6-and 12-months Research Articles

Post-Covid-19 condition (Long Covid) in children and young people 12 months after infection or reinfection with the Omicron variant: a prospective observational study.

Our previous study in children and young people (CYP) at 3- and 6-months post-infection showed that 12-16% of those infected with the Omicron (B.1.1.529) variant of SARS-CoV-2 met the research definition of Long Covid, with no differences between first-positive and reinfected CYP. The primary objective of the current study is to explore the impact of the Omicron variant of SARS-CoV-2 infection on young people 12 months post infection. 345 CYP aged 11-17years with a first laboratory-confirmed infection with the Omicron variant and 360 CYP reinfected with the Omicron variant completed an online questionnaire assessing demographics, symptoms, and their impact shortly after testing and again at 3-, 6-and 12-months post-testing. Vaccination status was determined from information held at UKHSA. Comparisons between groups were made using chi-squared, Mann-Whitney U, and Kruskal-Wallis tests. The most common symptoms in first-positive and reinfected CYP 12-months post-testing were tiredness (35.7 and 33.6% respectively) and sleeping difficulties (27.5 and 28.3% respectively). Symptom profiles, severity and impact were similar in the two infection status groups. Overall, by 12-months, 17.4% of first-positives and 21.9% of reinfected CYP fulfilled the research consensus Long Covid definition (p = 0.13). 12-months post Omicron infection, there is little difference between first-positive and reinfected CYP with respect to symptom profiles and impact. Clinicians may not therefore need to consider number of infections and type of variant when developing treatment plans. Further studies are needed to assess causality of reported symptoms up to 12-months after SARS-CoV-2 infection.

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

OUTCOMES OF THE ADULT DAY SERVICE PLUS (ADS PLUS) PROGRAM: A HYBRID TYPE I MULTISITE TRIAL DESIGN

Abstract This paper presents the main outcomes of a cluster randomized hybrid trial (type I) involving 34 adult day services (ADS) in the US. Eighteen sites were randomized to control (ADS as usual); 16 sites provided ADS and caregiver support (ADS Plus). Trained staff met with caregivers onsite to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12-months. Main outcomes included depressive symptoms (CES-D) and well-being at 6-and 12-months, and attendance of clients (people living with dementia) over 12-months. Of 203 caregivers (Intervention=102; Control=101), 5.9% at 3-months, 12.8% at 6-months, and 22.7% at 12-months were lost-to-follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as white/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had >college education and were 65.0 years old (SD=13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (>16 CES-D) at baseline. By 6-months, 43.6% control versus 34.2% ADS Plus caregivers had >16 scores (odds ratio=0.38, p=0.072). By 12-months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p=0.013) and lower depressed affect scores (p=0.015). Of 18 sites providing 12-month client attendance data, nine intervention sites reported 126.05 days attended versus 78.49 days for nine control sites (p=0.079). Compared to ADS alone, by 12-months ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance benefits for clients, caregivers and ADS.

265 Polypharmacy and potentially inappropriate medication prescriptions in older Nursing Home Residents presenting to the Emergency Department

Abstract Background Nursing Home Residents (NHR) have high rates of polypharmacy and Potentially Inappropriate Medication (PIM) prescriptions. Emergency Departments (ED) are an access point to acute hospitals for unwell NHRs. Attendance is associated with adverse outcomes. This project aims to identify polypharmacy and PIMsin older NHRs presenting to ED and associations with adverse outcomes. Methods A prospective cohort study including all NHR aged≥50 years presenting to ED over one year (01/10/2019–30/09/2020). Data collected included demographics, medications at attendance, Charlson Comorbidity Index (CCI), Clinical Frailty Score (CFS), modified Barthel Index (BI), continence, falls history, ED presentation details, ED Length of Stay (LoS), hospital LoS and 6-and 12-month mortality. Polypharmacy was defined as ≥5medications. The Screening Tool of Older Persons’ Prescriptions version2 (STOPP), STOPPFrail and Beers’ Criteria were used to identify PIMs Results There were 516 attendances by 343 individual NHRs. Mean age was 78.6 years (50–103; ±10.9). Prescriptions were available for 93.0% (480/516). A mean of 12.4 (0–31,±5.24) medications were prescribed per patient, with polypharmacy present in 96.0% (461/480). Mean age of the polypharmacy group was lower (76.2 vs 83.7; p < 0.001). There were no significant differences in CCI, CFS or modified BI scores. STOPP identified 99% (n = 475) as having ≥1 PIM(mean 7.47[0–19; ± 3.67] per patient). All had ≥1PIM according to STOPPFrail(mean 8.59[0–26; ±3.90] per patient). Beers’ classified 97.5% (n = 468) as having ≥1PIM (mean 4.32[0–13,±2.41] per patient). STOPPFrail identified continence (71.9% vs 65.8%) and intellectual disability (76.7% vs 67.5%) as significantly associated with a higher proportion of PIMsp < 0.001). Beers’ identified delirium and hospital admission as associated with a lower proportion of PIMs31.7% vs 36.8%, 33.2% vs 38.1% respectively; p < 0.001). All tools showed NHRs who died at 6-and 12-months had a lower proportion of PIMs Conclusion Polypharmacy and PIMsare common in NHRs attending ED and should be considered at presentation. NH liaison services may facilitate medication review and deprescribing.

