Clinical Record Research Articles

Factors Related to Favorable Outcomes in Older Adults Undergoing Home-Visit Rehabilitation Therapy.

Increasing elderly population is a major health concern worldwide, requiring various at-home care services. The aim of home-visit rehabilitation therapy is to support at-home living of the elderly and to promote their participation in social activities. There is a paucity of data about the clinical conditions of this population that can contribute to the achievement of goals in-home visit rehabilitation therapy. This study aimed to clarify clinical variables that could be related to the achievement of goals in-home visit rehabilitation therapy. We collected retrospective clinical data of the older adults who underwent home-visit rehabilitation therapy between July 2006 and June 2021. We searched the clinical variables of home-visit rehabilitation therapy users and their frequency of utilization of home-visit rehabilitation therapy services from the clinical record. The initial and final clinical variables evaluated in this study included the abilities of daily living, degree of being bedridden, dementia rating, and levels of support or long-term care. Those variables were evaluated by rehabilitation therapists and doctors. The users were divided into three groups according to the reason for terminating rehabilitation therapy: goal achievement (achieved group), aggravation of underlying disease (aggravated group),and treatment suspension because of their own/others' wish (suspended group). The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were evaluated among the groups. The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were statistically evaluated among those three groups, using the chi-square test and Kruskal-Wallis test. In the achieved, aggravated, and suspended groups, 45, 190, and 38 users were respectively enrolled. The aggravated group showed significantly higher finalcare level (p = 0.002), degree of being bedridden (p=0.001), and dementia rating (p = 0.017) and significantly lower Barthel index scores (p < 0.001) and Frenchay Activities Index scores (p = 0.001) than the achieved group. Persons requesting the therapy were significantly older adults themselves in the achieved group (p = 0.018). The therapy was significantly performed more than once per week in the achieved group (p = 0.018). Older adults undergoing self-motivated home-visit rehabilitation therapy more than once per week may contribute to the achievement of the goal.

Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol

IntroductionEarly sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood...

Mobile Monitoring-Enabled Telehealth for Patients with Complex Chronic Illnesses.

Telehealth has the potential to improve management of poorly controlled chronic diseases relative to clinic-based care alone. Mobile monitoring-enabled technologies could enhance telehealth for chronic illness care. Implementation in practice settings would rely on automated integration of data into the electronic health record (EHR). We describe the integration and visualization of data from four remote monitoring devices into the EHR that is coupled with the evaluation of an evidence-based nurse and pharmacist-led telehealth care model for patients with uncontrolled diabetes and hypertension. Using this new pragmatic infrastructure, clinicians use the EHR to prescribe for patients a suite of devices. Alerts are placed upon the data that notify a clinician when values go above or below set thresholds. These data are visualized in the clinical record and clinicians use the EHR as a tool for efficiently delivering and documenting patient telehealth encounters.

CYTOKINE MULTI-OMICS AND MACHINE LEARNING IDENTIFY MIP1ALPHA AS A NOVEL MEDIATOR IN INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Macrophage inflammatory protein 1 alpha (MIP1a) is a proinflammatory cytokine previously related to murine models of inflammatory bowel disease (IBD), but not definitively in the human disease. MIP1a acts as a chemoattractant of immune cells from the blood to the gut mucosa. We aimed to delineate the alterations to MIP1a and macrophages in relation to a range of IBD severity. HYPOTHESIS To characterize the changes to MIP1a production and localization in response to disease activity in IBD. APPROACH Both IBD (n=63) and control patients (n=118) were enrolled in this study (HSREB 6033229). Cytokine profiles were investigated using a 17-plex multi-fluorescent bead-based immunoassay (FirePlex, Abcam, Cambridge, UK) on serum from a subset of patients. Disease activity and macrophage levels were extracted from the clinical record. Activity was quantified using the Physician Global Assessment Score. Machine learning (ML) was performed with custom R scripts utilizing the tidymodels package (version 1.1) to determine the optimal model. Immunohistochemistry (IHC) was used to localize MIP1a in patient biopsies and quantified using QuPath software (v0.4). RESULTS An extreme gradient boost ML model was found to have optimal sensitivity and specificity for predicting disease activity based on serum cytokine levels. Within this model lower levels of serum MIP1a were associated with higher severity of IBD activity. However, in GI mucosal biopsies, the percentage of MIP1a positive cells in colon tissue increased with the severity of IBD. Macrophage concentrations in the peripheral blood were higher in patients on prednisone, and relatively similar across all other medications used in our cohort. CONCLUSIONS With the data collected, we identify MIP1a as a possible prognostic tool for quantifying IBD activity.

