Shared clinical decision making

@#Most patients want to play an active role in their own health care. There is now a movement from medical paternalism to patient-centered care in the consultation process that is based on the therapeutic alliance and negotiation between the doctor and patient, aptly named “shared decision-making” (SDM). It is a process where doctors work together with patients, including their families and caregivers, to select tests, treatments, management, or support packages, based on clinical evidence and personal informed preferences, health beliefs, and values. Successful implementation of SDM is associated with improved quality of consultations, favorable patient-reported health outcomes, and increased patient and doctor satisfaction. Patients are empowered to make proactive health decisions resulting in decreased anxiety, faster recovery, increased treatment compliance, and reduced unnecessary health care expenditure. There are multiple existing models in facilitating SDM. Two simple and easyto-follow models are the “three-talk model” and “S.H.A.R.E. approach.” The three-talk model endorsed by the NICE divides the SDM consultation into three steps, namely: team talk (explaining the need to consider treatment options as a team), option talk (describing the alternatives in more detail, and making use of patient decision aids [PDA] whenever appropriate), and decision talk (helping patients explore and form their personal preferences). On the other hand, the S.H.A.R.E. approach promoted by the Agency for Healthcare Research and Quality (AHRQ) is a five-step SDM consultation process that includes exploring and comparing the benefits, harms, and risks of each treatment option through meaningful dialogue about what matters most to patients.

Knowledge, attitudes, and practices of patients in using telemedicine for primary care consultations at a community-based clinic chain in Pasig City, Metro Manila: A cross-sectional study

Introduction@#Due to COVID-19, face-to-face human interaction has become a health risk. There is a need to adopt technology to provide alternative means in delivering health care for those who are unable or unwilling to see a doctor in person.@*Objective@#The objective was to determine the baseline knowledge, attitudes, and practices of patients in using telemedicine for primary care consultations at a community-based clinic chain in Pasig City, Metro Manila@*Methods@#The study utilized a multi-center, cross-sectional descriptive design. A 34-item self-administered questionnaire was devised, pilot-tested, and distributed to 242 respondents in 4 clinics in Pasig City from October to November 2020.@*Results@#A total of 242 questionnaires were distributed with 100% response rate. Telemedicine awareness was at 44.6%. There is a favorable attitude towards telemedicine. Only 20.25% had experience in using telemedicine. Among those who had experience with telemedicine, the most used device was the mobile phone (93.4%). The respondents had various resources, with cellphone signal (47.9%) and mobile data (45.9%) being the most common. The respondents prefer phone calls (48-57%) as their primary telemedicine platform followed by video conferencing (36-40%).@*Conclusion@#Telemedicine awareness and utility in the surveyed community remain low despite the information and communication technology (ICT) resources available and information drives being conducted. Preliminary data suggest that the majority of the surveyed community is open to the idea of telemedicine. Phone calls and video conferences using mobile phones are the modalities of choice for consultations. A follow up study with a larger sample size and more inclusive sample is recommended

Orbital Implant Infection after Drilling Procedure

PURPOSE: To report the severity of orbital implant infection related to a drilling procedure and to provide a foundation for reevaluating this procedure. METHODS: We investigated retrospectively 17 patients who were suspected of orbital implant infection and whose infected implants were ultimately removed. In these patients, increased mucopurulent eye discharge and implant exposure after the drilling procedure were observed. We attempted to treat them with topical and systemic antibiotics, but the discharge and implant exposure did not improve. RESULTS: Of the 17 removed implants, 13 were hydroxyapatite and 4 were Medpor(R). The pegs used were plastic pegs in 12 cases and titanium pegs in 5 cases. The average duration from the first orbital implant insertion to drilling was 10.2+/-5.3 months. The average duration from drilling to severe infection symptoms was 37.0+/-30.0 months. The average duration from the onset of symptoms to implant removal was 12.9+/-12.6 months. The mean follow-up period after final surgery was 15.4 months. In most cases, the deep portions of the removed implants were fragile, malodorous, and filled with pus. Acute and chronic inflammatory cell infiltrations were observed in the pathological examinations, and H. influenzae, S. aureus, S. viridans were identified. They did not receive any drilling procedure thereafter and no infection or inflammatory sign was subsequently observed. CONCLUSIONS: Drilling and pegging can cause unexpected, severe complications such as orbital implant infection, in which the infected implant has to be removed to be cured. Therefore, before performing a drilling procedure doctors should carefully consider the patient's preferences and urgent needs.

Acute lead poisoning associated with backyard lead smelting in Jamaica / Envenenamiento agudo con plomo asociado con la fundición casera de plomo en Jamaica

Long-term backyard smelting of lead in a district known as Mona Commons, Kingston, Jamaica, has produced lead burdens as high as 30 000 mg/kg in soils near to the smelter, and indoor dust loadings of 373 microg/f2 in the residents' home. The blood lead levels (BPb) of 107 children from the district were in the range 2.2-202 microg/dL. Fifty-nine per cent of these had BPb levels above 10 microg/dL and the population mean was an unacceptably high 25.1 microg/dL. The highest levels were observed for five siblings, two of whom presented with lead encephalopathy. This severe chronic exposure to lead was exacerbated by a significant history of pica, and chronic nutritional anaemia. Chelation therapy significantly reduced the BPb levels but due to lead storage in other organs, the values after several months were still higher than desirable. This study emphasizes the importance of reducing the exposure of children to lead.

Blood lead levels in children in Jamaican basic schools

Blood lead levels (BLL) for 285 children, three to six years old, from seven basic schools located in known areas of anthropogenic pollution, and in urban and rural areas are reported. The samples were obtained by the finger-prick method and analyzed for lead by anodic stripping voltammetry. The majority of the children had blood lead levels below the now accepted limit of 10 micrograms dL-1 and there was no indication of cases that would represent medical emergencies. The present results show considerable improvement in the BLLs of children living in contaminated sites indicating the effectiveness of the previous remediation steps. Follow-up intervention work is in progress for cases of blood lead levels in excess of the recommended limit