Sexual growth and destiny beliefs: Longitudinal associations with dyadic coping among couples seeking medically assisted reproduction.

Medically assisted reproduction is a vulnerable time for couples' sexual health. Believing that sexual challenges can be worked through (i.e., sexual growth beliefs) or that these challenges indicate incompatibility (i.e., sexual destiny beliefs) may be related to dyadic coping-the strategies couples use to cope-with the physical and psychological stressors of medically assisted reproduction. In the current study we aimed to examine the longitudinal associations between typical (i.e., average) levels of sexual growth and destiny beliefs and positive and negative facets of dyadic coping and how greater than typical levels of these constructs predicted each other across time. Couples (n = 219) seeking medically assisted reproduction were recruited for an online longitudinal, dyadic study. Couples completed online measures of sexual growth and destiny beliefs and positive and negative dyadic coping at baseline, 6-and 12-months. Random intercept cross-lagged panel models demonstrated that at the within-person level, reporting higher sexual growth beliefs at baseline, relative to their average across time points, was associated with lower negative dyadic coping at 6 months. Higher negative dyadic coping at 6 months, relative to their average, was linked to lower sexual growth beliefs at 12-months. When individuals reported higher sexual destiny beliefs at 6-months, relative to their average, they and their partners reported higher negative dyadic coping at 12 -months. At the between-person level, higher overall levels of sexual destiny beliefs were related to higher overall levels of negative dyadic coping. No associations with positive dyadic coping were identified. Couples may benefit from identifying and reducing unhelpful beliefs about sex and negative dyadic coping. Strengths of this study include our large, inclusive sample, engagement of community partners, and novel analytical approach to assess change over time. However, following couples in 6-month increments and not using questionnaires specific to medically assisted reproduction may have limited our ability to detect nuanced changes that couples experience during this time. Lower sexual growth and higher sexual destiny beliefs may promote couples' engagement in less adaptive coping behaviors as they seek medically assisted reproduction.

Bevacizumab loaded CalliSpheres® bronchial arterial chemoembolization combined with immunotherapy and targeted therapy for advanced lung adenocarcinoma.

Background: As a new drug delivery and embolization system, drug-eluted bronchial artery chemoembolization (DEB-BACE) can not only embolize the tumor blood supply artery but also load chemotherapy drugs and slowly release them into the local environment. Bevacizumab (BEV) combined with chemotherapy drugs has attained significant achievements in the first-line treatment of advanced non-squamous non-small cell lung cancer (NSCLC). The role of BEV-loaded DEB-BACE combined with immunotherapy and targeted therapy in patients with lung adenocarcinoma (LUAD) is unclear. This study was designed to evaluate the efficacy and safety of bevacizumab-loaded CalliSpheres® bronchial arterial chemoembolization combined with immunotherapy and targeted therapy in patients with lung adenocarcinoma. Methods: Nine patients with LUAD who received BEV-loaded CalliSpheres® BACE combined with immunotherapy and targeted therapy from 1 Jan 2021 to Dec 2021 were included in this study. The primary endpoint was the disease control rate (DCR) and the objective response rate (ORR). The secondary endpoints were the overall survival rates (OS) at 6months and 12months. The tumor response was evaluated according to the mRECIST standard. Safety was assessed by the occurrences of adverse events and the severity of the adverse events. Results: All patients received CalliSpheres® BACE loaded with BEV (200mg) in combination with immunotherapy and targeted therapy. A total of nine patients received the BACE procedures 20 times, four of them received a third session of BACE, three underwent a second session of DEB-BACE, and two underwent one cycle of DEB-BACE. Partial response and stable disease were found in seven (77.8%), and two (22.2%) patients, respectively, 1month after the last multimodal treatment. The ORR at 1, 3, 6, and 12months was 77.8%, 66.7%, 44.4%, and 33.3%, respectively, while the DCR was 100%, 77.8%, 44.4%, and 33.3%, respectively. The OS rates at 6-and 12-month were 77.8% and 66.7%, respectively. There were no serious adverse events. Conclusion: BEV-loaded CalliSpheres® transcatheter bronchial arterial chemoembolization combined with immunotherapy and targeted therapy is a promising and well-tolerated treatment for patients with lung adenocarcinoma.