Clinical characterization of a hypersensitivity mixed bacterial and fungal dermatitis in a translational model of porcine NASH.

The development of animal models of chronic liver disease via diet modification is a promising avenue for translational research but can lead to unexpected side effects that impact model adoption. While these side effects are well characterized in rodent models of nonalcoholic steatohepatitis (NASH), limited knowledge of these effects exists for novel porcine models of NASH. To close this gap, the present study investigates the side effects of diet-based NASH induction in pigs, with a systematic analysis of the pathologic mechanisms underlying dermatitis development and evaluation of treatment approaches. Twelve pigs (10 large domestic pigs, 2 Goettingen minipigs) were fed a methionine- and choline-deficient, high-fat diet for 8 weeks to induce NASH. A retrospective review of each animal's clinical record was performed to identify the side effects of the diet. Following the identification of diet-associated dermatitis, severity was judged by using a novel gradation system that characterized the individual lesions and body regions resulting in a cumulative evaluation. In addition to this clinical assessment, the etiology of the dermatitis was investigated via histopathologic and microbiologic testing. Furthermore, the success of prophylactic and therapeutic treatment approaches was evaluated by considering dermatitis development and clinical course. All study animals demonstrated unexpected side effects of the methionine- and choline-deficient, high fat diet. In addition to marked dermatitis, study pigs showed impaired weight gain and developed steatorrhea and anemia. Based on the skin gradation system, five animals developed severe dermatitis, four animals moderate dermatitis, and three animals mild diet-associated dermatitis. Histological and microbiological evaluation of the affected skin showed signs of a hypersensitivity reaction with secondary infection by bacteria and fungi. The analysis showed that preemptive bathing extended the lesion-free duration by nearly 20 days. Furthermore, bathing in combination with a targeted antibiotic treatment represented a helpful treatment approach for diet-associated dermatitis. The provision of a methionine- and choline-deficient, high fat diet represents an effective approach for inducing NASH liver disease in pigs but predisposes study animals to multiple side effects. These side effects are universal to animals on study but can be adequately managed and do not represent a significant limitation of this model.

N01 “Just Live with it”- Exploring patients’ experience of using IBD-F scale in clinical practice – A mixed methods study using focus groups and cross-sectional questionnaires

Abstract Background Inflammatory bowel disease (IBD) related fatigue is one of the most common, yet debilitating symptoms reported by patients with IBD. The causes for the issue are not fully understood, and patients and clinicians alike struggle to communicate about this topic in consultations. In 2014, the IBD-F scale was created to assist this communication, and this study aimed to explore its role in the experiences of patients assessing and managing their IBD fatigue with Health Care Professionals (HCP’s). Methods A mixed methods study was conducted consisting of an online survey and 3 online patient focus groups. The survey was advertised through patient charities and explored individual fatigue assessment and management. 24 patients from across the UK were recruited to participate in the online focus groups, providing 243 minutes of discussion. This data was recorded, transcribed, and anonymised before being coded by two independent researchers. Results The online survey received 426 responses. 272 (64%) respondents reported fatigue levels between 7-10 on a scale of 0-10. When the medical assessment of their fatigue was explored, only 41(10%) respondents reported a medical assessment of the fatigue, 27 (6%) reported being offered support or advice, and 5 (1%) reported that the fatigue had been reassessed. 162 (38%) respondents said they would use the IBD-F on a regular basis and wanted this information to be shared with their medical teams, and 136 (32%) requested the results be attached to their clinical record. The topics arising from the patient focus groups support the notion that fatigue is both overwhelming, and underserved. The main findings are collated into three main themes or “desires”, constructed to represent the patient’s call to HCP's; 1) The desire to “Give up”, 2) The desire to be heard, 3) The desire to change their situation. All groups reported a desire to improve clinical and public education around IBD fatigue and introduce communication tools like the IBD-F into clinical consultations and medical notes. Conclusion This mixed methods exploration highlights a significant, perceived gap in clinical provision for patients experiencing IBD related fatigue. IBD patients are reporting a sense of alienation and abandonment from HCP’s, but also a resounding desire to utilise their voices to educate their medical teams and a willingness to take advantage of additional resources to help improve education, communication and treatment of this symptom. Further research is needed to explore this phenomenon from the HCP’s perspective, and to explore the practical implications of the suggested changes to IBD fatigue education, assessment, and management within these clinical settings. Figure 1:

