Fracture Liaison Service and Its Role in Secondary Fracture Prevention in Malaysia: A Scoping Review

@#Introduction: Fragility fractures, which occur after a lowtrauma injury, increases with advancing age. Such fracture doubles the life-time risk of sustaining another fracture. This risk is highest in the immediate 18 months after the index fracture. However, most patients do not receive the appropriate risk assessment and intervention to reduce this risk. A coordinated model of care termed Fracture Liaison Service (FLS) has been reported to address this treatment gap. Materials and methods: This scoping review aims to explore the potential role and delivery of FLS services in Malaysia. Scientific and non-scientific sources relevant to FLS were identified from electronic bibliographic databases, specialist journals and relevant websites. Findings were categorised into themes and presented narratively. Results: FLS services remain concentrated in the Klang Valley. Even within FLS services, many do not have extensive coverage to risk assess all fracture patients. These services are multidisciplinary in nature where there are links between different departments, such as orthopaedics, osteoporosis expertise, bone densitometry, rehabilitation, falls services and primary care. FLS was able to increase the number of people undergoing fracture risk assessment and treatment. The importance of FLS was highlighted by local experts and stakeholders. Its implementation and delivery are supported by a number of national guidelines. Conclusion: FLS is central to our national efforts to reduce the impending fragility fracture crisis in the coming years. Continued effort is needed to increase coverage within FLS services and across the country. Training, awareness of the problem, research, and policy change will support this endeavour.

Caracterización de las atenciones de la unidad de psiquiatría de enlace durante seis meses en un hospital general de Lima, Perú / Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru

Resumen Introducción: La psiquiatría de interconsulta y enlace es un área de la psiquiatría clínica cuya función es que psiquiatras lleven a cabo una serie de actividades dentro de un hospital general. En el contexto internacional, el número de unidades de psiquiatría de enlace se ha incrementado significativamente, situación que está repercutiendo en Perú. Sin embargo, este desarrollo es heterogéneo y desconocido, por lo que se requieren reportes de estudios recientes que revelen las características y los detalles de los servicios de atención clínica de estas unidades. Objetivo: Examinar y reportar las características sociodemográficas y clínicas de los pacientes evaluados en la Unidad de Psiquiatría de Enlace del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) de Lima, Perú, y analizar la naturaleza de los cuadros sintomáticos y sindrómicos presentes. Métodos: Estudio descriptivo y transversal de las interconsultas recibidas por la Unidad de Psiquiatría de Enlace del HNGAI entre mayo y octubre de 2019; se aplicó un análisis factorial de los síntomas. Resultados: En el total de 400 pacientes vistos en interconsulta, la media de edad fue 58 ± 17,09 arios. El 61,5% eran mujeres. La tasa de derivación fue del 2,73%. El servicio con el mayor número de referencias fue Medicina Interna (13,9%). Los trastornos más frecuentes fueron de naturaleza ansiosa (44%); los síntomas más frecuentes fueron ánimo depresivo (45,3%), insomnio (44,5%) y afecto ansioso (41,3%). Con respecto al tratamiento, el más prescrito fue con antidepresivos (44,3%). El análisis factorial exploratorio de los síntomas mostró 3 factores o componentes sindrómicos importantes: delirio, depresión y ansiedad. Conclusiones: El paciente típico de esta muestra es una mujer al final de su quinta década de vida, con enfermedad médica no psiquiátrica y con evidencia de trastornos ansiosos como diagnóstico principal resultante de la interconsulta psiquiátrica.

ABSTRACT Introduction Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. Aim To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyze the symptomatic and syndromic nature of the identified conditions. Methods Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. Results In a total of 400 referrals evaluated, the average age was 58 ± 17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. Conclusions: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Medical Affairs/Medical Science Liaison: Organizational Structure and Medical Contributions / 医薬品情報学

Objective: To identify the organizational structure and medical contributions of Medical Affairs/Medical Science Liaison (MA/MSL) and its impact on the spread of the coronavirus-19 (COVID-19) infection.Method: We conducted a web-based survey for 45 pharmaceutical companies based in Japan. The outcome of 43 questions related to organizational structure, business activities, key performance indicators (KPI), and indicators of medical contribution were analyzed and compared.Results: Responses were received from 43 pharmaceutical companies (95.6%; 26 Japanese and 17 foreign). The total number of MSLs exceeded 1,000 with an average of 30.1 MSLs/company. MSLs supervised an average of 21.8/MSL Key Opinion Leaders/Key Thought Leaders (KOLs/KTLs). There were eight MSL organizations per company on average, and Phase II/III had the most number of MSL organizations. Further, 22 companies (56.4%) had MSL organizations in the oncology area. All the companies were independent from departments mainly engaged in "sales and promotion activities," and the most common KPI was “collection insight from KOL/KTL.” Despite having medical qualifications and highly specialized degrees, training was provided continuously to improve expertise. Based on the life cycle of products, Japanese companies are promoting evidence generation and medical events with KOL/KTL supported by internal and external insights and foreign companies are promoting medical-education activities. Due to the COVID-19 pandemic, the number of “in person” activities have significantly decreased and that of "online" activities have increased considerably, and this trend might continue even after the end of the pandemic.Conclusion: The organizational structure and medical contribution of MA/MSL are partially different between Japanese and foreign companies. MSL continued to increase; however, the organization and activities were affected by the product.

