Outpatient Clinic Setting Research Articles

Achieving Age-Friendly Health Care in an Outpatient Perioperative Clinic

Your Patient's Brain| January 2023 Achieving Age-Friendly Health Care in an Outpatient Perioperative Clinic Heather Lander, MD; Heather Lander, MD Search for other works by this author on: This Site PubMed Google Scholar Daniel J. Cole, MD, FASA; Daniel J. Cole, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Stacie Deiner, MD, MS; Stacie Deiner, MD, MS Search for other works by this author on: This Site PubMed Google Scholar Marjorie Gloff, MD Marjorie Gloff, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor January 2023, Vol. 87, 20–21. https://doi.org/10.1097/01.ASM.0000911756.61867.27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Heather Lander, Daniel J. Cole, Stacie Deiner, Marjorie Gloff; Achieving Age-Friendly Health Care in an Outpatient Perioperative Clinic. ASA Monitor 2023; 87:20–21 doi: https://doi.org/10.1097/01.ASM.0000911756.61867.27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: outpatients, perioperative care According to a recent World Health Organization (WHO) publication, in 2020 the number of people aged 60 years and older outnumbered children younger than 5 years worldwide (asamonitor.pub/3NC2L83). Simultaneous to the rapidly growing older population, their surgical and perioperative needs are also increasing. Minimally invasive surgical techniques and procedures are allowing patients with increasingly complex comorbidities to proceed with intervention, when once this may not have been offered to them given the intrinsic risk. There is an expanding effort to provide comprehensive perioperative care to the older surgical patient. Housing the assessment, risk-stratification, and education of these patients and their caregivers in an outpatient clinic setting is an effective means of meeting this demand and to allowing a standardized process for evaluation. It is also in line with the national efforts of the Geriatric Surgery Verification Program. There are, however, multiple logistical obstacles to achieving effective, streamlined, age-friendly... You do not currently have access to this content.

A Cross-sectional Survey on the Perception of Pediatricians about Constipation in Indian Pediatric Patients (CROSCIP)

Background: Constipation accounts for more than 50% of the workload in pediatric outpatient clinics, with functional constipation being the most frequently diagnosed condition. Pediatricians have varied perceptions about constipation and its management. Objective: A national prospective questioner based cross-sectional survey was conducted to understand the perceptions and practices of Indian pediatricians on the current management of pediatric constipation. Methods: A 14-item questionnaire with open and closed-ended questions was developed with a focus on understanding the prevalence of constipation in the pediatric setting, common clinical presentations, management approaches, treatment choices, and patient compliance. Pediatricians PanIndia, among varied practice backgrounds, were invited to participate in the survey. Results: A total of 1150 pediatricians were invited, of which 1042 completed the survey. The majority of the responding pediatricians were based in the outpatient clinic setting. The most common age group of children presenting with functional constipation was 2-4 years. The most commonly reported symptoms were painful passage of hard and dry stools with a frequency of fewer than two stools per week. Polyethylene glycol (PEG) 4000 was the preferred choice for fecal disimpaction and maintenance by the majority of pediatricians. Most pediatricians prescribe laxatives for 1-3 months. The major challenge with PEG 3350 was the volume to be consumed and poor palatability. The survey results showed poor compliance and a high relapse rate in children with functional constipation. Conclusion: Functional constipation is prevalent in toddlers with growing incidence and is managed by pediatricians in outpatient clinics. We found that Indian pediatricians prefer PEG 4000 for fecal disimpaction and maintenance therapy.

Результаты клинической апробации специализированного продукта диетического лечебного питания «Бифинилан» для детей старше семи лет, больных фенилкетонурией

Objective. To evaluate the efficacy, safety, and tolerability of a specialized food product for dietary therapeutic nutrition “Bifinilan” in children over 7 years of age with phenylketonuria. Patients and methods. An open-label prospective study was conducted in outpatient clinical settings. It included 17 children with phenylketonuria aged between 8 and 15 years (12 girls and 5 boys), who received a specialized product “Bifinilan” for 30 ± 2 days. Clinical and anamnestic characteristics, blood phenylalanine levels determined by the fluorescent method were assessed at the beginning and at the end of the study. Results. During the study, blood phenylalanine levels decreased significantly and were within the reference range (median before the study was 9.11 mg/dL, at the end of the study – 6.17 mg/dL, p < 0.05). At the same time, in children with initially elevated phenylalanine level, it decreased to an acceptable range, and in children with a normal phenylalanine level, it remained within the same range. Patients, their parents, and physicians were completely satisfied with the use of the product, which was well tolerated and the transition to which was not followed by an adaptation period. Conclusion. The efficacy, safety, and good tolerability of a specialized food product for dietary therapeutic nutrition “Bifinilan” in children over 7 years of age with phenylketonuria was demonstrated. Key words: children, specialized food product for dietary therapeutic nutrition, phenylalanine, phenylketonuria

