Assessing Frailty in the General Medical Clinic of a Tertiary Hospital in Northern Malaysia: The FRAIL Scale or the Clinical Frailty Scale

Background. Frailty potentially influences clinicians’ decision making on treatment provided they can select the appropriate assessment tools. This study aims to investigate the difference between the FRAIL scale and the Clinical Frailty Scale (CFS) in assessing frailty among community-dwelling older adults attending the General Medical Clinic (GMC) in Seberang Jaya Hospital, Penang, Malaysia. Methods. The medical records of 95 older patients (age ≥ 65) who attended the GMC from 16 December 2019 to 10 January 2020 were reviewed. Frailty was identified using the FRAIL scale and the CFS. Patient characteristics were investigated for their association with frailty and their difference in the prevalence of frailty by the FRAIL scale and CFS. Results. The CFS identified nonsignificant higher prevalence of frailty compared to the FRAIL scale (21/95; 22.1% vs. 17/95; 17.9%, ratio of prevalence = 1.235, p = 0.481 ). Minimal agreement was found between the FRAIL scale and the CFS (Kappa = 0.272, p < 0.001 ). Three out of 5 components of the FRAIL scale (resistance, ambulation, and loss of weight) were associated with frailty by the CFS. Higher prevalence of frailty was identified by the CFS in those above 70 years of age. The FRAIL scale identified more patients with frailty in ischaemic heart disease patients. Conclusion. Patient characteristics influenced the choice of the frailty assessment tool. The FRAIL scale and the CFS may complement each other in providing optimized care to older patients who attended the GMC.

Implementing person-centered care in a general medical clinic: cultural barriers and driving forces

Public healthcare organisations in Sweden have been described as strongly hierarchical and coherent organisations [1]. To bring about control, generalized care models have been developed to handle hospital clinics and primary care sites [2]. This paper examines the preparedness to change in hospital settings. The purpose of the present study was to reveal barriers to the introduction of person-centred care (PCC). Organisational culture and resistance to change on hospital ward and clinical level and was based on the 2 concepts of “organisational culture” and “resistance to change”. These 2 concepts were measured by questionnaires based on theories of organisational culture and resistance to change.

The Infrequency of Spirometry Use in Medical Clinics

Background: Spirometry is advocated for adults with obstructive lung disease such as asthma or chronic obstructive lung disease (COPD), for individuals with risk factors such as cigarette smoking, and for patients with chronic respiratory symptoms. This record review study was performed to determine how frequent medical residents order spirometry for the above indications. Methods: Outpatient general medical clinic records from 337 patients followed in the medical clinics of a large, teaching hospital in an urban setting were reviewed. Inclusion criteria for review included age > 45 yr and one of the following: 1) a diagnosis of asthma and/or COPD, 2) either current or previous cigarette smoking, 3) one or more of the following chronic respiratory symptoms: dyspnea, cough, sputum production. Results: The mean (SD) age was 57 + 10 yr. Of this group, only 31% had spirometry or an order for spirometry documented in the outpatient record. Conclusion: This finding underscores the under-utilization of spirometry as a diagnostic tool, even in an academic setting.

Quality of Life in Parkinson's Disease: Movement Disorders Clinic vs General Medical Clinic - A Comparative Study

Objectives: to determine the effect of attending a movement disorders (MD) clinic on quality of life (QOL) outcomes for patients with Parkinson's disease (PD). Methods: Postal questionnaire study of forty-two patients with Parkinson's disease attending either a movement disorders clinic or more conventional general medical clinic were selected consecutively to complete the Parkinson's Disease Quality of Life Questionnaire (PDQL). All patients were diagnosed by a consultant physician with an interest in Parkinson's disease (S.B.R.) and had attended either the movement disorders clinic or the general medical clinic on at least three occasions. Questionnaires were completed independently of the examiners and returned by post. Results: Mean PDQL score was 124.1 [5.16] in the movement disorders clinic and 95.9 [5.86] in the general medical clinic. Analysis of covariance revealed that those subjects attending the MD clinic reported a significantly higher QOL than those subjects in general medical care (F(1,39)= 161.98, P<0.001). Conclusion: These data indicate that the quality of life of respondents attending the movement disorders clinic is significantly higher than those attending the general medical clinic.