effect of lifestyle modification on severity of constipation and quality of life of elders in nursing homes at Ismailia city, Egypt

Constipation has a significant impact on the quality of life [QOL]. Lifestyle modification is widely accepted and recommended by experts as first-line therapy. This study aimed at using education on lifestyle modification to improve the QOL of the elderly in nursing homes suffering from functional constipation [FC]. This study was conducted in nursing homes in Ismailia city, Egypt. It involved 23 elderly patients suffering from FC, who were randomly selected according to the sample equation. They fulfilled the inclusion criteria of being >/= 60 years age and according to Rome II criteria. Participants completed personal characteristics and lifestyle questionnaire, the Patient Assessment of Constipation Symptom questionnaire [PAC-SYM] to assess the severity of symptoms, and the Patient Assessment of Constipation Quality of Life Questionnaire [PAC-QOL] to assess pre- and post-intervention. The intervention was conducted in three sessions, of 30 min each, 2 weeks apart using group discussions to educate the sample about dietary pattern, fluid intake, regular physical activity, and the use of laxatives. Statistical analysis: Data were analyzed using a statistical package for social sciences [SPSS version 20]. The lifestyle modification education on constipation significantly reduced the severity of symptoms as measured by PAC-SYM, including its total score and subscores [P < 0.001]. It also improved the QOL of elderly suffering from constipation as measured by PAC-QOL and reduced total scores of dissatisfaction [P = 0.001] with the exception of the psychosocial subscale. It also significantly increased the satisfaction subscale of PAC-SYM [P < 0.001]. Education on lifestyle modification leads to an improvement in the severity of the symptoms of constipation and the QOL of the elderly in nursing homes

Quality care of patients with diabetes mellitus in the diabetic clinic at Al Wakra healthcare center, Qatar

Diabetes mellitus is a chronic illness that requires continuous medical care. Patient health education and self-management aim to prevent acute complications and to reduce the risk of long-term complications. Care of diabetic patients is a complex proces and requires many issues beyond glycemic control. This study is conducted to assess quality of care of diabetic patients in the diabetic clinic-at Al Wakra Healthcare Center and to determine some factors that may affect the quality of this care. This is a descriptive, cross-sectional study. The target population was all diabetic patients [Type 2] that meet the inclusion criteria and registered at the center. Two checklists assessed the structure of diabetic care; the first checklist is for the essential items of care [thirteen items] and the second one is for the less essential items [ten items]. The indicators of the process of diabetic care was assessed by a scoring system that depends on ten items for standard diabetic care by the primary care physicians in the past year. Assessment of the outcome was done according to an international quality assurance protocol and it includes: the degree of diabetic control, obesity, smoking among the diabetic patients and control of blood pressure. We added HbAlc to this list. Another questionnaire was designed to determine factors that may affect quality of diabetic care-related to patient's knowledge and attitude and it is divided into 4 sections: personal data, patient knowledge about diabetes, patient attitude toward care and clinical and biochemical assessments. A pilot study was carried out to test the questionnaires. Epi-info. Six statistical package was used for data entry and statistical analysis. Chi square or Fisher exact tests were used to test the significance, and P value<0.05 was considered significant. The study showed that diabetic care at Primary Healthcare Centers [PHC] in Qatar represented by Al Wakra Primary Healthcare Center is better when compared to the care in other studies in different countries. 86.7% of physicians show that most of the structure items are good to fair except for the absence of chiropodist and identification cards for diabetic patients. Assessment of the process of care showed that there is good to fair recording in 91.75% of cases; foot examination is not recorded in most of cases; and fundus examination is not recorded in 31.7%. The out-come indicators showed that patient knowledge about diabetes is poor in 35% of cases, uncontrolled FBS in 75.6% of cases, uncontrolled HbA1c in 5 7.8%; obesity in 63.5% and control of blood pressure is not achieved in 49% of cases. Diabetic Clinic at Al Wakra Primary Healthcare Center provides good care for diabetic patients in terms of structure, process and outcome; however, more efforts are needed for refining these services

Assessment of knowledge and practice of primary health care physicians regarding bronchial asthma in Qatar