ChatGPT's potential role in non-English-speaking outpatient clinic settings.

Researchers recently utilized ChatGPT as a tool for composing clinic letters, highlighting its ability to generate accurate and empathetic communications. Here we demonstrated the potential application of ChatGPT as a medical assistant in Mandarin Chinese-speaking outpatient clinics, aiming to improve patient satisfaction in high-patient volume settings. ChatGPT achieved an average score of 72.4% in the Chinese Medical Licensing Examination's Clinical Knowledge section, ranking within the top 20th percentile. It also demonstrated its potential for clinical communication in non-English speaking environments. Our study suggests that ChatGPT could serve as an interface between physicians and patients in Chinese-speaking outpatient settings, possibly extending to other languages. However, further optimization is required, including training on medical-specific datasets, rigorous testing, privacy compliance, integration with existing systems, user-friendly interfaces, and the development of guidelines for medical professionals. Controlled clinical trials and regulatory approval are necessary before widespread implementation. As chatbots' integration into medical practice becomes more feasible, rigorous early investigations and pilot studies can help mitigate potential risks.

Accelerated intermittent theta burst transcranial magnetic stimulation is a safe and efficacious treatment for adolescents with depressive symptoms

Abstract Background: Intermittent theta burst stimulation (iTBS) has been shown to be a safe and effective therapy for depression in adult populations and more recently, newer protocols of accelerated transcranial magnetic stimulation (TMS) have become popularized due to the fast-acting effects. Previous literature has shown that iTBS in adolescents is safe and that TMS may be more effective in younger individuals, but it has yet to be explored in great detail with accelerated protocols. Methods: This case series describes three patients seen in the context of an outpatient clinic setting at Acacia Mental Health. The patients were treated for depressive symptoms which were confirmed by a staff psychiatrist. Self-reported mood surveys as assessed by the patient health questionnaire-9 (PHQ-9), were administered pre-treatment and post-treatment. The accelerated TMS treatment protocol administered to these patients varied in the brain region(s) targeted, TMS machine output intensity, protocol laterality, number of sessions per day, and total number of sessions. The TMS treatments were delivered via a MagVenture MagPro R30 system (MagVenture A/S, Denmark) equipped with a MagVenture Cool-B65 A/P coil. Results: All three cases were prescribed distinct accelerated protocols; two achieved self-reported remission and one achieved response as measured by the PHQ-9. All patients tolerated accelerated iTBS sessions without significant adverse events, demonstrating that this is a safe and effective treatment for adolescents with MDD. Conclusion: In these adolescent patients, accelerated TMS protocols were tolerated and showed meaningful clinical effects. These cases support rationale for future clinical applications of accelerated TMS in adolescent populations. Future studies should examine larger cohorts to gain a deeper understanding of accelerated TMS safety and efficacy in adolescents. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: Transcranial Magnetic Stimulation, Theta Burst, Adolescence, Depression

Effectiveness of DBT skills training in outpatient men: A naturalistic study.

A plethora of research highlights the effectiveness of dialectical behavioral therapy (DBT) in improving emotion regulation and psychological functioning transdiagnostically. However, the majority of this research has focused on women, and the limited existing research on men has concentrated on high acuity patients in forensic and inpatient settings. The present study examined the effectiveness of DBT skills groups in reducing emotion regulation difficulties in a transdiagnostic sample of adult men in a university-based clinical outpatient setting using a naturalistic design. Sixteen adult male patients completed self-report measures examining emotion regulation difficulties (Difficulties in Emotion Regulation Scale) at intake and following one 12-week module of DBT skills group. Men showed a significant reduction in overall difficulty regulating emotions with a moderate effect size (d = 0.63, p < .05) following one module of DBT skills group, which were accounted for primarily by improvements on the impulse control difficulties subscale (d = 1.06, p < .01). In comparison, women (N = 82) showed significant improvements in global emotion regulation difficulties (d = 0.71, p < .01), with marked improvement across all six subscales. Implications of findings for the application of DBT for men in outpatient settings is discussed, limitations reviewed, and areas for future research suggested. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between Inhalation Instruction Method in Community Pharmacies and Inhaler Device Handling Error in Patients with Obstructive Lung Disease: An Evaluation of the Impact of Practical Demonstration by Pharmacists.

