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  • ISSN: 2379-0547
    Volume 2, Issue 8
    Case Report
    Anthony K. Dah, Gabriella Dah, Tracy Dah, Emelia Adjardjah, Paschal Dah and Daniel Abaye*
    Case Presentation: A 68-year old man, weak, frail and unable to walk, with extensive and large bullae covering the whole body, some of which had burst with bloody offensive discharge, was brought to our clinic at the time of Ebola virus disease (EVD) outbreak in the West African sub-region
    Background: The public's lack of trust and confidence in national governments' ability to contain the spread of EVD across national borders and to tackle cases. The fear of EVD among the public and health professionals.
    Approach: We took steps to overcome fear among staff by promoting discipline, adherence to stringent procedures, training and supportive supervision of staff, application of the standard precautions of 'all times for all patients' was reinforced, including hand hygiene and use of disposable gloves. This led to staff being dedicated and staying at post and correctly diagnosing a severe case of bullous pemphigoid (BP).
    Treatment: The patient was treated with a high dose of prednisolone and antibiotics to which he responded well; blisters with the lesions healed. He developed treatment induced diabetes mellitus which was also timely diagnosed and effectively managed due to excellent monitoring systems at the clinic.
    Conclusions: 1. This was the first BP case in this clinic that was accurately diagnosed and managed due to our preparedness, leadership and collective responsibility of overcoming the fear associated with possible EVD. 2. Training and simulation exercises, discipline and dedication of staffled to efficacious results being achieved from supportive supervision of staff. 3. Relevant and timely information provided by WHO on EVD led to an accurate diagnosis.
    Short Communication
    Namita Bhardwaj*, Thomas F. Northrup, Michelle R. Klawans, DeepaVasudevan, and Angela L. Stotts
    Background and Objectives: The American Diabetes Association (ADA) has established guidelines to aid in the management of diabetes. Patient engagement with physicians is a core strategy of successful management; however, it is uncertain how well patient-centered interventions facilitate physician adherence to disease management guidelines. This study examined if a cost-effective, patient-centered diabetes care card (DCC) would lead to improvement in physicians' adherence to ADA guidelines.
    Methods: DCCs were given to the first 200 diabetic patients seen at an urban primary care practice during a quality-improvement project. Data on diabetic quality-of-care metrics were abstracted at three time points (pre-implementation, 6- and 12-months post implementation) from electronic medical records, including diabetic labs, immunization status, and other diabetic patient exams.
    Results: Prior to implementation, fewer than half of patients had foot exams, about one-third of patients were current on their pneumococcal vaccination and less than 10% had documented eye exams. There were no statistically significant differences seen at the 6- and 12-month post-implementation intervals. Patients seen for more office visits were more likely to receive their hemoglobin A1C and lipid profiles and were more likely to be immunized against influenza. Patients seen by different physicians were more likely to receive a diabetic foot examination.
    Conclusions: Brief implementation of a DCC did not produce a significant increase in diabetic quality-of-care metrics. Given the high health and economic burden related to diabetes, a cost-effective, coordinated care approach needs to be developed to aid management in primary care.
    Gary E. Ruoff*
    Both the diagnosis and treatment of migraine headaches are difficult and time consuming tasks for the family physician. Though there is no known cure for migraine headaches, they can be managed by the physician in concert with the patient. That is to say a successful outcome relies as much on the willingness of the patient to modify his or her lifestyle or habits as it does on the prescribed treatment of the physician. The patient who presents with migraine suffers from a genetic condition which causes him or her to be more reactive to certain sensory stimuli or triggers, either external or internal. Migraine triggers or risk factors can be rooted in diet, stress, irregular sleep patterns, hormonal activity, environmental factors, certain medications and/or sensory input. They can occur singly, or in combination, or they may accumulate over time until the body and brain are overwhelmed and a headache ensues. Medication is often necessary and proper, but the author contends that avoidance, modification or elimination of certain triggers can often reduce the frequency and/orintensity of migraines with a concomitant reduction of or reliance upon medication.
    Wong QS, Chan CHY* and Tam MYJ
    Abstract: With the advancement in technology, many couples with infertility choose in vitro Fertilization (IVF) treatment as a significant mean to achieve their dream of parenthood. However, with very low success rate, many of them face treatment failures and experience complicated emotions.
    In our qualitative study, we have contacted women (N=16) who have experienced IVF treatment failure, and were considering to continue on next treatment in order to conceive. During the focus groups launched, they revealed many ambivalent thoughts throughout the whole treatment. They swung between making their decisions and stances on various aspects, with more salient themes in treatment goals, continuation of treatment, husband's involvement and disclosure issues. They tended to seek for intimacy of others by wishing to be cared and accompanied throughout the treatment, but at the same time kept distance by shouldering all the suffering without sharing. These thoughts will be discussed and analyzed under adult attachment theory.
    Research Article
    Roy N. Morcos*, Thomas Macabobby, Angelina Rodriguez, and Cary Jordan
    We are proposing in this paper a new measure, the Hospitalization Rate Index (HRI), that evaluates the rate at which patients in a given practice or group are admitted to the hospital, and the duration of such hospitalization, corrected for the total number of patients cared on an outpatient basis in a given period of time. The numbers must be collected on a daily basis and the HRI calculated for a period of time. HRI=Number of hospitalized patients÷ Number of office patients x 100. Excluded from the HRI are hospitalizations for certain defined conditions such as accidents and maternity care. Office visits for purely nursing encounters or immunizations are also excluded from the calculation. We propose that the HRI may be viewed as a measure of overall quality of care especially if used to monitor one given practice over time, or if used to compare different practices only after meticulous attention is given to minimizing confounding variables. As changes in the way medical care is provided, such as the introduction of the patient-centered medical home, the HRI may be an important tool to evaluate the overall impact of such changes on patient outcomes.
    Jaya Aysola*, DaShawn Groves and LeRoi S Hicks
    Background: Current policy promotes health center professional training and pipeline programs as solutions to bolster primary care workforce in shortage areas, despite the paucity of evidence.
    Methods: We analyzed data from US health centers we surveyed from March to June 2010, merged with federal health center data, to estimate associations between health center training and pipeline programs and provider recruitment and retention.
    Results: Of the 976 surveyed, 391 health centers responded. Health centers with career ladder programs compared to those without had higher adjusted rates of no/minimal difficulty in recruitment of primary care providers. (17.6% vs. 10.6%; p=.01) and close to double the adjusted rates of reporting no/minimal difficulty in retention of primary care providers (39.4% vs. 21.2%; p=.0001).
    Discussion: There remains a need for further evaluation of health professional programs in order to expand models, such as career ladder programs, that demonstrate effectiveness in improving the primary care workforce in shortage areas.
    Mukadder Mollaoglu*, Muratcan Mollaoglu and Laser Sanal
    Abstract: Nursing students are often exposed to blood- borne infections during clinical practicum. The aim of this study is to evaluate the compliance of nursing students with standard precautions in clinical procedures.
    A cross-sectional survey was undertaken, involving 413 nursing students from a University hospital. Three forms were used for data collection in the research. The research data were were assessed using the Statistical Package for Social Sciences (SPSS) version 11.0
    The students showed high level of compliance with standard precautions such as wearing gloves, hand washing, and protection against penetrating injuries. However, the levels of compliance with wearing mask, using goggles, and wearing protective gowns were low. Students at advanced ages and those in their senior years displayed higher compliance with the standard precautions.
    Particularly when they start clinical practicum, the students should be informed and educated about how they can protect themselves from blood-borne infections.
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