Impact of integrated care coordination on pediatric asthma hospital presentations.

IntroductionFrequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs).MethodsThe integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2–16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program.ResultsDuring December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II.ConclusionOur results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

Clinical observation of superior rectus transposition with/without augmented suture and vertical rectus transposition for the treatment of strabismus caused by complete abducens nerve palsy

Objective: To evaluate the efficacy and safety of superior rectus transposition (SRT) with/without augmented suture and vertical rectus transposition (VRT) for the treatment of strabismus caused by complete abducens nerve palsy. Methods: This was a retrospective cohort study. Forty-two patients (42 eyes) with complete abducens nerve palsy underwent strabismic surgeries from January 2015 to November 2020 in Tianjin Eye Hospital. According to the different procedures, the patients were divided into three groups: SRT group (16 cases, SRT with medial rectus recession), superior rectus transposition with augmented suture (SRTA) group (13 cases, SRT with Buckley suture and medial rectus recession) and VRT group (13 cases). The preoperative and postoperative (1, 6 and 12 months) data including deviations, ocular motility, binocular vision and surgical complications among three groups were analyzed and compared. χ2 test was used for comparison of count data among three groups. The measurement data were compared among three groups by the repeated measures ANOVA. LSD-t test was used for within-group comparison and between-group comparison. Results: There was no difference in sex ratio, age and course of disease among the groups (all P>0.05). The horizontal deviations of the three groups at 1, 6 and 12 months after surgeries was lower than that before surgeries, and the difference was statistically significant (all P<0.001). The horizontal deviations of the SRT group, SRTA group and VRT group at 12 months after surgeries were (+0.8±5.8), (+0.8±4.5), (+1.2±2.5) prism diopters (PD), respectively, lower than that of the preoperative (+82.8±17.2), (+77.7±26.1), (+71.5±18.6) PD. However, there was no significant difference among different postoperative follow-up timepoints (all P>0.05). There was no difference in horizontal deviations before surgeries and at 1, 6 and 12 months after surgeries among three groups (P>0.05). There were significant differences in the scales of abduction motility among preoperative, postoperative 1, 6 and 12 months measurements for three group (all P<0.001). The scales of abduction before surgeries in the SRT group, SRTA group, and VRT group were (-4.4±0.5), (-4.4±0.5), (-4.5±0.5) scale and at 12 months after surgeries were (-2.3±0.7), (-2.2±0.5), (-2.1±0.6) scale respectively. But there was no change among different postoperative follow-up timepoints (all P>0.05). Preoperative and postoperative 1-, 6-and 12-month abduction motility was similar among three groups (P>0.05). There were significant differences in the scales of adduction limitation among preoperative, postoperative 1-, 6-and 12-months measurements for three group (all P<0.05). But there was no change among different postoperative follow-up timepoints (all P>0.05). There were significant differences between the SRT group [(-0.9±0.6), (-0.8±0.6) scale] and the SRTA groups [(-1.5±0.5), (-1.4±0.5) scale] (t=-2.62, -2.52) and between the SRTA group and the VRT group [(-0.8±0.8), (-0.6±0.7) scale] (t=2.62, 3.01) at 6 and 12 months after surgeries (all P<0.05). The outcomes of binocular vision at postoperative 12 months were similar among three groups (P>0.05). No patient had torsional diplopia and anterior segment ischemia. Only 2 patients from the SRTA group had hypotropia of 4 to 5 PD in the primary position associated with supraduction limitation. Conclusions: SRT with/without augmented suture and VRT are effective and safe procedures for the treatment of strabismus caused by complete abducens nerve palsy. They could correct deviations, improve abduction motility and restore binocular vision, with stable outcomes and a small risk of vertical and torsional diplopia.

Evaluation of drought propagations with multiple indices in the Yangtze River basin.

