Day 1 :
Keynote Forum
Jawahar Jay Kalra
University of Saskatchewan, Canada
Keynote: Quality care and patient safety: Global approaches to medical error disclosure
Time : 09:10-09:35
Biography:
Jawahar Jay Kalra, an educator, researcher, and quality health care advocate, is a Professor of Pathology in the University of Saskatchewan and has served as Head of the Department of Pathology and Laboratory Medicine. He is recognized for his many contributions as a clinical scientist, academic leader, and health system administrator. He has been a pioneer in establishing guidelines for thyroid-function testing, quality assurance program and contributed nationally and internationally in the area of total quality management. He has published extensively and is the author of the book “Medical Errors and Patient Safety: Strategies to reduce and disclose medical errors and improve patience safety.”
Abstract:
Disclosure of an adverse event is an important element in managing the consequences of a medical error. We have previously reported the Canadian provincial initiatives encouraging open disclosure of a critical event and have suggested its integration into a ‘no-fault’ model. We reviewed and compared the various medical error disclosure initiatives across the globe (USA, Australia, New Zealand, and United Kingdom) to analyze the progress made in this area. In Australia, disclosure policy integrates the disclosure process with risk management analysis towards investigating the critical events. In New Zealand, in any adverse event, patients are rehabilitated and compensated through a no-fault state funded compensation scheme. The United States Joint Commission on Accreditation of Healthcare Organizations mandated an open disclosure of any critical event during care to the patient or their families’. Effective communication between health care providers, patients and their families throughout the disclosure process is integral in sustaining and developing the physician patient relationship. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature on disclosure. In conclusion, the designing of an error disclosure policy requires integration of various aspects including bioethics, physician-patient communication, quality of care, and team-based care delivery. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure. We suggest that a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient’s right to an honest disclosure be implemented.
Keynote Forum
Andrew W Gottschalk
Ochsner Health System, USA
Keynote: An evidence-based, multidisciplinary team approach to sports concussion management
Time : 09:35-10:00
Biography:
rnAndrew W Gottschalk, MD trained in Sports Medicine at both Mayo Clinic and Cleveland Clinic. His extensive experience includes treating athletes of all levels of competition, including those in the NFL, NBA, MLB, and NCAA Division I. As the Ochsner Health System’s Director of Primary Care Sports Medicine, he serves as Head Medical Team Physician for the NBA New Orleans Pelicans. He is also an avid writer; his multiple publication projects include his regular newspaper column, “The Sports Medicine Doctor.” He is the current Musculoskeletal Health Editor for the medical journal Evidence-Based Practice.rn
Abstract:
Recent studies demonstrate dramatically improved health outcomes when a multidisciplinary care team model is utilized in the treatment of complex medical diagnoses. These studies have focused on improving outcomes in the treatment of chronic conditions such as diabetes mellitus, hypertension, and congestive heart failure. The multidisciplinary care team model has been shown to reduce medical complications, reduce number of hospital admissions, and improve overall quality of life in patients with these diseases. So strong is the evidence in favour of these models that they have become the standard of care in many medical systems in the United States and around the world. The multidisciplinary care team approach is now being evaluated for application in more acute settings, such as post-operative recovery. Studies confirm that the coordinated efforts, shared knowledge, and ongoing communication of the multidisciplinary care team significantly improve outcomes in these more acute settings as well. Applying the multidisciplinary care team approach in the treatment of sports concussions is as necessary as it is promising. In our model, when an athlete is concussed we immediately assign a Medical Team, a Home Team, and a School Team. Each team is responsible for well-defined aspects of the concussed athlete’s treatment, including symptom monitoring, symptom reporting, and treatment. The ultimate goals of this multidisciplinary care team approach to sports concussion treatment are to: reduce concussion symptoms and improve patient comfort; maximize safe and healthy brain recovery and; minimize time away from sports participation.
Keynote Forum
Marc Matthews
Mayo Clinic, USA
Keynote: Reevaluating the value of primary care using design thinking
Time : 10:00-10:25
Biography:
Marc Matthews graduated from the University of Maryland School of Medicine and completed his residency training at the Mayo Clinic. His first task at Mayo was to redesign a community health clinic around the community’s definition of health, and this work led to a deeper understanding of how the healthcare system is not very aware of what it means for a community to be healthy. He is the Associate Medical Director of the Mayo Clinic Office of Population Health Management and an Assistant Professor of Family Medicine. In these roles, he focuses on rethinking the way large healthcare organizations deliver care.
Abstract:
Primary care is at a critical crossroads. Our current delivery systems are unsustainable and lack the resilience to survive in new environments where total cost of care, patient experience, and patient centered outcomes are the primary determinants of success. In order for primary care to remain relevant and viable, new solutions must be created that are practical and transformative, attract and retain new patients and provide high value, high satisfaction services that meet their consumer needs. Our cost of care must come down and our quality must remain high in order for us to be able to deliver affordable care in future reimbursement realities. Our institution approached this problem by using the tools of design thinking to develop a novel patient centered approach and then implemented this population health management model across primary care clinics in multiple geographic areas. Population Health Management has become a hot topic of conversation in medical literature and popular media, but the concept is poorly defined and implementation of a population health framework is not well understood. Here we report the initial results of our implementation, which suggests increased patient and staff satisfaction with little impact on finances in a fee for service environment. We also uncovered significant cultural barriers to implementation that are likely to be universal.
- Track 1: Primary Health Care
Track 2: Primary Care Medicine
Location: The Oberoi Dubai, Dubai
Chair
Jay Kalra
University of Saskatchewan ,Canada
Co-Chair
Andrew W. Gottschalk
Ochsner Health System, USA
Session Introduction
Brian Littlechild
University of Hertfordshire, UK
Title: The management of violence and aggression against staff in mental health work: responding effectively through a co-production approach to issues for service users, carers, staff and agencies.
Time : 10:40-11:00
Biography:
Brian Littlechild holds a PhD and is a Research Lead in the Department of Nursing and Social Work at the University of Hertfordshire, UK. A Qualified and Registered Social Worker, he worked in hospitals and in the community with particular mental health needs before working in universities. He has published 44 books/book chapters/monographs, and 28 refereed journal articles. He has carried out 20 qualitative and mixed methods research projects, and published widely on, amongst other areas, mental health issues for young and adult offenders, mental health and risk assessment, and on violence from parents in child protection work.
Abstract:
This presentation examines the causes and consequences of violence from mental health patients on staff, the patients themselves, and others in their formal and informal networks. It addresses how best to respond to staff and patients after such incidents, and the potential for jointly produced solutions to the problem. The presentation is based on analysis of the evidence arising from a review of the research and wider literature, and how we might analyse this evidence in order to produce best practice in policy guidance and direct work with patients, including the evidence and recommendations from the UK’s National Institute for Health and Care Excellence (NIHCE) Guideline Development Group’s systematic review on ‘Violence and Aggression: The short-term management of violent and physically threatening behaviour in mental health, health and community settings’ (2015). The presentation will consider how the use of restorative justice and mediation techniques can be used as a nuanced approach to heal the damaging effects on staff and others, in conjunction with the use of co-production approaches with service users and staff, in order to encourage staff groups, agencies, and personal learning for patients and staff involved to reduce the risk of further such situations. The presentation will take into account a key feature of health care policies in the United Kingdom, concerning service user involvement in patient care. Key issues in taking this approach are addressed, with methods for how to do this in practice covered, with a model proposed for enacting such approaches.
Gillian Hood
Queen Mary, University of London, UK
Title: The diabetes Myquest consultation tool© study
Time : 11:00-11:20
Biography:
Gill Hood has been involved in diabetes care since qualifying as a nurse in 1984 and from 1997 began working in diabetes research. She managed the NE London Diabetes Research Network from 2007-2013 increasing patient recruitment 5 fold during this period and conducting her own research into fasting during Ramadan for people with diabetes, how older adults manage diabetes over time, and improving the patient-doctor consultation in diabetes. Gill is also an original member of the EU funded Diamap study which aimed to project diabetes research milestones for the next ten years. She is also involved with patient and public information groups encouraging users to discuss research and be more involved. She is an honorary research fellow at Queen Mary, University of London (QMUL) and continues to manage diabetes clinical research at QMUL. Gill is the Workforce Development and Patient and Public Involvement and Engagement Lead for the North West London Clinical Research Network funded by the National Institute of Health Research. In her capacity as Workforce Lead Gill runs course in Clinical Research for nurses and allied health professionals. She also runs courses for patients and the public who want to be involved with research. Gill is a member of the Foundation of European Nurses in Diabetes (FEND) and the Novo Nordisk Research Foundation for Nurses and Allied Health Professionals. Gill’s diabetes research interests are in ethnic minorities and engaging hard to reach groups in research, diabetes and older adults, health professional education, and patient and public involvement.