Inhaler devices play an important role in the management of obstructive lung diseases including asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap. Some of these patients show suboptimal inhaler techniques; however, time for inhaler instruction by pharmacists is limited in daily clinical practice. Therefore, sufficient education regarding inhaler device handling should be provided within a limited time frame. The current study aimed to investigate the instruction methods provided by community pharmacists and their influence on inhaler device handling techniques in outpatient clinical care settings. We retrospectively collected the data of outpatients with obstructive lung diseases who were referred to our hospital and who underwent inhalation technique assessments conducted by community pharmacists. The prevalence of handling errors, clinical characteristics of patients, and instruction methods were analyzed. In total, 138 patients (170 devices) were included in this study. Approximately 70.0% of patients received verbal explanations combined with leaflets about inhaler instructions. In a device-based analysis, 63 (37.1%) of 170 devices had at least one technical error and 18 (10.6%) of the devices had critical errors. Patients without critical errors received practical demonstration instructions from pharmacists combined with leaflets and verbal explanations more frequently than those with critical errors (22.8 vs. 0%, p < 0.01). This study revealed that patients with obstructive lung diseases commonly present with inhaler device handling errors and critical errors were observed with non-negligible frequency in daily practice in Japan. Combined instruction with leaflet, verbal explanation, and pharmacist demonstration may be effective in improving proper inhaler treatment.

Overview of Literature Related to Post COVID-19 Rehabilitation

<h3>Objective(s)</h3> To examine current literature on the role of physical therapy (PT) in management of post COVID-19 related conditions and common symptomatology in adults, as well as potential guidelines for rehabilitation in the outpatient setting. <h3>Data Sources</h3> PubMed, CINAHL, Medline, Cochrane. <h3>Study Selection</h3> Searches were conducted to examine current data related to PT interventions and their effectiveness for treating post COVID-19 conditions. Articles were evaluated for relevance based on the following criteria: articles in English, original peer reviewed articles, adult population (over 18), relevant PT interventions for rehabilitation, post-acute infection of COVID-19. Consensus agreement confirmed approximately 25% of reviewed articles. <h3>Data Extraction</h3> Articles were analyzed for relevance to implications regarding post COVID-19 and potential PT rehabilitation interventions. Interventions were assessed in feasibility and applicability to an outpatient clinic setting. Independent data extraction followed by consensus discussion was applied. Articles were examined for content regarding the latest updates on disease criteria, manifestations, new classifications, and cohorts emerging as the pandemic progresses as well as management strategies applicable to PT practice. <h3>Data Synthesis</h3> After article analysis, the findings include a key theme that PT services helped improve overall functional mobility and symptom management in patients after an acute infection of COVID-19. An essential consideration is keeping the interventions specific to the patient and their goals while preventing exacerbations of symptoms that could lead to further setbacks. <h3>Conclusions</h3> PT has a growing role in the management of post COVID-19 deficits as well as implications related to long COVID sequelae. By choosing the appropriate parameters and having awareness of the varying symptomology amongst patients, physical therapists can improve patients' functional mobility and post COVID-19 disease management. The focus of future studies should include more specific interventions related to managing conditions and finding the most effective treatment strategies. <h3>Author(s) Disclosures</h3> No conflicts to disclose.

Video consultations in community palliative care – patient satisfaction: mixed methods study

ObjectivesCommunity palliative care (CPC) has traditionally been delivered face to face in the home or in the outpatient clinic setting. The COVID-19 pandemic necessitated the introduction of video consultation (VC)...

Peripherally Inserted Central Line Catheters following Hand and Wrist Infections.

