Ambulatory Consultation Research Articles

N04 Optimizing patient-reported outcome measurement in an IBD care pathway: results of the PROMOTION study

Abstract Background Patient-reported outcome measurements (PROMs) are essential for the clinical evaluation of patients and serve as a key quality indicator in IBD.1,2 Patient engagement is needed to collect PROMs, but often remains suboptimal. The PROMOTION (Patient Reported Outcome Measurement questiOnnaire intervenTION) study evaluated the response rate to PRO questionnaires before and after a patient empowerment intervention. Additionally we assessed the number of patients with IBD in PRO-2 remission in an entire cohort. Methods PROMOTION was a single-center, nurse-led prospective study, including all patients in follow-up within the designated IBD care pathway during the study period (January to September 2024). PRO questionnaires (PRO-2, IBD Disk, IBD Control) were sent before every (in-person or remote) ambulatory consultation, and bi-annual to patients in follow-up at the day clinic for IV therapy. The intervention was an information and empowerment campaign that took place in April 2024, aiming to improve patients’ insights in the use and importance of PROMs. Response rates (percentage of questionnaires returned with partial or complete answers) were evaluated three months before (period 1) until six months after (period 2) the intervention. Secondary outcomes included the number of patients in PRO-2 remission during follow-up (CD: abdominal pain ≤1 and stool frequency ≤3; UC: rectal bleeding =0 and stool frequency ≤1). Results A total of 1593 PRO questionnaires were sent to 811 individual patients during follow-up. Overall response rate was 58.6% (933/1593) (figure 1). Almost half (45%, 190/422) of the non-responders had low digital literacy. Responders and non-responders did not differ in mean (SD) age (47 (16) yrs responders vs. 51 (19) yrs non-responders) nor in type of follow-up (consultation vs infusion unit). There was no difference in the overall response rate in the periods before and after the intervention (period 1: 57.7% (335/581) vs period 2: 59.02% (598/1012); p=0.6; figure 2). Response rates in the first month after the intervention were, however, significantly higher than in the rest of the study period (71.8% (79/110) vs 57.6% (854/1483); p=0.004). PRO-2 remission was seen in 65.4% (323/494) of the total population who fully completed all questionnaires, with similar proportions seen in patients with CD (62.3%, 177/284) and UC (69.5%, 146/210; p=0.1). Conclusion Improving patient participation in the assessment of PROMs by a single patient empowerment intervention leads to good short-term but poor long-term results. A more continuous motivational approach with direct feedback to the patients warrants further investigation. Clinical remission, as targeted by STRIDE-II, was achievable in the majority of patients.

Acute Needs, ACUTE Response: Development and Delivery of a Mental Health Urgent Care in the Bronx.

As mental health needs rise, creative and timely solutions are essential. Leveraging the expansion and flexibility of virtual services to create telehealth and hybrid offerings is crucial for addressing systemic barriers in mental health, enhancing accessibility, and providing flexible, comprehensive care options for diverse patient populations. This article discusses the development of a mental health urgent care program within a large medical system in a densely populated, under-resourced community. The program was designed to address common community mental health barriers across multiple care entry points, including ambulatory settings, emergency care, and consultation services. Using a multipronged approach, this program aims to improve patient access, care continuity, and outcomes. The authors encourage others to consider adopting a similar programmatic infrastructure to reduce mental health care barriers in their communities.

Femoroacetabular Impingement Morphological Changes in Sample of Patients Living in Southern Mexico Using Tomographic Angle Measures.