Abstract:
Background: The consultation between nurses and patients is an important aspect of managing diabetes, which can improve clinical outcomes. It can also be a frustrating experience due to limited time, training, and unidentified patient emotional problems. The diabetes MyQuest Consultation Tool© is a collaboration between nurses and patients to provide a meaningful guide to consultations through a patient questionnaire. The questionnaire combines clinical information, self-care statements and approved psychological scales, so that patients’ needs can be more readily recognised and addressed. Aims: The aim of this pilot study was to provide a supportive, structured, and time-efficient tool for patients and nurses to use, to optimise diabetes self-care, and to identify any mental health problems. Methods: This pilot study was a mix of methods in randomised control trial involving patients with type 2 diabetes and with no current mental health problems. Patients were randomised to routine consultations (control) or to use the MyQuest Consultation Tool© in their diabetes appointment (intervention). Patients were given pre and post measures of diabetes knowledge (DK), consultation satisfaction (PNIF), empowerment (DES) and interviewed. Results: 120 patients (40-90 years; m=67 years) were consented into the study. Of these, 106 patients (66 male; 40 female; average diabetes duration 9 years) completed all study visits. There were significant changes for the whole sample between pre and post study measures of DK (0.0001*), PNIF (0.0004*) and DES (0.0010*). 38% of participants scored below the clinical cut-off point on the WHO-5 Wellbeing Index indicating a need for clinical intervention. Qualitative results demonstrated a strong preference for using this tool, highlighting its empowering structure and guidance. Conclusion: This pilot study demonstrates: High acceptability of the diabetes MyQuest Consultation Tool©; positive changes in diabetes knowledge, satisfaction and empowerment; identification of unknown mental health problems; but only slight changes in HbA1c, BMI and Cholesterol. A longer term study is now needed to test whether MyQuest could also improve clinical measures in addition to providing welcomed structure for the consultation. With T2D remaining at epidemic proportions, MyQuest may be an efficient, realistic and cost effective strategy for managing diabetes in primary care.
Clive Tobutt
University of Surrey, UK
Title: Delivering primary health care in community justice settings: Motivational interviewing brief interventions to reduce alcohol consumption in hazardous drinkers
Time : 11:20-11:40
Biography:
Clive Tobutt is a Registered Nurse (Adult & Mental Health Nursing and Practice Educator). He completed a Post-graduate Diploma in Addiction Studies at the Institute of Psychaitry, London University and an MSc in Sociology (Health & Illness) from London South Bank University. He is currently a PhD student at the Univertsity of Winchester. He is a teaching Fellow (Mental Health Nursing) at Surrey University and a Senior Lecture at the University of Winchester. He has published 8 papers in reputed journals and has been serving as an Editorial Board Member of the Advances of Dual Diagnosis Journal.
Abstract:
Alcohol has an association with intoxication and violence. Hazardous drinkers may be caight up in the criminal justice system as there is a relationship between alcohol and violence. For example, the risks of violence and offending behaviour increase with alcohol intoxication. A number of offences have been linked with hazardous drinking, including, criminal damage, theft, drunk and disorderly, violent assault, grievious bodily harm, domestic violence, sexual offences, drink drving, drug-related offences and public disorder and there are health risks too. An entry into the criminal justice system occurs with arrest and detention within a police custody suite. With regards to alcohol-related offences, depending on the time of the arrest e.g., evening or during the night or the previous day would mean being charged with a court appearance the next day. Whilst there has been limited research to date concerned with reducing alcohol consumption amongst offenders arrested and/or detained in police custody suites, such settings offer a number of advantages integrating the UK National Health Service primary health care workers. Successfully delivered interventions within these settings have potential to interrupt hazardous drinking earlier than those that are offered later in the cycle of offending, such as within probation settings, police custody and magistrate courts as well as better health outcomes.
Ingrid Schusterova
Children University Hospital, Slovakia
Title: Importances of cardiovascular disease in primary healthcare
Time : 11:40-12:00
Biography:
I Schusterová is an Associated Professor and the Head of the Department of Paediatrics and Adolescent medicine, Children University Hospital, P J Š University in Košice, Slovakia. At the same time, she is the Head Physician in the tertiary center for valvular and congenital heart defects, Eastern Slovak Institute of Cardiac and Vascular Diseases. She took specialization exam from Adult and Pediatric Cardiology at National Institute of Cardiac and Vascular Diseases in Bratislava, Slovak Republic. After Graduation, she took part in Fellowship Training at Ottawa Civic Hospital, and later on performed research work in the area of cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/2004, she completed her training at Cardiologic department, II. Internal Medicine Clinic, General hospital, Vienna under supervision of Professor Dr Gerald Maurer. Later in 2005, she broadened her professional knowledge and skills at Cardiac Surgery Clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity, and disorders of lipid metabolism, atherosclerosis and their prevention in the pediatric age group.
Abstract:
The process of atherosclerosis begins already in childhood and its relationship to the presence and intensity of the known cardiovascular risk factors has been already proved. Expert panel on integrated guidelines for cardiovascular reduction in children and adolescents highlighted early identification of risk factors and their elimination, as they plays a key role in the prevention of CVS diseases. AHA definition of “CVS health” encompasses these parameters: tobacco use, BMI adjusted to the gender and age of a child, physical activity, score of healthy food, total cholesterol, blood pressure, fasting glycaemia. As an important part of primary prevention we perform screening program, examining the serum concentration of total cholesterol in 11 and 17 years old children and adolescents allover Slovak Republic by primary paediatricians. In case, total cholesterol level are higher than 5.4 mmol/l patients are refered to the specialist outpatient care department – pediatric cardiologist and endocrinologist. Selective screening is provided in population with high risk of CVS disease (with positive family history of CVS diseases, concentrations of cholesterol higher than 6.2 mmol/l, etc.) in specialised terciary centers for lipid metabolism disorders and preventive cardiology. Markers of subclinical atherosclerosis, increased Carotid Intima-Media Thickness (CIMT) assessed with ultrasound, endothelial dysfunction (reduced arterial dilation), and increased left ventricular mass with cardiac ultrasound are examined in the pediatric centers of preventive cardiology. The identification of children and adolescents with high risk and effective management of identified risk factors represents the key point in prevention of future CVD.
Gustavo H. Marin
National University of Central Buenos Aires (ESCS-UNICEN), Argentina
Title: Proposal to improve Primary Health Care effectiveness
Time : 12:00-12:20
Biography:
Gustavo H Marin is Doctor in Medicine; Magister in Public Health; Magister in Health Economics; Magister in Political Sciences; Post-doc in Public Health Assistance, Paris, France. He is the Former Director of Primary Health Care of Buenos Aires; Director of Scientific Research Commission, Buenos Aires, Argentina; PAHO Health International Leadership Fellowship; Head Professor of Health, National University of Central Buenos Aires, UNICEN, Argentina. He is the Author of more than 150 papers and books in Public Health Research.
Abstract:
Primary Health Care (PHC) has been an excellent theoretical strategy however, in practice, after more than 30 years from the proposal, health’s results and indicators are not the one expected. From Alma Ata to our days, the epidemiological approach of diseases has changed. Chronic illnesses such as hypertension and diabetes mellitus have replaced the infectious diseases as the major causes of morbidity and mortality worldwide. Our group has focused the absence of nominal responsibility and customization of the practices by the health team as one of the major drawbacks of the lack of success with PHC strategy. To demonstrate this point, we examined the impact of nominal and customized health care model in patients with diabetes and hypertension. 2,400 patients were included in a randomized study. Patients were assigned to a control group or to an intervention. Both groups received medication prescribed by health professional for free, but “control” group received the treatment on demand; while in the "intervention" group, a weekly regular contact by one of the member of the health team. A nominal responsibility of the patient was being then assigned to that team’s member. After 24 months of running this health care model, results showed 46% reduction in cardiovascular events and 62% decrease in hospital admissions due to events related to these diseases. We conclude that PHC strategy showed a substantial improvement of the goals when a nominal responsibility is assigned to a member of the health team in order to provide this care practices.
Muhammad Ajmal Zahid
Kuwait University, Kuwait
Title: Prevalence of psychiatric morbidity in the primary health clinic attendees in Kuwait
Time : 12:20-12:40
Biography:
Muhammad Ajmal Zahid has done his MBBS from King Edward Medical College, Lahore. He is working as a Professor; Faculty of Medicine in Kuwait University, Kuwait. He has attended many international conferences and organized many workshops. He has published nearly 30 abstracts in many reputed journals. He is an invited speaker to many conferences.
Abstract:
Background: A substantial proportion of primary clinic attendees suffer from psychiatric disorders and many of them are neither recognized nor adequately treated by primary clinic physicians. Objectives: To determine the point prevalence of, and identify risk factors for, depression, anxiety and somatisation disorder in the primary health clinics in the country. Method: The Physical Health Questionnaires (PHQ-SADs) were administered to a randomized sample of 1046 primary clinic attendees in all the five governorates of the country over a 5-month period. The descriptive data were computed with chi-square tests while the association of demographic characteristics with psychiatric disorders was determined with the logistic regression test. Results: 42.7% of our patients suffered from psychiatric disorders including depressive (22.9%), anxiety (17.7%), and somatisation (33.4%) disorder. Comorbidity between the three disorders was found in 20.4% of the sample; 11% had two and 10.4% had all three disorders. The Kuwaiti nationals, female gender, older age group subjects and those with lower level of education were more likely to suffer from psychiatric disorder. Limitations: The inter-rater reliability may have affected the results as a large number of physicians were responsible for administering the questionnaires. Moreover, the study did not include eating and substance-abuse disorders and the findings were limited to detection of somatisation, depression and anxiety disorders. Conclusions: In order to ensure timely provision of appropriate treatment, the primary care physicians need adequate information on different forms of presentation, and basic front line treatment, of the common mental disorders at the primary care level.