The PearlDiver Patients Records Database was queried to identify patients who underwent treatment for infection of the hand, wrist, and forearm between 2010 and 2018. Logistic regression analysis was utilized to evaluate the association of patient-related risk factors with PICC utilization, complications, readmissions, and length of stay (LOS). A total of 24,665 patients with an upper extremity infection were included in the study. Ultimately, 416 patients required a PICC placement (1.69%). Patients with older age, male gender, certain medical comorbidities, and infection involving deeper structures were more likely to require a PICC. Ninety-day all-cause medical complication rates were significantly higher for the PICC group (19.7% versus 6.7%) compared to those without. Any hospital readmission rates were significantly higher for PICC group at 90 days (28.4% versus 6.3%) and 1 year (35.8% versus 10.9%). Readmission rates remained slightly higher at 1 year for both groups. The PICC group demonstrated significantly longer LOS by 2 days (7.72 days versus 5.14 days). While not required for the majority of hand, wrist, and forearm infections, PICC placement is associated with increased medical complications, more frequent hospital readmissions, and longer LOS.

Standardized Communication Tool Improves Inpatient-Outpatient Care Transitions for Adults with Acute Leukemia

Background: Management of adults with acute leukemia involves frequent transitions between high acuity inpatient and intensive outpatient clinical settings. While clinical handoffs between inpatient team members are well-studied, little is known about the optimal means and clinical impact of inpatient-to-outpatient handoffs. The aim of our study was to develop a standardized discharge communication tool using the electronic medical record (EMR). We hypothesized that improvement in consistent inpatient-to-outpatient handoffs at our institution would lead to improved clinical care of adults with acute leukemia. Methods: This project was performed as a quality improvement initiative at The Medical College of Wisconsin and its associated tertiary care hospital, Froedtert Hospital, between November 2020 and April 2022. Survey data was collected from inpatient and outpatient leukemia team members and was utilized to create a standardized communication tool and discharge process that was implemented in May 2021. Team members included physicians (attending, fellow, and resident physicians), advanced practice providers (APPs), and outpatient nursing and scheduling staff. The communication tool was sent by the inpatient team via EMR in-basket messaging approximately 48 hours prior to discharge. Included topics covered anticipated discharge date, types and timing of appointments needed, hospital complications, and results and tasks requiring follow-up. EMR data was collected for all discharged patients from the acute leukemia service including discharge date, follow-up appointments, and compliance with the communication tool. Patients were excluded if they were deceased prior to follow-up or discharged to hospice. 30-day readmission data was obtained from Vizient, and charts were reviewed to identify the primary reason for readmission. A follow-up survey was conducted 9 months after the tool was deployed to assess perceived changes in communication. Primary outcomes included rate of appointments scheduled prior to discharge, adherence with use of communication tool, and perceived success of the communication tool. Secondary outcomes included 30-day unplanned readmission rate and satisfaction with use of the communication tool. Significance testing was performed utilizing Chi-square testing for discrete variables and Mann-Whitney U-test for continuous variables. Results: There were 755 total discharges between November 2020 and April 2022 from the acute leukemia service: 242 (32%) in the pre-intervention group and 513 (68%) in the post-intervention group (Table 1). Compliance with use of the communication tool occurred in 70% of cases. Overall, the percentage of scheduled follow-up clinic visits remained stable between groups (89% vs. 89%), but appointments scheduled prior to discharge significantly increased from 34% to 45% (p=0.007). The percentage of total infusion visits significantly decreased in the post-intervention group (81% vs 72%, p=0.004), but there was a significant increase in those scheduled before discharge (20% vs 33%, p=0.001) (Table 1). Perceptions of communication (strongly agree + somewhat agree) significantly increased regarding timely communication, outpatient staff members being informed of clinical plans, appointments scheduled prior to discharge, and correct appointment types being made (Table 2). There was a non-significant increase in in perceived sufficient communication between teams (Table 2). The 30-day readmission rate decreased from 23% to 16% after implementation of the communication tool (p=0.017) (Table 1). The most common reasons for readmission between November 2020 and April 2022 were neutropenic fever (n=41, 29.1%) and infection not including neutropenic fever (n=21, 15%). Other reasons for readmission included respiratory complaints (n=15, 11%) gastrointestinal complaints (n=14, 10%), and neurologic complaints (n=13, 9%,). Cytopenia, oncologic reasons (treatment or transfusion reactions), and weakness/falls followed for a combined 15% (n=22). Conclusion: Implementation of a standardized discharge communication tool was associated with increased follow-up scheduled prior to discharge, perceived communication between inpatient and outpatient teams and decreased 30-day unplanned readmission rates. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Workflow Improvement after Implementing Remote Blood Allocation Devices at an Academic Medical Center Blood Bank

