Average Percentage Of Patients Research Articles

Progress Toward Tuberculosis Elimination and Tuberculosis Program Performance - National Tuberculosis Indicators Project, 2016-2022.

Elimination of tuberculosis (TB) is defined as reducing TB disease incidence in the United States to less than 1 case per million persons per year. In 2022, TB incidence in the United States was 2.5 TB cases per 100,000 persons. CDC's TB program developed a set of national TB indicators to evaluate progress toward TB elimination through monitoring performance of state and city TB program activities. Examining TB indicator data enables state- and city-level TB programs to identify areas for program evaluation and improvement activities. These data also help CDC identify states and cities that might benefit from technical assistance. The 5-year period for which the most recent data were available for each of five indicators: 1) overall TB incidence (2018-2022), 2) TB incidence among non-U.S.-born persons (2018-2022), 3) percentage of persons with drug susceptibility results reported (2018-2022), 4) percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment (2017-2021), and 5) percentage of patients with completion of TB therapy within 12 months (2016-2020). The National TB Indicators Project (NTIP) is a web-based performance monitoring tool that uses national TB surveillance data reported through the National TB Surveillance System and the Aggregate Reports for TB Program Evaluation. NTIP was developed to facilitate the use of existing data to help TB program staff members prioritize activities, monitor progress, and focus program improvement efforts. The following five indicators were selected for this report because of their importance in Federal TB funding allocation and in accelerating the decline in TB cases: 1) overall TB incidence in the United States, 2) TB incidence among non-U.S.-born persons, 3) percentage of persons with drug susceptibility results reported, 4) percentage of contacts to sputum AFB smear-positive TB cases who completed treatment for LTBI, and 5) percentage of patients with completion of TB therapy within 12 months. For this report, 52 TB programs (50 states, the District of Columbia, and New York City) were categorized into terciles based on the 5-year average number of TB cases reported to National TB Surveillance System. This grouping allows comparison of TB programs that have similar numbers of TB cases and allocates a similar number of TB programs to each category. The following formula was used to calculate the relative change by TB program for each indicator: [(% from year 5 - % from year 1 ÷ % from year 1) × 100]. During the 5-year period for which the most recent data were available, most TB programs had improvements in reducing overall TB incidence (71.2%) and increasing the percentage of contacts receiving a diagnosis of LTBI who completed LTBI treatment (55.8%); the majority of programs (51.0%) also had improvements in reducing incidence among non-U.S.-born persons. The average percentage of persons with drug susceptibility results reported in most jurisdictions (28 of 52, [53.9%]) met or exceeded the 5-year national average of 97% (2018-2022). The percentage of contacts to sputum acid-fast bacillus (AFB) smear-positive TB patients with newly diagnosed latent TB infection (LTBI) who completed treatment increased in 29 of 52 (55.8%) jurisdictions from 2017 to 2021, signifying that, for most jurisdictions, steps have been taken to enhance performance in this area. The average percentage of patients with completion of TB therapy within 12 months was at or above the national average of 89.7% in approximately two-thirds (32 of 52 [61.5%]) of jurisdictions. This report is the first to describe a 5-year relative change for TB program performance. These results suggest that TB programs are making improvements in activities that help identify persons with TB and LTBI and ensure patients complete treatment in a timely manner. Use of NTIP data from individual TB programs enables a more detailed examination of trends in program performance and identification of areas for program improvement. Assessing indicator trends by TB program provides an opportunity to gain a better understanding of program performance in comparison to other programs. It can also facilitate communication between programs regarding successes and challenges in program improvement. This information is valuable for TB programs to allocate resources effectively and provide additional context on TB control for public health policymakers.

Microsurgical Techniques for Digital Nerve Injuries and Vascular Injuries.