This paper explored the drought propagation phenomenon based on meteorological, hydrological, and agricultural aspects in the Yangtze River basin (YRB), China. To evaluate meteorological, hydrological, and agricultural droughts, this paper used three drought indices, standardized precipitation evapotranspiration index (SPEI), standardized runoff index (SRI), and standardized soil moisture index (SSMI), respectively. The community land model (CLM) in the YRB to generate the monthly evapotranspiration, soil moisture, runoff data, which are required for the estimation of drought index, were applied. Different mean durations (6-and 12-month) were used for drought estimation, and propagations of meteorological to hydrological and meteorological and agricultural droughts were investigated for different durations as SPEI6-SRI6, SPEI6-SSMI6, SPEI12-SRI12, SPEI12-SSMI12. The average drought propagation between 1950 and 2010 presented the highest autocorrelation and correlation with one-month lags in four combinations of drought indices in SPEI6-SRI6, SPEI6-SSMI6, SPEI12-SRI12, and SPEI12-SSMI12. Additionally, this paper estimated the optimal lags of SPEI-SRI and SPEI-SSMI drought propagations using mean 6-and 12-month lag times for six representative drought periods. Therefore, the propagation phenomenon of meteorological to hydrological and to agricultural droughts were confirmed in the YRB.

Acceptability, quality of life and cost overview of a remote follow-up plan for patients with colorectal cancer

IntroductionColorectal cancer (CRC) follow-up has a major impact on outpatient services. The aim was to examine patient acceptability and costs of a new remote follow-up regimen for patients with CRC. Material and methodsAll patients with stage I-III CRC and having completed at least one-year of follow-up at Radboud University Medical Center located in Nijmegen, The Netherlands, were considered for remote follow-up. Enrolled patients received the EORTC-C30 (Quality of Life, QoL), Cancer Worry Scale (Fear of Cancer Recurrence, FCR), (e)Health literacy and patient satisfaction questionnaires. Follow-up use and costs were evaluated. ResultsA total of 118 patients with stage I-III CRC have been followed according to the new remote follow-up regimen. Median length of follow-up at start of remote follow-up was 34 months (interquartile range of 24–41) and all patients were sufficiently health literate. Overall satisfaction towards remote follow-up at 6-and 12-months was rated 7.8 and 7.5 out of 10. Satisfaction with the online self-management information was rated 8 out of 10. Over a one-year period, QoL remained high and patients experienced low FCR. More than 70% of the patients self-organized their care, while the others sought contact by telephone, MyChart or hospital visits. Remote follow-up for the total cohort led to €22,408 cost-savings over one-year compared to standard hospital follow-up. ConclusionsImplementation of remote follow-up for patients with stage I-III CRC is feasible, comes with high patient satisfaction and considerable cost-savings. Short-term results did not show differences in QoL or FCR during the course of remote follow-up.

The changes in corneal transparency after orthokeratology with juvenile myopia

Objective: To evaluate the changes of corneal transparency undergoing overnight orthokeratology treatment. Methods: Prospective cohort study. Right eyes of juvenile myopic patients fitted with Ortho-K CL at Qingdao Eye Hospital were enrolled. Corneal optical density values were measured by the Pentacam Scheimpflug system before orthokeratology and at 1 day, 1 week, and 1, 3, 6, and 12 months after wearing. Four concentric radial zones centered on the apex of the cornea (≤2 mm, >2 mm and ≤6 mm, >6 mm and ≤10 mm, and>10 mm and ≤12 mm diameter) were applied. Anterior layer (anterior 120 μm), central layer, and posterior layer (posterior 60 μm) were defined according to corneal depth. The data analysis were used One-Way Repeated Measures ANOVA and LSD test. Results: Forty patients (40 eyes) with myopia (24 male and 16 female, age 10.76±1.74 years) were in enrolled. Corneal optical density value was 13.18±0.23 before orthokeratology, then showed a decreasing trend at the early stage, but there was no statistical difference (within 3months: t=-1.594, -1.472, 0.064, 1.971; P>0.05). The value increased significantly and reached the peak (15.31±0.23, t=7.613, P<0.01) at 6-month, and was still maintained in a high value at 1-year (15.15±0.24, t=7.227, P<0.01). Anterior, central, and posterior layer of corneal optical density values had a downward trend at early stage, and increased significantly in 6-and 12-month (anterior layer t=7.143, 6.177, central layer t=7.508, 6.563, posterior layer t=6.722, 8.533;P<0.01). Only the values decreased significantly in posterior layer at 1-week (baseline 10.21±0.14 vs. 1-week 9.91±0.14, t=-2.348, P=0.024). The corneal optical density value of ≤2 mm diameter began to increase significantly at 1-month (baseline 12.88±0.14 vs. 1-month 13.31±0.19, t=2.158, P=0.037),>2 mm and ≤6 mm diameter at 3-month (baseline 11.71±0.13 vs. 3-month 12.50±0.19, t=3.213, P=0.003), and>6 mm and ≤10 mm diameter at 6-month (baseline 11.40±0.30 vs. 6-month 13.70±0.33, t=7.635, P=0.000). The high values lasted for 1 year at this three areas. However, >10 mm and ≤12 mm diameter had no obvious change in optical density (F=1.668, P>0.05). In addition, the significant reduction of optical density values at early stage were mainly concentrated in the posterior layer of the cornea and the>6 mm and ≤10 mm diameter. Conclusions: Orthokeratology transiently increases corneal transparency of the posterior layer and the>6 mm and ≤10 mm diameter at early stage. However, long-term wearing can cause a decrease of transparency within a 10 mm diameter range. The corneal transparency changes first at the center of the optical zone, then gradually expanding to the periphery, and the anterior, central and posterior layers of cornea are all affected. We speculate orthokeratology affect the corneal oxygen supply and compress cornea mechanically, that leads to corneal stromal remodeling. (Chin J Ophthalmol, 2019, 55:435-441).

