Ambulatory Patients Research Articles

Initiation of oral hepatitis C virus treatment: Which barriers are pertinent for ambulatory individuals with a history of illicit substance use? A qualitative interview study.

The World Health Organization has set a goal to eradicate hepatitis C virus (HCV) by the year 2030. Nonadherence to HCV treatment has substantial economic implications due to high treatment costs, among others. Barriers to start HCV treatment may be critical. The aim of this study was to assess pertinent barriers to HCV treatment in ambulatory patients with a history of illicit substance use and to compare them to the literature. Barriers to HCV treatment mentioned by the key risk group (i.e., people who inject drugs) were retrieved from literature through a pragmatic literature search. From 34 published articles, we identified 80 modifiable barriers that were bundled in 23 items within the four topics "Personal difficulties and barriers to treatment," "Personal motivation to be treated," "Knowledge about the disease," and "Received information about the medicine." In-depth semistructured interviews were performed face-to-face with ambulatory patients from the University Psychiatric Clinics in Basel, Switzerland. Transcripts were coded inductively. Interviews were performed with seven individuals (mean age: 48.3 years; range: 38-63 years; one woman) treated with oral direct-acting antivirals between 2014 and 2022. Thirteen barriers to start HCV treatment were mentioned that corresponded to the five categories: information, attitudes, swallowing difficulties, social environment, and unfavorable lifestyle. The barrier "swallowing difficulties" emerged exclusively from the statements provided by the interviewees. Barriers to the initiation of HCV treatment indicated by our interviewees clearly differed from the literature. Notably, the challenge of swallowing medicines may be particularly relevant for physicians prescribing and pharmacists dispensing HCV medication.

Development of a Patient-Reported Experience Measure Tool for Ambulatory Patients With Acute Unexpected Needs: The APEX Questionnaire.

Background: The aim of this study was to develop a patient-reported experience measure (PREM) for comparing the experience of care received by ambulatory patients with acute unexpected needs presenting in emergency departments (EDs), walk-in clinics, and primary care practices. Methods: The Ambulatory Patient EXperience (APEX) questionnaire was developed using a 5-phase mixed-methods approach. The questionnaire was pretested by asking potential users to rate its clarity, usefulness, redundancy, content and face validities, and discrimination on a 9-point scale (1 = strongly disagree to 9 = strongly agree). The pre-final version was then tested in a pilot study. Results: The final questionnaire is composed of 61 questions divided into 7 sections. In the pretest (n = 25), median responses were 8 and above for all dimensions assessed. In the pilot study, 63 participants were enrolled. Adjusted results show that access, cleanliness, and feeling treated with respect and dignity by nurses and physicians were significantly better in the clinics than in the ED. Conclusion: We developed a questionnaire to assess and compare experience of ambulatory care in different clinical settings.

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice.

Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are -16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non-invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension.

Factors associated with independent ambulation at 3 months after putaminal hemorrhage: an observational study.

[Purpose] This study was aimed at evaluating the clinical indicators for predicting ambulation at 3 months after putaminal hemorrhage. [Participants and Methods] The participants were 84 inpatients with putaminal hemorrhage. The patients' background characteristics and computed tomography findings at the time of the onset of putaminal hemorrhage were obtained from their medical records. Impaired consciousness, severity of hemiplegia, higher brain dysfunction, sensory impairment, activities of daily living, and ambulatory ability were evaluated. Logistic regression analysis was performed to identify factors associated with ambulation at 3 months, and receiver operating characteristic curve analysis was conducted to determine the predictive value of the identified factors and the optimal cut-off values. [Results] Ventricular rupture, severity of hemiplegia (determined using the 12-grade hemiplegia function test), and Functional Independence Measure cognitive score were found to be independent predictors of prognosis. Severity of hemiplegia was the strongest predictor of ambulation, with a sensitivity of 80.4% and specificity of 100% when the cut-off was set at grade 6 (the ability for coordinated movement of the extensor and flexor muscles of the hip joint). [Conclusion] The severity of hemiplegia, Functional Independence Measure cognitive score, and ventricular rupture were independently associated with ambulation in patients with putaminal hemorrhage. The ability of the hip joint movement is one of the most important factors in ambulation prognosis.