Tension-free end-to-end digital nerve repair or reconstruction under loupe or microscope magnification are surgical treatment options for lacerated digital nerves in patients with multiple injured digits, injuries to the border digits, or injuries to the thumb, with the goal of improved or restored sensation and a decreased risk of painful traumatic neuroma formation. Different techniques for primary repair have been described and include epineurial sutures, nerve "glues" including fibrin-based gels1,2, biologic or synthetic absorbable or nonabsorbable nerve wraps or conduits, or a combination of these materials. Nerve "glues" have demonstrated decreased initial gapping at the repair site3 and an increased tensile load to failure when utilized with a nerve wrap or conduit4,5. When there is a gap or defect in the nerve and primary repair is not feasible, nerve allograft and autograft provide similar results and are both better options than conduit reconstruction6. Concomitant or isolated digital vascular injuries may also be surgically treated with end-to-end repair in a dysvascular digit, with the goal of digit and function preservation. In the absence of complete circumferential injury or complete amputation, redundant or collateral flow may be present. Single digital artery injuries often do not need to be repaired because of the collateral flow from the other digital artery. Digital nerve and vascular injuries are often found in the context of traumatic wounds. In such cases, surgical exploration is often required, with possible surgical extension of the wounds to facilitate identification of the neurovascular bundles. The proximal and distal ends of the transected nerve and/or artery are identified, and the traumatized ends are incised sharply, maintaining as much length as possible to facilitate end-to-end repair, interposition of a graft, and the use of a conduit. The proximal and distal aspects of the nerve and/or artery are appropriately mobilized by dissecting or releasing any scar tissue or soft tissue that may be tethering the structure. The defect is measured in the natural resting position of the digit. Gentle flexion of the digit may be performed to facilitate a primary repair in the setting of very small defects. Primary repair or reconstruction is selected, and an 8-0 or 9-0 nonabsorbable monofilament suture is utilized to anastomose the appropriate structures under magnification with use of a single or double stitch6. A tubular nerve conduit is placed prior to epineurial suturing, or a nerve conduit wrap is applied circumferentially around the repair site and augmented with a fibrin glue. The wound is then irrigated and closed in a standard fashion, as determined by the presence of any soft-tissue or structural injury. Alternatives to primary repair include the use of conduits or autologous or allogenic grafting. Factors that necessitate reconstruction include gapping and poor soft-tissue integrity, which can be related to the mechanism of injury. Alternatives to repair or reconstruction include treatment of the-soft tissue or structural injury without concomitant repair or reconstruction of the damaged digital nerves or vessels. Primary end-to-end repair and reconstruction of digital nerves increases a patient's likelihood of sensation recovery, and arterial repair can preserve a digit and avoid the need for amputation. Sensation in the digits is very important for fine motor skills and interaction with the environment, and it is particularly important for patients who rely on their hands for work and/or recreation. For these reasons, the digital nerves to the border digits, such as the ulnar aspect of the small finger, radial aspect of the index finger, and both digital nerves to the thumb, are given particular attention. Surgical intervention to repair or reconstruct the digital nerves increases the likelihood of recovering pre-injury sensation; however, the chance of complete recovery remains low. A systematic review of the outcomes of digital nerve repair in adults published in 2019 showed that the average percentage of patients who had undergone repair and reported a recovery to Highet grade 4 was 24% (range, 6% to 60%)8. The rate of adverse events was comparable between the operatively and nonoperatively treated patients, with complications including neuromas, hyperesthesia, and infection. The use of a microvascular background material can provide better visualization of the proximal and distal ends while performing the repair.It is important to sharply guillotine the ends of the nerve to freshen up the laceration and provide healthy nerve ends for repair.Repair sutures need to be passed through the epineurium, with care taken not to pass through the nerve fascicles. OR = operating roomPIP = proximal interphalangealPT = prothrombin timePTT = partial thromboplastin time.

The economic impact and role of health communication in the economic recovery of tuberculosis (TB) patients in Indonesia

Tuberculosis (TB) patients suffer physically and bear the economic burden as many patients cannot work or generate income when ill. Concerning this issue, health communication plays a role in addressing the economic impact through advocacy strategies. This study aims to analyze how the economic impact and health communication advocacy conducted by Aisyiyah and Terjang NGOs contribute to TB patients' economic recovery in Bandung. This research adopts a cross-sectional approach involving data collection at a specific point in time. The findings indicate that the average percentage of patients who are the primary breadwinners of the family is 44.33%, patients who have lost their jobs is 82.33%, patients with loans is 38.67%, patients selling property is 55.67%, patients receiving government assistance is 68.33%, patients receiving assistance from private institutions is 21%, patients receiving assistance from family is 78%, and the median value of aid in the last three months is 21.83 USD. Aisyiyah and Terjang provide information on treatment costs, skills training, access to social support programs, and awareness of stigma and discrimination among TB patients. Terjang also provides legal assistance to patients who experience discrimination. This health communication advocacy can enhance social and economic support for TB patients and their families.