Contributions of the Medical Affairs Department to Healthcare Professionals and the Effects of the New Coronavirus Disease 2019 Pandemic on the Contributions / 医薬品情報学

Objective: The purpose of this study was to assess the opinions of healthcare professional regarding the contributions of the Medical Affairs department. Furthermore, we aimed to identify factors influencing and reasons for the contributions in the new coronavirus disease 2019 (COVID-19) pandemic situation.Design/Methods: A web-based survey was conducted among healthcare professionals (Key Opinion Leader/Key Thought Leader, KOL/KTL) who had multiple contacts with the Medical Affairs department, Japan.Results: The responses of 141 KOL/KTLs in Japan were collected; 77.3% of the respondents indicated that the contributions of the Medical Affairs department exceeded their expectations (achieved the expected level of contribution). The most common responses were “the identification of unmet medical needs” and “the dissemination of medical and scientific information, providing advanced medical and scientific information;” other responses included “promoting sales of the company's drugs.” The requests from KOL/KTLs regarding quality were “knowledge about biological and clinical statistics” and “proposal and quick response ability from the perspective of medical staff and patients,” but these responses were partially different between physicians and pharmacists. COVID-19 has resulted in substantial changes, for example, “face-to-face” interactions have significantly decreased from 91.5 to 50.4% and “Online” interactions have significantly increased from 20.6 to 70.9%. However, the effects of the declaration of emergency state could not be identified. The KOL/KTLs requested to make the meeting times more appropriate, conduct in-depth two-way discussions, provide latest information, and discuss about professional manners and behaviors.Conclusion: In summary, regardless of the changes in the types of activities caused by COVID-19, the Medical Affairs department has made substantial contributions to healthcare professionals, who highly appreciated them. Furthermore, depending on responses of individuals whose expectations could not be met, areas of improvements have been suggested.

Application of fracture liaison service-based intervention in elderly patients with meniscus injury / 中国实用护理杂志

Objective:To investigate the intervention effects of fracture liaison service (FLS)-based intervention in elderly patients with meniscus injury, to provide reference for clinical rehabilitation.Methods:A total of 86 elderly patients with meniscus injury from February 2018 to October 2019 in the Second Affiliated Hospital of Xi ′an Jiaotong University were divided into experimental group and control group according to random number table method. There were 43 cases in each group.The control group was given routine nursing, and the experimental group implemented FLS-based nursing intervention on the basis of the control group. The clinical effects were compared between the two groups by using knee function, knee joint mobility and degree of frailty. Results:Finally, 38 cases were included in the experimental group and 41 cases in the control group. There was no significant difference in knee function, knee joint mobility and degree of frailty between the two groups at discharge ( P>0.05). At 1, 3 months after discharge, the knee scores and knee joint mobility were (75.37 ± 4.68) points, (90.34 ± 3.02) points and (96.68 ± 8.11)°, (119.11 ± 7.92)° in the experimental group, higher than those in the control group (73.17 ± 3.92) points, (87.76 ± 2.93) points and (91.76 ± 7.75)°, (108.61 ± 7.72)°, the differences were statistically significant ( t values were 2.26-5.96, all P<0.05). The knee function scores and knee joint mobility of the two groups changed with time ( F=264.33, 279.54, both P<0.05). There were interaction effects between groups and time in the knee joint mobility of the two groups ( F=6.12, P<0.05). At 1, 3, 6 months after discharge, the physiological dimension scores and frailty total scores were 5.08 ± 1.34, 4.74 ± 1.10, 4.13 ± 0.88 and 8.32 ± 1.50, 7.82 ± 1.31, 6.82 ± 0.95 in the experimental group, lower than those in the control group 5.68 ± 1.15, 5.22 ± 0.85, 5.02 ± 0.76, 9.05 ± 1.28, 8.40 ± 0.89, 8.18 ± 0.90, the differences were statistically significant ( t values were 2.15-6.57, all P<0.05). At 6 months after discharge, the psychological and cognitive dimension scores were 0.98 ± 0.30 and 0.45 ± 0.24 in the experimental group, lower than those in the control group 1.32 ± 0.37 and 0.59 ± 0.22, the differences were statistically significant ( t=4.49, 2.82, both P<0.05). The physiological and cognitive dimension scores and total scores of the two groups changed with time ( F=30.61, 31.72, 38.50, all P<0.05). There were interaction effects between groups and time in the physiological demension scores and the frailty total scores of the two groups ( F=2.86, 4.03, both P<0.05). Conclusions:FLS-based intervention can promote the rehabilitation of knee joint function and alleviate the degree of frailty of elderly patients with meniscus injury.