A Novel Approach for Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Left Ventricular Decompression Therapy With Impella (ECPella)

Percutaneously placed veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly used to support patients with refractory cardiac arrhythmias or arrest and worsening cardiogenic shock (CS). Peripheral VA-ECMO by retrograde flow of blood in the aorta results in a significant increase in left ventricle (LV) afterload. A severely dysfunctional LV may be unable to overcome this afterload to open the aortic valve and unload itself. This may lead to LV distension, increased left ventricular pressure, poor coronary blood circulation, increased left atrial pressures, pulmonary edema, and pulmonary hypertension. Moreover, it jeopardizes ventricular recovery, particularly in the presence of ischemia-induced myocardial impairment. Furthermore, if the aortic valve remains closed during the cardiac cycle, stasis of blood in the LV and aortic root may increase the risk of thrombus formation. These complications may preclude cardiac recovery and the patient from being a heart transplant candidate. In patients with CS, utilizing Impella with VA-ECMO, commonly referred to as ECPella, has consistently been shown to reduce mortality and improve outcomes. Patients who need prolonged ECPella support as a bridge to recovery or transplant may remain bed-bound since ambulation of patients with two mechanical circulatory support devices is challenging. We present the technique of ECPella placement through Y chimney graft anastomosis on the axillary artery for arterial cannula and Impella insertion and percutaneous cannulation of the right internal Jugular vein for venous cannula. This technique gives the ease of ambulation and decannulation of VA-ECMO under local anesthesia without requiring intubation or a trip to the operating room.

The association between objectively measured preoperative light-intensity physical activity and postoperative ambulation in patients with gastrointestinal cancer.

[Purpose] To clarify the association between preoperative physical activity and postoperative ambulation based on physical activity intensity, and independent of functional capacity and depression, in patients with gastrointestinal cancer. [Participants and Methods] Seventy patients who underwent surgery for primary colorectal or gastric cancer were enrolled. Preoperative moderate-to-vigorous-intensity physical activity, light-intensity physical activity, and sedentary behavior were assessed using an accelerometer. The primary outcome was the days to postoperative first ambulation (capable of independently and continuously walking 150 m). Functional capacity and depression, as confounders, were evaluated by measuring the 6-minute walk distance and using the Hospital Anxiety and Depression Scale. [Results] Of the 70 patients, 28 had insufficient accelerometer data, and 42 were included in the analysis. Preoperative light-intensity physical activity, but not moderate-to-vigorous-intensity physical activity and sedentary behavior, was negatively associated with the days to postoperative first ambulation, after adjusting for age, preoperative functional capacity, and preoperative depression. [Conclusion] Preoperative light-intensity physical activity was associated with the days to postoperative ambulation independently of age, functional capacity, and depression. Hence, predicting delayed ambulation by preoperative light-intensity physical activity in patients with gastrointestinal cancer may be useful.

Systematic Brain Natriuretic Peptide Measurement for Cardiac Screening in Patients with Severe Obesity: The OLECOEUR Study

Introduction: Heart failure (HF) is difficult to diagnose in obese patients because of cardiovascular and pulmonary comorbidities associated with physical deconditioning, all of which lead to dyspnea. Methods: The OLECOEUR study is a prospective screening for HF using systematic brain natriuretic peptide (BNP) measurement in ambulatory patients with obesity from a department of Nutrition (Paris, France). Clinical, biological, and echocardiographic data were extracted from electronic medical records. Results: We included 1,506 patients middle-aged (mean age: 47.2 ± 14.6 years old) with severe obesity (mean body mass index: 40.4 ± 6.6 kg/m2). Patients with BNP ≥35 pg/mL had left heart remodeling including thicker interventricular septum (10.4 ± 2.0 vs. 9.6 ± 1.8 mm; p = 0.0008), higher left ventricular mass (89.9 ± 24.3 vs. 77.2 ± 20.0 g/m2; p = 0.0009), and significant changes in both left and right atria consistent with a higher proportion of prior atrial fibrillation. Markers of right heart remodeling on echocardiography were also significantly higher (pulmonary artery systolic pressure: 33.3 ± 17.3 vs. 24.5 ± 6.3 mm Hg; p = 0.0002). Conclusion: The OLECOEUR study shows left and right subclinical cardiac remodeling in obese patients screened for HF with systematic dosing of BNP with usual cut-off of 35 pg/mL.