The Use of SARS-CoV-2-Positive Donors in Hematopoietic Stem Cell Transplantation

Since 2019, the SARS-CoV-2 pandemic has become a global issue due to its high fatality rate. Over time, the characteristics of the virus have evolved and led to the creation of an omicron strain with higher infectivity but a significantly decreased fatality rate. For patients in urgent need of hematopoietic stem cell transplantation (HSCT), whether the SARS-CoV-2 infection status of donors has a significant impact on HSCT recipients should be clarified. To estimate the transplantation risk of SARS-CoV-2-positive donors, 24 patients who underwent HSCT from December 1, 2022 to January 30, 2023 were retrospectively included. The ratio of the observation group (SARS-CoV-2-positive donors, n=12) to the control group (SARS-CoV-2-negative donors, n=12) was 1:1. We observed the time of hematopoietic reconstruction, donor chimerism, severe infection, acute graft vs host disease, and hepatic vein occlusion disease during hematopoietic reconstruction. In the observation group, the average time of myeloid hematopoietic reconstruction was 11.58 days, and in the control group, it was 12.17 days (P=.3563 [>.05]). On average, all patients achieved a 90% donor chimerism rate of +13.58 (±4.5) days (P=.5121 [>.05]). The average percentage of patients that achieved successful hematopoietic reconstruction was 96.75% in the observation group and 96.31% in the control group (P=.7819 [>.05]). A total of 6 adverse events occurred during this study: 3 in the observation group and 3 in the control group. Our preliminary results showed favorable short-term outcomes in recipients of SARS-CoV-2-positive HCST donors.

Patient Likelihood to Repeat Surgery After Highly "Successful" Hand Procedures.

Outcomes for routine hand procedures, such as carpal tunnel release, trigger finger release, and first dorsal compartment release, are typically reported as "highly successful" with "infrequent complications" based on classic literature. No contemporary study has utilized a large prospective registry to assess patient willingness to repeat surgery. We utilized a prospective hand registry to evaluate the proportion of patients that would repeat surgery after common hand procedures. We utilized a prospective, hand surgery registry to collect postoperative patient likelihood to repeat surgery in patients undergoing surgery for 9 common hand procedures. All measures were reported at 12, 24, or 52 weeks. We analyzed the percentage of patients that would repeat the procedure for all diagnoses, as well as stratified by the most common 9 isolated diagnoses. At the time of analysis, 1905 patients met our inclusion criteria. The average percentage of patients across all procedures that would repeat surgery was 81.6%. When stratified by the most common 9 diagnoses the percentage of patients that would repeat surgery ranged from 51.9% (ulnar nerve surgery at the elbow) up to 87.5% (endoscopic carpal tunnel release). After undergoing routine hand procedures, a significant percentage of patients would choose not to repeat surgery. Hand surgeons can do better in setting clear and realistic preoperative expectations when counseling patients prior to even routine hand surgeries.

778-P: Variations in Insulin Pump Use across Pediatric Endocrinology Centers in the U.S.