Effects of Sealing Marginal Occlusal Defects of Composite Restorations with a Nanofiller-Reinforced Flowable Resin Composite: A Double-Blind, Randomised Clinical Trial with One-Year Follow-Up.

To evaluate the 6-and 12-month performance of microrepairs of marginal occlusal microdefects of resin composite restorations in a group of patients with high caries risk. Thirty-five patients with at least three resin composite restorations with marginal occlusal defects were randomly distributed into three treatment groups: (1) sealed with flowable resin composite; (2) sealed with resin-based sealant; or (3) control. Restorations in all groups were assessed using World Dental Federation (FDI) criteria at three time points: baseline, and at 6 and 12 months after sealing. After 1 year, 32 patients were examined. Of all the repaired restorations, those of the flowable resin composite (RC) group maintained an FDI value of 1 for marginal occlusal adaptation for 81.3% of the restorations at 6 and 78.1% at 12 months. The resin-based sealant group kept a value of 1 for the same parameter on 65.6% of restorations at 6 and 50% at 12 months with a statistically significant difference (p= 0.024) between the two time periods. There was a statistically significant difference between the two groups at the 12-month comparison (p = 0.015). Occlusal RC restorations that were sealed using either a resin-based sealant or a nanofilled flowable RC benefited from improved clinical status after 12 months. Use of the latter presented the better clinical performance of the two by providing a higher rate of total retention of sealing materials.

Secondary psychological outcomes in a controlled trial of Emotional Freedom Techniques and cognitive behaviour therapy in the treatment of food cravings

ObjectiveExamining the effectiveness of psychological interventions in treating secondary psychological outcomes of obesity has become prioritized in recent times. The objective of the present study was to compare an eight-week Cognitive-Behavioural Therapy (CBT) and Emotional Freedom Techniques (EFT) intervention program, in the treatment of food cravings and secondary psychological outcomes among overweight or obese adults (N = 83). MethodA controlled non-inferiority trial was performed comparing group-delivered CBT to group-delivered EFT. Participants completed the Patient Health Questionnaire at pre- and post-intervention, and at six and 12-months follow-up. ResultsThe CBT group did not report any significant changes in anxiety scores over time, but the decrease in depression symptoms pre-to post-intervention was significant and this was maintained at 6-and 12-months. Anxiety and depression scores significantly decreased from pre-to post-intervention for the EFT group, and was maintained at 6- and 12-month follow-up. Somatoform scores significantly decreased from pre-intervention to all follow-up points for the CBT group, while the EFT group did not report any significant changes in somatoform symptoms. Results also revealed that EFT is capable of producing reductions in anxiety and depression symptoms, and may be comparable to gold standard approaches such as CBT. ConclusionThe current study supports the hypothesis that psychological intervention is beneficial for treating psychological comorbidities of obesity and points to the role mental health issues may play in this area.