Effect of Tibetan herbal formulas on symptom duration among ambulatory patients with native SARS-CoV-2 infection: A retrospective cohort study

BackgroundDespite abundant data regarding factors that influence COVID-19 symptom severity and need for hospitalization, few studies examine time to resolution of symptoms and potential complementary and alternative therapies that may expedite outpatient recovery. Uncertainty in expected symptom duration and potential missed opportunities to decrease this time persist. Likewise, studies tracking outpatient COVID-19 experiences among marginalized communities are lacking. ObjectiveTo describe the impact of complex Tibetan herbal formula regimens on symptom duration among ambulatory patients with native SARS-CoV-2 infection. MethodsThis multi-center, cohort study assessed deidentified data from patients with laboratory-confirmed SARS-CoV-2 infection. The study assessed cases from March 12, 2020 to May 5, 2021 for which vaccinations were not available, and thus reflect native infections. InterventionDiagnoses were made via telemedicine by a traditional Tibetan medical physician, and herbal formulas were prescribed based on specific symptom presentation of COVID-19 using the personalized medicine approach integral to traditional Tibetan medicine. ResultsOf 145 patient cases assessed for eligibility, 86 (59.3%) met inclusion criteria, and 67 (46.2%) had documented symptom resolution. Resolution of symptoms occurred within a median [interquartile range (IQR)] of 11.7 (10.1–13.5) days. The most common symptoms reported were cough and fever. Time to recovery did not significantly differ based on symptom presentation at baseline, except for a couple symptom groupings such as headache and joint pain where recovery time was shorter when those symptoms were present. Conclusions and relevanceAmbulatory patients diagnosed with SARS-CoV-2 infection receiving Tibetan herbal formulas had recovery from symptoms at a median of 11.7 days, fewer than other published reports in patients following standard of care. The Tibetan approach of targeting treatment based on symptom groups, especially those within classical Tibetan medical nosology, appears to result in quick symptom resolution.

Effect on Physical Position of Peak Inspiratory Flow in Stable COPD: An Observational Study.

We examined the effect of physical position on peak inspiratory flow (PIF) in patients with chronic obstructive pulmonary disease (COPD) using dry-powder inhalers (DPIs) with low‑medium internal resistance (R2) and/or high internal resistance (R5). This prospective study in stable, ambulatory patients with spirometry-confirmed COPD evaluated the effect of 3 physical positions on maximal PIF achieved. Participants had PIFs of 30-90L/min (R5) or 60-90L/min (R2 DPIs) using the In-Check™ DIAL. PIF was measured in triplicate randomly in 3 positions that patients might be in while using their inhaler (standing, sitting, and semi-upright [supine position with the head of the bed at 45°, neck flexed forward]) against prescribed DPI resistance (R2/R5/both). Correlations between PIF and percentage decline in PIF between positions and differences in participant characteristics with >10% versus ≤10% PIF decline standing to semi-upright were calculated. A total of 76 participants (mean age, 65.2 years) had positional measurements; 59% reported seated DPI use at home. The mean (standard deviation) PIF standing, sitting, and semi-upright was 80.7 (13.4), 77.8 (14.3), and 74.0 (14.5) L/min, respectively, for R2 and 51.1 (9.52), 48.6 (9.84), and 45.8 (7.69) L/min, respectively, for R5 DPIs. PIF semi-upright was significantly lower than sitting and standing (R2; P < 0.0001) and standing (R5; P= 0.002). Approximately half of the participants had >10% decline in PIF from standing to semi-upright. Patient characteristics exceeding the 0.10 absolute standardized difference threshold with the decline in PIF for both the R2 and R5 DPIs were waist-to-hip ratio, modified Medical Research Council dyspnea score, and postbronchodilator percentage predicted forced vital capacity and PIF by spirometry. PIF was significantly affected by physical position regardless of DPI resistance. PIF was highest when standing and lowest when semi-upright. We recommend that patients with COPD stand while using an R2 or R5 DPI. Where unfeasible, the position should be sitting rather than semi-upright. ClinicalTrials.gov identifier NCT04168775.

Revision Transtibial Medial Meniscal Root Repair With Concomitant Medial Opening-Wedge Proximal Tibial Osteotomy

