Evaluation of the Implementation of Integrated Primary Care for Patients with Type 2 Diabetes and Hypertension in Belgium, Cambodia, and Slovenia.

Introduction: Integrated care of chronic patients improves quality of their management, but there is scarce evidence of its implementation in different healthcare settings. With this article, we wanted to determine the level of integrated care implementation in the management of T2D (diabetes) and HT (hypertension) in three different settings: Belgium, Slovenia, and Cambodia. Methods: This was an observational study with integrated approach. It was conducted in primary health care organisations in three countries. In each primary health care organisation, we aimed to include primary care workers that worked with Type 2 Diabetes (T2D) and hypertension (HT) patients. Data was collected with the Integrated Care Package (ICP) grid (consisting of six elements: identification, treatment, health education, self-management, caregiver collaboration, and care organisation). Results: ICP is almost completely implemented without major differences within Slovenia. There is a considerable variability across practice types in Belgium. Implementation is constrained by health system resources in Cambodia. Some elements, especially identification, are better implemented then others, across health systems. Conclusion: Countries can enhance integrated care for chronic diseases by implementing central policies, standardized protocols, and local adaptation, addressing resource constraints, promoting systematic screening and health education, and providing training for healthcare workers, tailored to community needs, to improve patient outcomes and healthcare delivery.

Comparison between rectal and body surface temperature in dogs by the calibrated infrared thermometer.

Because dogs tolerate conventional rectal temperature measurements poorly, a calibrated infrared thermometer was tested for assessing canine body surface temperature. Body surface temperature of 204 dogs was estimated on various sites (digit, snout, axilla, eye, gum, inguinal region, and anal verge). Having rectal temperature as the gold standard, temperature difference, Spearman's correlation coefficient, hyperthermia and hypothermia detection sensitivity and specificity, and stress response score was calculated for each measurement site. Although the canine body surface temperature was considerably lower than the rectal temperature, there was a moderate correlation between both temperatures. Spearman's coefficients were 0.60 (p < 0.001) for the inguinal region with a single operator and 0.50 (p < 0.001) for the gum with multiple operators. Measurement site on the gum additionally guaranteed hyperthermia detection sensitivity and specificity up to 90.0% (95% CI: [66.7 100]) and 78.6% (95% CI: [71.6 85.2]), respectively. Measurements with the infrared thermometer provoked a statistically significant lower stress response (mean stress scores between 1.89 and 2.48/5) compared to the contact rectal measurements (stress score of 3.06/5). To conclude, the correct body surface temperature measurement should include a calibrated thermometer, reliable sampling, and the control of external factors such as ambient temperature influence. The transformation of body surface temperature to the recognized rectal temperature interval allows more straightforward data interpretation. The gum temperature exhibited the best clinical potential since the differences to rectal temperatures were below 1°C, and hyperthermia was detected with the sensitivity of up to 90%.

Random cancers as supported by registry data.

There has been considerable interest in recent years in quantifying the rate of unavoidable or so-called random cancers, as opposed to cancers linked to environmental, genetic or other factors. We propose a data-based approach to estimate an upper limit to this probability, based on an analysis of multiple registry data. The argument is that the cumulative hazards for random cancers cannot exceed the minimum reliable cumulative hazard observed across the registries. We propose a Monte Carlo method to identify this upper limit and apply the method to data on nine different cancers recorded by 423 registries. We compare our values with estimates obtained from a random mutations argument.

Increased perioperative C-reactive protein and decreased postoperative albumin is associated with acute posttraumatic osteomyelitis in patients with high-energy tibial fractures.

BACKGROUND: Early diagnosis of acute posttraumatic osteomyelitis (POM) is of vital importance for avoiding devastating complications. Diagnosing POM is difficult due to the lack of a highly specific and sensitive test, such as in myocardial infarct, stroke and intracranial bleeding. Serum inflammatory markers, C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) can support clinical findings but they are not able to differentiate between inflammatory response to infection and the host response to non-infection insult with high specificity and sensitivity. AIM: The objectives of the study were to investigate whether the biochemical and immunoinflammatory patient profile could facilitate postoperative monitoring, guide the antibiotic treatment and timing of revision surgery. PATIENTS AND METHODS: This prospective nonrandomised cohort study included 86 patients after high-energy injury to the shin requiring primary surgical treatment (open or closed reduction and internal fixation of tibial fracture). Values of the biochemical and immunoinflammatory profile were measured on admission (ADD), first postoperative day (POD1) and fourth-postoperative day (POD4). RESULTS: We discovered on our sample that the development of POM is associated with increased CRP on ADD, POD1 and decreased albumins on POD4. Further studies are needed to prove that these differences can be useful in diagnosing the risk of infection. The assessment of other important risk factors such as: the extent of soft tissue damage, multiple fractures, transfusion rate, need for conversion primary external fixation to intramedullary (IM) nailing or locking plate fixation can empower our clinical judgment of POM. CONCLUSIONS: We can improve prediction of posttraumatic osteomyelitis by using the perioperative inflammatory biomarker CRP in combination with postoperative albumins levels and other associated independent risk factors.