P076 Five years of feedback for the newly diagnosed course – an evaluation of a peer-led intervention for people diagnosed with HIV

IntroductionNew diagnosis of HIV can be psychologically challenging, and presents an important opportunity to improve health literacy and engagement in care. Peer-led interventions are an effective means of providing support to people living with HIV (PLWH). We present an evaluation of a newly-diagnosed course (NDC) in London.MethodThe NDC, established in its current form in 2011, is accessible to ‘those recently diagnosed or struggling with diagnosis’. Providing a structured, peer-led, group-based, participatory programme delivered by experienced facilitators. NDC comprises 6 sessions (21 contact hours). All participants were invited to complete pre-and post-course questionnaires (using a 4-or 5-point scale), most did at the first and last sessions. This analysis presents data from 2011-2016. Data were analysed in STATA using Wilcoxon signed rank test.ResultsAcross 30 NDCs, 314 participants completed both questionnaires (response rate 87%). The majority were men who have sex with men (91.3%), 72% of whom were of white ethnicity. Approximately 15% were female, the majority Black-African ethnicity (56%) and heterosexual (88%). Heterosexual men and transgender individuals represented 6.5% and 0.3% respectively. The table summarises participant’s responses for selected questions (P Values &lt;0.001 for all comparisons):Pre- and Post-Course Questions:•Pre-course n/N (%)•Post-course n/N (%)*Current emotional state144/136 (43)287/339 (85)*Confidence in dealing with HIV status130/335 (39)307/339 (91)*Confidence around sex and relationships46/336 (14)172/279 (62)*Confidence in the future130/338 (39)290/332 (90)How confident do you feel about disclosing your HIV status?26/338 (8)136/340 (40)How satisfied are you with your ability to get more information about HIV medications?97/336 (29)130/314 (41)How much knowledge do you have about how HIV is transmitted?183/337 (54)324/340 (95)How much do you know about how to access Post Exposure Prophylaxis (PEP)?169/337 (28)274/340 (81)How much knowledge do you have about CD4 count and HIV viral load?82/337 (24)300/340 (88)Personal satisfaction with NDC overall n/N (%) rating ‘mostly’ or ‘fully’ useful324/328 (99)*Questions headed: ‘Thinking about your HIV how would you rate the following’ Respondents rating highest using 4- or 5-point scaleDiscussionThis innovated peer-led NDC engaged over 300 PLWH since 2011, resulting in short-term self-reported improvements. 6-and 12-month questionnaires would assess durability of changes, and we’re exploring the association with attendance at NDC and clinical outcomes (e.g. viral suppression and retention in care). In conclusion, the NDC is a sustainable and acceptable model, providing holistic support and promoting self-management in PLWH.

Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups.

BackgroundPersistent pain affects a large proportion of patients after thoracotomy and is associated with sensory disturbances. The objective of this prospective study was to investigate the time course of pain and sensory disturbances over a 12-month period.MethodsPatients scheduled for thoracotomy were recruited. Data were collected on the day before surgery, including baseline characteristics and the presence of any preoperative pain. At 6- and 12-month follow-ups, data on pain were collected using the Brief Pain Inventory-Short Form, and perceived sensory disturbances around the thoracotomy scar were recorded from a self-exploration test.ResultsAt 12 months after surgery, 97 patients had complete data including baseline and 6-and 12-month measurements. Almost half of the patients reported post-thoracotomy pain at the follow-ups. However, 20% of the patients not reporting post-thoracotomy pain at 6 months did report it at 12 months. Between 40% and 60% of patients experienced some kind of sensory disturbance at 6 months. A small decline in some kind of sensory disturbance was reported by 20%–50% of patients at 12 months.ConclusionA proportion of patients experienced either resolved or delayed onset of pain. Sensory changes were strongly associated with post-thoracotomy pain syndrome, but were also present in a large proportion of patients without it.

A Comparison of Clinical Outcomes Between Frame-based and Frameless Stereotactic Radiosurgery for Brain Metastases