Abstract Introduction/Objective Patients with hematological cancer routinely receive red blood cell (RBC) transfusions in the outpatient infusion clinical setting as part of their clinical therapy. Typically, RBCs are delivered to the outpatient infusion clinic via the pneumatic tube (P-tube). However, due to the recent expansion of the hospital footprint and the new location of the transfusion services, the P-tube encountered challenges that impacted the reliability of the delivery of RBC, which can delay patient care and affect patient satisfaction. This study’s purpose is to evaluate the pre-and post-implementation of the Haemobank-20 (HB20), remote blood storage and dispensing device, by reviewing the turn-around time (TAT) and the number of orders fulfilled outside of the transfusion service. Methods/Case Report Blood products are stocked to the HB in the infusion center. An electronic transfusion schedule is reviewed the night before scheduled transfusions to ensure appropriate inventory. When a patient is ready for the transfusion, the clinical nurse will use the device to retrieve blood products for the patient from the HB20. The average timed delivery time from the transfusion service to the outpatient infusion center is about 11 minutes. Data was retrospectively gathered from a 10-month interval before and after HB20 implementation to evaluate the number of orders fulfilled by the HB20. Results (if a Case Study enter NA) The HB has helped maintain nurse-to-patient ratios, reduced traffic at the blood bank issue window, and significantly sped up the turnaround time of RBCs from 11 minutes to less than 60 seconds. Before HB implementation, staff at the blood bank received 2853 units of RBCs through the blood bank window. This has been decreased by 61.2 percent to 1136 RBCs. Conclusion Implementing the Haemobank-20 in the outpatient infusion center has successfully reduced the turnaround time and the workload within the Transfusion Services. The current results study demonstrate that the remote blood-release system is safe and helpful in improving the efficiency of blood issue for patients in remote outpatient locations.

Analysis of Electrolyte Abnormalities in Adolescents and Adults and Subsequent Diagnosis of an Eating Disorder

Eating disorders lead to increased mortality and reduced quality of life. While the acute presentations of eating disorders frequently involve electrolyte abnormalities, it remains unknown whether electrolyte abnormalities may precede the future diagnosis of an eating disorder. To determine whether outpatient electrolyte abnormalities are associated with the future diagnosis of an eating disorder. This population-level case-control study used provincial administrative health data for residents of Ontario, Canada aged 13 years or older from 2008 to 2020. Individuals without an eating disorder (controls) were matched 4:1 to individuals diagnosed with an incident eating disorder (cases) based on age and sex. Both groups had outpatient electrolyte measurements between 3 years and 30 days prior to index. Index was defined as the date of an eating disorder diagnosis in any inpatient or outpatient clinical setting for cases. Controls were assigned a pseudo-index date according to the distribution of index dates in the case population. Individuals with any prior eating disorder diagnosis were excluded. The data analyzed was from January 1, 2008, through June 30, 2020. Any electrolyte abnormality, defined as abnormal test results for a composite of hypokalemia, hyperkalemia, hyponatremia, hypernatremia, hypomagnesemia, hypophosphatemia, metabolic acidosis, or metabolic alkalosis. Eating disorder diagnosis including anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified. A total 6970 eligible Ontario residents with an eating disorder (mean [SD] age, 28 (19) years; 6075 [87.2%] female, 895 [12.8%] male) were matched with 27 878 age- and sex-matched residents without an eating disorder diagnosis (mean [SD] age, 28 [19] years; 24 300 [87.2%] female, 3578 [12.8%] male). Overall, 18.4% of individuals with an eating disorder had a preceding electrolyte abnormality vs 7.5% of individuals without an eating disorder (adjusted odds ratio [aOR], 2.12; [95% CI, 1.86-2.41]). The median (IQR) time from the earliest electrolyte abnormality to eating disorder diagnosis was 386 (157-716) days. Specific electrolyte abnormalities associated with a higher risk of an eating disorder were: hypokalemia (aOR, 1.98; 95% CI, 1.70-2.32), hyperkalemia (aOR, 1.97; 95% CI, 1.48-2.62), hyponatremia (aOR, 5.26; 95% CI, 3.32-8.31), hypernatremia (aOR, 3.09; 95% CI, 1.01-9.51), hypophosphatemia (aOR, 2.83; 95% CI, 1.82-4.40), and metabolic alkalosis (aOR, 2.60; 95% CI, 1.63-4.15). In this case-control study, individuals with an eating disorder were associated with a preceding outpatient electrolyte abnormality compared with matched controls. Otherwise unexplained electrolyte abnormalities may serve to identify individuals who may benefit from screening for an underlying eating disorder.