Femoroacetabular impingement (FAI) is a condition caused by abnormal contact between the femur head and the acetabulum, which damages the labrum and articular cartilage. While the prevalence and the type of impingement may vary across human groups, the variability among populations with short height or with a high prevalence of overweight has not yet been explored. Latin American studies have rarely been conducted in reference to this condition, including the Mayan and mestizo populations from the Yucatan Peninsula. We aimed to describe the prevalence of morphological changes in femoroacetabular impingement by measuring radiological angles in abdominopelvic tomography studies in a sample of patients from a population with short height. In this prospective study, patients with programmed abdominopelvic tomography unrelated to femoroacetabular impingement but with consistent symptoms were included. Among the 98 patients, the overall prevalence of unrelated femoroacetabular impingement was 47%, and the pincer-type was the most frequent. The cam-type occurred more frequently among individuals with taller stature compared to their peers. Alpha and Wiberg angles predicted cam- and pincer-type, respectively, with over 0.95 area under the curve values in ROC analyses. The inter-rater agreement in the study was >91%. In a patient population from Yucatan, Mexico, attending ambulatory consultations unrelated to femoroacetabular impingement, an overall morphological changes prevalence of 47% was observed. Angle measurements using tomographic techniques can be used to predict cam- and pincer-type femoroacetabular impingement. Average stature was observed to be shorter in patients with cam-type femoroacetabular impingement, but body mass index did not vary between groups.

Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial.

Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable. This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up. Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, P = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, P = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, P = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline. Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.

QLTI-12. COST ANALYSIS OF EMERGENCY PROCEDURES FOR BRAIN TUMORS – WHEN YOU CAN WAIT

Abstract BACKGROUND Neurosurgery is expensive and requires advanced technology to achieve the best outcomes, especially for brain tumors. Generally patients are prepared during consultations for a brain tumor surgery, with anesthesiology, cardiology, neuropsychology and other specialties evaluations. Ideally, the hospitalization is planned before and patient is admitted only when is in good conditions. However some patients with brain tumors are evaluated in emergency department and sometimes require urgent procedures. OBJECTIVE This study aimed to estimate the direct cost of specialized care for adult neuro-oncological patients considering previous scheduled procedures versus urgent surgeries and another factors that may impact decision about nonelective procedures. METHODS This observational economic analysis describes the direct cost of care of neuro-oncological patients in Santa Casa de São Paulo, Brazil. Only adult patients with a common primary brain tumor were included. RESULTS The global mortality rate considering all patients were 12.7% and 92.3% of them occurred in nonelective procedures. Also these patients had a greater infection rate and period of hospitalization. Because of this we reviewed when a patient with brain tumor really need an urgent procedure. Despite several patients are initially diagnosed through ER investigation, probably the majority could be compensated through ambulatory consultations and after admitted with better conditions. Situations in which emergency surgery are required include acute hydrocephalus and non-compensated intracranial hypertension. CONCLUSIONS These patients usually have difficulty access to neurosurgical evaluation and so, only look for health assistance when the disease cause severe disability. Emergency surgeries were associated with an increased rate of infections and mortality. The findings of this study could be used by policymakers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. severe disability. KEY WORDS: costs; brain tumor; emergency; infections

Echocardiographic abnormalities in chronic hemodialysis patients

Introduction: Cardiovascular abnormalities are prevalent and often insidious in individuals with renal insufficiency, significantly contributing to mortality and morbidity among hemodialysis patients. Echocardiography plays a crucial role in detecting these abnormalities early, allowing for tailored interventions. This study aimed to assess the prevalence of echocardiographic findings in chronic hemodialysis patients. Methods: This descriptive study was conducted at the cardiology department of Ibn Rochd University Hospital from July 2022 to December 2023. Forty-two chronic hemodialysis patients were included, selected from ambulatory echocardiography consultations or cardiac hospitalizations. Transthoracic echocardiography examinations were performed. Results: Forty-two participants (25 women, 17 men) with an average age of 45.34 ± 13.4 years were enrolled. Left ventricular hypertrophy (LVH) was the most common abnormality, affecting 54.7% of the cohort. Valvulopathy was identified in 41% of cases, with 10% showing valve calcifications. Left ventricular dilatation was present in 29.8% of participants. Pulmonary arterial hypertension was detected in 9% of cases, and pericarditis in 3.2%. The mean systolic ejection fraction (EF) was 51.52 ± 6.02%, with 10.4% displaying systolic dysfunction of the left ventricle. Discussion: Our findings corroborate global research, underscoring LVH as the predominant anomaly. Echocardiography emerges as indispensable in identifying these abnormalities, guiding tailored interventions to mitigate cardiovascular risk in hemodialysis patients. Conclusion: Echocardiography proves invaluable in diagnosing cardiac anomalies non-invasively, offering precision and reproducibility. Given the high prevalence of cardiac-related mortality in hemodialysis patients, its integration into clinical management protocols is imperative for improved patient outcomes.