Research on the application of Internet + technical liaison service model in elderly osteoporotic hip fractures patients after surgery / 中国实用护理杂志

Objective:To explore the effect of Internet + technical liaison service mode on the postoperative continuing nursing of elderly patients with osteoporotic hip fractures.Methods:A total of 92 elderly patients with osteoporotic hip fractures who were admitted into in Orthopaedics Department of the First Affiliated Hospital of Soochow University from July 2018 to December 2019 were selected, and randomly divided into intervention group and control group by random number table method, with 46 cases in each group. The control group was given routine follow-up outside hospital, while the intervention group was given the continuing nursing led by the orthopedic specialist nurses based on the Internet + Technology home orthopedic care platform. All patients were followed up to 6 months after operation, and the differences of Harris Hip Score (Harris), Numeric Rating Scales (NRS), Barthel Index, Short Form 36-item Health Survey (SF-36) between the two groups were compared.Results:The Harris scores were 49.74 ± 4.28, 76.59 ± 4.33 and 90.78 ± 2.61 in the intervention group, and 46.17 ± 3.85, 74.26 ± 4.24 and 88.65 ± 2.17 in the control group in 1, 3 and 6 months after operation, respectively. The differences were statistically significant ( t=-4.20, -2.60, -4.26, all P<0.05). The NRS scores in the intervention group were 1.33 ± 0.47, 0.83 ± 0.38 and 0.76±0.43 in 1, 3 and 6 months after operation respectively, while the NRS scores in the control group were 1.61 ± 0.54, 0.96 ± 0.42 and 0.84 ± 0.38, respectively. The difference in pain scores between the two groups was statistically significant only at 1 month after operation ( t=2.68, P<0.05). The Barthel Index in the intervention group were 61.74 ± 8.90, 93.80 ± 5.29 and 98.26 ± 2.83 in 1, 3 and 6 months after operation respectively, while those of the control group were 60.33 ± 5.81, 91.09 ± 7.52 and 97.83 ± 3.10, respectively. The difference in Barthel Index between the two groups was statistically significant only in 3 months after operation ( t=-2.00, P<0.05). The scores of SF-36 in the intervention group were 93.73 ± 3.89, 100.26 ± 3.77 and 107.50 ± 3.56 at 1, 3 and 6 months after operation respectively, while those of the control group were 92.67±3.42, 97.71±2.67 and 103.68±2.83, respectively. The difference in SF-36 scores between the two groups was statistically significant only at 3 and 6 months after operation ( t=-3.74, -5.71, P<0.05). Conclusions:The continuing nursing based on multi-disciplinary team cooperation in hospital + Internet + Technology home orthopaedic nursing platform led by orthopaedic specialist nurses can improve joint function, relieve pain and improve quality of life of elderly patients with osteoporotic hip fractures after operation.

Upon that which binds me

@#The patient is a 36-year-old- male who was bullied by peers and was emotionally abused by his father for being effeminate and preferring to play with dolls. These adverse childhood experiences made him vulnerable to depression. He told himself that he could no longer rely on anyone else but himself and took pride in his independence. He gave his best with his endeavors and did not settle for mediocrity, frequently reviewing his work. During the pandemic, he experienced several hardships such as disruption of activities, inability to meet the financial needs of his family and unemployment. He found himself struggling but surviving. While in a work-from-home arrangement, he was so frustrated about his internet connection that he complained on social media. The internet company then threatened him of possible legal charges and felt stuck in a hopeless situation. This affected his day-to-day activities until he felt so overwhelmed that he attempted suicide by ingesting multiple medications. He was then brought to the emergency room and was admitted. He was diagnosed to have Major Depressive Disorder and was started on antidepressants. Psychotherapy focused on identifying stressors and strengthening adaptive coping mechanisms while he was admitted at an isolation facility. He then followed up at the outpatient department of a tertiary government hospital in Mindanao with noted improvement in mood and functionality overtime. During admission, he was also diagnosed to have Diabetes Mellitus and COVID-19, which added to his burden as these were the biologic factors that were correlated to his depression. The case highlighted the interplay between the effects of multiple traumatic experiences in a vulnerable individual and thus necessitating a holistic management.

Dissolução da adoção: (des)encontros entre maternidade e filiação / Disolución de la adopción: (des)encuentros entre maternidad y afiliación / Dissolution in Adoption: (dis)encounters between motherhood and sonship / Dissolution de l'adoption: (dis)rencontres entre la maternité et l'affiliation

A adoção é um processo complexo, que nem sempre terá um desfecho bem sucedido. A partir de um estudo de caso, objetivou-se compreender as experiências de uma mulher, mãe por adoção de cinco filhos, que vivenciou a dissolução da adoção. A filha mais velha solicitou o retorno para a instituição de acolhimento, após sete anos de convivência com a família adotiva. Os dados foram obtidos pela construção do genograma e entrevista semiestruturada com a mãe. Na visão da participante, a dificuldade na constituição de vínculos afetivos entre mãe e filha levou à dissolução da adoção, associada ao não acesso ao acompanhamento profissional no período pós-adoção. Discute-se a questão da irrevogabilidade da adoção, a aplicabilidade dos termos devolução e duplo abandono e a importância da rede de apoio