Litty Varghese
Seha Ambulatory Healthcare Services, UAE
Title: Barriers to adult immunizations and strategies to improve coverage
Time : 12:40-13:00
Biography:
Litty Varghese (RN; MSN) is working as A/Head of Nursing Education, AHS/SEHA, UAE. She has 34 years of experience in the field of PHC, UAE and has expertise as JCIA chapter lead and tracer team member, quality improvement coordinator, diabetic clinic project coordinator, community program organizer, nurse educator, newsletter editor and researcher. She holds Master’s Degree in Community Nursing, Post Graduate Diploma in Nursing Administration and obtained certification in Principles of Epidemiology and Biostatistics from CDC, Atlanta. With her continuance in excellent professionalism, she won the First Seha Best Employee Award 2012, the 3rd Best Abstract Award at The Pan Arab Hypertension Conference in Abu Dhabi Feb. 5-9, 2000 and actively participated in winning the following Awards: 2009 Arab Health Award for PHC Chronic Disease program; 2010 Arab Health Award for Nursing HR development.
Abstract:
Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions available. Most causes of vaccine preventable illness among children are relatively uncommon due to high rates of vaccination and very effective vaccines. Adult vaccination is one of the most important tool for reducing morbidity and mortality not just in the elderly but in other members of the society by increasing herd immunity, reducing severe clinical outcome and helping in eradication of the disease. The immunization program overall has been very successful with kids. We are not doing so well with adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations and other considerations. Although provider recommendation is a key predictor of vaccination, more often clients report not receiving vaccine recommendations at healthcare provider visits. Other barriers for vaccinating adults include the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.
Tim Carr
Maharishi Ayurveda Association of Australia, Australia
Title: Personalized diet and lifestyle prescription in primary health care
Biography:
Tim Carr has completed his Medical degree from the University of Sydney in 1976 and Postgraduate studies at the MIU Institute of Ayur-Vedic Studies, Iowa, USA and the Gujarat Ayur-Veda University, Jamnagar, India in 1984-85. He has authored and co-authored several articles on the clinical applications of Maharishi Ayurveda. He was appointed as Expert Adviser on Ayurveda to Complementary Medicines Evaluation Committee, Therapeutic Goods Administration from 2002 to 2009. He is currently the President of the Maharishi Ayurveda Association of Australia.
Abstract:
Diet and lifestyle are recognized as the primary determinants of major chronic diseases. Primary health care physicians are ideally placed to advise patients about primary and secondary preventive measures. Compliance, however, is largely dependent on patients’ motivation. This can be improved by personalizing preventive advice, so that the recommended measures are more relevant to and compatible with the patient. Maharishi Ayurveda, the reconstruction of the ancient Vedic system of medicine, offers a systematic approach to adapt preventive advice to the patient. Central to this approach is the determination of the patient’s mind/body type and digestive capability. This is assessed through a short questionnaire and simple clinical examination. The mind/body type is indicative of the patient’s metabolic type and responsiveness to different food groups, exercise programs and daily routines. Knowing the patient’s digestive capability, however, is the first step in formulating the dietary advice. It is known that the products of digestion can alter gut flora and the integrity of the gut lining and in turn influence the body’s immunological and endocrinological responses. Dietary manipulation of the digestive function therefore can have a major impact on health outcomes. In this approach the patient also learns to monitor the effects of dietary and lifestyle changes and to modify them accordingly – and is thereby empowered to take more responsibility for his or her health. Clinical experience confirms that by personalizing diet and lifestyle prescriptions in this way and educating the patient to self-monitor the results, compliance with preventive advice is greatly enhanced.
Brendan Mitchell
Gold Coast University Hospital, QLD, Australia
Title: Medication adherence one month after hospital discharge in medical inpatients
Time : 11:35-11:55
Biography:
Brendan Mitchell completed a Bachelor of Science at the University in Queensland in 2010, and subsequently a Doctor of Medicine at the University of Melbourne, graduating in 2014. He is currently working as a resident medical officer at Gold Coast University Hospital in Queensland, Australia.
Abstract:
Background: The rate of medication non-adherence has been consistently reported to be between 20-50%. The majority of available data comes from international studies, and we hypothesized that a similar rate of adherence may be observed in Australian patients. Aims: To determine the rate of adherence to medications after discharge from acute general medical hospital admission, and identify factors that may be associated with non-adherence. Methods: A prospective cohort study of 68 patients, comparing admission and discharge medication regimens to self-reported regimens 30-40 days after discharge from hospital. Patients were followed up via telephone call and univariate and multivariate binary logistic regression used to determine patient factors associated with non-adherence. Results: A total of 27 of 68 patients (39.7%) were non-adherent to one or more regular medications at follow up. Intentional and unintentional non-adherence contributed equally to non-adherence. Using multivariate analysis, presence of a carer responsible for medications was associated with significantly lower non-adherence (OR 0.20 (0.05-0.83), p=0.027) when adjusted for age, comorbidities, chemist blister pack and total number of discharge medications. Conclusions: Non-adherence to prescription medications is suboptimal, and consistent with previous overseas studies. Having a carer responsible for medications is associated with significantly lower rates of non-adherence. Understanding patient’s preferences and involving them in their healthcare may reduce intentional non-adherence.
Trish Morison
Universal College of Learning, New Zealand
Title: When pregnancy is no longer the issue
Time : 14:40-15:00
Biography:
Trish Morison has completed a Master’s degree in Public Health. Her research was published in the New Zealand Journal of Primary Health Care. She has lectured in Anatomy, Physiology and Pharmacology for the last 14 years.
Abstract:
The rate of sexually transmitted infections amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy ‘cougars’ are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore the enablers and barriers to safer heterosexual sex as perceived by midlife and older New Zealand women, who are re-partnering or in casual relationships. This qualitative study utilized Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviors in women’s accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with clinicians. Results highlighted women’s ambivalence about prioritizing safer sex, preferring to comply with partners’ wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasized that women predominantly aligned their choices with men’s preferences. This study highlights that midlife women are both ill-informed and vulnerable with regards to sexual health. Primary healthcare clinicians are well placed to provide education and sexual health advice.
Haw-Yueh Thong
Shin Kong Wu Ho-Su Memorial Hospital ,Taiwan
Title: Experience of Photopneumatic Therapy in Taiwanese Acne Patients
Time : 15:00-15:20
Biography:
Haw-Yueh Thong is Chief of the Cosmetic Center at Shin Kong Wu Ho-Su Memorial Hospital in Taipei, Taiwan ROC. After graduating from National Taiwan University College of Medicine, she completed an Internship in National Taiwan University Hospital. Her Residency was in dermatology at National Taiwan University Hospital and her Fellowship was in cosmetic dermatology at the University of California, San Francisco. She had worked closely with Professor Howard Maibach at UCSF. She is also a Graduate of Stanford University with a Master’s degree in management science and engineering, focusing on medical decision analysis. She has published numerous articles in professional journals and serves on many advisory boards and committees. Her interest in dermatology include acne vulgaris, cosmetic dermatology and filler injections
Abstract:
Acne is a disease of the pilo-sebaceous unit affecting both teenagers and adults. The treatment of acne is sometimes frustrating due to the emergence of antibiotic resistance, skin irritation and lack of novel therapy. Light and vacuum devices, also known as photo-pneumatic therapy, have been shown promising as a generally well-tolerated adjunctive treatment of acne vulgaris. We conducted a clinical study using such device to assess the efficacy and safety as an adjunctive treatment of acne in Taiwanese patients. Twenty patients received six sequential treatments every one to two weeks in the facial region. A 4×4 cm2 area on cheek was chosen as a control area and was not treated with photo-pneumatic device. Safety parameters and adverse events were recorded. VISIA Complexion Analysis System was used for image analysis on the improvement of four parameters, namely, pigmentation, pore reduction, redness and porphyrin levels. There was an overall improvement in pigmentation, pore size, redness and porphyrin levels on treatment areas. The treatment areas showed statistically significant improvement (p<0.05) in pigmentation and pore sizes compared with the control areas using paired samples T-test. Mild and self-limiting localized adverse events, mostly focal petechiae or mild irritation, were reported. Our study has demonstrated that photo-pneumatic therapy is an effective, safe and relatively well-tolerated procedure in Taiwanese acne patients.
Salwan Tariq Al-Ani
UIT Arctic University of Norway, Norway
Title: Symptoms, signs and biomarkers during exacerbations of asthma and COPD in primary care: Which findings are most strongly related to a drop in lung function?