Clinician Insights into Effective Components, Delivery Characteristics and Implementation Strategies of Ambulatory Palliative Care for People with Heart Failure: A Qualitative Analysis

To elicit perspectives from specialist palliative care (SPC) and cardiology clinicians concerning the necessary components, delivery characteristics and implementation strategies of successful ambulatory SPC for people with heart failure (HF). Palliative care is a recommended component of guideline-directed care for people with HF. However, optimal strategies to implement SPC within ambulatory settings are unknown. We conducted a qualitative descriptive study composed of semistructured interviews with SPC and cardiology clinicians at Veterans Affairs Medical Centers (VAMCs) with the highest number of ambulatory SPC consultations within the VA system among people with HF between 2021 and 2022. Clinicians were asked how they provided ambulatory SPC and what they felt were the necessary components, delivery characteristics and implementation strategies of care delivery. Interviews were analyzed using directed content analysis. We interviewed 14 SPC clinicians and 9 cardiology clinicians at 7 national VAMCs; 43% were physicians, and 48% were advanced-practice registered nurses/physician associates. Essential components of ambulatory SPC encompassed discussion of goals of care (eg, prognosis, advance directives) and connecting patients/caregivers to resources (eg, home care). Preferred delivery characteristics included integrated (ie, embedded) approaches to SPC delivery, standardized patient selection and referral procedures, and formalized procedures for handoffs to and from SPC. Strategies that addressed SPC implementation included deploying palliative champions, educating non-SPC clinicians on the value of ambulatory SPC for people with HF and developing ambulatory models through leadership support. Facilitating the broader adoption of ambulatory SPC among people with HF may be achieved by prioritizing these mutually valued and necessary features of SPC delivery.

The digital era of pediatric urological clinical care: telemedicine for management of lower urinary tract symptoms and nocturnal enuresis - a comprehensive tertiary center insight.

Lower urinary tract symptoms (LUTS) and nocturnal enuresis (NE) are complex conditions requiring a long-term follow-up. Telemedicine is an emerging technological tool in the surgical field, and its availability exponentially grew during the COVID-19 pandemic, expanding its application fields, optimizing technical aspects, reducing costs, and ensuring high-quality standards. This work describes our experience with telemedicine in a Division of Pediatric Urology for the follow-up of enuresis and LUTS. A retrospective analysis of our telemedicine preliminary experience was conducted at Regina Margherita Children's Hospital in Turin, Italy. This study included all the patients aged <18 years who were monitored for enuresis and LUTS through telemedicine between September 1, 2021 and July 31, 2023. Clinical data and outcomes were analyzed, and patients and families were asked to voluntary fill an evaluation questionnaire on their satisfaction. Additionally, we focused on the post COVID-19 period, between September 2022 and July 2023, analyzing the data of two different patients' populations: the first one (G1) of patients choosing telemedicine outpatients visits (TOVs) and the second one (G2) of those choosing a face-to-face visit. One hundred five patients were enrolled. One hundred sixty-two TOVs were performed. The median age at first visit was 9.7±0.66 years (range 7-16 years). Diagnosis were: 77/105 (67%) NE and 28/105 (33%) LUTS. The average referred distance between the patients' residence and the hospital was 46.35±129.37 km (range 2-1300 kilometers) and the time taken to overcome it was 44.21±77.29 minutes (range 10-780 minutes). In 64/105 cases (61%) the follow-up was interrupted for total healing or symptoms resumption. Only two cases (2%) required the conversion to an in-person ambulatory consult, due to a social-linguistic barrier. 146/162 families (90%) filled the survey questionnaire at the end of each TOV, reporting in 94% of cases a high satisfaction level. In the comparative statistical analysis of the two patient groups, G1 (52 telemedicine office visits, [TOVs]) vs. G2 (25 face-to-face visits), the average referred distance was 17.78±7.98 km (range: 5-35 km) for G1, contrasting with 7.04±3.35 km (range: 2.5-14 km) for G2 (P=0.00001). Additionally, the waiting time before the visit was 3.96±2.90 minutes (range: 0-10 minutes) for G1, in contrast to 26.52±11.22 minutes (range: 5-44 minutes) for G2 (P=0.00001). Furthermore, a higher compliance with behavioral or pharmacological indications was observed in the G1 group, exhibiting lower adherence in only 12 out of 52 cases compared to 14 out of 25 cases in G2 (P=0.0091). Telemedicine is a proper solution and an effective tool to manage the therapeutic follow-up of NE and LUTS, ensuring suitable quality standards and reducing social costs, such as the loss of working days and transport costs. The implementation and complete integration of its use into the healthcare system should be the goals to pursue in order to take full advantage of all its potentials.

