Clinical Consultation Research Articles

The Decline of Medicare Reimbursement in Clinical Pathology

Abstract Introduction/Objective Access to clinical pathology services nationwide is threatened by the lack of an annual inflationary update for physician reimbursement from the Centers for Medicare & Medicaid Services (CMS). Most recently, the 2024 Medicare Physician Fee Schedule (MPFS) implemented an overall 2.0% reduction in pathology reimbursement. The effects of recent inflationary trends on clinical pathology physician reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2004 to 2024 for clinical pathology procedures. Methods/Case Report The Physician Fee Schedule Look-Up Tool from the CMS was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. A subset analysis was conducted to assess physician pathology clinical consultation services average annual and total percent change in reimbursement pre- and post- 2022 MPFS Update. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation- adjusted monetary data. Results (if a Case Study enter NA) Prior to adjusting for inflation, the average physician reimbursement decreased by 6.8% from 2004 to 2024 for included clinical pathology CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 44.0% for included CPT codes. The greatest decrease in reimbursement observed from 2004 to 2024 was for flow cytometry interpretation, 2-8 minutes at 69.5% ($114.44 to $34.95) followed by flow cytometry interpretation, 9-15 minutes at 57.8% ($142.77 to $60.25) and flow cytometry interpretation, >16 minutes at 56.6% ($188.05 to $81.55). The average CAGR was -2.86%. Prior to adjusting for inflation, the average physician reimbursement for clinical pathology consultation services pre-2022 decreased by 0.9%, and when adjusted for inflation, decreased by 30.0%. Post-2022 MPFS revision, the average physician reimbursement for clinical pathology consultation services decreased by 3.5%, and when adjusted for inflation, decreased by 12.2%. The average CAGR pre-2022 was -2.0% and post-2022 was -4.3%. Conclusion Medicare physician reimbursement for common clinical pathology procedures is decreasing at an untenable rate annually. It is critical that policymakers understand these trends to ensure continued access to quality clinical pathology care at healthcare institutions.

Red herrings and zebras and TB, oh my! Unexpected bone marrow presentation of Mycobacterium tuberculosis

Abstract Introduction/Objective Epithelioid granulomas are uncommon and non-specific findings in bone marrow samples, and should prompt additional testing for appropriate diagnosis and treatment, especially in the immunocompromised patient. The differential diagnosis for bone marrow granulomas includes infections, neoplasia, autoimmune disease, sarcoidosis, and drug/therapy reaction. Although bone marrow workup to delineate the cause of granulomas should include staining to rule out both infection and lymphoma, morphologic review is often inconclusive. Final diagnosis requires clinical consultation and additional testing. Methods/Case Report A 76-year-old male was admitted to the hospital from the emergency department for a level 2 trauma after being found on the ground ~3 hours after a fall. The patient reported a recent increasing frequency of falls with associated weakness, as well as an almost 30 lb weight loss over the last 3.5 months and low grade fevers over several weeks. His past medical history was significant for treatment for urothelial carcinoma with transurethral resection and BCG therapy, hypertension, coronary artery disease, and peripheral vascular disease. Imaging showed hepatosplenomgaly, suspicious for early cirrhosis, and mild peripancreatic lymphadenopathy. Initial laboratory abnormalities demonstrated mild anemia, low albumin, and mild increase in ALT, AST, and alkaline phosphotase. Initial Infectious Diseases workup was negative for causative etiology (blood cultures, tick-borne parasites, and respiratory pathogens). Patient symptoms did not improve and cytopenias worsened. A bone marrow biopsy showed multiple non-necrotizing epithelioid granulomas. Despite low clinical concern for infectious etiology, mycobacteria blood culture isolated Mycobacterium tuberculosis complex. Final results were available 112 days after specimen collection. Results (if a Case Study enter NA) NA Conclusion Although tuberculosis is commonly associated with granulomatous pathology, infection is very uncommon in North American patients who have not traveled and alternative diagnoses might initially be favored. A high suspicion for mycobacterial infections is essential for diagnosis even in low-incidence populations with no known exposure or risk factor(s).