Purpose/Objective(s): Though frame-based immobilization was the gold standard for cranial stereotactic radiosurgery (SRS), modern experiences report the non-invasive frameless techniques to be an effective alternative. Frameless techniques may potentially increase set up variation resulting in inferior targeting and commonly require additional margin to the target volume. Given these concerns, we aim to compare the rates of local control and radiation necrosis in frameless versus frame-based SRS. Materials/Methods: We reviewed all patients treated at our institution with SRS for brain metastases from 2008 to 2014. Ninety-eight patients (170 lesions) with radiologic and clinical follow-up had complete patient, tumor and treatment information. Group 1 consisted of 34 patients (61 lesions) immobilized with a standard head-ring. Group 2 had sixty-four patients (109 lesions) immobilized with an SRS specific mask. Patient-, tumor-, and treatment-characteristics were recorded as well as the intervals from treatment to local recurrence, radiation necrosis; elsewhere brain failure, and death. Radiographic asymptomatic radiation necrosis was included in the analysis. Results: Median patient age and KPS were 59 years (range 25 -89) and 80 (range 50-100), respectively. Median radiologic and clinical follow up were 6.5 months (range 0.7-44.3) and 7 months (range 0.7-45.7). A median of 2 tumors were treated per treatment course (range 1-5) with a median dose of 18 Gy (range 13-24 Gy). Six targets failed locally in Group 1 with 6and 12-month failure rates of 7.2% and 14.5%. Eighteen local failures were documented in Group 2 with 6-and 12-month failure estimates of 15.3% and 30.8%. Comparison of the Kaplan Meier estimates with the log-rank test demonstrated a p-value of 0.1446. Thirtyone patients (50%) in Group 1 had additional margins with a 0.69 cc mean increase in target volume compared to 93 patients (85%) with a 1.2 cc mean increase in Group 2. Eleven targets had radiation necrosis (8 symptomatic) in Group 1 with 6and 12-month necrosis rate estimates of 1.7% and 36.5%. Radiation necrosis was documented in 14 targets (6 symptomatic) in Group 2 with 6and 12-month necrosis estimates of 3.1% and 16.5%. Log-rank statistics showed a p-value of 0.3911. Cox regression for univariate analysis identified variables predictive for necrosis. Only SRS dose >17 Gy was statistically significant on multivariate analysis (HR 0.303, 95% CI 0.1-0.89). There were no statistically significant factors found on multivariate analysis for local progression. Conclusion: In this report, frameless SRS techniques demonstrated quality clinical outcomes without statistically significant differences in local control or radiation necrosis when compared to frame-based SRS. Author Disclosure: N.R. Bennion: None. T. Malouff: None. V. Verma: None. A.O. Wahl: None. W. Zhen: None. C. Lin: None.

An observational study to assess back pain in patients with severe osteoporosis treated with teriparatide versus antiresorptives: An Indian subpopulation analysis.

Background:One year, prospective, observational study in an Indian subpopulation to assess back pain in patients with severe osteoporosis treated with teriparatide or antiresorptives in a clinical setting.Materials and Methods:One hundred and nineteen teriparatide-naοve Indian men and postmenopausal women (mean age 68.0 years) with previous osteoporotic vertebral fracture participated. Patients were assessed at baseline, 6-and 12-months to evaluate relative risk (RR) of new/worsening back pain using the Back Pain Questionnaire. The incidence of back pain and changes in back pain severity were assessed using the visual analog scale (VAS); Health outcomes were assessed using the euroquol-5 dimensions (EQ-5D) questionnaire. All tests were conducted with a two-sided alpha of 0.05.Results:Of 562 overall patients, 57, 60, and 2 Indian patients received teriparatide, antiresorptive, or teriparatide and antiresorptive, respectively. Baseline disease characteristics were slightly worse for antiresorptive-treated patients, whereas teriparatide-treated patients were older with more comorbidities. At 6-months, the incidence of new/worsening back pain was 5.3% for teriparatide-treated patients versus 4.4% for antiresorptive-treated patients (RR: 1.00, 95% confidence interval: 0.68, 1.48); the incidence of severe back pain was 0% versus 12.5% (P = 0.017); in these treatment groups, respectively. Mean VAS change scores (mean ± standard deviation [SD]) were − 1.9 ± 1.73 versus − 1.4 ± 1.77, and mean EQ-5D change scores were 4.2 ± 27.20 versus 9.9 ± 26.23 at 6-months. At 6 months, more teriparatide-treated patients felt better (89% vs. 61%; P = 0.001) and were at least very satisfied with their treatment (30% vs. 9%; P = 0.011).Conclusion:Teriparatide-treated Indian patients had similar new/worsening back pain risk and minimal risk of severe back pain compared with antiresorptive-treated patients at 6-months.

Autologous peripheral blood CD34+ stem cells transplanted into 100 patients with advanced cirrhosis

To investigate whether transplantation of autologous peripheral blood CD34+ stem cells is a viable approach for treating patients with advanced cirrhosis,which is currently hindered by a shortage in liver donors. A total of 100 patients with advanced cirrhosis and who had failed to respond to conservative therapy were recruited for transplantation of autologous peripheral blood CD34+ stem cells.The success of transplantation was investigated 6-and 12-months later by measuring markers of liver biosynthesis function (coagulation,albumin level,indocyanine green clearance,Child-Pugh score) and assessing pathological changes (Knodell score) and morphologic changes in the liver tissue.Complications were also recorded during follow-up. The 1-year cumulative survival rate was 100%. Fifty-two patients with massive ascites showed gradual reduction and disappearance of the ascites.Four patients experienced upper gastrointestinal bleeding and three patients developed with hepatic encephalopathy (I-II degree) at 3 months post-transplantation.All patients showed significantly improved liver biosynthesis function,liver elasticity and Knodell score after transplantation (P less than 0.05). Autologous peripheral blood CD34+ stem cell transplantation is a safe and effective treatment for advanced cirrhosis,and has high cost-benefit since it improves liver function,liver histology,and quality of life.