The position of the Queen Elisabeth Rehabilitation hospital (KEI) in the chain of Integrated Care

Introduction: Governments put health-system strengthening as priority. They particularly strive for person-centred health-systems. Integrated Care is seen as the way forward to achieve this. To improve patient experience and health outcomes, healthcare should be organised ‘horizontally’ around the patient and should be ‘vertically’ integrating services in various levels and settings. The Queen Elisabeth Rehabilitation hospital (KEI), encompassing 165 beds, wants to play a role in better healthcare for patients with specific and complex rehabilitation needs (cardiopulmonary, locomotor and neurological) and strives to centre its services on the needs of the patients, their families and the broader community.&#x0D; Methods and aim: In order to formulate a well-articulated strategic plan, KEI critically scrutinised its current work by studying available data. Since KEI developed a high level quality control management-plan, data from 2021 could be extracted from the patients records and analysed.&#x0D; Results: KEI, driven by a holistic vision on rehabilitation (medical, functional, social and psychological) intensively puts efforts in interdisciplinary team-integration (specialist-physicians, dietitians, occupational, speech- and language-, physiotherapists, psychologists, nurses, assistant nurses) supported by electronical patient-records and grounded in patient-participation. Also preventive (mostly ambulatory) coaching is offered (e.g. smoking cessation, tackling malnutrition and obesity). Patients admitted to KEI in 2021 (n= 1215) were transferred from hospitals (9% university-hospitals/83% non-university), from home (7%) and from nursing-homes (1%). They are discharged towards home (74%), nursing-homes (11%) or back to a hospital (11%). After discharge, extensive ambulatory follow-up was conducted with 2178 ambulatory consultations. This means that KEI extensively collaborated and exchanged information with stakeholders in the region: regional hospitals, primary care, nursing-homes. To fulfil its supra-regional task, KEI collaborates also with university-hospitals throughout Flanders. Several official agreements and care pathways are in place to organise al this collaboration. &#x0D; Discussion and conclusion: Aiming to improve patients/informal caregivers’ experiences, KEI developed pre- and post-trajectories, which is only possible through well-integrated care and good cooperation with other facilities, e.g. acute hospitals, care for the older persons (nursing-homes, assisted-living facilities) and primary care. KEI has expanded this diversity within the own facilities, but also with other partners. In this way, KEI is today playing a local as well as a supra-regional role, but strives to upgrade his part as legitimate, recognized, complementary and responsible partner in transversal collaboration towards integrated between micro-, meso-and macro-level. Although Integrated Care is an explicit task the Flemish government directed towards rehabilitation-hospitals, it is hard to really integrate care around the needs of patients and informal caregivers, mainly because of insufficient ‘vertical integration’ since services are not organized under one management umbrella. The locoregional acute hospital networks in development might be a step forward since they allow the formation of alliances and arrangements on a local level, though rehabilitation-hospitals are not part of it. Several challenges still lie ahead such as the search for a common reason of being, i.e. understanding the needs from a population health goals; common mission and strategy; joint funding and planning with shared outcomes. Also strong leadership with trust in each other and clear governance arrangements are needed.