Several suggestions for improving diagnosis and management of patients with neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disease caused by the mutations in the NF1 gene, with an incidence of approximately 1/3 000. Affecting multiple organs and systems throughout the body, NF1 caused a wide variety of clinical symptoms. A comprehensive multidisciplinary diagnostic and treatment model is needed to meet the diverse needs of NF1 patients and improve their quality of life. In recent years, the emergence of targeted therapies has further benefited NF1 patients, and the number of clinical consultations has increased dramatically. However, due to the rarity of the disease itself and insufficient attention previously, the standardized, systematic, and precise diagnosis and treatment model of NF1 still needs to be further improved. In this paper, we reviewed the current status of comprehensive diagnosis and treatment of NF1 in China, combine with our long-term experiences in diagnosis and treatment of this disease. Meanwhile, we propose future directions and several suggestions for the comprehensive diagnosis and treatment model for Chinese NF1 patients.

What patients with kidney stones believe about their condition.

Patients' beliefs about their illness are of central importance in understanding how a person adjusts to their condition and adheres to self-management recommendations. No previous studies have set out to quantitatively examine Illness beliefs in patients with kidney stones (KS). 112 patients with radiological confirmation of KS (59% male, mean (x̄) age = 50.1 years [sd14.15 years], 50.5% previous surgical treatment) attending for clinical consultation completed the Brief-Illness Perception Questionnaire alongside a range of demographic and illness related variables. Template analysis was undertaken on the free text responses of patients' beliefs about what had caused their KS. Almost a third (31.2%) of patients did not know what had caused their KS. Of those who cited a cause, dietary factors, fluid intake, medical risk factors (e.g. Inflammatory bowel disease), genetics, and psychological factors were ranked as the most important. Patients generally believed they had a reasonable understanding of KS (x̄=6.32 [sd3.21]), but reported poor levels of personal control over their KS (x̄=2.90 [sd2.93]) and high confidence in the effectiveness of treatments (x̄=8.64 [sd1.90]). Patients with a recurrence believed KS had a significantly greater impact on their life (z=-2.56, p = 0.01) and had greater emotional consequences (z=-2.77, p < 0.01). Perceptions of poor personal control over KS and a strong belief in medical/surgical treatment was evident regardless of first or recurrent stone, gender, age, previous surgical management of KS or time since diagnosis. Results highlight the need to actively increase patients' perceptions of personal control in the management and prevention of KS.

Consultation Content and Techniques for measurement-Based Care Implementation in Youth Community Mental Health Settings.

Measurement-based care (MBC) is an evidence-based practice (EBP) focused on regularly administering outcome measures to clients to inform clinical decision making. While MBC shows promise for improving youth treatment outcomes, therapist adoption remains low. Clinical consultation is one strategy that improves MBC implementation, but our limited understanding of consultation hinders the ability to optimize its impact. This research explored the content of, and techniques used during MBC consultation calls. Therapists (N = 55) in a randomized controlled trial treating adolescents with anxiety and/or depression were trained to utilize MBC with usual treatment using the Youth Outcome Questionnaire (YOQ) through an online measurement feedback system (MFS). Weekly ongoing consultation followed an initial workshop training in MBC. Case discussions (N = 294) during consultation calls were coded using a developed codebook, including 12 content and 10 consultant techniques. Results indicated that content focused predominantly on interpretation of client symptom and alliance report, planning for YOQ administration, and discussion of data with clients in session. Common consultant techniques included modeling and eliciting report viewing and interpretation, making clinical suggestions, and didactics about clinical and technical issues. Notably, role-play/behavioral rehearsal was not used. The prevalence of passive consultation techniques (suggestions, didactics) suggests a focus on teaching rather than active techniques (behavioral rehearsal, modeling), potentially influenced by the novelty of MBC and MFS. Technical aspects of MBC, such as measure administration and system usage, emerged as key consultation content, highlighting an unanticipated emphasis on logistics over clinical implementation. These findings underscore the evolving role of consultation in supporting MBC implementation and suggest that addressing technical challenges early in training might enhance adoption.