La adopción es un proceso complejo y no siempre tendrá un resultado exitoso. A partir de un estudio de caso, el objetivo fue comprender vivencias de una mujer, madre por adopción de cinco hijos, que vivió la disolución de la adopción. La hija mayor solicitó el regreso luego de siete años de convivir con la familia por adopción. Los datos se obtuvieron mediante la construcción del genograma y la entrevista semiestructurada con la madre. A juicio de la participante, la dificultad para formar vínculos afectivos entre madre e hija llevó a la disolución de la adopción, asociada a falta de acceso a seguimiento profesional en período pos-adopción. Fueran discutidos aspectos de irrevocabilidad de la adopción, la aplicabilidad de los términos retorno y doble abandono y importancia de red de apoyo

Adoption is a complex process and will not always have a successful outcome.From a case study, the objective was to understand the experiences of a woman, a mother by adoption of five children, who experienced the dissolution of adoption. The eldest daughter requested there turn to foster care after seven years of living with the adoptive family. The data were obtained by constructing the genogram and semi-structured interview with the mother. According to the participant, the difficulty in establishing affective bonds between mother and daughter led to the dissolution of the adoption, associated with the lack of access to professional monitoring in the post-adoption period. Questions onthe indissolubilityof the adoption, the terminology used and the importance of the support network were discussed

L'adoption est un processus complexe qui n'aura pas toujours de succès. À partir d'une étude de cas, l'objectif était comprendre les expériences d'une femme, mère adoption de cinq enfants, qui vécu la dissolution de l'adoption. Dans cas, la fille aînée qui a demandé ce retour après sept ans vie avec la famille adoption. Les données ont obtenues en construisant génogramme et en entretien semi-structuré avec la mère. Il a été constaté que, l'avis du participant, la difficulté à nouer liens affectifs entre la mère et la fille entraînait la dissolution de l'adoption, associée au manque d'accès au suivi professionnel dans la période post-adoption. En conséquence, il a été possible de problématiser certains aspects de l'irrévocabilité de l'adoption, l'applicabilité des termes retour et double abandon et l'importance du réseau de soutien

Effect of moderate exercise therapy and fracture liaison service on osteoporotic hip fracture / 中国实用护理杂志

Objective:To explore the clinical effect of moderate exercise therapy and fracture liaison service in osteoporotic hip fracture.Methods:From June 2018 to June 2020, 120 patients with osteoporotic hip fracture admitted to Nanjing Hospital Affiliated to Nanjing Medical University were selected. The patients were divided into study group and control group by random number table method, 60 cases in each group. The control group was treated with routine nursing and moderate exercise therapy, and the control group was treated with fracture liaison service, clinical observation and comparison of treatment compliance, bone mineral density (BMD), Numerical Rating Scale (NRS) score and nursing satisfaction before and after intervention.Results:The BMD and NRS scores in the study group were (0.90±0.25) g/cm 2, (1.0±0.3) points, higher than those in the control group (0.80±0.18) g/cm 2, (1.0±0.25) points. The difference was statistically significant ( t values were 2.514, 2.547, P<0.05). The total compliance rate and nursing satisfaction of the study group were 93.30% (56/60) and 95.00% (57/60) respectively, which were significantly higher than 80.00% (48/60) and 83.33% (50/60) of the control group. The difference was statistically significant ( χ 2 values were 4.615, 4.227, P<0.05). Conclusion:Moderate exercise therapy and fracture contact service intervention can effectively improve bone mineral density and total compliance rate, relieve pain and improve nursing satisfaction.

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Objectives: Spiritual pain is not formally defined. The aim of this study was to clarify the beliefs about spiritual pain among Japanese palliative care physicians and liaison psychiatrists and to compare their beliefs. Methods: A nationwide questionnaire survey was conducted by mail August, 2019 on certified palliative care physicians and liaison psychiatrists. We asked 9 questions about spiritual pain (i.e. current status, definition, and the delivery of care) using a 5-Likert scale. Result: 387 palliative care physicians (response rate, 53%) and 374 psychiatrists (45%) responded. 72% (76% of the palliative care physicians/69% of the psychiatrists) reported that spiritual pain was distinct from depression, but 69% (66/71) reported that it was not defined adequately; and 59% (59/60) perceived the risks of using the words ambiguously. Only 43% (40/47) recommended the universal definition of spiritual pain, and opinions about how spiritual pain should be defined (i.e, higher being, meaning/value, or specific terms) differed among physicians. Perception about spiritual pain of the physicians were significantly associated with their religion, while beliefs about spiritual pain were essentially similar between palliative care physicians and psychiatrists. Conclusion: Although physicians regarded the definition of spiritual pain as being inadequate, the opinions about preferable definition differed among physicians. Discussion about the value of developing a consensus of spiritual pain is needed.