Care trajectories of individuals with anxiety disorders: A retrospective cohort study

BackgroundAnxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs. MethodsThis is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis. ResultsThe cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care. LimitationsAdministrative and survey data may have coding errors, missing data and self-report biases. ConclusionFive types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness.

Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review

BackgroundThe objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.MethodsWe included experimental studies manipulating the length of...

Mapping the risk of respiratory infections using suburban district areas in a large city in Colombia

BackgroundAcute respiratory infections (ARI) in Cúcuta -Colombia, have a comparatively high burden of disease associated with high public health costs. However, little is known about the epidemiology of these diseases in the city and its distribution within suburban areas. This study addresses this gap by estimating and mapping the risk of ARI in Cúcuta and identifying the most relevant risk factors.MethodsA spatial epidemiological analysis was designed to investigate the association of sociodemographic and environmental risk factors with the rate of ambulatory consultations of ARI in urban sections of Cúcuta, 2018. The ARI rate was calculated using a method for spatial estimation of disease rates. A Bayesian spatial model was implemented using the Integrated Nested Laplace Approximation approach and the Besag-York-Mollié specification. The risk of ARI per urban section and the hotspots of higher risk were also estimated and mapped.ResultsA higher risk of IRA was found in central, south, north and west areas of Cúcuta after adjusting for sociodemographic and environmental factors, and taking into consideration the spatial distribution of the city’s urban sections. An increase of one unit in the percentage of population younger than 15 years; the Index of Multidimensional Poverty and the rate of ARI in the migrant population was associated with a 1.08 (1.06—1.1); 1.04 (1.01—1.08) and 1.25 (1.22—1.27) increase of the ARI rate, respectively. Twenty-four urban sections were identified as hotspots of risk in central, south, north and west areas in Cucuta.ConclusionSociodemographic factors and their spatial patterns are determinants of acute respiratory infections in Cúcuta. Bayesian spatial hierarchical models can be used to estimate and map the risk of these infections in suburban areas of large cities in Colombia. The methods of this study can be used globally to identify suburban areas and or specific communities at risk to support the implementation of prevention strategies and decision-making in the public and private health sectors.

#2610 NURSE-LED OPTIMIZATION OF VOLUME AND BLOOD PRESSURE IN KIDNEY DISEASE – ENABLING AT MULTI-LEVELS USING A TECHNOLOGY (NOVELTY) PROGRAM

Abstract Background and Aims Fluid overload and hypertension are common in chronic kidney disease (CKD). They increase healthcare utilization due to frequent ambulatory consults and/or hospitalizations but can be avoided with self-management. We evaluated the feasibility of a nurse-led, team-based program that incorporated (1) objective fluid volume assessment using body impedance analysis (BIA) to enable diuretic and antihypertensive titration, and (2) structured patient education and action plan coaching for ambulatory patients with CKD and fluid overload and/or uncontrolled blood pressure. Method Prospective pilot study of adults who participated in the 4-week program (Figure 1) between August and October 2022. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) &amp;gt;160 mmHg or diastolic BP &amp;gt;100 mmHg at the ambulatory renal clinic. We evaluated fluid overload symptoms and signs, standardized clinic BP, BIA over-hydration volume and patient reported outcomes on (1) chronic disease self-management using the Partner in Health (PIH) questionnaire (2) perceived autonomy support from the healthcare team using the modified Health Care Climate Questionnaire (HCCQ), and (3) health-related quality of life (HrQOL) using the EuroQOL-5 Dimension (EQ5D5L) questionnaire, before and after the program. Results Fifteen patients were referred by their nephrologists, but 1 was uncontactable and 1 did not want to adhere to the recommended treatment. Among 13 patients in the pilot, 64.3% was male, median age was 68 (range 40 – 85) years and 35.7% had ≥4 visits to healthcare institutions in the past six months. Causes of kidney disease were diabetes (64.3%), hypertension (21.4%) and glomerulonephritis (14.3%), with a median eGFR of 30 (14 – 106) ml/min/1.73 m2. At enrolment, fluid overload was present in 57.1% and BIA over-hydration value was 1.7L (0 – 6.4L). Eleven patients (84.6%) completed the 4-week follow-up; 1 stopped after the first consult due to lack of time, while 1 stopped after 2 weeks (already confident of self-management). At 4 weeks, systolic BP [141 (109-179) mmHg versus 162 (120-198) mmHg at enrolment, p = 0.046] and PIH score [84 (72-96) versus 57 (10-94), p = 0.04] had improved significantly compared to enrolment, while HrQOL was not different (Table 1). Patients generally perceived a high level of autonomy support from the healthcare team. Serum creatinine did not change significantly after antihypertensive and diuretic titration. Conclusion A nurse-led program incorporating objective fluid volume assessment, structured patient education and action plan coaching was well-received, with improved BP and self-management in patients with kidney disease.

