Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer ...service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service.
This was a retrospective observational outcome study. Data were collected from electronic documents of patients' referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years.
286 were referred from primary care according to the NICE guidelines of '2-week wait for ovarian cancer'. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above.
One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.
Differences in patient demographic and tumour characteristics between patients of South Asian and White ethnicity diagnosed with an endometrial cancer (EC) and currently living in England are not ...well described. We undertook a retrospective study of EC cases diagnosed at the University Hospitals of Leicester, UK. A total of 1884 cases were included, with 13% of the patients being of South Asian ethnicity. South Asian women were diagnosed at a significantly younger age (mean age of 60.3 years) compared to women of White ethnicity (mean age of 66.9 years) with a mean difference of 6.6 years (95% CI 5.1 to 8.1, p < 0.001). Rising body mass index (BMI) in the White patient group was significantly correlated with younger age at diagnosis (p < 0.001); however, this association was not seen in South Asian patients. A linear regression that adjusted for diabetes status, BMI, and the interaction terms of diabetes status with BMI and ethnicity with BMI, highlighted a younger age of diagnosis in South Asian patients with a BMI less than 45 kg/m2. The difference was greatest at lower BMIs for both non-diabetics and diabetics. Further investigation is needed to explain these differences and to determine their impact on suspected cancer referral criteria.
We present the case of fishtail deformity of distal humerus in a 13-year-old boy presenting with a refracture 8 years after the original surgically treated lateral condyle fracture. This unusual ...incomplete vertical fracture of distal humerus starting at the apex of fishtail was treated non-surgically and went on to union but refractured yet again 12 months later. This also went on to full healing with conservative treatment, however the fishtail deformity persists. We discuss the possibility that fishtail deformity reflects an inherent weakness in the distal humerus. We suggest that children and parents should be warned about the potential risk for refracture, particularly if they participate in contact sports.
Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also ...often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic.
This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17.
Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years).
Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe.
The individual application of pure and active compounds such as methionine may help to address water scarcity issues without compromising the yield of wheat. As organic plant growth stimulants, amino ...acids are popularly used to promote the productivity of crops. However, the influence of the exogenous application of methionine in wheat remains elusive. The present investigation was planned in order to understand the impact of methionine in wheat under drought stress. Two wheat genotypes were allowed to grow with 100% field capacity (FC) up to the three-leaf stage. Twenty-five-day-old seedlings of two wheat genotypes, Galaxy-13 and Johar-16, were subjected to 40% FC, denoted as water deficit-stress (D), along with 100% FC, called control (C), with and without L-methionine (Met; 4 mM) foliar treatment. Water deficit significantly reduced shoot length, shoot fresh and dry weights, seed yield, photosynthetic, gas exchange attributes except for transpiration rate (E), and shoot mineral ions (potassium, calcium, and phosphorus) in both genotypes. A significant increase was recorded in superoxide dismutase (SOD), catalase (CAT), hydrogen peroxide (H2O2), malondialdehyde (MDA), and sodium ions (Na+) due to water deficiency. However, foliar application of Met substantially improved the studied growth, photosynthetic, and gas exchange attributes with water deficit conditions in both genotypes. The activities of SOD, POD, and CAT were further enhanced under stress with Met application. Met improved potassium (K), calcium (Ca2+), and phosphorus (P) content. In a nutshell, the foliar application of Met effectively amended water deficit stress tolerance by reducing MDA and H2O2 content under water deficit conditions in wheat plants. Thus, we are able to deduce a positive association between Met-induced improved growth attributes and drought tolerance.
The electrochemical treatment of canal water was investigated in a batch-wise system in the presence of stainless steel 316-grade electrodes. Three effective process parameters, including current ...density, reaction time, and electrode spacing, were evaluated in the range of 0.25–2.5 mA/cm2, 1–10 min, and 0.5–2.5 cm, respectively. Operational variables of electrochemical disinfection are optimized in response surface methodology (RSM) using Box–Behnken design. Before electrochemical disinfection, a pretreatment process of coagulants mixing for turbidity removal was conducted. Results revealed that a 10 ppm dosage of Ferric chloride (FeCl3.6H2O) and alum (Al2(SO4)3·16H2O) at neutral pH is appropriate. Furthermore, the RSM analysis shows that interelectrode spacing is the most prominent factor affecting the disinfection performance, and increasing electrode spacing inversely affects the disinfection efficiency. Results revealed that 1.52 mA/cm2 current density, 6.35 min reaction time, and 1.13 cm of electrode spacing are the optimum conditions, resulting in a statistically 98.08% disinfection of the total coliform. The energy required for electrochemically disinfection of water at optimum conditions was 0.256 kWh/m3.
Diabetes mellitus is a chronic progressive illness that causes considerable morbidity related to macro and micro vascular complications, resulting in an ever growing healthcare burden globally. Early ...Initiation of Insulin has significant impact on improving both long term health outcomes and quality of life among diabetics in comparison to oral medications alone. But both patients and physicians often resist early initiation of therapy, a phenomenon known as “Psychological Insulin Resistance” (PIR). Objective of study was to assess such barriers among diabetic patients in Pakistan. We selected 300 patients both type 1 and 2 through convenience sampling from diabetic clinics of 2 tertiary care hospitals. Data was collected through structured questionnaires and analyzed using SPSS version 17. A p-value <0.05 was considered statistically significant. (1)Variables i.e. embarrassment about injecting insulin in public, expense, affordability and side effects ( skin reactions, injection site pain) of insulin, frequent shots and interference with social activities when cross tabulated with gender of participants, educational status and duration of disease, were found statistically significant (p-value <0.05) proving them possible barriers to early initiation of therapy. Results were comparable to a study conducted on type 2 diabetics in Mexico to assess insulin adherence. (2). It was also observed that people with longer (>5 years) and advanced disease were more satisfied about their glycemic control with insulin and willing to recommend it to others but at the same time, feared about its lifelong commitment once started, with all these variables having statistical significance (p-value<0.05) .Although only patients perceptions were assessed but results were comparable with DAWN study in which belief in insulin efficacy was stronger among patients with poor control of disease and more distress. Concluded that patient’s perceptions and misconceptions arise from lack of primary education about long term benefits of insulin and prove major barriers to its early initiation. Patients consider insulin efficacious and last resort when they develop complications. Such perceptions tend to prevail more in areas of poor socioeconomic background and high illiteracy rate.
Reference:
(1) Bermeo et al., Insulin Adherence in Type 2 Diabetes: Jul 15; 2018 (2) Peyrot et al., Diabetes Attitudes, Wishes, and Needs (DAWN) study. 2005
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Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients ...but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic.
Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17.
Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years).
Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe.
How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):39-44. doi: https://doi.org/10.12669/pjms.35.1.237
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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