A Study on the Patterns of Psychiatric Referrals in a Tertiary Care Hospital in the North-Eastern Part of India.

Consultation-liaison psychiatry holds a special place, especially in general hospital setting. We wanted to study the socio-demographic variables, reasons for referral, and clinical correlates of psychiatric referrals from different wards in a tertiary care hospital. MethodsThis was a retrospective chart-review study carried out in the Gauhati Medical College Hospital, Guwahati, for a period of one month (May 2019). Demographic data of the participants was collected. Their primary medical / surgical diagnoses were noted along with the department where they were admitted. The reason for psychiatric consultation as well as the psychiatric diagnoses were analysed by descriptive statistics with the use of GraphPad InStat. ResultsMost of the sample was men (men: women: 106:72), mostly between 11 to 30 years (44.38%) and Hindus (Hindu: Muslim: 140:38). Majority of the consultations was from the Department of Medicine (47.19%), followed by Orthopaedics (15.17%) and Surgery (14.61%). Among the surgical/medical illnesses, most of them had fractures (ten), closely followed by neurological conditions like cerebrovascular accident (five) and head injury (four). Deliberate self-harm was the most common reason for psychiatric liaison (56), that constituted a high number with poisoning (45) as well as hanging (six) and cut neck (five). Psychiatric consultation was asked for use of alcohol in a substantial number of patients (45). ConclusionsAddressing the psychiatric comorbidity while continuing treatment for the surgical/medical illnesses gives a holistic approach towards our patients that can influence not only the course but also the quality of life of them.

The Roles, Organizational Structure, Responsibilities, Recruitment, Skills, Performance Indicators and Future Trends of Medical Science Liaison in Japan―Results of a 2019 Questionnaire / 医薬品情報学

Objective: The purpose of this survey was to identify the roles, organizational structure, responsibilities, recruitment, skills, performance indicators and future trends of Medical Science Liaisons (MSLs). In addition, we compared the trend of changes with past surveys.Method: We contacted 52 pharmaceutical companies with a questionnaire survey on MSLs which included 28 items and analyzed the anonymized results using a web response system in Japan.Results: Responses were received from 40 companies (76.9%). The range of MSLs in each company was 0 to 80, the average number for companies withone or more MSLs was 23.6 (median was 13.0). Except for one company, the definition of “MSL” was generally the same. Except for one company, MSLs operated independently of the sales promotion activities. One MSL was responsible for an average of 21 Key Opinion Leader/Key Thought Leaders (KOL/KTL). The key performance indicators (KPI) for MSL activities mainly focused on quantitative indicators such as the number of information collections from KOL/KTL. On the other hand, qualitative indicators were also incorporated suchas feedback from KOL/KTL. “Knowledge of clinical medicine” and “Communication skills” were necessary skills for all companies. 41.9% of companies had an in-house certification program. Some companies will retain and/or decrease the number of MSLs in the future. MSLs were required to have advanced medical expertise as well as medical professional qualifications, and it was confirmed that there are various options for career plans such as MA, R&D, and promotional departments. No matter what the MSL’s therapeutic area (TA), many companies had high expectations for their activities.Conclusion: The current status of expected mission and responsiblities, KPI, size and career plans for MSL were revealed. Companies want MSL’s to play a central role in the inplementation of medical strategies and contribute to internal and external stakeholders.

A rare presentation of acute hyperglycemia with secondary mania: a case report

This case report aims to highlight the diagnostic challenges in consultation-liaison psychiatry in case of Type 1 Diabetes Mellitus. Author report the case of a 60-year-old male who presented to the Psychiatry OPD with first episode of mania. Although hypoglycaemia is known to be associated with multiple psychiatric manifestations, the incidence of psychiatric symptoms and disorders in association with hyperglycaemia is not well reported. This case report highlights the rare presentation of secondary mania in a patient with Type 1 Diabetes Mellitus.

Caracterización de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Docente "Juan Manuel Márquez" / Characterization of psychiatric interconsultations carried out at "Juan Manuel Márquez" Pediatric Teaching Hospital

RESUMEN Introducción: La relación entre las diferentes especialidades es necesaria para elevar la calidad de la atención a los pacientes. Objetivo: Describir las características de las interconsultas de psiquiatría realizadas en el Hospital Pediátrico Juan Manuel Márquez entre enero de 2017 y junio de 2018. Material y Métodos: Se realizó un estudio descriptivo, longitudinal prospectivo, entre enero 2017 y junio 2018, a partir de 154 solicitudes de interconsultas de psiquiatría (escritas). Se constituyeron además en unidades de análisis los pacientes interconsultados. Los datos fueron recogidos en una planilla, y se analizaron descriptivamente con el software SPSS 21.0. Las correlaciones consideraron p< 0,05 como valor de significación. Resultados: Se verificó aumento semestral sostenido en la solicitud de interconsultas. Miscelánea fue el servicio que más solicitudes hizo (51,9%). El 81.9% de las solicitudes expresaba los motivos de interconsulta, la valoración por intento suicida fue el más frecuente (40,8%). El diagnóstico más frecuente fue Trastorno de Adaptación (35.7%). El 94.8% de los casos fueron vistos el mismo día de la solicitud. Las interconsultas paralelas (66.9%) fueron las más realizadas. Conclusiones: La imagen de la psiquiatría de interconsulta y enlace está cambiando al interior de la cultura hospitalaria, pero aún persisten claras evidencias de las carencias que tienen los médicos de otras especialidades en relación con la interpretación de las manifestaciones psicopatológicas de sus pacientes y la asociación con las patologías de base.