Background: Complete meniscal root tears disrupt dispersion of axial loading forces through hoop stresses. This increases point-loading on tibiofemoral cartilage and leads to chondromalacia and accelerated osteoarthritis (OA). Posterior root tears may be treated successfully with a transtibial pullout repair. Varus malalignment also leads to increased medial compartment pressures, increasing the risk of early OA and putting increased stress on the meniscus and stabilizing knee ligaments. In particular, revision medial meniscal root repairs without correction of varus malalignment are at increased risk of failure. Genu varum may be corrected with a medial opening-wedge proximal tibial osteotomy (OW PTO). Indications: Meniscal root repairs are indicated for acute or chronic tears in active patients with healthy cartilage. OW PTO is indicated for varus malalignment in ambulatory patients with healthy cartilage, or who are at risk for failure of meniscal or ligamentous procedures. Technique Description: After exposure of the osteotomy site, arthroscopy is performed through the incision and the revision posterior meniscus root repair is performed via a double-tunnel transtibial pullout technique. The positioning of these tunnels is modified superiorly so as to not cross the planned osteotomy site. The osteotomy is then performed by drilling 2 guide pins under fluoroscopy to delineate the plane of the cut. An OW plate is placed, and the root repair is tensioned last. Results: Double-tunnel transtibial pullout repairs increase meniscal fixation contact surface and have been shown to be biomechanically superior to all-inside fixation techniques. Medial OW PTO restores knee alignment and reduces supra-anatomic stresses in the medial compartment, additionally decreasing the risk of a revision medial meniscus repair failure. Discussion: Biomechanical studies have shown that meniscal root tears are functionally equivalent to complete meniscectomy. Varus malalignment increases the risk of medial meniscal tears, and reduces the risk of a successful long-term repair. We describe a technique for a revision transosseous posterior root repair with concomitant proximal tibial osteotomy, with discussion of surgical pearls and pitfalls. This technique restores anatomic position and native function of the medial meniscus while correcting tibiofemoral malalignment that could jeopardize the repair. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Ambulatory Patient Satisfaction Indicators at Tugurejo Regional General Hospital in Semarang City

Tugurejo Hospital is a Type B hospital operated by the regional government of Central Java Province. Each year, the hospital conducts patient satisfaction surveys. Between 83% and 94% of patients report being satisfied with the services provided by the hospital; however, there is a large variation in patient satisfaction between types /departments. Ambulatory (outpatient) services continue to see an increasing number of patients per day. While most existing research focuses on the factors influencing patient satisfaction, there is a pressing need for research on patient satisfaction indicators. Such research is crucial as it provides hospitals with practical tools and references to assess and improve patient satisfaction. This study aims to identify indicators of ambulatory patient satisfaction in Tugurejo Hospital. This observational study employs a quantitative approach. Data were collected cross-sectionally using a questionnaire and analysed descriptively and through principal component analysis. the sample consisted of 150 ambulatory patients. The highest levels of satisfaction were for customer service officers (98.7%) and waiting room comfort (98.7%), while the lowest satisfaction was for service announcements (58.7%). All measured variables were found to be related to ambulatory patient satisfaction. There were 65 satisfaction items with an extraction value above 0.800. Four components were identified: service products, the behaviour of hospital staff, communication, and hospital facilities. A total of 26 satisfaction indicators were identified. The hospital should review these indicators and findings to continue improving patient satisfaction.

From Paralysis to Progress: The role of Robotic Gait Training in Restoring Ambulation in Spinal Cord Injury Patients: A Review

From Paralysis to Progress: The role of Robotic Gait Training in Restoring Ambulation in Spinal Cord Injury Patients: A Review

Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics

BackgroundDiaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients. MethodsA retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs. ResultsCompared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively. ConclusionsCentral-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

Characteristics of femoral neck fractures in osteogenesis imperfecta: Series of four-teen consecutive hips in twelve patients

IntroductionWhile long bone fractures are commonly seen in individuals with Osteogenesis Imperfecta (OI), femoral neck fractures (FNF) are exceedingly rare. There is a lack of comprehensive data regarding the etiology of FNFs, their characteristics, and the treatment protocols. Our aim was to determine the characteristics of femoral neck fractures in children with OI. Materials and methodsThis study was conducted as retrospective series covering period of January 2011-December 2022. Total of 14 femoral neck fractures in 12 patients were included into final analysis. Age, gender, fracture location, ambulation level, injury mechanism, Sillence type, pre-fracture collo-diaphyseal angle, presence of previous implants and applied treatments were noted. ResultsThe mean age was 9.3 (range: 3–16), 8 out of 12 patients were males. Sillence type 3 OI was most common (50 %) type. Among 12 patients, 2 (16.6 %) were restricted ambulatory while 5 (41.6 %) were non-ambulatory. Seven patients had prior femoral implants. Six fractures were managed non-operatively, while others underwent surgery, with cannulated screws (42.8 %) or plate osteosynthesis (7.1 %). All eight cases (100 %) with minor trauma or unknown origin were Sillence type 3–4, displaying varus deformity. FNFs that occured in mobile patients required higher-energy traumas. ConclusionFemoral neck fractures in OI showed differing trauma mechanisms in ambulatory vs. non-ambulatory patients. Non-surgical treatment may be considered with in patients with high-risk anesthesia concerns, requiring higher level clinical studies.