Further evidence regarding the convergent and discriminant validity of Minnesota Multiphasic Personality Inventory-3 (MMPI-3) scores in the preoperative psychological evaluation of patients seeking metabolic and bariatric surgery

BackgroundPsychological testing is used in some preoperative psychological evaluations of patients seeking metabolic and bariatric surgery. The Minnesota Multiphasic Personality Inventory-3 (MMPI-3) contains new norms, updated item content, and new scales such as Eating Concerns and Impulsivity, which are relevant to the assessment of patients seeking metabolic and bariatric surgery. ObjectiveThe goal of this investigation was to establish convergent and discriminant properties of the MMPI-3 scales with relevant clinical interview and medical record data from electronic medical records. SettingAcademic medical center in the Midwest. MethodsA sample of 790 consecutive patients who completed a preoperative psychological evaluation and took the MMPI-3 were included. Data from medical records and the assessment report were coded by a trained research assistant. ResultsMMPI-3 scale scores demonstrated good convergent and discriminant validity. For instance, the Emotional/Internalizing Dysfunction scales correlated with depression and anxiety disorder, suicide history, sexual abuse history, psychotropic medication use, and eating behaviors. Behavioral/Externalizing Dysfunction scales correlated with alcohol, nicotine, and substance use and eating behaviors such as loss-of-control overeating. The Eating Concerns scale demonstrated the highest correlational patterns with various eating behaviors such as loss-of-control overeating, binge eating, and stress eating. ConclusionsMMPI-3 scale scores perform as well as their Minnesota Multiphasic Personality Inventory-2 Restructured Form counterparts. Newer scales, such as Eating Concerns and Impulsivity, perform particularly well in the assessment of various eating behaviors.

Enhancing Patient Safety in Spain: Streamlining Adverse Event Detection in Occupational Healthcare Records

Background: Given the lack of previous studies on adverse events (AEs) in the area of occupational healthcare in Spain, it is very important to begin to understand this phenomenon in order to act on it. The objective was to accurately quantify AE occurring in occupational healthcare in MC Mutual during May 2021. Methods: We conducted a review of a representative random sample of 250 clinical records to identify AEs through an active search audit, focused on the frequency, type, severity, and preventability of these events, categorized using standardized scales. Results: We detected seven AEs in the sample of clinical records, representing 3% AEs per clinical record, while in the APEAS Spanish Study, they were detected in 10% of patients. The most frequent AE type was postoperative, followed by medication and diagnostic delay. The AEs were of intermediate severity and high severity and with a variable degree of being preventable. Conclusions: The detection of AEs has been useful in the development of projects and action plans such as specific training courses, safety patient newsletters, ambulatory risk maps, and treatment plans framed in the official certification of patient safety. These results should be evaluated in other companies similar to MC Mutual.

Etiological and risk factors in recurrent febrile seizures: Insights through EEG analysis.