ABSTRACT Introduction: The relationship between different specialties is necessary to give better care to patients. Objective: To describe the characteristics of psychiatric interconsultations carried out at "Juan Manuel Marquez" Pediatric Teaching Hospital from January, 2017 to June, 2018. Materials and Methods: A descriptive prospective cross-sectional study was conducted between January 2017 and June 2018 on the basis of 154 written requests for psychiatric interconsultations. The patients consulted were also considered as units of analysis. The data were collected on a list and analyzed descriptively using SPSS version 21.0 software. The correlations considered p< 0.005 as significance value. Results: A sustained increase in the semester was determined in the request for interconsultations. The miscellaneous service made more requests (51.9%). The reasons for consultation were expressed in 81.9% of the requests, and the assessment for suicide attempt was the most frequent (40.8%). The most frequent diagnosis was Adjustment Disorder (35.7%). Also, 94.8% of the cases were seen the same day. Parallel consultations (66.9%) were the most performed. Conclusions: The image of consultation-liaison psychiatry is changing in the interior environment of hospital culture, but there is still clear evidence of the deficiencies that doctors from other specialties have in relation to the interpretation of psychopathological manifestations of their patients and their association with the underlying pathologies.

Impact of Liaison Officers in a Tertiary Care Hospital (Modern Government Maternity Hospital Petlaburz Hyderbad) on Patient Care – A Project

Introduction: There is an increased concern about theservices delivered by the hospitals and more importantlythe quality of services offered. This project explored therole of liaison officer in a government teaching hospital toimprove communication and administrative function betweenhealthcare provider and patient families.Material and methods: Three liaison officers with master’sdegree in social welfare are identified. They were allocateda well-furnished room for being approachable to the patientsand their attenders round the clock. Their duties were toclarify, counsel and direct patients & their family membersabout any query regarding admission process, treatment orany socio-psychological help on one to one basis. Numberof patients/attenders approaching liaison officer, their queriesand what was done was entered in a register.Results: This project included statistics from April 2018 toMarch2019. 64% of high risk cases who are admitted in ICUapproached liaison officer for various reasons most importantwas for socio-psychological issues and 9% of attenders wereworried about patient condition in the Labor room or ward.4% wanted information about family planning methods, 6%had doubts regarding their diet to be taken after delivery.Immunization schedule was explained to 5% of the cases. 4%of the anemia patients were helped with their treatment. WrongEntries in the birth register and KCR Kits were rectified.Conclusion: With the availability of liaison officer roundthe clock in the hospital has helped both patient healthcareproviders and patients to run the hospital smoothly. There wasnot a single case of violence or argument between patient andhealth care providers. Health care providers had more time toconcentrate on management of the patient. Presence of liaisonofficer in the hospital premises round the clock has created apositive and peaceful environment in the tertiary care teachinggovernment hospital.

Servicio de enlace para pacientes con fracturas por osteoporosis / Osteoporotic fracture liaison service

Los pacientes con fracturas por fragilidad presentan elevadas tasas de morbimortalidad, lo que implica además un alto costo para el erario público. Luego de una fractura por osteoporosis, la mayoría de los pacientes no recibe una adecuada evaluación y tratamiento. Para suplir este vacío de atención médica se crearon distintas políticas; la mejor de ellas son los Servicios de Enlace de Pacientes con Fracturas (Fracture Liaison Service, en inglés). Estos programas tienen una vigencia internacional de más de diez años y son patrocinados por organismos internacionales. La finalidad de estos servicios es la prevención secundaria de fracturas. La modalidad de trabajo tiene como objetivo facilitar y asegurar la rápida identificación, el diagnóstico y la terapéutica de esta población en diferentes contextos asistenciales. La experiencia internacional demuestra que estos servicios son exitosos pues logran incrementar el inicio y la adherencia al tratamiento, disminuir las tasas de mortalidad, de morbilidad y de nuevas fracturas, y son costo-efectivos. En nuestro medio, el inicio de los Servicios de Enlace es reciente. El propósito de esta actualización es realizar una revisión de los fundamentos, características, modalidad operativa y los logros obtenidos por dichos programas. Las fracturas por fragilidad ósea constituyen un problema importante para la salud pública. Esta presentación tiene como objetivo alertar y motivar a la comunidad médica a intervenir de manera sistemática y dinámica para mejorar el cuidado habitual en esta población de pacientes. (AU)