Time : 15:20-15:40
Biography:
Salwan Tariq Al-Ani is a PhD student at the Arctic University of Norway since 2011; he is doing his research about asthma and COPD in primary care as a part time. He is working as a General Practitioner and community medicine Doctor in Fauske Municipality in the north of Norway. During the last 4 years, he published 2 articles about the exacerbation of asthma and COPD from his research and attended many scientific meetings and conferences like IPCRG, GRIN and Nordic congress and presented abstracts from his research in these meetings.
Abstract:
Background: Little is known about the association between lung function and other physiological changes with the clinical course of the exacerbation of asthma and COPD in primary care. The purpose of this study was to describe these changes and the association between them at the time of presentation. Aims: To describe the changes in symptoms, signs and biomarkers during acute exacerbation of asthma or COPD in primary care, and to identify which findings are most strongly related to a drop in lung function. Methods: Patients aged 40 years or more registered with diagnosis of asthma and/or COPD in the previous 5 years from seven general practice offices in Norway were identified, and 1111 patients were invited for baseline examinations. Those included were asked to contact their GPs if they experience exacerbations during the following year. Symptoms, chest findings, CRP, pulse oximetry and spirometry were registered both at baseline and during exacerbations. COPD clinical questionnaire (CCQ) was used to register the symptoms. Results: Of the 376 patients in stable phase included at baseline, 95 patients experienced one or more exacerbation during the study period. Of the 88 patients, who underwent spirometry during exacerbation, the FEV1 had dropped 10% or more in 36 patients (40.9%). Crackles recorded at exacerbation, but not at baseline and a drop in oxygen saturation of at least 2% to 94% or less were the findings most strongly associated with a 10% or more reduction in FEV1. Conclusion: Most respiratory symptoms and chest findings changed during the acute exacerbations of asthma or COPD, but chest signs, together with a decrease in oxygen saturation were much stronger indicators of a drop in lung function than were the respiratory symptoms.
Ahmad A Mirza
Taif University, Saudi Arabia
Title: Diagnosis and control of hypertension as indicators of the level of education and awareness among the relatives of medical students
Time : 16:20-16:40
Biography:
Ahmad A Mirza has completed his MBBS from Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. Recently, he has been appointed as Demonstrator (Teaching Assistant) in Department of Surgery, Taif University. He has published 2 papers in reputed journals and currently, he is working on 7 ongoing researches. He has been attended and presented in many national and international conferences.
Abstract:
Education and awareness of patients play an important role in the early diagnosis and control of many diseases, including hypertension. We aimed to assess the level of education and awareness among the relatives of medical students, as indicated by the prevalence of undiagnosed and uncontrolled hypertension in this specific population. In this cross-sectional design, senior medical students were invited to interview their respective adult first-degree relatives for the following factors: age, body mass index (BMI), smoking and history of diabetes or any cardiovascular disease, as well as the existence of diagnosed hypertension. Subsequently, students were instructed to measure the blood pressure (BP) of their relatives twice with 5 minutes interval. In case if hypertension is detected (average systolic BP≥140 mmHg and/or average diastolic BP≥90 mmHg), relatives were analyzed either as undiagnosed or uncontrolled hypertension, according to the absence or existence of hypertension in their history, respectively. Comparisons between different sub-groups regarding demographic and clinical factors were made using Chi-Square test and a multivariate logistic regression was used to analyze these factors as predictors for having undiagnosed or uncontrolled hypertension. We included 770 relatives (36.4% females, 16.3% aged≥60) of 82 (57.7%) total students’ participations. Hypertension was detected in 246 (31.9%) relatives, with higher proportions in older (up to 56%, p<0.001), obese (43.2%, p<0.001) and non-diabetic subjects (47.4%, p<0.001) and no difference across gender (p=0.093), marital (p=0.712) or smoking status (p=0.555). The prevalence of undiagnosed hypertension in the total study population was 14.4% (111 cases); while that of known hypertension was 16.9% (130 cases), among which 61.9% cases of uncontrolled hypertension. Predictors for undiagnosed hypertension were age<40 (p=0.004), current smoking (OR=1.96; 95% CI [1.08, 3.58]; p=0.028), absence of diabetes (OR=3.45; 95% CI [1.96, 6.25]; p<0.001) and absence of other cardiac diseases (OR=8.33; 95% CI [2.33, 25.0]; p=0.001); while none of the investigated factors showed to be a significant predictor for uncontrolled hypertension. There is an insufficient level of awareness and education among the family members of medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The typical profile associated with the lowest level of awareness in this specific population is that of the young smoker with no history of diabetes or cardiac disease. Healthcare professionals should have a significant contribution in raising the levels of awareness and education in their close circle.
Natalia Alexeeva
Stanford University Graduate School of Business, USA
Title: Virtual primary care-new models for guideline adherenace, efficiency and access
Time : 16:40-16:55
Biography:
Natasha Alexeeva is a serial entrepreneur and health care enthusiast. She spent past 5 years in top notch innovation teams and those endeavors got her to start friendly. Her background is in technology and entrepreneurship. She graduated with computer science degree and math minor from Moscow State University in Russia and attended Graduate School of Business at Stanford University where she co-founded and sold another company in electronic education.
Abstract:
Virtual primary care is the fastest growing market segment in health care. It is projected to reach 42% this year. This is compared to 7% growth of the Urgent Care and 14% growth for retail clinics. The market says it all consumers, physicians and healthcare organizations all over the world see the value in more efficient ways to deliver high quality care. There are two major models in delivering health over electronic medium: Syncherenous (video and phone) and asyncherenous (model that does not require real time interaction). Syncherenous models have been shown to be effective in mental health and clinician to clinicial communications. However, it delivers limited efficiency, since the time taken to assess someone’s health via a video visit is almost identical to the time needed to do the same in the office (23 minutes vs 25 minutes average). Asyncherenous healthcare delivery, on the other hand, creates efficiency as well as increases access and convenience. It relies on latest evidence based guidelines to collect information from the patient using sophisticated computer algorithsms and then serves it to the physician, so that they can access non-critical cases using clinical marginal capacity. Friendly is the market leader in asyncherenous communication. The unique approach is showing an average doctor visit reduced by a factor of 10. Physician documentation is reduced by 50%. Patient loyalty and satisfaction is much higher as compared to in-person visit.
Alzbeta Tohatyova
Pavol Jozef Šafárik University, Slovakia
Title: Ad36 infection can lead to overweight and obesity?
Time : 16:55-17:10
Biography:
Alzbeta Tohatyova is currently a PhD student at Medical Faculty, P J Safarik University in Kosice, Slovakia. Her research interests focus on pediatric cardiology and preventive cardiology.
Abstract:
Introduction: Ad36 is the first human adenovirus reported that causes obesity in experimentally infected animals and shows association with obesity in humans. More human studies, all over the world, are related to the relationship between Ad36 infection and obesity, and till now have not been explanatory, studies show contradictory results. Aim: The main aim of our study is to assess the association between Ad36 infection and obesity in high-school students from Eastern Slovakia. Methods: Two hundred and twenty-four randomly selected students (17.72±1.20 years of age, 120 female) from 7 high-schools in Kosice were included in the study. Subjects with secondary causes of obesity were excluded and none were taking medications or had a history of cardiovascular disease. In 224 healthy students, anthropometric parameters, fasting plasma glucose and insulin were measured. Ad36 antibody was detected by ELISA test. Results: No significant differences were found between Ad36 positive and Ad36 negative high-school students in prevalence of obesity (chi-kv: 1.91, p=0.16). Study found no significant differences between high-school students with and without IR in prevalence of Ad36 positivity (chÃ-kv: 0.66, p=0.41). We confirmed significant differences between Ad36 positive and Ad36 negative in normal weight high-school students (p<0.05, U=2221.50). We also confirmed the high prevalence of overweight and obesity in healthy high-school students (23.66%). Conclusion: The current study shows a possible association between Ad36 infection and the risk of development of obesity in normal weight children and adolescents. Our results do not support that any Ad36 adipogenic adenovirus effect on body composition is operating in human through an insulin-resistance-related mechanism. Further studies in different age groups of children and adults are required to elucidate this biological mechanism of such complex relationship.
Lamia K Alsenaidi
United Arab Emirates University, UAE
Title: Women’s knowledge and attitude towards pregnancy in a high-income developing country
Time : 17:10- 17:25
Biography:
Lamia K Alsenaidi is a 6th year Medical student in United Arab Emirates University/College of Medicine and Health sciences. She has published 2 papers in reputed journals and she is currently working in a new research about cancer awareness.
Abstract:
Objective: The aim of this study was to determine the knowledge and attitudes among women in a high-income developing country regarding pregnancy and antenatal care. Methods: Women who participated in the study were asked to complete a questionnaire. The questionnaire enquired about age, level of education, internet use, marital status and employment. It also included questions regarding their knowledge of ultrasound, the effects of sexual activity and other exercise during pregnancy, breast feeding and premature delivery. The collected data were subjected to statistical analysis using SPSS. Results: The total number of women included in this study was 205. A total of 115 women (56.1%) thought that the most important benefit of ultrasound was to discover fetal abnormalities. Only 75 (36.6%) thought that regular exercise was not harmful during pregnancy. Of the total respondents 116 (56.6%) of 205 thought that sex during pregnancy was harmful to the fetus or did not know. Age (P=0.001), marital status (P=0.001) and working status (P=0.005) were found to significantly affect their knowledge. Conclusion: Knowledge about pregnancy among Emirati women is low. There is a need for effective prenatal classes that focus on educating women about issues related to pregnancy and antenatal care.