Preoperative Tamsulosin to Prevent Postoperative Urinary Retention after Pelvic Floor Repair Surgery

<h3>Study Objective</h3> The purpose of the study is to evaluate the effect of preoperative Tamsulosin on postoperative urinary retention (POUR) in patients undergoing surgery for pelvic organ prolapse. <h3>Design</h3> A prospective randomized control trial. <h3>Setting</h3> Patients enrolled in the outpatient clinic setting. Medication given in the preoperative area, the day of surgery. Voiding trial was performed in the post-anesthesia recovery unit (PACU). <h3>Patients or Participants</h3> 100 patients were enrolled with 50 in each arm, randomly assigned. Patients diagnosed with pelvic organ prolapse undergoing vaginal or laparoscopic reconstructive pelvic surgery with or without mid-urethral sling. <h3>Interventions</h3> Oral Tamsulosin 0.4mg given 30-90 minutes before the procedure. Active voiding trial was performed within 4 hours of patients arriving to the PACU. <h3>Measurements and Main Results</h3> 48 patients enrolled in the control group and 47 patients in the study group. When comparing demographics, there were no statistically significant differences between the groups except for preoperative uterine prolapse <i>(p<0.05).</i> For the primary outcome, there was no statistically significant difference in incidence of POUR between the 2 groups <i>(p=0.73).</i> A total of 36 patients had POUR; 17 (36.2%) in the study group and 19 (39.6%) in the placebo group. A multivariate cox regression analysis determined that the study group had a hazard risk of 1.1 [95% CI 0.47-2.59] but was not statistically significant <i>(p=0.81).</i> Preoperative uterine prolapse also had an increase hazard risk of 1.25 [95% CI 0.52-3.04] but also failed to meet statistical significance <i>(p=0.62).</i> Postoperative narcotic use <i>(p=1.0)</i> and increased length of surgery <i>(p=0.51)</i> had no increase in POUR. <h3>Conclusion</h3> In this study, the incidence of POUR was not significantly decreased after a single preoperative dose of Tamsulosin. Receiving Tamsulosin with preoperative uterine prolapse had an increased hazard risk for POUR but was not statistically significant. At this time, we do not recommend a single dose of tamsulosin to decrease POUR after prolapse surgery.

Clinical Trial-Ready Patient Cohorts for Multiple System Atrophy: Coupling Biospecimen and iPSC Banking to Longitudinal Deep-Phenotyping

Multiple system atrophy (MSA) is a fatal neurodegenerative disease of unknown etiology characterized by widespread aggregation of the protein alpha-synuclein in neurons and glia. Its orphan status, biological relationship to Parkinson’s disease (PD), and rapid progression have sparked interest in drug development. One significant obstacle to therapeutics is disease heterogeneity. Here, we share our process of developing a clinical trial-ready cohort of MSA patients (69 patients in 2 years) within an outpatient clinical setting, and recruiting 20 of these patients into a longitudinal “n-of-few” clinical trial paradigm. First, we deeply phenotype our patients with clinical scales (UMSARS, BARS, MoCA, NMSS, and UPSIT) and tests designed to establish early differential diagnosis (including volumetric MRI, FDG-PET, MIBG scan, polysomnography, genetic testing, autonomic function tests, skin biopsy) or disease activity (PBR06-TSPO). Second, we longitudinally collect biospecimens (blood, CSF, stool) and clinical, biometric, and imaging data to generate antecedent disease-progression scores. Third, in our Mass General Brigham SCiN study (stem cells in neurodegeneration), we generate induced pluripotent stem cell (iPSC) models from our patients, matched to biospecimens, including postmortem brain. We present 38 iPSC lines derived from MSA patients and relevant disease controls (spinocerebellar ataxia and PD, including alpha-synuclein triplication cases), 22 matched to whole-genome sequenced postmortem brain. iPSC models may facilitate matching patients to appropriate therapies, particularly in heterogeneous diseases for which patient-specific biology may elude animal models. We anticipate that deeply phenotyped and genotyped patient cohorts matched to cellular models will increase the likelihood of success in clinical trials for MSA.