Fragility fractures are associated with increased morbidity and mortality rates and higher costs. After a fracture, most patients do not receive adequate assessment and treatment. To fill this gap in medical care, different policies have been created; the best of them being the Fracture Liaison Services. These programs have been in place for over ten years worldwide and are sponsored by international organisms and societies. The purpose of the Fracture Liaison Services is secondary fracture prevention. Their goal is to ensure the rapid identification, diagnosis and treatment of this population in different clinical contexts. They increase treatment adherence and decrease mortality and morbidity rates and the incidence of new fractures. International experience shows that these services are successful and costeffective. (AU)

Medición de la concordancia en la elección de antidepresivos entre psiquiatras costarricenses que no aplican y sí aplican el algoritmo de razonamiento psicofarmacológico / Measurement of the concordance in the selection of antidepressants between costarican psychiatrists that do not apply and apply the Psychopharmacological Reasoning Algorithm

Resumen Justificación: existe una alta comorbilidad entre las enfermedades médico-quirúrgicas y la depresión. No hay parámetros sistematizados que guíen la selección individualizada del tratamiento farmacológico en estas circunstancias. Objetivo: analizar la concordancia entre los psiquiatras costarricenses que no aplican y sí aplican el algoritmo de razonamiento psicofarmacológico para la elección de los antidepresivos, en 3 casos clínicos de pacientes deprimidos y con una enfermedad médico-quirúrgica. Metodología: se distribuyó de forma aleatoria en dos grupos a los participantes, y se les presentó tres casos clínicos reales y anónimos de personas deprimidas y con una enfermedad médico-quirúrgica. El grupo A eligió el antidepresivo según sus criterios personales, mientras que el grupo B realizó la elección del tratamiento basándose en la implementación del algoritmo de razonamiento psicofarmacológico. Resultados: no hubo concordancia respecto al fármaco entre los 22 psiquiatras del grupo que solo aplicó el criterio clínico (kappa= -0,0154, p= 0,3851), mientras que la concordancia sí fue estadísticamente significativa en el grupo de los 24 psiquiatras que aplicó el algoritmo de razonamiento psicofarmacológico (kappa=0,016, p<0,01). La concordancia entre ambos grupos fue del 25 % en el caso 1, el 16,67% en el caso 2 y el 20,83% en el caso 3. Los psiquiatras que emplearon el algoritmo de razonamiento psicofarmacológico lo consideran útil (87,50%), aplicable (83,33%) y con posible impacto clínico (91,67%). Conclusiones: el algoritmo de razonamiento psicofarmacológico aumentó la concordancia entre los psiquiatras para la selección de los antidepresivos en tres casos clínicos de pacientes deprimidos con enfermedades médico-quirúrgicas, en comparación con el criterio personal. La concordancia entre los grupos A y B fue muy baja. El algoritmo de razonamiento psicofarmacológico es una herramienta considerada útil, aplicable y de posible impacto en la práctica clínica.

Abstract There is a high comorbidity between medical surgical diseases and depression. There is no current systematic approach to guide how to select an individualized treatment under these circumstances. Objective: to analyze the concordance between psychiatrist that do not use and those who use the Psychopharmacological Reasoning Algorithm to choose the treatment for 3 clinical cases of depression and medical surgical diseases. Methodology: Three case vignettes of anonymous real depressed patients with medical surgical diseases were presents to both groups. Group A made the selection of the antidepressant using their personal criteria; group B made the selection applying the Psychopharmacological Reasoning Algorithm. Results: There was no concordance on the drug among the 22 psychiatrists in the group that only applied the clinical criterion (kappa = -0.0154, p = 0.3851), whereas concordance was statistically significant in the group of 24 psychiatrists who applied the Psychopharmacological Reasoning Algorithm (kappa = 0.016, p <0.01). The concordance between groups A and B was 25% in the case 1, 16.67% in the case 2 and 20.83% in the case 3. The biggest majority of the psychiatrist that used the PPRA considers it useful (87.50%), applicable (83.33%) and with the possibility of impact the clinical practice (91.67%). Conclusion: The Psychopharmacological Reasoning Algorithm increased the concordance in the selection of antidepressants made by Costa Rican psychiatrists in 3 clinical vignettes of depressed patients with a medical surgical disease, when compared to personal criteria. The concordance in the selection of the antidepressants in the 3 cases between both groups is low. The Psychopharmacological Reasoning Algorithm is a tool considered useful, applicable and with a possible impact in clinical practice.

Osteoporosis liaison service in Japan

A fracture liaison service (FLS) is a secondary fracture prevention program that is led by a coordinator. A program called the osteoporosis liaison service (OLS), which includes FLS, was first implemented in Japan and has become popular for solving problems related to osteoporosis treatment. OLS and FLS have the same purpose, namely preventing fragility fractures, but while FLS focuses mainly on secondary fracture prevention in fracture patients, OLS addresses this issue as well as primary fracture prevention at clinics and in communities.