Previous studies from other countries that have investigated the level of knowledge of bronchial asthma and competence of primary care physicians in management issues concluded that there is a substantial variation among general practitioners in both their knowledge and management practices. There is no such study conducted in Qatar, therefore, we have conducted assessment for PHC physicians for further educational interventions that improve their quality of care for asthmatic patients. It is a cross sectional observational study. Our target population was the PHC physicians working in PHC centers affiliated to Hamad Medical Corporation in Qatar. Of the 21 centers present in Qatar, we selected 3 urban and 3 rural centers randomly. The total number of physicians who attended the evaluation setting was 55 [30 urban and 25 rural physicians]. The evaluation format was of three groups of questions to collect data for evaluation of knowledge and practice. Previously validated 30 MCQ questions were used to evaluate knowledge and 2 written problems were used to evaluate the practice. 50% and 60% were the cut of point to pass the evaluation for knowledge and practice respectively. Epi-Info statistical package was used for data entry and statistical analysis. The percentage of physicians who passed the knowledge evaluation was 44% of the total number of physicians while 37% only of them passed the practice assessment. Age [p= 0.04], nationality [p= 0.003], specialty [p=0.00], last certificate [p=0.00], and No of years since graduation [p=0.00] were significant variables in pas sing the knowledge test while age [p=0.018], specialty [p=0.00], and last certificate [p=0.00] were significant variables in passing practice test. Regarding source of information about asthma, 96.7% of urban physicians reported that their main source is conferences and meetings while 84% of rural physicians using textbooks as their main source of information [p=0.02]. 80% of urban physicians versus 48% of rural doctors felt that they need more knowledge and training in asthma diagnosis and management [p-0.00] while 73.3% of urban physicians recommended more CME seminars to improve their asthma practice and 64% of rural physicians recommended standard guidelines [p=0.04]. This study addresses areas of weakness that might be a stimulus to design a tailored educational interventions in order to improve the PHC physician's knowledge and practice of asthma

Measurement of adherence to anti hypertensive medication as perceived by doctors and patients

In the absence of objective evidence, doctors frequently overestimate the level of their patient's adherence to medication and there is no published work looking at what factors influence the doctor's perceptions of medication adherence by hypertensive patients. Therefore, the aim of this study to determine the doctor's perceptions of adherence to antihypertensive medication and to compare this with their perceptions of the clinical situation and with the patient's self-reported medication adherence. An English self reporting measure [7-item questionnaire] was adapted and translated to Arabic and used to determine the adherence to hypertensive medication. Also, a 10-item questionnaire was developed to elicit the doctor's perception of adherence [taking > 80 percent of doses] and the treatment and overall condition. This descriptive study was conducted in across 2 primary health centers in Abu-Dhabi, UAE. About 40 percent of them were controlled regarding BP and 30 percent of hypertensive patients were diabetics. The doctors estimated adherence to be high [taking more than 80 percent of doses] in 143 [71 percent] of patients compared with 103[52 percent] patients who reported high adherence by using Morisky score where, there was a statistically significant relationship between them. Of the 143 subjects perceived by their doctors as having high adherence, only 64 [45 percent] succeeded to achieve the target blood pressure [p < 0.001] while 55 [52 percent] of the adherent patients from the self-reported point of view achieved their target BP [p < 0.001]. The doctor evaluation was not as good as expected for treatment effectiveness and quality of communication [57 percent only were evaluated as good]. Only the doctor's evaluation of the seriousness of the medical situation showed a significant correlation with the self-reported adherence and this was in the opposite direction [gamma = - 0.32, p <0.05]. 71 percent of the adherent patients perceived by doctors were estimated to have effective treatment [p < 0.0001] while 81 percent of patients achieved their target BP were estimated to have effective treatment by their doctors. The practical assessment of adherence and drug management would have been greatly enhanced if the results of the Arabic/English self-reporting measure had been available to the doctors in the course of routine practice

Frequency of bacteruria among primary health care patients in Abu Dhabi

In this study, a sample of 1588 urine culture results was taken including allages and both sexes. From Mafraq Hospital, the results of 660 urine cultures referred for the primary health care centers in the last 4 months in the year1997 were taken. It was shown that most of the symptomatic patients who were tested were females [86.2%] and adults [87.3%]. The females constituted 92.5%of the positive significant growth. Out of 1588 samples, only 16.8% had a significant bacterial growth and another 12% had an insignificant growth. Pyuria and hematuria were present in 77.9% and 33.7% of the significant bacterial growth, respectively. The most frequent cultured organism was E.Coli, followed by Staph. aureus. Mafraq Hospital showed a similar predominance of female patients and pyuria was present in 41.3% and only 9.5% of the patients had a significant bacterial growth. The commonest organism was E. coli