Bacterial Etiology and Antibiotic Susceptibility in Isolates from Conjunctivitis Patients in Tripoli, Libya

Acute conjunctivitis is described as inflammation of the conjunctiva that lasts less than 3 to 4 weeks, showing cellular infiltration and exudation. Conjunctivitis can cause significant and lasting harm to the eye, resulting in severe inflammation in the corneal lid. This study seeks to isolate and identify the particular bacterial pathogens responsible for conjunctivitis in patients at Tripoli Eye Hospital. Collection of bacterial samples from patients with conjunctivitis was conducted at the ophthalmic consultative clinic within Tripoli Eye Hospital, Libya between September 2021 and January 2022. Tests were done to separate bacterial pathogens causing conjunctivitis and to test their resistance to antibiotics. Among 140 samples, bacterial infection was detected in 86% of cases while 14% yielded negative results. Males had a higher prevalence of bacterial infections at 63% in comparison to females. Both male and female individuals aged 60-79 years had the highest percentage of bacterial conjunctivitis cases at 51%. Segregation tests showed that the majority (82%) were Gram-positive, while a minority (18%) were Gram-negative, with Staphylococcus aureus being the most prevalent bacteria (35%), closely followed by Staphylococcus epidermidis (32%). Streptococcal pneumoniae and Enterobacter spp had rates of 2% which were lower. The majority of organisms showed sensitivity to levofloxacin (43%), while there was only a small amount of resistance to polymyxin B (4%). Professional attention and microbiological research are crucial for verifying clinical diagnoses and carrying out suitable and efficient treatments.

Evaluation of patients who re-admitted to the emergency department within 24 hours

Aim: It was conducted to investigate the demographic and clinical characteristics of patients who re-admitted to the emergency department within 24 hours and to contribute to studies on reducing the re-admission rate. Methods: The data of patients who re-admitted to the emergency department within 24 hours between November 2021 and September 2023 in a secondary level public hospital were retrospectively examined. Data regarding the patients' demographic information, admission dates and times, clinical characteristics, examinations, diagnoses, consultations, hospitalization and referral status were obtained from the hospital automation system. Results: 496270 patients admitted to the emergency department during the study period. 6991 (1.4%) of the patients were admitted to the emergency department again within 24 hours. 40.3% of these patients were between the ages of 19-35 and 52.4% were women. The most common reason for re-admission to the emergency department was upper respiratory tract diseases. It was determined that 66.7% of the patients applied to the emergency department again 13-24 hours after their first admission. In their second admission, 43 patients were hospitalized or transferred for various reasons; It was determined that 1 of these patients died 5 months after being admitted to the intensive care unit. Conclusion: Effective triage practices, directing green area patients to family physicians, making the referral chain effective, increasing health literacy, making an accurate diagnosis, allocating appropriate time to patients and explaining the treatment and expectations from treatment, ensuring that patients referred to polyclinics are evaluated as soon as possible and returned to the emergency department will significantly reduce applications.

Ultrasound assessment of insular development in adequate-for-gestational-age fetuses and fetuses with early-onset fetal growth restriction using 3D-ICRV technology.

This study aimed to evaluate the growth trajectory of the insula in adequate-for-gestational-age (AGA) and early-onset fetal growth restriction (FGR) fetuses and analyze the difference between the two groups using three-dimensional inversion crytal and realistic vue technique (3D-ICRV). Singleton pregnant women, with a gestational age ranging from 20 to 32+6 weeks, who underwent routine examinations at Shandong Maternal and Child Care Hospital between March 2023 and December 2023 were included. The participants were divided into two groups: the FGR and AGA fetuses. Three-dimensional volumes were obtained using transabdominal ultrasound in the transverse section of the fetal hypothalamus based on different gestational ages. 3D-ICRV rendering technology was used for 3D imaging of the fetal insula. Volumes with a clear display of the insula were selected. We observed the morphology of the insula, and measured the area and circumference of the insula. By evaluating the growth trajectory of the insula in AGA and FGR fetuses, differences in insular development between the two groups were compared. Overall, 203 participants were included in this study, with 164 and 39 in the AGA and FGR groups, respectively. The 3D volumes were successfully acquired, and the area and circumference of the insula were measured using 3D-ICRV imaging technology. We found that as gestational age increased, the area and circumference of the insula gradually increased and showed positive correlations with the gestational age, with no significant changes in morphology. The growth rate of insular area and insular circumference in the FGR group is slower than that in the AGA group (insular area: 0.15 vs 0.19 cm2 / week, insular circumference: 0.25 vs 0.28 cm / week). The area and circumference of the insula in the FGR group were significantly different from those in the AGA group (insular area: p = 0.003, insular circumference: p = 0.004). The measured values of the insula using 3D-ICRV identify the differences in insular development between the FGR and AGA fetuses. The findings of this study have important implications for the prenatal evaluation of cortical development and maturity in FGR fetuses and further clinical consultation and management.