Galya Ghalib Al Ghalib Alsharif
King Abdulaziz University Hospital, Saudi Arabia
Title: The benefit of pre- and post-operative instructions
Time : 17:25- 17:40
Biography:
Galya Ghalib Al Ghalib Alsharif has completed her MBBS from King Abdulaziz University Hospital. She is currently a medical intern.
Abstract:
Millions of people each year undergo surgery. Despite the development in the surgical field; patients remain in fear of the complications that may take place. 140 patients were randomly selected from the clinics at King Abdul-Aziz University Hospital, in Jeddah. A questionnaire was used to test their knowledge of the instructions before and after a surgery; ear nose and throat specialty in particular. Another questionnaire was given after educating the patients of the instructions in one of the surgical operations in this specialty. The aim is to educate the patients about these instructions in the event of undergoing any future operations. The result was: 64% of patients knew the existence of instructions before and after operations, while 36% didn’t know the existence of such instructions. The most known instruction by 86% was: to stop eating at midnight on the night of the operation. And the least known by 34% was: to stop taking Aspirin 7 days before the operation. The benefit rate from the explained instructions was 100%. 54% of these patients received only verbal instructions, while 10% received both verbal and on paper instructions and the remaining 18% of patients didn’t receive any instructions.
Christos Stefanou
Limassol General Hospital, Cyprus
Title: Electrical muscle stimulation: Essential in health and disease, in primary and secondary prevention
Time : 17:40- 17:55
Biography:
Christos Stefanou is an Internist and Intensivist in Limassol General Hospital ICU of Cyprus, where he is in-charge of the educational program and an Honorary Associate Professor of Medicine at St George’s University. He was ranked first class in his Medical School of Athens University and finished his fellowship at Evangelismos Hospital of Athens, Greece and his internship in the USA. He is a PhD candidate and researcher in the pathophysiology and regenerative properties of electrical muscle stimulation. He has also been the President of psychosocial support and health group of Cyprus Red Cross.
Abstract:
Electrical muscle stimulation (EMS) is just following the steps and evolution of exercise: one of the enormous accumulations of evidence about its possible medical benefits and high safety and feasibility profile. EMS is nearing inclusion at contemporary essential guidelines for health maintenance, primary and secondary prevention and rehabilitation, with a range of actions extending from healthy people to various categories of chronic patients. It appears to exert regenerative and reparatory effects on the endothelium, to mobilize endothelial progenitor cells; to favorably affect the microcirculation; to induce mesenchymal stem cell potentiation; to exert multilevel beneficial immune, metabolic and endocrine actions related to cytokine, hormonal, neural, anti-inflammatory and anti-oxidant modifications. By these pleotropic pathophysiologic mechanisms, it is evidenced that, EMS improves cardiovascular fitness and overall health; prevents ICU- acquired weakness or sarcopenia, pressure ulcers and venous thromboembolic disease; decreases pathological cardiac remodeling in heart disease, and sympathetic activity; alleviates dyspnea in malignancy or COPD; improves glucose metabolism in metabolic syndrome or diabetes patients; reinforces post injury neuroregeneration; improves spasticity, urinary/fecal incontinence, pelvic floor dysfunction, and chronic pain syndromes; enhances tissue perfusion; and assists in muscle reeducation. Further emerging applications relate to psychological health (such as depression); to post-surgical prevention of atelectasis and cough reinforcement; and to dysphagia in stroke or anorexia nervosa patients. Many applications of this endless list are FDA approved already. EMS needs to be considered as part of numerous medical conditions and any health-care professional needs to be aware of its indications.
Vijayalakshmi Gopalan Nair
University of Nizwa, Oman
Title: Influence of balanced diet on the nutritional status of the children between 1 to 3 years
Time : 17:55- 18:10
Biography:
Vijayalakshmi Gopalan Nair is a registered Nurse and Midwife with Master’s in Community Health Nursing Specialty in 2000. She has completed a Post-graduate diploma in Computer Application and pursuing PhD. She is currently working as Lecturer at College of Pharmacy & Nursing, University of Nizwa, Sultanate of Oman.
Abstract:
Aim: In the present study the researcher wanted to examine the nutritional status of children between 1 to 3 years (preschoolers). This study also wanted to investigate the improvement of weight and hemoglobin level through administration of balanced diet. Methods: One group per-test post-test design was adopted in the study. In pre-test nutritional assessment, dietary intake, anthropometric measurements and hemoglobin level of the children were assessed. The data collection was done for a period of 45 days. Physical assessment, nutritional assessment, dietary intake (pattern), nutritional deficiency diseases, anthropometric measurements like height, weight, head circumference, chest circumference, mid-arm circumference and hemoglobin levels were assessed. Education was given to the mothers on balanced diet and was demonstrated individually in their home setting on their menu planned for their children. After assessing, 30 children data were collected from their mothers. Results: The study findings revealed that among 96% of children there was a significant increase in the weight (from 0.5 to 1.2 kg), mid arm circumference and hemoglobin level (0.6 to 1.2gms dl). None of the child reported to have nutritional deficiencies. There was no significant difference in height, chest circumference and head circumference of the children. However, it has not increased to the ICMR recommended allowances. All the mothers perceived the importance of balanced diet and were able to prepare and feed the prescribed diet to their children comprised of rice, ragi, beef, egg, fish, milk, daal and vegetables including green leafy vegetables, roots and tubers and locally available fruits. Conclusion: The study brings to the attention that proper preparation and administration of balanced diet assures satisfactorial growth and development, prevention of infectious disease, nutritional deficiencies and thereby promoting well being of the children.
Jawahar Jay Kalra
University of Saskatchewan, Canada
Title: Quality care and patient safety: Global approaches to medical error disclosure
Biography:
Jawahar Jay Kalra, an educator, researcher, and quality health care advocate, is a Professor of Pathology in the University of Saskatchewan and has served as Head of the Department of Pathology and Laboratory Medicine. He is recognized for his many contributions as a clinical scientist, academic leader, and health system administrator. He has been a pioneer in establishing guidelines for thyroid-function testing, quality assurance program and contributed nationally and internationally in the area of total quality management. He has published extensively and is the author of the book “Medical Errors and Patient Safety: Strategies to reduce and disclose medical errors and improve patience safety.â€
Abstract:
Disclosure of an adverse event is an important element in managing the consequences of a medical error. We have previously reported the Canadian provincial initiatives encouraging open disclosure of a critical event and have suggested its integration into a ‘no-fault’ model. We reviewed and compared the various medical error disclosure initiatives across the globe (USA, Australia, New Zealand, and United Kingdom) to analyze the progress made in this area. In Australia, disclosure policy integrates the disclosure process with risk management analysis towards investigating the critical events. In New Zealand, in any adverse event, patients are rehabilitated and compensated through a no-fault state funded compensation scheme. The United States Joint Commission on Accreditation of Healthcare Organizations mandated an open disclosure of any critical event during care to the patient or their families’. Effective communication between health care providers, patients and their families throughout the disclosure process is integral in sustaining and developing the physician patient relationship. The Canadian provincial initiatives, though similar in content, remain isolated because of their non-mandatory nature on disclosure. In conclusion, the designing of an error disclosure policy requires integration of various aspects including bioethics, physician-patient communication, quality of care, and team-based care delivery. The complexities of medical error disclosure to patients present ideal opportunities for medical educators to probe how learners are balancing the ethical complexities involved in error disclosure. We suggest that a uniform policy centered on addressing errors in a non-punitive manner and respecting the patient’s right to an honest disclosure be implemented.
- Symposium on Preventive cardiology and obesity, dyslipidemia
Location: The Oberoi Dubai, Dubai
Chair
Gillian Hood
Queen Mary, University of London, UK
Co-Chair
Marc Matthews
Mayo Clinic, USA
Session Introduction
Schusterova I
P. J. Šafárik University in Kosice, Slovakia
Title: Universal screening for hypercholesterolemia in children at 11- and 17 years of age: unique in Slovakia for 17 years
Time : 13:40-14:25
Biography:
Schusterová I is an Associate Professor and the Head of the Department of Paediatrics and Adolescent Medicine, Children University Hospital, P J Š University in Košice, Slovakia. At the same time, she is the Head Physician in the Tertiary Center for Valvular and Congenital Heart Defects, Eastern Slovak Institute of Cardiac and Vascular Diseases. She took specialization exam from Adult and Pediatric Cardiology at National Institute of Cardiac and Vascular Diseases in Bratislava, Slovak Republic. After Graduation, she took part in Fellowship Training at Ottawa Civic Hospital, and later on performed research work in the area of Cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/2004, she completed her training at Cardiologic Department, II. Internal Medicine Clinic, General Hospital, Vienna under supervision of Professor Dr Gerald Maurer. Later in 2005, she broadened her professional knowledge and skills at Cardiac Surgery Clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity, and disorders of lipid metabolism, atherosclerosis and their prevention in the paediatric age group.