Background: The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a learning network of over forty US type 1 diabetes clinics. Clinics share best-practice ideas for quality improvement and use data for population health research. This study benchmarks insulin pump use across pediatric clinics in the T1DX-QI. Method: T1DX-QI clinics report monthly on critical metrics, including the percentage of patients with HbA1c <7% or using a pump, and other quality metrics. Median values for each site were calculated using Lahey P run charts between July 2020 and June 2021. These results are shared non-anonymized internally among participating T1DX-QI clinics. Results: Across 17 T1DX-QI clinics, the percentage of patients using pumps ranged from 23% to 79% (Figure 1, A; mean and median pump use were 51.5% and 49.0%, respectively) . Clinic-specific average percentage of patients with HbA1c < 7% ranged from 35% to 12% (Figure 1, B) . There were no observed differences in pump use by patient population size. Conclusion: The T1DX-QI benchmarks key clinical metrics to support quality improvement, share best practices, and promote learning across clinics. Disclosure A. Mungmode: None. B.V. Adams: None. O. Docter: None. N.R. Fogel: None. R. Izquierdo: None. J.M. Lee: Advisory Panel; GoodRx. Consultant; Tandem Diabetes Care, Inc. B. Miyazaki: None. A. Neyman: None. I. Reckson: None. J. Schmitt: None. O. Ebekozien: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Redefining the epidemiology of cardiac amyloidosis. A systematic review and meta-analysis of screening studies.

An algorithm for non-invasive diagnosis of amyloid transthyretin cardiac amyloidosis (ATTR-CA) and novel disease-modifying therapies have prompted an active search for CA. We examined the prevalence of CA in different settings based on literature data. We performed a systematic search for screening studies on CA, focusing on the prevalence, sex and age distribution in different clinical settings. The prevalence of CA in different settings was as follows: bone scintigraphy for non-cardiac reasons (n=5 studies), 1% (95% confidence interval [CI] 0%-1%); heart failure with preserved ejection fraction (n=6), 12% (95% CI 6%-20%); heart failure with reduced or mildly reduced ejection fraction (n=2), 10% (95% CI 6%-15%); conduction disorders warranting pacemaker implantation (n=1), 2% (95% CI 0%-4%); surgery for carpal tunnel syndrome (n=3), 7% (95% CI 5%-10%); hypertrophic cardiomyopathy phenotype (n=2), 7% (95% CI 5%-9%); severe aortic stenosis (n=7), 8% (95% CI 5%-13%); autopsy series of 'unselected' elderly individuals (n=4), 21% (95% CI 7%-39%). The average age of CA patients in the different settings ranged from 74 to 90 years, and the percentage of men from 50% to 100%. Many patients had ATTR-CA, but the average percentage of patients with amyloid light-chain (AL) CA was up to 18%. Searching for CA in specific settings allows to identify a relatively high number of cases who may be eligible for treatment if the diagnosis is unequivocal. ATTR-CA accounts for many cases of CA across the different settings, but AL-CA is not infrequent. Median age at diagnosis falls in the eighth or ninth decades, and many patients diagnosed with CA are women.

Analysis of the infectious morbidity of humans, domestic animals and poultry in Russia for 2016-2019

Relevance . The article provides an analysis of the infectious mor-bidity in the Russian Federation of humans, domestic animals and birds for 2016-2019. The aim of the study is to compare the epizootological and epidemiological situation and to establish a correlation between individual types of zoonoses, anthro-ponoses and zoonoses with anthroponoses. Materials and Methods . The study was carried out by processing statistical data obtained from open sources of Rosstat and the Federal State University of the Russian Academy of Sciences of the IAC of the Department of Veterinary Supervision of Vladimir. Collected data were processed using Excel and STATISTICA-10 programs. Results and Discussion . A sample of infectious diseases (IB) was formed, which, during the specified period, infected peo-ple, pets, incl. cattle and small ruminants, pigs, horses and poultry. The average per-centage of patients with a specific type of infectious diseases was calculated, taking into account the differentiation by zoonoses, anthroponoses and the average percent-age of sick animals for all identified types of IB, which made it possible to establish IB, which are most common in each of the groups, and in general in all animals and birds. The assessment of the distribution of information security in differentiated groups has been carried out, distribution graphs have been constructed and formulas have been established by which it is possible to predict the dynamics of their further development. The STATISTICA-10 software was used to calculate the correlation coefficients ( r ) between zoonoses (XX), anthroponoses (YY), as well as zoonoses and anthroponoses (XY). Conclusion . Stably significant positive correlations were determined for zoonoses and anthroponoses. The data obtained prove the existence of a close connection of a person with the environment and his responsibility for the health of animals and birds, in order to prevent the risk of infectious diseases.

COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied.
 Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED.
 Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively.
 Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

Improving Follow-Up of Tests Pending at Discharge.

Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.