ADDICTION AND THE EVOLUTION AND COMPLIANCE OF SCHIZOPHRENIC PATIENTS

Introduction Schizophrenia is a chronic illness, affecting approximately 1% of the general population. The more chronic a treatment is, the poorer the quality of adherence. In fact, approximately 60% of patients with schizophrenia are incompletely or non-adherent within one year of the first episode. Poor adherence has consequences in terms of clinical status, quality of life and psychosocial functioning due to associated relapses. One of the main factors of poor compliance is the use of addictive substances. Half of schizophrenic patients have, or have had, an addictive comorbidity during their life. Moreover, schizophrenic patients with addictive comorbidity have a more severe symptomatology and have more associated physical, psychological and social problems, representing a challenge in the managementObjectives The objective of our work is to evaluate the impact of addictive comorbidity on medication adherence and relapse.Methods This is a cross-sectional study, carried out in patients with schizophrenia hospitalized or followed in ambulatory consultation, at the psychiatric hospital Ar-razi of Salé. The data collection (sociodemographic, clinical and therapeutic) is carried out by a questionnaire established for this purpose. The use of substances is evaluated according to the DSM-V criteriaResultsA total of 110 schizophrenic patients were followed or hospitalized, of which 61.8% had a substance use disorder. The average age of onset of substance use was 18 years. The duration of substance use ranged from 1 to 11 years and up to 49 years for tobacco and cannabis. 72% of the addicts tried to stop their use alone or in outpatient settings, only 17% in inpatient settings. The average duration of abstinence was 11 months and ranged from 1 to 18 years. 81% reported remission of the disease after abstinence. The hospitalization rate was 88.2% for addicts versus 85% for non-addicts. The number of hospitalizations was 180 for addicts versus 78 for non-addicts. The cumulative duration of hospitalization is 208 months against 96 months for addicts. The duration of remission is 5 months for addicts and 24 months for non-addicts. 71% of non-addicts patients have well observed their treatment against 57% of addictsConclusionsThe weight of co-morbid addictions represents between 1/5 and 1/3 of the factors at stake in the compliance and the risk of relapse of patients suffering from schizophrenia. The development of specific care strategies for a global management of addiction and schizophrenia should be a priority.Disclosure of InterestNone Declared

Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics

BackgroundHeart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team.ObjectiveTo determine the outcome benefit of HVC approach compared with standard of care...