Psychological distress and academic success: a two-year study comparing the outcome of two online interventions at a university counseling and consultation service in Italy.

The mental health of college students has been a significant concern in higher education, representing a priority for the institutions. Enhancing effective online interventions could represent excellent support for university counseling services that deal with students' well-being. The present study aimed to evaluate the effectiveness of two online interventions provided by the Counseling and Consultation Service for Students (SACS) of the University of L'Aquila (Italy), namely Videochat with Clinical Mental Health consultation (VCMH) and Therapist-supported Internet Cognitive Behavioral Therapy (Ts-iCBT), a 12-module asynchronous program for anxiety management. The primary outcome was focused on the emotional well-being of students (GHQ-12). The secondary academic outcome was represented by the attainment of their final degree. Students requesting help from the SACS between March 2020 and March 2022 during different periods of the COVID-19 pandemic restrictions were asked to fill out a brief structured screening tool and access the PSYDIT.COM platform. Based on their personal preferences, students chose to access one of the two different online interventions: VCMH and Ts-iCBT. Over the two-year duration of this study, 379 students (267 women, 70.4%) contacted the service. Out of 334 students, 72.5% asked to be included in the Ts-iCBT group, whereas 27.5% expressed a preference for the VCMH group. A statistically significant decrease in emotional distress was obtained by both forms of online intervention, highlighting a better outcome for VCMH. In addition to clinical variables, 28.8% of students who completed online interventions attained their degree, with a statistically significantly higher percentage of graduated students in the Ts-iCBT compared to VCMH group. A high proportion of students (37.7% of total sample) dropped out (DO) of digital interventions, with a statistically significant lower rate of dropouts in the VCMH group. The effectiveness of online interventions is extremely promising and yields a growing source of suggestions for use in providing more tailored interventions. Videochats and frequent therapist online contacts would be recommended for more severe psychopathological conditions. Students in conditions of moderate and non-severe emotional distress who feel more able to "manage the problem alone" could be addressed to asynchronous online interventions.

5144 Lessons Learned: Evaluation of a Fracture Liaison Service Quality Improvement Efforts

Abstract Disclosure: M.S. Rothman: None. D.R. Fixen: None. L.M. Schilling: None. A.M. Elsheikh: None. A.M. Marcus: None. S.J. Billups: None. Background: The Fracture Liaison Service (FLS) care model, a care coordination program for patients experiencing a fragility fracture, is proven to improve management of patients with an osteoporotic fracture, but treatment initiation gaps persist. We describe the evolution of a centralized FLS within a university-based healthcare system, including impact of adding clinical pharmacist consultation and describe circumstances surrounding continued care gaps. Design: Cohort analysis of osteoporosis medication initiation before FLS, after initial implementation, and after addition of pharmacist consultation. Patients: Individuals aged 65 and older experiencing any fragility fracture between 7/1/16 - 3/31/22. Intervention: A centralized team outreached eligible patients, ordered dual x-ray absorptiometry and laboratory tests as needed, and scheduled an osteoporosis-focused primary care appointment. Three years after FLS implementation, clinical pharmacist consultative review was added prior to the primary care visit. Main Measures: Initiation of osteoporosis pharmacologic therapy, completion of DXA, primary care follow-up rate, and description of circumstances where therapy was not initiated. Key Results: Of 1204 new fractures between 7/1/16-3/31/22, 315 patients were enrolled in one of two FLS phases, and 89 eligible historical controls were identified. Medication initiation rates went from 22/89 (25%) pre-FLS to 201/428 (47%) after-FLS phase 1 [POST1], (p&amp;lt;0.001) and to 106/187 (57%) after FLS phase 2 (POST2), when clinical pharmacist consultation was added (p=0.03 versus POST1). DXA was completed in 56/89 (67%) of pre-FLS patients, 364/428 (85%) POST1 patients (p&amp;lt;0.001 versus pre), and 163/187 (87%) POST2 (p&amp;lt; 0.001 versus PRE, p=0.59 versus POST1). Of 375 patients who did not initiate osteoporosis medication, more in the combined post-FLS cohorts attended a follow-up primary care appointment (233/308, 76% attended, versus pre-FLS 41/67, 61% , p=0.016). Conclusion: An FLS including centralized outreach and care coordination significantly improved patient follow-up, DXA, and medication initiation. Addition of de-centralized pharmacist consultation further improved medication initiation rates. Presentation: 6/3/2024