Assessment of the Correlation Between Serum Phosphate Level and Muscle Strength as Measured by Handgrip Strength in Patients Treated With Hemodialysis.

Sarcopenia, commonly observed in patients treated with hemodialysis, correlates with low serum phosphate levels. Although normophosphatemia is desired, dietary phosphate restriction is difficult to achieve and may result in undesirable protein restriction. We aimed to evaluate whether hyperphosphatemia is associated with higher muscle strength in patients receiving hemodialysis treatment. A single-center prospective observational study. Ambulatory prevalent patients undergoing hemodialysis treatments in a dialysis unit of a tertiary hospital. Participants included prevalent patients treated with hemodialysis. All patients were above 18 years. Only patients with residual kidney function below 200 mL/24 hours were included to avoid bias. Muscle strength was measured by handgrip strength (HGS). Each patient repeated 3 measurements, and the highest value was recorded. Handgrip strength cutoffs for low muscle strength were defined as <27 kg in men and <16 kg in women. Biochemical parameters, including serum phosphate level, were driven from routine monthly blood tests. Hyperphosphatemia was defined as serum phosphate above 4.5 mg/dL. Handgrip strength results were compared to nutritional, anthropometric, and biochemical parameters-in particular phosphate level. Long-term mortality was recorded. Seventy-four patients were included in the final analysis. Handgrip strength was abnormally low in 33 patients (44.5%). Patients with abnormal HGS were older and more likely to have diabetes mellitus and lower albumin and creatinine levels. There was no correlation between HGS and phosphate level (r = 0.008, P = .945). On multivariable analysis, predictors of higher HGS were body mass index and creatinine. Diabetes mellitus and female sex predicted lower HGS. Hyperphosphatemia correlated with protein catabolic rate, blood urea nitrogen, and creatinine. On multivariable analysis, predictors of hyperphosphatemia were higher creatinine level, normal albumin level, and heart failure. During mean follow-up time of 7.66 ± 3.9 months, 11 patients died. Mortality was significantly higher in patients with abnormally low HGS compared with normal HGS (odds ratio = 9.32, P = .02). A single-center study. All measurements were performed at one time point without repeated assessments. Direct dietary intake, degree of physical activity, and medication compliance were not assessed. Hyperphosphatemia correlated with increased protein intake as assessed by protein catabolic rate in patients treated with hemodialysis; however, neither correlated with higher muscle strength as measured by HGS.Trial registration: MOH 202125213.

Kiosk 8R-TA-08 - The Pattern of T1 and T2 Mapping Values in Ambulatory Long COVID Patients

Kiosk 8R-TA-08 - The Pattern of T1 and T2 Mapping Values in Ambulatory Long COVID Patients

Treatment satisfaction and medication adherence and predictors among patients with heart failure in Ethiopia: a hospital-based cross-sectional study.

Globally, about 18 million people died from cardiovascular diseases (CVDs) in 2019, over three-quarters in developing countries. Non-adherence to medication in CVD patients causes hospitalization, worsened symptoms, higher healthcare costs, and more emergency visits. Hence, this study aimed to assess treatment satisfaction and medication adherence and predictors in heart failure (HF) patients attending Debre Berhan Comprehensive Specialized Hospital (DBCSH), Ethiopia. A hospital-based cross-sectional study was undertaken at the medical referral clinic of DBCSH. A total of 344 ambulatory HF patients who visited the medical care of the DBCSH medical referral clinic during the study period were included. Treatment satisfaction was assessed using a self-administered Medicine Questionnaire (SATMED-Q). Relationships between predictor variables and treatment satisfaction were determined using one-way analysis of variance (ANOVA) and an independent t-test. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). Participants with drug-drug interactions (DDIs) were approximately 38% less likely to adhere to medication compared to their counterparts (AOR = 0.62, 95% CI: 0.54-0.71). Additionally, participants who had taken five or more drugs were approximately 68% less likely to adhere to medication compared to those who had taken only one drug (AOR = 0.32, 95% CI: 0.2-0.51). The correlation between medication adherence and drug-drug interactions remains a possible pseudo-correlation via the number of medications taken. There was a noteworthy positive correlation (rs = 0.34, p = 0.027) between participants' treatment adherence and treatment satisfaction. The rate of treatment satisfaction and treatment adherence among HF patients was 67.6% and 60.9%, respectively. The presence of DDI and the number of drugs were identified as predictors to medication adherence.