Referral rates of patients with diabetes to secondary care are inversely related to the prevalence of diabetes in each primary care practice and confidence in treatment, not to HbA1c level

AimsTo determine the factors affecting the referral rates of patients with diabetes from primary care to secondary care. MethodsA study based on 66 GP surgeries in the Cardiff and Vale University Health Board (population: 515,581) was conducted. We included patients who had an established clinical diagnosis of diabetes (type 1 and type 2) from September 2017 to September 2018.HbA1c outcome data of GP surgeries were obtained from the Quality and Outcomes Framework (QOF) database published for 2018. Referral rates were obtained from the electronic referral database of Cardiff and Vale University Health Board over the same period, and this was adjusted according to the number of patients with diabetes in each GP surgery. Confidence level on the treatment of diabetes among GPs was assessed as a sub-study conducted in nine GP surgeries in the same area, using a self-administered questionnaire. Linear regression was undertaken to assess the relationship between adjusted referral rate and key factors which might influence prescribing rate. ResultsThe average adjusted referral rate to secondary care in one year was 4.23% of patients with diabetes in each GP surgery, with a wide variation of 1.24% to 16.28%. The average percentage of patients with diabetes with HbA1c<59mmol/mol was 63.17% (range: 43.19–76.23%). The average confidence score of GPs in treating diabetes was 67% and ranged from 50–85% in the sub-study. Referral rates correlated inversely with the numbers of patients with diabetes in each practice β=−0.32; (95% CI −0.57, −0.08) p=0.01, but there was no significant correlation with the HbA1c outcome β=−0.13; (95% CI −0.39, 0.12); p=0.30. Borderline significant negative correlation was observed between referral rates and overall practice size β=−0.23; (95% CI −0.48, 0.02) p=0.07. ConclusionsReferral rates of patients with diabetes to secondary care are determined by the number of patients with diabetes in each practice and confidence level in treatment, not by the overall practice size or HbA1c level. Ensuring quality training in diabetes care for primary care teams as well as the development of integrated diabetes care may be the best way to optimise the volume and appropriateness of referrals to secondary care.

A Psoriatic Patient-Based Survey on the Understanding of the Use of Vaccines While on Biologics During the COVID-19 Pandemic [Formula: see text

Psoriatic patients who are actively receiving biologic treatment have protocols in place to achieve optimal immunity. Inactivated vaccines are safe to use during biological treatment, without interruption. Conversely, live vaccines are used with caution and likely interruption of treatment. Given the novel coronavirus (SARS-CoV-2), nation-wide administration of vaccinations is underway. This survey gathered information on the level of education psoriatic patients have concerning vaccinations. An electronic survey was sent to 661 patients suffering from psoriasis. Patients originated from a single solo-practitioner community-based dermatology practice. The average percentage of patients who understand the difference between live and inactivated vaccines between the control and study group was 36.6%. The average response to not knowing the difference between the vaccines was 36.6% and 26.6% were "unsure." When asked if it was possible to receive inactivated vaccines while on a biologic, the mass response amidst the control and study group was "unsure" (66.9%). This questionnaire demonstrates that there is a need for supplementary education about vaccines for psoriatic patients on a biologic. Physicians will need to counsel their patients on the use of potential vaccines for SARS-Cov2 while on biologics.

Prevalence of Thyroid Function Abnormalities in Patients with Chronic Renal Failure under Regular Hemodialysis

Background: There are various changes in the thyroid gland and its function in end stage renal disease (ESRD). It is not surprising that impairment of kidney function leads to disturbed thyroid physiology. Objective: Is to detect thyroid function abnormalities in hemodialysis patients. Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and thyroid functions. Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels. Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels. However, HCV positive patients experienced lower levels of T4 and TSH. Conclusion: The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis duration.