Pragmatic observations from a post-COVID-19 cardiac evaluation register: prevalence of cardiological alterations from a basic diagnostic sequence and contribution of the clinical hystory

Abstract Introduction The prevalence of cardiological sequelae in patients recovered from COVID-19 varies in different reports. This may be due to the population diversity studied or to the complementary methods on which the diagnosis was based. Objective 1) To determine the prevalence of “de novo” cardiological alterations (DN) in the population recovered from COVID-19 using a basic cardiological evaluation sequence. 2) To evaluate the contribution of the clinical history (CH) in the detection of DN. Methods Patients (pts) with COVID-19, PCR (+) were included. The pts attended an ambulatory consultation office at least 30 days after discharge from COVID-19. The evaluation was performed in a stepwise manner: first Interview: CH, physical examination (PE), and EKG; second Interview: routine laboratory test, C-reactive protein, echocardiogram and cardiac biomarkers. Other complementary studies (Holter, RMI, CCG) were requested according to previous findings. The diagnosis of DN (by PE, EKG or echocardiogram, alone or with the addition of other methods) was defined as the appearance of cardiological alterations in patients with no pre-existing known heart disease or the progression of a known cardiac disease. The prevalence of DN is described. Sensitivity, specificity and predictive value of CH for DN are reported. Results A total of 246 pts were evaluated with the first interview (age: 52±13 years; women: 47.8%; caucasian: 60.6%; overweight: 79%; some pathological history: 71.5%; previous heart disease: 15.4%; hospitalization during the acute phase of COVID: 78.8%; mild Covid: 37%, moderate: 39%, severe: 24%; time between discharge and post-COVID evaluation: 68±42 days). DN were detected in 62 pts: rhythm disturbances: 41 (sinus tachycardia: 23 (18 isolated), sinus bradycardia: 3, supraventricular arrhythmia: 6, ventricular arrhythmia: 14); conduction disturbance: 10, ventricular dysfunction: 20 (12 de novo, 8 progression). Specific diagnoses: myocarditis: 6, coronary artery disease: 5, acute mitral insufficiency: 1. In 16 pts (6.5%) DN had clinical relevance. Six of them (2.4%) required hospitalization. In previously healthy pts with mild COVID, only rhythm disorders were detected in 3 pts. Se, Sp and PV of the CH is shown in Table 1. Eighteen Holter monitoring tests (5 +), 9 MRIs (5 +), 4 CCGs (2 +) were performed. Conclusions 1) Using a basic cardiac diagnostic sequence, at least 30 days after discharge, a quarter of post-COVID patients had “de novo” cardiological findings. However, a small percentage became clinically relevant. The causal relationship of DN with COVID-19 cannot be unequivocally asserted. Previously healthy patients have low prevalence of cardiac findings detected with a basic diagnostic sequence. 2) The data obtained from the clinical history have a low positive predictive value. Funding Acknowledgement Type of funding sources: None.

Integrating Ambulatory Addiction Consultation Service Into a Community Mental Health Center.

Despite the escalation in substance related overdose mortality-culminating in more than 100,000 deaths in each of the first 2 years of the COVID-19 pandemic-healthcare systems have not kept up with the demands for care among people who use drugs. There remains a significant gap in access to evidence-based treatment. The addiction consult services has served to address this gap, as a critical intervention that engages mostly hospitalized patients and initiate addiction treatment in acute settings, but little is known about addiction consult services in ambulatory settings. This model of care could potentially serve to scale up the care for people who use drugs in the community by embedding the limited number of addiction professionals within existing ambulatory systems, thus extending their reach. We describe here an innovative, yet simple and potentially replicable model for an ambulatory addiction consultation service in a large, advanced community mental health center.

Trouble de la personnalité borderline: état des connaissances et des représentations auprès de praticiens francophones en santé mentale