Effect of Albumin-Bilirubin Score on Prognosis in Ambulatory Heart Failure Patients with Reduced Ejection Fraction.

Heart failure (HF) often impacts liver function due to reduced cardiac output and increased venous congestion. The Albumin-Bilirubin (ALBI) score has recently been shown to possess prognostic value in patients hospitalized with HF. In this study, we aimed to evaluate the association of the ALBI score with long-term mortality in ambulatory HF patients with reduced ejection fraction (HFrEF). Consecutive patients with HFrEF were included between 2014 and 2019. The ALBI score was calculated using the following formula: (log10 total bilirubin [mg/dL] × 0.66) + (albumin [g/dL] × -0.085). Patients were categorized into two groups: low ALBI (≤ -2.60) and high ALBI score (> -2.60). The endpoint was all-cause mortality. Patients were followed up for a median of 55 (42.6-68.4) months. A total of 417 patients were included in the study. The mean age of the group was 51.5 ± 11.9 years, and 74.8% of the patients were male. 36.5% (n = 152) of the patients were in the high ALBI score group. Patients with a high ALBI score were more likely to be in the New York Heart Association functional class III/IV. These patients had significantly higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, systolic pulmonary arterial pressure, and inferior vena cava diameter, along with worse right ventricular systolic function than patients with a low ALBI score. All-cause mortality was significantly increased in the high ALBI score group (41.4% vs. 27.2%, P = 0.003). Multivariate analysis revealed the ALBI score (HR 1.53, 95% CI 1.09-2.15, P = 0.02) as an independent predictor of long-term mortality. The ALBI score is associated with increased long-term mortality in outpatients with HFrEF. It can easily be evaluated and utilized as a liver dysfunction score in this patient group, providing prognostic information.

Use of a toll-free call center for COVID-19 response and continuity of essential services during the lockdown, Greater Kampala, Uganda, 2020: a descriptive study.

on March 21, 2020, the first case of COVID-19 was confirmed in Uganda. A total lockdown was initiated on March 30 which was gradually lifted May 5-June 30. On March 25, a toll-free call center was organized at the Kampala Capital City Authority to respond to public concerns about COVID-19 and the lockdown. We documented the set-up and use of the call center and analyzed key concerns raised by the public. two hotlines were established and disseminated through media platforms in Greater Kampala. The call center was open 24 hours a day and 7 days a week. We abstracted data on incoming calls from March 25 to June 30, 2020. We summarized call data into categories and conducted descriptive analyses of public concerns raised during the lockdown. among 10,167 calls, two-thirds (6,578; 64.7%) involved access to health services, 1,565 (15.4%) were about social services, and 1,375 (13.5%) involved COVID-19-related issues. Approximately one-third (2,152; 32.7%) of calls about access to health services were requests for ambulances for patients with non-COVID-19-related emergencies. About three-quarters of calls about social services were requests for food and relief items (1,184; 75.7%). Half of the calls about COVID-19 (730; 53.1%) sought disease-related information. the toll-free call center was used by the public during the COVID-19 lockdown in Kampala. Callers were more concerned about access to essential health services, non-related to COVID-19 disease. It is important to plan for continuity of essential services before a public health emergency-related lockdown.

Yearly motor function changes in patients with Duchenne muscular dystrophy, including a COVID-19 behavioral restriction period.

[Purpose] This study aimed to assess the motor function status of ambulatory patients with Duchenne muscular dystrophy in 2020, which included a 3-month period of behavioral restriction due to the coronavirus disease of 2019 (COVID-19) pandemic, in comparison to the previous 2 years. [Participants and Methods] A retrospective analysis was conducted on 12 patients (children with mean age: 9.58 ± 3.43 years in 2020). Parameters such as lower leg maximum circumference, 10-m running time, rising-from-the-floor time, ankle joint range-of-motion, 6-min walk distance, and North Star Ambulatory Assessment score were evaluated. [Results] Significant increases in the maximum right thigh circumference and prolonged 10-m running time were observed in 2020. Interestingly, an unexpected improvement in ankle dorsiflexion angle was noted in both ankles. No other statistically significant differences were observed among the assessed time points. [Conclusion] These findings highlight the critical importance of continuous exercise and rehabilitation for ambulatory children with Duchenne muscular dystrophy, emphasizing the potential of rehabilitation to mitigate and restore the transient motor function deterioration observed during periods of behavioral restrictions.