Abstract:
Atherosclerosis begins in childhood. In adults, elevated non-HDL-cholesterol concentrations, low HDL-cholesterol concentrations, hypertension, smoking, diabetes, and obesity are associated with advanced atherosclerotic lesions and increased risk of clinically manifest atherosclerotic disease. These risk factors also are associated with early atherosclerosis in young persons. Control of these risk factors is the major strategy for preventing atherosclerotic disease. The current recommendations for the primary prevention of cardiovascular diseases in Slovakia include universal nation screening for hypercholesterolemia: national programmed routine examination of 11- and 17 years old children by primary pediatricians. The national universal screening in Slovakia was introduced gradually, and the referral rate to the tertiary institution reached its expected level only in 1998. Screening was gradually implemented throughout the whole country, reaching an estimated majority of 11 and 17-years-old children, approximately 1 million from 2004 until now. Data for the efficacy of a national universal screening for detection of familiar hypercholesterolemia are lacking. The universal screening for hypercholesterolemia together with familiar history and premature cardiovascular complicationidentified a disease- causing variant for familiar hypercholesterolemia. The long-range prevention of atherosclerosis and its squeal by control of the risk factors for adult coronary artery disease should begin in adolescence and young adulthood. Primary pediatricians play an important role in primary prevention of cardiovascular diseases, detection of familial hypercholesterolemia in a cohort of children with hypercholesterolemia. Clinic for preventive cardiology and lipid metabolism disorders focus on management and treatment of children with positive screening test result.
Tohatyova A
P J ŠUniversity in Košice, Slovakia
Title: Childhood obesity and obesity reduction program
Biography:
Alzbeta Tohatyova is currently a PhD student at Medical Faculty, P J Safarik University in Kosice, Slovakia. Her research interests focus on pediatric cardiology and preventive cardiology.
Abstract:
Over the past three decades the prevalence of overweight and obesity has increased substantially. Childhood obesity is an important public health problem and is of particular interest because of possible long-term associations with adult body weight status and morbidity. Obesity is associated with a shortened life expectancy mainly because of increased risk for cardiovascular disease and obesity related cardiomyopathy. However, a third of obese individuals never develop CV disease; and this group is called the metabolically “healthy” obese. Recent evidence suggests that not all obese persons are negatively affected by their body weight and that weight loss does not necessarily always improve health. Obese youth will live a longer portion of their life as obese and with chronic health conditions. Moreover, although weight loss in obese youth is associated with improved metabolic outcomes, weight management goals for this age group are more ambiguous than in adults. In our Children Faculty Hospital, the management of obesity includes hospitalization to exclude secondary causes of obesity, spa treatment and outpatients programs. Our highly specialized Clinic for preventive cardiology and lipid metabolism disorders, focus on individual and group outpatient therapy for obesity, and also on cardiovascular risk stratification in children and adolescent. Highly organized team of specialists is working on interdisciplinary outpatient program- “Obesity reduction program, School of Obesity”. This program is focused on the same sex groups of children and adolescent who are in the same range of ages. The goal of this program is to win the fight against obesity- prevention of cardiovascular disease associated with obesity, and treatment of childhood obesity by new ways. We confirmed that group outpatient therapy for children and their parents had significantly better results in body weight loss (p<0.05) compared to individual therapy during the childhood.
Biography:
Schusterová I is an Associate Professor and the Head of the Department of Paediatrics and Adolescent Medicine, Children University Hospital, P J Š University in Košice, Slovakia. At the same time, she is the Head Physician in the Tertiary Center for Valvular and Congenital Heart Defects, Eastern Slovak Institute of Cardiac and Vascular Diseases. She took specialization exam from Adult and Pediatric Cardiology at National Institute of Cardiac and Vascular Diseases in Bratislava, Slovak Republic. After Graduation, she took part in Fellowship Training at Ottawa Civic Hospital, and later on performed research work in the area of Cardiology at University of Ottawa in Canada. In the period from 11/1999 till 7/2004, she completed her training at Cardiologic Department, II. Internal Medicine Clinic, General Hospital, Vienna under supervision of Professor Dr Gerald Maurer. Later in 2005, she broadened her professional knowledge and skills at Cardiac Surgery Clinic, Kardiocentrum Universitätsklinik in Bad Oyenhausen, Germany. Her research interests focus on preventive cardiology, obesity, and disorders of lipid metabolism, atherosclerosis and their prevention in the paediatric age group.
Abstract:
Obesity causes chronic volume overload (increased preload) and dilation of the left ventricle (LV) of the heart. Hypertrophy LV itself as an adaptation to expanded intravascular volume determines the damage of the diastolic function LV especially by influencing later diastolic passive infilling. For persistent obesity they may of course result in systolic dysfunction and manifest heart failure while damaging the function of the myocardium correlates with body mass index and the duration of obesity. The clinical picture of the consequences of cardiomyopathy depends on the severity of the emerging cardiac changes, age, duration and severity of the obesity, as well as on associated diseases, which often accompany obesity (arterial hypertension, disorder in the metabolism of lipids and glucose, ischemic heart disease, sleep apnea syndrome, etc.). Studies of obese child patients indicate, initial signs of cardiomyopathy – changes of indices of diastolic and systolic functions, though they are clinically silent. Early structural and functional changes in the myocardium of obese children and overweight children represent a higher risk of clinical manifestation of this cardiomyopathy in early adulthood, and therefore they require increased vigilance of the pediatricians and pediatric cardiologists. In one of our study, we confirmed differences not only in LVM (p<0.001) and LVM index body height2.7 (p<0.05) but as well as the differences in left ventricle size (IVS (p<0.01), LVEDD (p<0.005), LVESD (p<0.05), PWTh (p<0.001)) and volumes include stroke volume (p<0.05) in spite of normal preserved systolic function in obese and overweight children. Increased LV mass in obese individuals is also a result of the increased amount of epicardial fat and fat infiltration of the myocardium. The thickness of epicardial adipose tissue (EAT) as measured by echocardiography represents an independent predictor of visceral adiposity. A very good positive correlation was found between echocardiographic measurements of EAT and MRI measurements, which represent the gold standard for assessing visceral fat mass. We confirmed significantly higher thickness of echocardiography EAT was found in overweight and obese adults and children (p<0.001). However, it requires the creation of a standardized examination methodology for children age, as well as the creation of certain reference values while considering the growth and development of children.
- Track 2: Primary Care Medicine
Track 3: Family Medicine and Primary Care
Track 4: Quality in Primary Care
Location: The Oberoi Dubai, Dubai
Chair
Gillian Hood
Queen Mary, University of London, UK
Co-Chair
Ingrid Schusterova
Children University Hospital, Slovakia
Session Introduction
Brendan Mitchell
Gold Coast University Hospital, Australia
Title: Medication adherence one month after hospital discharge in medical inpatients
Time : 14:25-14:45
Biography:
Brendan Mitchell completed his Bachelor of Science degree at the University of Queensland in 2010 and subsequently Doctor of Medicine degree at the University of Melbourne, graduating in 2014. He is currently working as a resident Medical Officer at Gold Coast University Hospital in Queensland, Australia.
Abstract:
Background: The rate of medication non-adherence has been consistently reported to be between 20-50%. The majority of available data comes from international studies and we hypothesized that a similar rate of adherence may be observed in Australian patients. Aims: To determine the rate of adherence to medications after discharge from acute general medical hospital admission and to identify factors that may be associated with non-adherence. Methods: A prospective cohort study of 68 patients, comparing admission and discharge medication regimens to self-reported regimens 30-40 days after discharge from hospital. Patients were followed up via telephone call and univariate and multivariate binary logistic regression used to determine patient factors associated with non-adherence. Results: A total of 27 out of 68 patients (39.7%) were non-adherent to one or more regular medications at follow up. Intentional and unintentional non-adherence contributed equally to non-adherence. Using multivariate analysis, presence of a carer responsible for medications was associated with significantly lower non-adherence (OR 0.20 (0.05-0.83), p=0.027) when adjusted for age, comorbidities, chemist blister pack and total number of discharge medications. Conclusions: Non-adherence to prescription medications is suboptimal, and consistent with previous overseas studies. Having a carer responsible for medications is associated with significantly lower rates of non-adherence. Understanding patient’s preferences and involving them in their healthcare may reduce intentional non-adherence.
Lori Sanderson
Loma Linda University, USA
Title: Lifestyle change interventions for children and adolescents with diabetes or kidney disease
Time : 14:45-15:05
Biography:
Lori Sanderson completed her Doctoral degree in Public Health Education and Promotion. She also holds a Master’s degree of social work and is currently a Licensed Clinical Social Worker. She has worked as a Medical Social Worker for over 10 years now and specializes with children and adolescents who have been diagnosed with kidney disease and/or diabetes. She recently accepted a part-time position at eating disorder clinic in Claremont, CA. She has developed several programs to help the children with whom she works with. She is currently working to develop a non-profit organization in eating disorders.