Patient information video: How to take care of your child after hypospadias surgery?

Patient/parent education and participation helps improve post-operative care. Dressing and catheter care after hypospadias surgery varies widely and young parents are keen to use available media when seeking for help, especially if surgery is done in an outpatient setting. An information video about post-operative care after hypospadias is made available through a tertiary referral hospital's website. Hypospadias surgery is an outpatient surgery in our setting. A double diaper system is used to prevent contamination of the urinary catheter and penile bandage with stools. A video explaining how the dressing works was made, helping parents maintaining the dressing and thereby solving possible questions/problems about dressing or medications while at home. Warning signs and symptoms are mentioned in which case parents should contact the urologist: fever, continuous blood loss and lack of urinary output. An information folder summarizing the latter, including a link to the video is given to all parents pre-operatively, providing reassurance according to parents' feedback. Parent participation can help improve post-operative care, especially in outpatient clinic setting. This video helps parents through post-operative care after hypospadias surgery. Its availability through informative folders and hospital's website is destined to educate and reassure parents.

Real-world use of once-weekly semaglutide in patients with type 2 diabetes at an outpatient clinic in Spain.

ObjectivesTo investigate the use of once-weekly semaglutide in a real population of people with type 2 diabetes mellitus (T2DM) in three Spanish hospitals.MethodAn observational, retrospective and multicenter clinical study was designed that included 166 participants with T2DM, distinguishing between a group naïve to GLP-1RA (n=72) and another switching from another GLP-1RA (n=94), all managed in the outpatient clinical setting. The primary endpoint was the change in HbA1c from baseline to the end of the study. The secondary endpoints included changes in body weight and the proportion of people with T2DM, achieving HbA1c <7.0% and body weight loss >5%.ResultsAfter 24 months of follow-up, the reductions in HbA1c were -0.91 ± 0.7% (p<0.001) in the total cohort, -1.13 ± 1.38% (p<0.019) for GLP-1RA-naïve participants, and -0.74 ± 0.9% (p<0.023) for GLP-1RA-experienced participants. Body weight reductions were -12.42 ± 9.1% in GLP-1RA-naïve participants vs. -7.65 ± 9.7% in GLP-1RA-experienced participants (p<0.001). In the total cohort, 77.1% reached the objective of an HbA1c level <7%, and 12.7% reached between 7.1% and 7.5%. Additionally, 66.9% achieved a weight reduction ≥5%. Of all cohort, 90% received 1 mg of semaglutide once a week. The reported adverse events were consistent with the known safety profile of semaglutide.ConclusionsIn routine clinical practice in Spain, the use of semaglutide once a week was associated with statistically significant and clinically relevant improvements in HbA1c and body weight in a wide range of adults with T2DM, without notable adverse effects, which supports real-world use.

COVID-19 vaccine acceptance and perceived risk among pregnant and non-pregnant adults in Cameroon, Africa.

BackgroundThe public health response to the global COVID-19 pandemic has varied widely by region. In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy. The aim of this study was to compare perceptions of COVID-19 infection and vaccination between pregnant women and non-pregnant adults in four regions of Cameroon, located in Central Africa.MethodsA cross-sectional survey study was conducted at urban and suburban hospital facilities in Cameroon. Participants were randomly selected from a convenience sample of adult pregnant and non-pregnant adults in outpatient clinical settings between June 1st and July 14th, 2021. A confidential survey was administered in person by trained research nurses after obtaining written informed consent. Participants were asked about self-reported sociodemographics, medical comorbidities, perceptions of COVID-19 infection, and vaccination. Descriptive statistics were used for survey responses and univariate and multivariable logistic regression models were created to explore factors associated with COVID-19 vaccine acceptability.ResultsFewer than one-third of participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by pregnancy status. Overall, 43% of participants doubted vaccine efficacy, and 85% stated that the vaccine available in Africa was less effective than vaccine available in Europe. Factors independently associated with vaccine acceptability included having children (aOR = 1.5; p = 0.04) and higher education (aOR = 1.6 for secondary school vs primary/none; p = 0.03). Perceived risks of vaccination ranged from death (33%) to fetal harm (31%) to genetic changes (1%). Health care professionals were cited as the most trusted source for health information (82%, n = 681).ConclusionCOVID-19 vaccine hesitancy and misinformation in Cameroon was highly prevalent among pregnant and non-pregnant adults in 2021 while vaccine was available but not recommended for use in pregnancy. Based on study findings, consistent public health messaging from medical professionals about vaccine safety and efficacy and local production of vaccine are likely to improve acceptability.