12572 Incidental Adrenal Enlargement On Ct Scan In South Brooklyn Health, How Often Is It Functional?

Abstract Disclosure: R. Ruggiero: None. N. Simon: None. Background: Incidental findings of adrenal hyperplasia are increased due to the widespread rise in cross sectional imaging, as well as improvement of imaging modalities. There is a lack of literature reporting on the prevalence of incidental adrenal hyperplasia. One study reported a prevalence of 11.3%. Adrenocortical hyperplasia can result from endocrine disorders such as ACTH dependent and independent Cushing syndrome, primary aldosteronism, Multiple Endocrine Neoplasia type 1, and congenital adrenal hyperplasia. Other reported causes are radiographic adrenal enlargement of unknown cause and without clinical or biochemical manifestations, inflammation, neoplasms, and depression. Most cases are a radiographic finding with no clinical significance. One study reported that 69.23% of cases were nonfunctional. There are currently no guidelines in place for biochemical evaluation of incidental adrenocortical hyperplasia. Patients are typically referred to endocrinology services. Objective: The purposes of this study was to: 1. Evaluate the number of patients referred to endocrinology clinic for incidental abnormal adrenal imaging. 2. Examine the percentage of abnormal adrenal imaging findings on CT scan, in particular adrenal hyperplasia, that are hormonally active. Methods: This was a retrospective study of patients who were referred to endocrinology clinic or electronic endocrine consult for incidental abnormal adrenal imaging, excluding those with clear diagnosis of masses, nodules, adenomas, or cysts. Data collected included demographics, type of study imaging and radiologist reader, hormonal studies, comorbid conditions such as diabetes mellitus, hypertension, obesity, osteoporosis, as well as visit type to endocrinology service (e-consult vs in person). Results: The total number of consults referred to endocrinology during this period was 138. Due to repeat referral or having an adrenal pathology other than hyperplasia, 83 patients were excluded from analysis. There were 55 patients with isolated adrenal hyperplasia, 86% of whom were Caucasian, 11% Hispanic, and 78% of patients were female. Median age 63 years old. Hypertension was noted in 69% of patients, 36% had diabetes mellitus or dysglycemia, 36% were obese, and 1.8% had osteoporosis. Imaging reading was performed by 3 radiologists, 75% of cases reported by one reader. Only 5% of referrals were answered as an e-consult. About 27% of patients did not show up to establish care. Hormonal workup was completed by 60% of the patients, with 16 % having abnormal findings. One patient required confirmatory workup. No patients required treatment. Conclusion: Adrenal Hyperplasia is often an incidental radiologic finding, that can be reader dependent. Most cases are nonfunctioning without abnormal findings on hormonal workup. E-Consultation can be an efficient tool to help PCP and reduce endocrine clinic visits. Presentation: 6/1/2024

What does current diabetes and endocrine speciality outpatient training look like and what will change? Observations from a single training region in England

Introduction: Diabetes and endocrine speciality training in the UK has traditionally been lasted five years but moved to a four- year model in 2021 with the introduction of the Internal Medical Training (IMT)3 year programme. Here we aim to review the case mix of outpatients seen by a single diabetes and endocrinology Specialty Registrar (SpR) during clinical training and offer insights into the range of patients seen. We will also review the NHS ePortfolio entries for Diabetes and Endocrinology and for General Internal Medicine to establish how many self-entered forms, assessments (completed and expired) and summary assessments are typically undertaken before certification of completion of training (CCT). Methods: A diabetes and endocrinology registrar (JD) kept an anonymised log of all outpatient consultations from starting speciality training as an ST3 in August 2017 up until his CCT was awarded in May 2023. Duration of training was extended because JD was a less than full time trainee (LFTT), with a period of shared parental leave. Non-patient-identifiable data included diagnosis or presenting complaint of patient seen, type of clinic and date of clinic between August 2017 and May 2023. Following CCT, NHS ePortfolio data were reviewed to establish NHS ePortfolio entries, including the number of requested assessments and number of completions. Results: For the last 18 months of training, approximately 40% of JD’s working time was spent on general medicine and 60% on diabetes and endocrinology. Over the total time of training from 2017 to 2023 JD had a total of 4,150 consultations in outpatient clinics. There were 1,347 consultations in the endocrine clinic and 2,803 consultations in the diabetes clinic. There were 472 ePortfolio entries: 158 of these were self-entered, 284 requested assessments completed and 30 summary or progression assessments. 130 requested assessments expired before completion, giving a response rate of 68.5%. Conclusion: Observations from a single training region in England show that five years of diabetes and endocrinology registrar training provided a broad mix and depth of outpatient experience. The greater number of patients seen in diabetes clinic represents the requirement for service delivery in the area and subspecialist interest being developed. The change to four years’ speciality training is likely to represent around 800 fewer consultations as a speciality trainee in diabetes and endocrinology. The reduction in training opportunities could be addressed through having more protected time for specialist teaching clinics, particularly pump and technology clinics. A large amount of evidence from both the trainee and assessors is required in NHS ePortfolio to achieve CCT in diabetes and endocrinology and general internal medicine. Although the data come only from one trainee and one region, they can provide a point of reference for future analysis of the effect of four years’ speciality specific training on the breadth of training and a stimulus for other trainees and other region to reflect and analyse their rota and data.