Febrile seizures, convulsive episodes in young children during febrile illnesses, are a significant concern due to their potential for recurrence and associated uncertainties. This study investigated the causes and risks associated with recurrent febrile seizures and the critical role of electroencephalogram (EEG) in their accurate diagnosis. Following Institutional Review Board approval and going through the consenting process with parents, this study gathered the clinical features and EEG recordings of children admitted with febrile seizures in the Department of Pediatrics, Mahatma Gandhi Memorial Hospital, Kakatiya Medical College, Warangal, Telangana, India. Descriptive statistics, including mean, standard deviation (SD), frequencies, and percentages, were computed to understand the data comprehensively. The Chi-Square test was employed to analyze the association between variables, with a significance level of 0.05, ensuring reliable and trustworthy findings. Out of 42 children studied, 28 (66.67%) presented with simple febrile seizures, with the mean time of occurrence of seizures from the onset of fever being 7.85 hours. Abnormal EEG was seen in 50% of children with complex febrile seizures and 16% with simple febrile seizures. Generalized epileptiform discharges were the most common epileptic activity observed. Low sodium levels had a significant relationship with febrile seizures in the analysis. This study emphasizes the importance of EEG in diagnosing febrile seizures, particularly in complex cases. Our findings suggest that low sodium levels may be a significant risk factor for febrile seizures. Further research is necessary to identify other preventable risk factors to reduce the burden of the medical condition.

Continuous cardiac monitoring in epilepsy: an implantable loop manual activation algorithm for improving ECG signal acquisition accuracy

BackgroundThe muscle artifacts, caused by prominent muscle contractions, mimicking cardiac arrhythmias, might compromise the ECG signal quality and the implantable loop recorder memory capacity in patients with epilepsy. We developed an epileptic seizures clinical pattern-based implantable loop recorder manual activation algorithm, presenting its real-world efficacy here.MethodsOne hundred ninety-three patients (18–60 years) with drug-resistant focal epilepsy were consecutively enrolled and underwent a subcutaneous loop recorder implantation. Patients with focal onset-aware seizures and patients with focal impaired awareness seizures /bilateral tonic-clonic seizures without aura were recommended to use the activator once - just after the episode. Patients with focal impaired awareness seizures/bilateral tonic-clonic seizures with aura, the caregivers of patients experiencing status epilepticus, were advised to use the activator twice - during the aura and after the episode/ regaining consciousness.ResultsSix thousand four hundred ninety-four ECG traces (4826 - auto-triggered events, 1668 - person-activated events) were recorded and analyzed. The rate of true positive events in the person-activated group was statistically higher than in the autoactivation group (72.5% vs.19.4%, p < 0.0001). Person-activated false-positive events were observed in 30.5% of patients with focal impaired awareness seizures and 27.7% in patients with bilateral tonic-clonic seizures. The highest rate of false-positive events (61.5%) was detected in patients undergoing epileptic status, and the lowest rate (3.8%) - was in patients with focal onset aware seizures. The rate of false-positive events was significantly higher in patients with impaired awareness seizures without aura both in focal impaired awareness (45.5% vs. 19.3%, p < 0.0001) and bilateral tonic-clonic seizure groups (38.8% vs. 5.9%, p < 0.0001).ConclusionsArrhythmias with varying clinical outcomes are expected in epilepsy patients and have been monitored continuously. The specified loop recorder external activation algorithm can improve the clinically relevant cardiac arrhythmia detection accuracy in epilepsy patients and the value of future studies.

Retrospective analysis of referrals for hypoxic challenge testing in children born preterm

IntroductionChildren with a history of bronchopulmonary dysplasia (BPD) may be at risk of hypoxaemia at altitude, such as during air travel. We have performed preflight hypoxic challenge testing (HCT) since...