PSU44 MANAGEMENT OF PERIPROCEDURAL THROMBOTIC AND BLEEDING EVENTS IN PERCUTANEOUS CORONARY INTERVENTIONS IN EUROPE: PILOT SURVEY OF TREATMENT STRATEGIES AND HOSPITAL RESOURCES USE

Evidence generation about real world medical practice in Europe regarding percutaneous coronary intervention (PCI) and periprocedural platelet aggregation inhibition management, as well as identification of current medical needs in this field. A survey focusing on periprocedural PCI management was distributed to interventional cardiologists in Europe. All answers and the responders’ personal information were coded and anonymized. The template consisted of 32 questions and 77 variables. Questions included information about epidemiological data on PCI procedures, current management of periprocedural thrombotic and bleeding events potentially associated with oral P2Y12 inhibitors (pre-loading) and glycoprotein IIb/IIIa inhibitors (bailout) respectively, as well as use of healthcare resources. 14 questionnaires were completed (Belgium (n=1), Germany (n=1), France (n=6), Portugal (n=3) and Spain (n=3)). Adherence to Guidelines in PCI management was high in all countries. Large variability was observed regarding the percentage of complex PCI performed per year, from 10% (Belgium) to 60% (Spain). The reported proportion of thrombotic and bleeding events in the first 48 h was 1%-50% and 2%-44% respectively. The average length of hospital stay in case of periprocedural events varied from 2 to up to 11 days. In general, average use of glycoprotein IIb/IIIa inhibitors for bailout was low (<6%) except in Spain (15%). High risk PCI were mostly identified in case of cardiogenic shock or active vomit, STEMI patients and elderly. The average percentage of patients where preloading with oral P2Y12 inhibitors was not feasible or desirable was 7.4% (1%-25%). The most valued characteristics of pharmacological innovations in this field would be definitely related to fast onset of action as well as short duration of effect. An expert consensus panel on PCI management would be advisable in order to validate all results across countries and cover potential dilemmas that may arise in clinical practice as preloading and bailout.

PC142. Quality Review of Veterans Administration Dialysis Access

Hemodialysis is the primary mode of renal replacement therapy for patients with end-stage renal disease. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative, specifically the “Fistula First Catheter Last” initiative, has improved dialysis access outcomes by advocating for arteriovenous fistula (AVF) placement for primary access in >68% of end-stage renal disease patients while reducing the percentage of patients with catheter-dependent dialysis >90 days to < 10%. To identify trends in dialysis quality end points for the Veterans Health Administration, we reviewed the Department of Veterans Affairs (VA) Dialysis Dashboard data for 2017-2018. We retrospectively analyzed the VA Dialysis Dashboard data from January 2017 through October 2018. Average percentage of patients with catheters >90 days and those with AVF for primary access were assessed across all 18 Veterans Integrated Service Networks (VISNs). Averages were calculated within each VISN, and then a weighted average was calculated for the VISN overall. VA-sponsored freestanding dialysis centers were also evaluated separately as a group. In 2017, VISNs 1 and 19 met Fistula First Catheter Last benchmarks of 68% or greater for AVF access, with VISN 1 also achieving the mark in 2018. VISN 20 met the catheter benchmark in 2017. None of the VISNs met the catheter benchmark in 2018. Ten freestanding VA-sponsored dialysis clinics overall had better compliance rates than the hospital-based dialysis centers. Performance within a VISN varied widely. Our home institution’s catheter rates decreased from 16% in 2017 to 11% in 2018 in part because of a concerted multidisciplinary approach to dialysis access. Developing a goal-oriented team is critical to expedite permanent access placement to meet or to exceed national guidelines and to ensure quality care. Our team includes a vascular surgeon, nephrologist, interventional radiologist, and anesthesiologist, all of whom collaborate to optimize patient care and outcomes. Further analysis of VISN data may identify other modifiable factors that could improve outcomes for dialysis patients.