Preferences for pre-exposure prophylaxis delivery via online pharmacy among potential users in Kenya: a discrete choice experiment.

Oral pre-exposure prophylaxis (PrEP) is highly effective, but coverage remains low in high HIV prevalence settings. Initiating and continuing PrEP remotely via online pharmacies is a promising strategy to expand PrEP uptake, but little is known about potential users' preferences. We conducted a discrete choice experiment (DCE) to assess preferences for online pharmacy PrEP services. We partnered with MYDAWA, an online pharmacy in Nairobi, Kenya. Eligibility criteria were: ≥18 years, not known HIV positive, interested in PrEP. The DCE contained four attributes: PrEP eligibility assessment (online self-assessed, guided), HIV test type (provider administered, oral HIV self-test [HIVST], blood-based HIVST), clinical consultation (remote, in-person) and user support options (text messages, phone/video call, email). Additionally, participants indicated whether they were willing to uptake their selected service. The survey was advertised on MYDAWA's website; interested participants met staff in-person at a convenient location to complete the survey from 1 June to 20 November 2022. We used conditional logit modelling with an interaction by current PrEP use to estimate overall preferences and latent class analysis (LCA) to assess preference heterogeneity. Overall, 772 participants completed the DCE; the mean age was 25 years and 54% were female. Most participants indicated a willingness to acquire online PrEP services, with particularly high demand among PrEP-naive individuals. Overall, participants preferred remote clinical consultation, HIV self-testing, online self-assessment and phone call user support. The LCA identified three subgroups: the "prefer online PrEP with remote components" group (60.3% of the sample) whose preferences aligned with the main analysis, the "prefer online PrEP with in-person components" group (20.7%), who preferred in-person consultation, provider-administered HIV testing, and guided assessment, and the "prefer remote PrEP (18.9%)" group who preferred online PrEP services only if they were remote. Online pharmacy PrEP is highly acceptable and may expand PrEP coverage to those interested in PrEP but not accessing services. Most participants valued privacy and autonomy, preferring HIVST and remote provider interactions. However, when needing support for questions regarding PrEP, participants preferred phone/SMS contact with a provider. One-fifth of participants preferred online PrEP with in-person components, suggesting that providing multiple options can increase uptake.

The 1-minute sit-to-stand test to evaluate fibrotic interstitial lung disease

IntroductionFibrotic interstitial lung diseases (ILD) are a heterogeneous group of conditions. Progression criteria include clinical, imaging, and/or lung functional decline. Currently, the 6-minute walk test (6MWT) is considered the gold standard for assessing exercise-induced desaturation. The 1-minute sit-to-stand test (1STST) has the advantage of being easy to perform, making it feasible for use during clinical consultations. The aim of this study was to compare the 1STST with the 6MWT in patients with fibrotic ILD to detect exercise-induced desaturation. MethodsA multicenter cross-sectional involved patients with fibrotic ILDs from two centers. The 6MWT and 1STST were performed with a 30-minute rest period between the tests. The modified Borg scale was used to assess dyspnea and lower limb fatigue and continuous SpO2 and heart rate were monitored. Desaturation was defined as SpO2 < 90% or decline >3%. ResultsNinety patients were included. The median walking distance in the 6MWT was 432 meters and the median number of repetitions in the 1STST was 22, with a significant correlation (p<0.001, ρ=0.383). In addition, the minimum SpO2 and the desaturation levels recorded during the tests exhibited a moderate significant correlation (p<0.001, ρ=0.502 and p<0.001, ρ=0.537, respectively). There was a strong association between the increase in Borg score for dyspnea and a moderate association between the increase in Borg score for lower limb fatigue after both tests (p<0.001, ρ=0.706 and p<0.001, ρ=0.656, respectively). ConclusionsThis study demonstrates a significant correlation between the 6MWT and the 1STST in detecting exercise-induced desaturation.