Evaluating a Hypothetical Learning Trajectory for nets of rectangular prisms: A teaching experiment

The ability to recognize and construct nets is a fundamental aspect of spatial reasoning skills; however, there is a lack of understanding regarding effective instructional sequences for fostering this ability. The aim of this study is to test a Hypothetical Learning Trajectory for enhancing sixth-grade students’ understanding of rectangular prism nets. Conducted over four weeks, this teaching experiment involved 12 sixth-grade students from a public school in Turkey, selected based on varying mathematics achievement levels. Data were collected through clinical interviews, video recordings, and student worksheets. Ongoing and retrospective analyses were employed to describe students’ understanding during the implementation of HLT. The findings detail the results of the teaching experiment and the HLT verified following the experiment. This study contributes to the existing research on students’ understanding of rectangular prism nets and provides valuable insights for mathematics educators aiming to design effective instructional sequences that promote spatial reasoning skills.

Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section.

Cesarean hemorrhage is one of the serious complications, and short-term massive blood transfusion can easily cause postoperative infection and physical stress response. However, predictive nursing intervention has important clinical significance for it. To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section (CS). A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021. According to the different nursing methods, patients divided into control group (n = 50) and observation group (n = 50). Among them, the control group implemented routine nursing, and the observation group implemented predictive nursing intervention based on the control group. Moreover, compared the differences in stress response, complications, and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS. The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing, and the psychological stress response of the observation group was significantly lower than that of the control group (P < 0.05). The heart rate and mean arterial pressure (MAP) of the observation group during delivery were lower than those of the control group, and the MAP at the end of delivery was lower than that of the control group (P < 0.05). Moreover, different pain scores improved significantly in both groups, with the observation group considerably less than the control group (P < 0.05). After nursing, complications such as skin rash, urinary retention, chills, diarrhea, and anaphylactic shock in the observation group were 18%, which significantly higher than in the control group (4%) (P < 0.05). Predictive nursing intervention can effectively relieve the pain, reduce the incidence of complications, improve mood and stress response, and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Improving hospice delirium guideline adoption through an understanding of barriers and facilitators: A mixed-methods study.

This study seeks to understand and address barriers to practitioners' optimal assessment and management of people with delirium in hospices. Retrospective clinical record review to identify areas of low concordance with guideline-adherent delirium care; Survey of healthcare practitioners to identify barriers and facilitators to optimal care; Qualitative interviews with health care practitioners to explore and develop strategies to address barriers or optimise facilitators; Meeting with senior clinical staff to refine identified strategies. Eighty clinical records were reviewed. Elements of poor guideline concordance were identified. Delirium screening on admission was conducted for 61% of admissions. Non-pharmacological management was documented for 59% of those we identified as having delirium from the clinical records. Survey and interview data identified key barriers to delirium assessment as competing priorities, poor knowledge and skills and lack of environmental resources (staff and guidelines, environment). Consultation with staff resulted in strategies to address barriers and enhance facilitators including champions, educational meetings, audit and feedback, and environmental changes (including careful consideration of the staff skills mix on shift and tools to support non-pharmacological management). We conducted a theoretically underpinned, internationally relevant study in a hospice in England, UK. Implementation of strategies should result in greater guideline-adherent delirium care. Further work should test this in practice and include both process and clinical outcomes (e.g., reduction in delirium days).

Chronic diseases among women of reproductive age in primary care: prevalence and associated factors.

To analyze the prevalence and associated factors with chronic diseases among women of reproductive age in primary health care. Cross-sectional study conducted with 397 women of reproductive age living in northern Paraná, Brazil. Data were collected from July 2019 to September 2020. The Women's Clinical Record was used to collect sociodemographic data, risk behaviors, diagnosis of chronic diseases and medication use. Chi-Square test was performed for association analysis, and Logistic Regression estimating Odds Ratio and 95% confidence intervals. The prevalence of chronic diseases among women of reproductive age was 38.53% and the associated factors were: age group from 31 to 40 years old (OR=3.67; p=0.001) and from 41 to 49 years (OR =9.7; p=0.001), incomplete high school education (OR= 2.7; p=0.001), obesity (OR= 2.25; p=0.001) and smoking (OR=2.23; p=0.001). Age at the end of the reproductive phase, obesity and smoking were associated with the presence of chronic diseases. Knowledge of these factors can assist in screening, monitoring and health education actions provided to women of childbearing age.