Application of fracture liaison service model in patients with osteoporotic vertebral compression fractures / 中华创伤杂志

Objective@#To investigate the effects of fracture liaison service (FLS) model on the medication compliance of patients, quality of life, pain and re-fracture rate in patients with osteoporotic vertebral compression fracture (OVCF).@*Methods@#A prospective case control study was conducted to analyze the clinical data of 117 OVCF patients admitted to Department of Pain of Guizhou Provincial People's Hospital from January 2017 to September 2017. According to the random table method, patients were divided into control group (58 patients) and intervention group (59 patients). Routine nursing was adopted in the control group, and fracture liaison service mode was adopted in the intervention group on the basis of the control group until 3 months after discharge. Morisky scale was used to compare the medication compliance of patients on admission, at discharge, 1 month, and 3 months after discharge, and SF-36 was used to evaluate the quality of life. The SF-36 scale contained eight dimensions including physiological function, physiological performance, physical pain, overall health, vitality, social function, emotional function and mental health. Visual analogue scale (VAS) was used to evaluate the pain of patients. The re fracture rates of the two groups were compared.@*Results@#There were no significant differences between the two groups concerning gender, age, history of diabetes, history of hormone use, number of vertebral fractures, fracture site and cause of injury (P>0.05). In the intervention group, the medication compliance scores of patients in the first and third months after discharge were (5.5±2.0)points and (6.3±1.8)points, which were higher than those in the control group [(3.5±2.2)points and (3.3±1.8)points] (P<0.05). Within each group, there were significant differences among the medication compliance scores at the different time points of evaluation (on admission, at discharge, 1 month, and 3 months after discharge). The scores of the eight dimensions of the SF-36 scale in the intervention group were higher than those in the control group at 1st and 3rd months after discharge (P<0.05). Within each group, there were significant differences among the SF-36 scores at the different time points of evaluation. The pain scores of the intervention group at discharge and 1st and 3rd months after discharge were ( 3.1±1.7)points, (1.8±1.3)points, (1.4±1.3)points, all lower than those in the control group [(5.2±1.7)points, (3.6±1.6)points, (2.7±1.8)points] (P<0.05). Within each group, there were significant differences among the pain scores at the different time points of evaluation. At 1st and 3rd months after discharge, the re-fracture rates of the intervention group were both 2%, and the those of the control group were 3% and 9%, respectively, showing no significant difference between the two groups (P>0.05).@*Conclusion@#The FLS model can effectively alleviate the pain of OVCF patients, improve the medication compliance and quality of life of patients after discharge, but it cannot reduce the short-term re fracture rate after discharge.

Application of fracture liaison service model in patients with osteoporotic vertebral compression fractures / 中华创伤杂志

Objective To investigate the effects of fracture liaison service(FLS)model on the medication compliance of patients,quality of life,pain and re-fracture rate in patients with osteoporotic vertebral compression fracture(OVCF).Methods A prospective case control study was conducted to analyze the clinical data of 117 OVCF patients admitted to Department of Pain of Guizhou Provincial People's Hospital from January 2017 to September 2017.According to the random table method,patients were divided into control group(58 patients)and intervention group(59 patients).Routine nursing was adopted in the control group,and fracture liaison service mode was adopted in the intervention group on the basis of the control group until 3 months after discharge.Morisky scale was used to compare the medication compliance of patients on admission,at discharge,1 month,and 3 months after discharge,and SF-36 was used to evaluate the quality of life.The SF-36 scale contained eight dimensions including physiological function,physiological performance,physical pain,overall health,varsity,social function,emotional function and mental health.Visual analogue scale(VAS)was used to evaluate the pain of patients.The re fracture rates of the two groups were compared.Results There were no significant differences between the two groups concerning gender,age,history of diabetes,history of hormone use,number of vertebral fractures,fracture site and cause of injury(P＞0.05).In the intervention group,the medication compliance scores of patients in the first and third months after discharge were(5.5±2.0)points and(6.3±1.8)points,which were higher than those in the control group [(3.5 ±2.2)points and(3.3± 1.8)points](P＜0.05).Within each group,there were significant differences among the medication compliance scores at the different time points of evaluation(on admission,at discharge,1 month,and 3 months after discharge).The scores of the eight dimensions of the SF-36 scale in the intervention group were higher than those in the control group at 1 st and 3rd months after discharge(P＜0.05).Within each group,there were significant differences among the SF-36 scores at the different time points of evaluation.The pain scores of the intervention group at discharge and 1st and 3rd months after discharge were(3.1±1.7)points,(1.8±1.3)points,(1.4±1.3)points,all lower than those in the control group [(5.2±1.7)points,(3.6±1.6)points,(2.7±1.8)points](P＜0.05).Within each group,there were significant differences among the pain scores at the different time points of evaluation.At 1 st and 3rd months after discharge,the re-fracture rates of the intervention group were both 2％,and the those of the control group were 3％and 9％,respectively,showing no significant difference between the two groups(P＞0.05).Conclusion The FI.S model can effectively alleviate the pain of OVCF patients,improve the medication compliance and quality of life of patients after discharge,but it cannot reduce the short-term re fracture rate after discharge.