A clinical application of gait quality patterns in osteoarthritis

AimTo investigate whether a smartphone-based gait analysis tool can reliably output gait quality parameters that can be cross-analyzed to establish individual & disease-based changes in gait quality patterns. MethodsA cross-sectional study made up of a 48-patients undergoing disability certification at the “Dr. José Castro Villagrana” or the “Dr. David Fragoso Lizalde” Health Centers in Mexico City, Mexico. Their sensorimotor performance was evaluated through an in-house smartphone/IMU based digital tool. Gait was analyzed by means of frequency analysis of the acceleration of the body mass measured at the sternum. A composite gait quality score was determined through principal component analysis based primarily on the explainability and uniformity of gait. Quality independence against demographic variables (age & weight) was tested through ANCOVA. The association between gait quality and gait parameters was analyzed by using multiple linear regression. ResultsA multiple regression model developed with a limited set of gait quality parameters successfully predicted gait smoothness with a 97.05 % accuracy with a mean square error of 0.085 between predicted and actual quality scores. The model demonstrates different predictive capacities across disease groups, with Osteoarthrosis + Osteoporosis having the highest R2 at 0.98 (p < 0.001) and Coxarthrosis having the lowest explained R2 at 0.79 (p < 0.001). ConclusionsThe assessment of gait quality, in family medicine, with low-cost digital tools is an area of opportunity yet to be explored. This tool can potentially disrupt the current disability workflow between primary and specialty care to have an objective method of assessing gait within a clinical consult. Individual patient-level benchmarking can give us insights into the patient's disease status, develop practical intervention strategies, and control the cost and quality of medical care by predicting an individualized course of disability or rehabilitation. Further studies are needed to validate digital gait assessments as clinical decision support tools for day-to-day clinical operations. MeSHGait Analysis, Smartphone, Primary Health Care, Osteoarthrosis

Dr Samir Johna Joins Lamassu BioTech as Clinical Advisor

Dr Samir Johna Joins Lamassu BioTech as Clinical Advisor

Diagnostic evaluation for abnormal uterine bleeding at emergency departments in the United States.

269 Background: Uterine cancer is the most common gynecologic malignancy in the U.S. with well-documented racial disparity in stage at diagnosis (more advanced stage among Black women). As there is no routine screening for uterine cancer, timely and proper evaluation of relevant symptoms is important for early diagnosis. Abnormal uterine bleeding (AUB) is a prominent symptom of uterine cancer, yet data on the quality of care around AUB evaluation are sparse, especially among patients presenting to the emergency departments (ED) who are particularly at risk for delayed diagnosis due to lack of access to primary care. This study aimed to examine the pattern of diagnostic evaluation for AUB in a national sample of women seeking care at EDs and potential racial and ethnic differences. Methods: Using the 2014-2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) data, we identified 7,900,653 (weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB. The primary outcomes were whether an ultrasound was performed/ordered at the ED visit and whether a referral/return to a physician or clinic for follow-up consultation was recommended. Multivariable logistic regressions were fit to assess the association of race and ethnicity with these diagnostic evaluations, while accounting for other characteristics of the ED visit (e.g. patient age, comorbidities, involvement of a consulting physician, type of insurance, geographic region, and metropolitan area location). All analyses accounted for the NHAMCS complex sample design and sampling weight to generate nationally representative estimates. Results: Non-Hispanic Black women were less likely than non-Hispanic White women to receive or have an ultrasound ordered (34.9% vs 42.5%, P = 0.004), which remained statistically significant after adjusting for other characteristics of the visit in multivariable analysis (adjusted OR = 0.58, 95% CI 0.36-0.92). Multivariable analysis also showed a lower likelihood of non-Hispanic Black women receiving referral or recommendation for follow-up consultation, compared to non-Hispanic White women (adjusted OR = 0.54, 95% CI 0.31-0.94). Hispanic women did not differ significantly from non-Hispanic White women in these measures. Perimenopausal age (45-54 years) and location in a non-metropolitan area were associated with a lower likelihood of having an ultrasound performed/ordered or a referral/follow-up consultation recommended. Involvement of a consulting physician at the ED visit increased the likelihood of having an ultrasound performed/ordered while reducing the likelihood of referral/recommendation for follow-up consultation. Conclusions: There is racial disparity in the diagnostic evaluation of AUB among women seeking care at EDs. Future efforts to improve care quality and equity in this area may help reduce disparities in early diagnosis of uterine cancer.