Validating a Portable Device for Blinking Analyses through Laboratory Neurophysiological Techniques.

Blinking analysis contributes to the understanding of physiological mechanisms in healthy subjects as well as the pathophysiological mechanisms of neurological diseases. To date, blinking is assessed by various neurophysiological techniques, including electromyographic (EMG) recordings and optoelectronic motion analysis. We recorded eye-blink kinematics with a new portable device, the EyeStat (Generation 3, blinktbi, Inc., Charleston, SC, USA), and compared the measurements with data obtained using traditional laboratory-based techniques. Sixteen healthy adults underwent voluntary, spontaneous, and reflex blinking recordings using the EyeStat device and the SMART motion analysis system (BTS, Milan, Italy). During the blinking recordings, the EMG activity was recorded from the orbicularis oculi muscles using surface electrodes. The blinking data were analyzed through dedicated software and evaluated with repeated-measure analyses of variance. The Pearson’s product-moment correlation coefficient served to assess possible associations between the EyeStat device, the SMART motion system, and the EMG data. We found that the EMG data collected during the EyeStat and SMART system recordings did not differ. The blinking data recorded with the EyeStat showed a linear relationship with the results obtained with the SMART system (r ranging from 0.85 to 0.57; p ranging from <0.001 to 0.02). These results demonstrate a high accuracy and reliability of a blinking analysis through this portable device, compared with standard techniques. EyeStat may make it easier to record blinking in research activities and in daily clinical practice, thus allowing large-scale studies in healthy subjects and patients with neurological diseases in an outpatient clinic setting.

Clinical feasibility of cognitive behavioural therapy for insomnia in a real-world mixed sample at a specialized psychiatric outpatient clinic

BackgroundA majority of psychiatric patients suffer from insomnia or insomnia-like problems. In addition to impairing quality of life, sleep problems can worsen psychiatric conditions, such as depression and anxiety, and can make treatment of various psychiatric conditions less successful. Several international guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first line treatment. However, patients in psychiatric care are rarely offered this treatment, and there is a lack of studies evaluating the treatment in regular psychiatric settings. In this pilot study, we aimed to determine the clinical feasibility of a group-based CBT-I intervention in an outpatient clinical setting for patients with depression, bipolar disorder, anxiety disorders and PTSD. We also aimed to investigate if symptoms of insomnia, depression and anxiety changed after CBT-I.MethodsSeventeen patients at an out-patient psychiatric clinic for mixed psychiatric problems of anxiety, affective disorders and PTSD, were enrolled in a six-week long group-based CBT-I intervention. Primary outcomes were pre-defined aspects of treatment feasibility. Secondary outcomes were changes in self-reported symptoms of insomnia severity, depression, and anxiety between pre – and post intervention. Assessment of insomnia severity was also performed 3 months after treatment. Feasibility data is reported descriptively, changes in continuous data from pre- to post-treatment were analysed with dependent t-tests.ResultsAll feasibility criteria were met; there were enough patients to sustain at least one group per semester (e.g., minimum 8), 88% of included patients attended the first session, mean of attended sessions was 4.9 of 6, and drop-out rate was 5.9%. Therapists, recruited from clinical staff, found the treatment manual credible, and possible to use at the clinic. Symptoms of insomnia decreased after treatment, as well as symptoms of depression and anxiety.ConclusionCBT-I could prove as a clinically feasible treatment option for insomnia in a psychiatric outpatient setting.Trial registrationClinicaltrials.gov identifier: NCT05379244. Retrospectively registered 18/05/2022.