PCV106 - Factors affecting persistence of treatment in recipients with newly-diagnosed hypertension in a medicaid population

PCV106 FACTORS AFFECTING PERSISTENCE OF TREATMENT IN RECIPIENTS WITH NEWLY-DIAGNOSED HYPERTENSION IN A MEDICAID POPULATION Baggarly SA1, Kemp RJ1, Wang X1, Magoun AD2 1University of Louisiana at Monroe, Monroe, LA, USA, 2Applied Research and Analysis, Inc., Tallulah, LA, USA OBJECTIVES: To describe initially-prescribed drug treatments for hypertension in newly-diagnosed recipients in a Medicaid population and to determine factors affecting 6and 12-month persistence rates. METHODS: This retrospective study included continuously-enrolled Louisiana Medicaid recipients aged 18-64 who were newly-diagnosed with hypertension between January 2006 and December 2008. Dually-eligible recipients were excluded. Recipients were followed for one year after their index date. Initial drug therapy was described, and persistence rates were calculated 6and 12-months post-index, for recipients who received diuretics, beta-blockers (BBs), angiotensin-II receptor blockers (ARBs), angiotensin converting enzyme inhibitors (ACEIs), and calcium channel blockers (CCBs). A 30-day grace period was allowed for refill gaps. Race, gender, age, and co-morbidity were used as predictor variables in logistic regression analyses of persistence for each drug class. RESULTS: A total of 4946 recipients were eligible for inclusion. Of these, 2352 received no drug therapy and 289 did not receive therapy in one of the analyzed drug classes, leaving a final study group of 2305 recipients. The study group was primarily female (68%) and African-American (67%). The majority of recipients received diuretics, followed by ACEIs, ARBs, BBs, and CCBs. Persistence rates for initially-prescribed drugs ranged from 21.6% for diuretics to 31.6% for ACEIs at 6-months, and from 10.7% for diuretics to 17.9% for CCBs at 12-months. Within drug classes, persistence ranged from 24.2% for diuretics to 33.1% for ACEIs at 6-months and 12.4% for diuretics to 19.3% for BBs at 12-months. Race, gender, and age were significant factors predicting persistence, with African-Americans less persistent than Whites, females less persistent than males, and younger recipients less persistent than older recipients. CONCLUSIONS: Approximately half of newly-diagnosed recipients did not receive drug therapy, and among treated patients, persistence rates were poor. Race, gender, and age were factors influencing persistence of therapy in this study group.

An Outpatient-Based Clinical Program For Diabetes Prevention: an Update

To update outcomes of the Diet-Exercise-Activity-Lifestyle (DEAL) program, a clinic-based diabetes prevention intervention. Changes in weight, fasting blood glucose, and 2-hour glucose after a 75-g oral glucose tolerance test were evaluated in patients who enrolled in the DEAL program between January 2007 and August 2009. The 221 qualified participants had a mean age of 62 years, weight of 87.4 kg, body mass index of 31.2 kg/m², fasting glucose level of 109 mg/dL, and 2-hour glucose value of 138 mg/dL. Among the program participants, 67% were women and 88% were white; 56% had isolated impaired fasting glucose, 5% had impaired glucose tolerance only, and 39% had both. The 6-month follow-up medical appointment was kept by 72% of program participants, but only 56% attended the 12-month visit. By 6 months after baseline, 59% had significantly lower fasting glucose concentrations, 59% had improvement in 2-hour glucose levels, and 61% had weight loss. Nearly 40%, however, were nonresponders and had increased fasting glucose, 2-hour glucose, and weight by 6 months. By the 12-month visit, significant declines in fasting glucose (P<.001), 2-hour glucose (P<.001), and weight (P = .008) occurred in comparison with baseline values; however, no significant changes occurred in these measures between the 6- and 12-month visits (P>.30 for all). Most DEAL participants showed improvement in glucose levels and weight, but some patients exhibited worsening glucose intolerance. Factors underlying nonresponse need to be identified. Ongoing experience and analysis should help revise the DEAL program so that outcomes for all participating patients will improve.