Psychiatry Consultation in Primary Care: Examining Treatment Access for Adolescent Depression

PurposeYouth in the United States are experiencing mental health concerns at an unprecedented level. Child Psychiatry Access Programs offer an innovative approach to close the gap between the need for care and insufficient mental health workforce. This study examined whether primary care provider consultation with a Child Psychiatry Access Program, Michigan Clinical Consultation & Care (MC3), was associated with greater access to treatment for adolescents with moderate to severe depression symptoms. MethodsA retrospective chart review was conducted of primary care visits between 2017 and 2021 for adolescent patients with first-time positive scores on the Patient Health Questionnaire-9. Descriptive statistics and logistic regression were used to examine if patients whose primary care provider used MC3 psychiatric consultations had improved access to depression treatment compared to those who did not. ResultsFour hundred seventy nine patients reported Patient Health Questionnaire-9 scores indicating moderate to severe depression symptoms. Compared to non-MC3 consult patients (n = 409), MC3 consult patients (n = 70) had higher odds of being prescribed antidepressant medications (odds ratio [OR], 2.16; 95% confidence interval [CI] [1.11–4.22], p = .05), 4 times higher odds of having a primary care follow-up visit to monitor depression symptoms (OR, 4.56, 95% CI [2.56–8.14], p < .001), and higher odds of accessing mental health therapy (OR, 2.14; 95% CI [1.13–4.05], p = .05). DiscussionUse of MC3 consultations was associated with increased utilization of evidence-based depression treatments including medication, therapy, and follow-up care. Greater adoption of models such as MC3 may increase the capacity for addressing mental health needs in children.

A novel mobile application is evaluated comparable to clinical consultation for individualized self-assessment of energy need and gap

A novel mobile application is evaluated comparable to clinical consultation for individualized self-assessment of energy need and gap

Association between medication adherence and health-related quality of life among type 2 diabetic adults in Mexico

ABSTRACT Purpose: Previous evidence suggests that non-adherence to medication among patients with chronic diseases might negatively affect their health-related quality of life (HRQoL); however, the evidence in adults with type 2 diabetes (T2D) is not conclusive, and information is scarce in the Mexican context. Therefore, this study aimed to evaluate the association between medication adherence and HRQoL among Mexican adults with T2D. Methods: A cross-sectional analytical study was conducted on a sample of 320 adults with T2D. Participants were recruited from two community health centers in Hidalgo, Mexico. The four-item Morisky Green Levine Medication Adherence Scale and the Short Form 36 Health Survey Questionnaire (SF-36) were used to assess medication adherence and HRQoL, respectively. The associations between the variables of interest were evaluated using logistic regression models. Results: It was found that 78.4% of the participants were non-adherent to medication. After adjusting for confounders, we observed that non-adherent adults were more likely to have poor HRQoL in six domains of SF-36: physical functioning (adjusted odds ratio [ORa] =2.02; 95% confidence interval [95% CI] =1.06, 3.80); physical role (ORa = 2.37; 95% CI = 1.13, 4.96); bodily pain (ORa = 2.71; 95% CI = 1.45, 5.06); general health (ORa = 2.57; 95% CI = 1.37, 4.80); vitality (ORa = 3.30; 95% CI = 1.70, 6.39); social functioning (ORa = 2.97; 95% CI = 1.56, 5.65); and mental health (ORa = 2.66; 95% CI = 1.42, 4.98). Conclusion: Non-adherence to medication was independently associated with HRQoL in Mexican adults with T2D. Therefore, it is necessary to plan awareness interventions to encourage adherence to therapeutic recommendations during routine clinical consultations in primary care.