ObjectivesPatients suffering from borderline personality disorder are very prevalent in various settings (emergency rooms, psychiatric and general hospitals, ambulatory consultations). However, it remains one of the most stigmatized and neglected mental health conditions, albeit being an area that is responsible for very interesting advances in psychotherapy. Today, the prognosis of patients with borderline personality disorder is rather favorable, provided that they follow a dedicated psychotherapy. Conceptions about this condition therefore deserve to be updated as it is sufficiently described in the literature that negative attitudes towards these patients diminish the quality of care they receive as well as their prognosis, and that these attitudes change with training. We decided to study the state of knowledge and attitudes towards borderline personality disorder in a group of French-speaking caregivers interested in these patients. MethodsBetween 2019 and 2020, at the start of training sessions in psychotherapeutic approaches to borderline personality disorder, we provided two questionnaires to 126 caregivers from various professional backgrounds (psychiatrists or child psychiatrists, psychologists, mental health nurses, social workers). The first consisted of 13 questions with 3 choice answers aimed at testing knowledge about borderline personality disorder and the second of 11 questions in the form of a Likert scale aimed at evaluating attitudes towards these patients (e.g. degree of comfort, involvement, hope, avoidance with these patients) adapted frome a questionnaire of Blake and colleagues. ResultsThe sample consisted of 126 caregivers (69 psychiatrists/pedopsychiatrists; 19 mental health nurses; 23 psychologists; 14 social workers). Fifty three of them (42.06 %) worked in an outpatient setting (either in a state facility or in private practice), 50 (39.68 %) worked in an inpatient psychiatric unit, 13 (10.32%) in both care systems, and 10 (7.94 %) worked in other facilities such as sheltered homes or workshops for persons with psychiatric disabilities. The average number of years in postgraduate training was 7.73 (SD=5.67; rank=0 to 31), and 35 (27.78%) had received at least one training course on borderline disorder in the past. The mean age of the sample was 37.89 (SD=10.08; rank=20 to 64) and there were 76 women (60.32%) and 50 men (39.68%). Concerning the first questionnaire (knowledge), the rate of correct responses among caregivers was relatively low (54%) considering that the vast majority of those assessed were caregivers already trained in mental health who were working with patients suffering from borderline personality disorder. The results showed a significant knowledge gap among professionals, in particular in the nursing profession, illustrating an ever more flagrant shortfall in formations in this sub-population. Concerning the second questionnaire (attitudes), the answers showed that attitudes of caregivers towards patients with borderline personality disorder were still tinged with fear and lack of confidence in taking charge of them. Thus, one participant out of five would have liked to avoid these patients, more than 12% of caregivers did not appreciate them, and 23% thought that they were manipulative. In addition, nearly half of the caregivers surveyed had low confidence in their ability to make a positive difference in the lives of borderline patients. However, there was a recognition of their distress as well as a demand for dedicated training. ConclusionsStigmas and ignorance persist around patients with borderline personality disorder. Current training courses do not allow caregivers who are on the front lines (in particular nurses) and who wish to be trained to acquire sufficient knowledge and tools necessary for the care of patients suffering from this disorder. This calls for an improvement in training as well as a reflection on the most appropriate approaches possible to the various target audiences.

Experience of a pediatric electrophysiology clinic during the COVID-19 pandemic.

Experience of a pediatric electrophysiology clinic during the COVID-19 pandemic.

Role of Empathy and Lifelong Learning Abilities in Physicians and Nurses Who Work in Direct Contact with Patients in Adverse Working Conditions.

Empathy and lifelong learning are two professional competencies that depend on the four principles of professionalism: humanism, altruism, excellence, and accountability. In occupational health, there is evidence that empathy prevents work distress. However, in the case of lifelong learning, the evidence is still scarce. In addition, recent studies suggest that the development of lifelong learning varies in physicians and nurses and that it is sensitive to the influence of cultural stereotypes associated with professional roles. This study was performed with the purpose of determining the specific role that empathy and lifelong learning play in the reduction in occupational stress. This study included a sample composed by 40 physicians and 40 nurses with high dedication to clinical work in ambulatory consultations from a public healthcare institution in Paraguay. Somatization, exhaustion, and work alienation, described as indicators of occupational stress, were used as dependent variables, whereas empathy, lifelong learning, gender, discipline, professional experience, civil status, and family burden were used as potential predictors. Three multiple regression models explained 32% of the variability of somatization based on a linear relationship with empathy, lifelong learning, and civil status; 73% of the variability of exhaustion based on a linear relationship with empathy, somatization, work alienation, and discipline; and 62% of the variability of work alienation based on a linear relationship with lifelong learning, exhaustion, and discipline. These findings indicate that empathy and lifelong learning play important roles in the prevention of work distress in physicians and nurses. However, this role varies by discipline.