Abstract:
The purpose of this research letter is to report on the availability of evidence-based interventions for promoting lifestyle change in children and adolescents with diabetes or kidney disease. References for this review were obtained using several electronic databases, including Ebsco Host, PsychInfo, Medline and CINAHL. Search topics included transplant adherence, diabetes adherence, kidney adherence, obesity and transplant, kidney disease, transplant noncompliance, renal failure, renal disease, chronic kidney failure, end-stage renal disease, obesity and diabetes, overweight and kidney disease, overweight and diabetes, overweight, treatment interventions and overweight, treatment interventions for obesity, children and obesity, growth chart, diabetes intervention, kidney disease intervention, obesity intervention, obesity and transplantation, obesity transplant intervention, motivational interviewing, physical activity level, physical activity, exercise intervention, body mass index measurement, body fat percentage, psychosocial issues of kidney disease, psychosocial issues of transplant, and coping with kidney disease. Search results included English language only and between the years 2000 and 2009. Very few lifestyle interventions have been shown to be effective for obese children or adolescents with diabetes and none for obese children and adolescents with kidney diseases. More research is needed to develop effective interventions for this vulnerable population.
Trish Morison
Universal College of Learning, New Zealand
Title: When pregnancy is no longer the issue
Time : 15:05-15:25
Biography:
Trish Morison has completed a Master’s degree in Public Health. Her research was published in the New Zealand Journal of Primary Health Care. She has lectured in Anatomy, Physiology and Pharmacology for the last 14 years.
Abstract:
The rate of sexually transmitted infections amongst midlife and older heterosexual women in New Zealand is rising. Popular culture celebrates a heightened sexuality for this population group. However, depictions of sexually savvy ‘cougars’ are at odds with reality for many women. International literature highlights that these women are often ill-equipped to negotiate safer sex and condom use, instead focusing on pleasing men and attributing their silence to spontaneity. The study aimed to explore the enablers and barriers to safer heterosexual sex as perceived by midlife and older New Zealand women, who are re-partnering or in casual relationships. This qualitative study utilized Interpretive Phenomenology Analysis, supported by the theory of gender and power, to examine the gender-normative assumptions and behaviors in women’s accounts of unprotected sex. Eight single women aged 40-69 participated in individual, in-depth interviews. Analysis indicated that these women held misconceptions about STI transmission but had not sought educational material, nor discussed their sexual health with clinicians. Results highlighted women’s ambivalence about prioritizing safer sex, preferring to comply with partners’ wishes, particularly when under the influence of alcohol. Women described valuing their own pleasure and their distaste for condom use, but data emphasized that women predominantly aligned their choices with men’s preferences. This study highlights that midlife women are both ill-informed and vulnerable with regards to sexual health. Primary healthcare clinicians are well placed to provide education and sexual health advice.
Dybesh Regmi
United Arab Emirates University, UAE
Title: Motivational interviewing- A necessity in medical education
Time : 15:25-15:45
Biography:
Dybesh Regmi is working as an Assistant Professor in the Department of Family Medicine at UAE University. He also holds a faculty membership at the Department of Family and Community Medicine at the University of Toronto. He completed his residency training in Family Medicine at McMaster University. He has been an examiner for the College of Family Physicians of Canada and was a peer assessor for the regulatory body in the province of Ontario.
Abstract:
Primary care is focused on prevention and adoption of healthy behaviors by the general population. A proven effective tool for patient behavior modification that has been utilized is Motivational Interviewing (MI). Compared to the trans-theoretical model which focuses on the stages of change, MI promotes personal desire for change within the patient. Such self-promotion of change is enhanced by the fact that the technique allows the patient to resolve doubts and identify barriers for change. Numerous studies have shown that MI is more effective than traditional method of giving advice to elicit behavior change particularly in weight loss, dyslipidemia and lowering of blood pressure. Furthermore, research indicates that techniques of MI are best taught by workshop sessions by experts who utilize MI within their primary care. The expert clinician asks open ended questions, assesses level of motivation and confidence and then tailors the interview accordingly. Ultimately, the expert determines the structure and direction of the interview, the patient is responsible for the change. Clerkship and residency programs should consider incorporating MI into their communication skills, thus enabling future primary care providers to be effective clinicians.
Haw-Yueh Thong
Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
Title: Experience of photo-pneumatic therapy in Taiwanese acne patients
Time : 16:00-16:20
Biography:
Haw-Yueh Thong is Chief of the Cosmetic Center at Shin Kong Wu Ho-Su Memorial Hospital in Taipei, Taiwan ROC. After graduating from National Taiwan University College of Medicine, she completed an Internship in National Taiwan University Hospital. Her Residency was in dermatology at National Taiwan University Hospital and her Fellowship was in cosmetic dermatology at the University of California, San Francisco. She had worked closely with Professor Howard Maibach at UCSF. She is also a Graduate of Stanford University with a Master’s degree in Management Science and Engineering, focusing on medical decision analysis. She has published numerous articles in professional journals and serves on many advisory boards and committees. Her interest in dermatology includes acne vulgaris, cosmetic dermatology and filler injections.
Abstract:
Acne is a disease of the pilo-sebaceous unit affecting both teenagers and adults. The treatment of acne is sometimes frustrating due to the emergence of antibiotic resistance, skin irritation and lack of novel therapy. Light and vacuum devices, also known as photo-pneumatic therapy, have been shown promising as a generally well-tolerated adjunctive treatment of acne vulgaris. We conducted a clinical study using such device to assess the efficacy and safety as an adjunctive treatment of acne in Taiwanese patients. Twenty patients received six sequential treatments every one to two weeks in the facial region. A 4×4 cm2 area on cheek was chosen as a control area and was not treated with photo-pneumatic device. Safety parameters and adverse events were recorded. VISIA Complexion Analysis System was used for image analysis on the improvement of four parameters, namely, pigmentation, pore reduction, redness and porphyrin levels. There was an overall improvement in pigmentation, pore size, redness and porphyrin levels on treatment areas. The treatment areas showed statistically significant improvement (p<0.05) in pigmentation and pore sizes compared with the control areas using paired samples T-test. Mild and self-limiting localized adverse events, mostly focal petechiae or mild irritation, were reported. Our study has demonstrated that photo-pneumatic therapy is an effective, safe and relatively well-tolerated procedure in Taiwanese acne patients.
Ahmad A Mirza
Taif University, Saudi Arabia
Title: Diagnosis and Control of Hypertension as Indicators of the Level of Awareness Among Relatives of Medical Students
Time : 16:20-16:40
Biography:
Ahmad A Mirza has completed his MBBS from Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia. Recently, he has been appointed as Demonstrator (Teaching Assistant) in Department of Surgery, Taif University. He has published 2 papers in reputed journals and currently, he is working on 7 ongoing researches. He has been attended and presented in many national and international conferences.
Abstract:
Introduction: Patients’ awareness plays an important role in the early diagnosis and control of many diseases including hypertension. We aimed to estimate the level of awareness among the relatives of medical students by assessing the prevalence of undiagnosed and uncontrolled hypertension. Methods: In this cross-sectional designed study, a certain group of medical students were invited to interview their respective adult first-degree relatives for risk factors and take measurement of their blood pressure in adequate conditions. According to the absence or presence of hypertension in their history, relatives who were measured with elevated blood pressure were analyzed as undiagnosed or uncontrolled hypertension, respectively; while those who were measured with normal values of blood pressure were analyzed as normal or controlled hypertension, respectively. Comparative analysis of different parameters was carried out between these subgroups. Results: We included 770 relatives of 82 (57.7%) total students’ participations. The prevalence of undiagnosed hypertension in the total study population was 14.4% (111 cases). Among participants diagnosed previously with hypertension, 61.9% were uncontrolled at the time of the study. Predictors for undiagnosed hypertension were aged below 40, working at the present time in either governmental or private sectors, current smoking, absence of diabetes and cardiac diseases; while none of the investigated factors showed to be a significant predictor for uncontrolled hypertension. Conclusions: There is insufficient level of awareness among the family members of medical students, as demonstrated by the high prevalence of both undiagnosed and uncontrolled hypertension. The typical profile associated with the lowest awareness level is that of the young smoking employee with no history of diabetes or cardiac disease.
Natalia Alexeeva
Stanford Graduate School of Business, USA
Title: Virtual primary care-new models for guideline adherence, efficiency and access
Time : 16:40-16:55
Biography:
Natasha Alexeeva is a serial entrepreneur and health care enthusiast. She spent past 5 years in top notch innovation teams and those endeavors got her to start friendly. Her background is in technology and entrepreneurship. She graduated with computer science degree and math minor from Moscow State University in Russia and attended Graduate School of Business at Stanford University where she co-founded and sold another company in electronic education.