AMBARAN FUNGSI HATI PASIEN SKIZOFRENIA YANG MENGKONSUMSI RISPERIDONE DENGAN LORAZEPAM

Treatment with risperidone 1.5-6.0 mg/day provides good benefits for schizophrenia treatment, severe psychiatric disorder with long-term disability potential and limited availability of treatment options. According to the average percentage of patients with abnormal liver function tests, patients with clinically significant improvement (> 3 times of the normal upper limit for SGPT, aspartate aminotransferase.Abnormalities that are commonly without any symptom occur within 6 weeks of antipsychotic use (Correll et al., 2015). The purpose of this study is to analyze the liver function of schizophrenic in-patients who take risperidone and lorazepam in Amino Gondohutomo’s psychiatric hospital of Central of Java Province. The research subjects were 132 schizophrenic diagnosed patients who take risperidone and combination of risperidone and lorazepam. We used Chi Square Tests, Paried T Tests and One Sample Test.Based on the research results, it can be concluded that there is a correlation between readmisi and age group, in age group > 29 years more risk relapse than age group <29 years. Also, it can be concluded the combination of risperidone and lorazepam at risk 0,933 times will increase SGOT than get treatment with risperidone only and therapy the combination of risperidone and lorazepam at risk twice will increase SGPT rather than receive treatment with risperidone only.

Inpatients’ satisfaction towards information received about medicines

ObjectiveHealthcare providers (HCPs) often overestimate the quality and quantity of information they provide to patients. This study aimed to find out inpatients’ satisfaction towards information about medicines provided during inpatient...

Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry.

287 Background: Advanced imaging for diagnosis of metastatic disease at the time of diagnosis of stage 0-II breast cancer is not recommended according to national guidelines. The purpose of this study was to examine the variation in ordering of CT chest, abdomen, and pelvis, PET, and bone scans across the state of Michigan, and to investigate clinical and non-clinical factors associated with test ordering. Methods: We prospectively collected data from all patients diagnosed with stage 0-II breast cancer from 2008-2014 in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI), a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality initiative. Demographic, imaging, and pathologic data were abstracted from the medical record. The primary endpoint was the percentage of patients with at least one advanced imaging test performed within 90 days after diagnosis of breast cancer. Analyses were performed using the chi-squared test of association. Results: Of the 27,011 patients, 4799 (17.8%) had at least one staging exam performed within 90 days of diagnosis. Imaging tests were primarily performed post-operatively. The average percentage of patients who had at least one staging exam performed varied by stage and by site (Table). The rate of testing decreased over time for stage 0-IIA cancers but not for stage IIB. On multivariate analysis, younger age, black race, hormone receptor negativity, HER2 positivity, and higher grade were associated with increased likelihood of undergoing imaging. Conclusions: There is considerable variability in ordering of staging scans at the time of diagnosis of early stage breast cancer across Michigan. Factors underlying use of imaging in stage IIB disease should be examined in order to develop interventions for rate reduction. [Table: see text]

Variability of antithrombotic dosing among veterans presenting with acute coronary syndrome.

BackgroundAntithrombotic therapy for acute coronary syndrome (ACS) patients is recommended by clinical practice guidelines. Appropriate dosing of antithrombotic therapy is necessary to ensure effectiveness and safety and is an American College of Cardiology/American Heart Association ST elevated myocardial infarction/non‐ST elevated myocardial infarction performance measure. This study describes the variability in dosing of unfractionated heparin (UH) and low‐molecular‐weight heparin (LMWH) in an integrated health care system with electronic medical records and computerized physician order entry (CPOE).Methods and ResultsThis was a mixed‐methods study of veterans presenting with ACS at 135 Veterans Health Administration hospitals from 2009 to 2011. Patients hospitalized with ACS and received antithrombotic therapy were included (n=36 682). The cohort was 98% male with an average age of 66 years and median body mass index (BMI) of 28.6. The average percentage of patients by hospital who received an above‐recommended dose of either antithrombotic was 7.5% and ranged 0% to 32.0%. By individual therapy, the average percentage of patients by hospital who received an above‐recommended dose of UH was 1.2% and LMWH was 12.9%. Risk‐adjusted analyses demonstrated that older age and higher BMI were associated with lower risk for receiving a dose above recommended levels. Additionally, there was an association between antithrombotic ordered by a resident and higher risk of the patient receiving an above‐recommended dose. Qualitative interviews supported the quantitative findings by highlighting the need to use current patient weight and the need to adequately train providers on the use of CPOE to improve antithrombotic dosing.ConclusionThis study found wide hospital variability in dosing of antithrombotics above the recommended level for patients treated for ACS.

A survey of physician practice and knowledge of drug allergy at a university medical center

A survey of physician practice and knowledge of drug allergy at a university medical center