. Conclusion. The results of the expert assessment of the organization of outpatient care helped to identify some approaches to optimizing its delivery in the territorial polyclinics. This is optimization of the work of district doctors; Transfer of a certain part of the functions performed by district doctors to district nurses and paramedics; The development of a system for counseling patients and district doctors by medical specialists of polyclinics and other medical organizations.

Background: Provision of multitude of medical services under one roof is a norm in modern hospitals. However, in many service hospitals, psychiatric services are still confined within the premises of psychiatric wards. Due to the social stigma attached to psychiatric care many psychiatric patients avoid visiting the psychiatric ward for mental health care. The main objective of this study was to improve attendance in the psychiatric outpatient department (OPD) by making it accessible and acceptable for the clientele in a busy multispecialty service hospital. Materials and Methods: This retrospective study was carried out from January 1, 2009, to December 31, 2010. During the 1st year of the study (i.e., 2009), psychiatry OPD services continued in the psychiatry ward. From January 1, 2010, psychiatric OPD was shifted to polyclinic with a new name as “Department of behavioral sciences and deaddiction.” The data for the year 2009 and 2010 were compared using the Chi-square test. Results: There was a significant rise in the total number of new OPD patients from 522 to 1779 (P < 0.05) in 2010. Among various age groups, in 41–50 years of age group (144 [27.6%] vs. 574 [32.26%], P < 0.05) and those above 70 years (12 [2.29%] vs. 96 [5.39%], P < 0.05) the rise was highly significant. There was a significant increase in the number of patients with substance abuse (38 [7.27%] vs. 188 [10.56%], P < 0.05) and childhood and adolescent psychiatric disorders (42 [8.04%] vs. 213 [11.97%], P < 0.05). Conclusion: Amalgamation of psychiatric OPD services with other specialist OPD services in service hospital resulted in better utilization of psychiatric services.