Abstract:
Virtual primary care is the fastest growing market segment in health care. It is projected to reach 42% this year. This is compared to 7% growth of the Urgent Care and 14% growth for retail clinics. The market says it all consumers, physicians and healthcare organizations all over the world see the value in more efficient ways to deliver high quality care. There are two major models in delivering health over electronic medium: Synchronous (video and phone) and asynchronous (model that does not require real time interaction). Synchronous models have been shown to be effective in mental health and clinician to clinician communications. However, it delivers limited efficiency, since the time taken to assess someone’s health via a video visit is almost identical to the time needed to do the same in the office (23 minutes vs. 25 minutes average). Asynchronous healthcare delivery, on the other hand, creates efficiency as well as increases access and convenience. It relies on latest evidence based guidelines to collect information from the patient using sophisticated computer algorithms and then serves it to the physician, so that they can access non-critical cases using clinical marginal capacity. Friendly is the market leader in asynchronous communication. The unique approach is showing an average doctor visit reduced by a factor of 10. Physician documentation is reduced by 50%. Patient loyalty and satisfaction is much higher as compared to in-person visit.
Alzbeta Tohatyova
Pavol Jozef Šafárik University, Slovakia
Title: Ad36 infection can lead to overweight and obesity?
Time : 16:55-17:10
Biography:
Alzbeta Tohatyova is currently a PhD student at Medical Faculty, P J Safarik University in Kosice, Slovakia. Her research interests focus on pediatric cardiology and preventive cardiology.
Abstract:
Introduction: Ad36 is the first human adenovirus reported that causes obesity in experimentally infected animals and shows association with obesity in humans. More human studies, all over the world, are related to the relationship between Ad36 infection and obesity, and till now have not been explanatory, studies show contradictory results. Aim: The main aim of our study is to assess the association between Ad36 infection and obesity in high-school students from Eastern Slovakia. Methods: Two hundred and twenty-four randomly selected students (17.72±1.20 years of age, 120 female) from 7 high-schools in Kosice were included in the study. Subjects with secondary causes of obesity were excluded and none were taking medications or had a history of cardiovascular disease. In 224 healthy students, anthropometric parameters, fasting plasma glucose and insulin were measured. Ad36 antibody was detected by ELISA test. Results: No significant differences were found between Ad36 positive and Ad36 negative high-school students in prevalence of obesity (chi-kv: 1.91, p=0.16). Study found no significant differences between high-school students with and without IR in prevalence of Ad36 positivity (chí-kv: 0.66, p=0.41). We confirmed significant differences between Ad36 positive and Ad36 negative in normal weight high-school students (p<0.05, U=2221.50). We also confirmed the high prevalence of overweight and obesity in healthy high-school students (23.66%). Conclusion: The current study shows a possible association between Ad36 infection and the risk of development of obesity in normal weight children and adolescents. Our results do not support that any Ad36 adipogenic adenovirus effect on body composition is operating in human through an insulin-resistance-related mechanism. Further studies in different age groups of children and adults are required to elucidate this biological mechanism of such complex relationship.
Lamia K Alsenaidi
United Arab Emirates University, UAE
Title: Women’s knowledge and attitude towards pregnancy in a high-income developing country
Time : 17:10- 17:25
Biography:
Lamia K Alsenaidi is a 6th year Medical student in United Arab Emirates University/College of Medicine and Health sciences. She has published 2 papers in reputed journals and she is currently working in a new research about cancer awareness.
Abstract:
Objective: The aim of this study was to determine the knowledge and attitudes among women in a high-income developing country regarding pregnancy and antenatal care. Methods: Women who participated in the study were asked to complete a questionnaire. The questionnaire enquired about age, level of education, internet use, marital status and employment. It also included questions regarding their knowledge of ultrasound, the effects of sexual activity and other exercise during pregnancy, breast feeding and premature delivery. The collected data were subjected to statistical analysis using SPSS. Results: The total number of women included in this study was 205. A total of 115 women (56.1%) thought that the most important benefit of ultrasound was to discover fetal abnormalities. Only 75 (36.6%) thought that regular exercise was not harmful during pregnancy. Of the total respondents 116 (56.6%) of 205 thought that sex during pregnancy was harmful to the fetus or did not know. Age (P=0.001), marital status (P=0.001) and working status (P=0.005) were found to significantly affect their knowledge. Conclusion: Knowledge about pregnancy among Emirati women is low. There is a need for effective prenatal classes that focus on educating women about issues related to pregnancy and antenatal care.
Galya Ghalib Al Ghalib Alsharif
King Abdulaziz University Hospital, Saudi Arabia
Title: The benefit of pre- and post-operative instructions
Time : 17:25- 17:40
Biography:
Galya Ghalib Al Ghalib Alsharif has completed her MBBS from King Abdulaziz University Hospital. She is currently a medical intern.
Abstract:
Millions of people each year undergo surgery. Despite the development in the surgical field; patients remain in fear of the complications that may take place. 140 patients were randomly selected from the clinics at King Abdul-Aziz University Hospital, in Jeddah. A questionnaire was used to test their knowledge of the instructions before and after a surgery; ear nose and throat specialty in particular. Another questionnaire was given after educating the patients of the instructions in one of the surgical operations in this specialty. The aim is to educate the patients about these instructions in the event of undergoing any future operations. The result was: 64% of patients knew the existence of instructions before and after operations, while 36% didn’t know the existence of such instructions. The most known instruction by 86% was: to stop eating at midnight on the night of the operation. And the least known by 34% was: to stop taking Aspirin 7 days before the operation. The benefit rate from the explained instructions was 100%. 54% of these patients received only verbal instructions, while 10% received both verbal and on paper instructions and the remaining 18% of patients didn’t receive any instructions.
Vijayalakshmi Gopalan Nair
University of Nizwa, Oman
Title: Influence of balanced diet on the nutritional status of the children between 1 to 3 years
Time : 17:40- 17:55
Biography:
Vijayalakshmi Gopalan Nair is a registered Nurse and Midwife with Master’s in Community Health Nursing Specialty in 2000. She has completed a Post-graduate diploma in Computer Application and pursuing PhD. She is currently working as Lecturer at College of Pharmacy & Nursing, University of Nizwa, Sultanate of Oman.
Abstract:
Aim: In the present study the researcher wanted to examine the nutritional status of children between 1 to 3 years (preschoolers). This study also wanted to investigate the improvement of weight and hemoglobin level through administration of balanced diet. Methods: One group per-test post-test design was adopted in the study. In pre-test nutritional assessment, dietary intake, anthropometric measurements and hemoglobin level of the children were assessed. The data collection was done for a period of 45 days. Physical assessment, nutritional assessment, dietary intake (pattern), nutritional deficiency diseases, anthropometric measurements like height, weight, head circumference, chest circumference, mid-arm circumference and hemoglobin levels were assessed. Education was given to the mothers on balanced diet and was demonstrated individually in their home setting on their menu planned for their children. After assessing, 30 children data were collected from their mothers. Results: The study findings revealed that among 96% of children there was a significant increase in the weight (from 0.5 to 1.2 kg), mid arm circumference and hemoglobin level (0.6 to 1.2gms dl). None of the child reported to have nutritional deficiencies. There was no significant difference in height, chest circumference and head circumference of the children. However, it has not increased to the ICMR recommended allowances. All the mothers perceived the importance of balanced diet and were able to prepare and feed the prescribed diet to their children comprised of rice, ragi, beef, egg, fish, milk, daal and vegetables including green leafy vegetables, roots and tubers and locally available fruits. Conclusion: The study brings to the attention that proper preparation and administration of balanced diet assures satisfactorial growth and development, prevention of infectious disease, nutritional deficiencies and thereby promoting well being of the children.
Rajni Nair(Video Presentation )
Metro-North Hospital Health Services, Australia
Title: Home is where health is
Time : 17:55-18:05
Biography:
Rajni Nair has completed her Master’s in Health Care Research from Griffith University, Australia and has publications related to "Extent and application of patient diaries in Intensive care unit in Australia". She has been the guest speaker in various conferences, like the Australian College of Critical Care Nurses and the Australian and New Zealand Intensive Care Society. She is the Nursing Director of Hospital in the Home service, in the Metro-North Health Services in Queensland. She has done extensive work in this sector, where active research is being conducted in “Hospital in the Home” and how the model would be effective to assist in patient journey in the field or Rehabilitation, Delirium, and more.
Abstract:
Hospital in the Home (HITH) involves the provision of acute, sub-acute treatments by health care professionals at a patient’s usual place of residence as a substitute for inpatient care received at a hospital. Patients are considered to be inpatient with preservation of medical governance. Most states and territories in Australia have HITH programs under which admitted patients are provided with hospital care in the home. The drive for HITH care in Australia has been due to rising health care costs increasing the need to reduce inefficient health care expenditure; growth in the demand of inpatient care in the context of limited public hospital bed supply; shifting demographics and population growth, hospital access issue, increased responsive to consumer preferences; and the development of portable hospital technologies, drugs delivery devices. The Metro-North HITH model of care has incorporated 4 tertiary hospitals, with care provision provided to patients in varied diagnosis related groups (DRG), with intravenous antibiotics, fluid management, wound management, blood transfusion, peritoneal dialysis and rehabilitation. Studies have shown that HITH is more beneficial when access block to hospitals is interjected, in Emergency Department. A pilot project conducted in one of the tertiary hospitals showed that the presence of a HITH nurse within the Emergency Department proved to be very effective and efficient in referring patients onto the HITH services. Other than the lesser waiting time for patient, outcomes were predominantly the portrayal of the efficiency in health services, cost savings, patient satisfaction, further referrals and less representation back to hospital.