Molar Incisor Hypomineralisation Patient Assessment: Comprehensive Oral, Clinical Records and Behavior Evaluation.

Comprehensively evaluating molar incisor hypomineralisation (MIH) involves the integration of anamnesis and clinical data to diagnose, create a care plan, and predict prognoses. Anamnesis reveals relationships between defects and time, patient expectations, and impacts on the quality of life. Clinical studies emphasize posteruptive breakdown in yellow-brown opacities, highlighting the importance of identifying risk factors. The classification and recording of the clinical features associated with MIH are essential and allow for the longitudinal follow-up of the patient. Assessment of dental caries lesions, oral hygiene, and pain guides the care plan. Depending on the severity of MIH and associated symptoms, intraoral radiographs and cone beam computed tomography may be necessary. In cases of scheduled extractions, extraoral radiographs, photographs, and study models are indicated. Evaluations of the quality of life, aesthetic perception, and dental fear and anxiety provide valuable insights into the patient's emotional status and guide empathetic practice. A positive dental experience is based on communication with the patient, trust, and the proper use of behavior guidance techniques.

Research on the Aided Diagnosis Method of Diseases Based on Domain Semantic Knowledge Bases

The health care domain is a knowledge-intensive domain. The quality of clinical diagnosis relies mainly on the medical knowledge and experience held by doctors. However, the ability of a single doctor is very limited, so the quality of clinical diagnosis is currently not high. In this paper, an aided diagnosis method based on domain semantic knowledge bases is proposed. Firstly, a domain semantic knowledge base is established by extracting and refining the knowledge of the medicine subject matter domain from the Freebase RDF dumps. Then, based on the semantic knowledge base, the algorithms for calculating the weights of the symptoms in the knowledge base, the relative weights of the diseases related to the input symptom set from a patient, and the related symptom set related to the input symptom set from the patient are proposed. Finally, the clinical medical record data of several common diseases are selected to make an evaluation on the proposed method. For each medical record, the symptom information is extracted from the chief complaint as the patient’s input symptom set. Based on the input symptom set, the method of this paper is used to obtain the list of related diseases and the ranking of disease relative weights. From the disease relevance rankings, the Top 1 (first diagnosis) and Top-3 (first 3 diagnoses) are compared with the doctor’s diagnoses in the medical records. Among them, ovarian cyst has the highest Top-1 and Top-3 hit rates of 67.3% and 89.1%, respectively. Followed by acute upper respiratory tract infection, Top-1 and Top-3 hit rates are 56.6% and 85.2%, respectively. The average Top-1 and Top-3 hit rates are 47.9% and 79.7%, respectively. Compared with the relevant methods, the method of this paper is better. The evaluation results show that based on the domain semantic knowledge base and the aided diagnosis method of diseases constructed in this paper, it is possible to provide aided diagnosis services of a large number of common diseases for general practitioners (especially inexperienced doctors) at the grass-roots level as well as self-diagnosis services of diseases for patients.

Identifying incarceration status in the electronic health record using large language models in emergency department settings.

Incarceration is a significant social determinant of health, contributing to high morbidity, mortality, and racialized health inequities. However, incarceration status is largely invisible to health services research due to inadequate clinical electronic health record (EHR) capture. This study aims to develop, train, and validate natural language processing (NLP) techniques to more effectively identify incarceration status in the EHR. The study population consisted of adult patients (≥ 18 y.o.) who presented to the emergency department between June 2013 and August 2021. The EHR database was filtered for notes for specific incarceration-related terms, and then a random selection of 1,000 notes was annotated for incarceration and further stratified into specific statuses of prior history, recent, and current incarceration. For NLP model development, 80% of the notes were used to train the Longformer-based and RoBERTa algorithms. The remaining 20% of the notes underwent analysis with GPT-4. There were 849 unique patients across 989 visits in the 1000 annotated notes. Manual annotation revealed that 559 of 1000 notes (55.9%) contained evidence of incarceration history. ICD-10 code (sensitivity: 4.8%, specificity: 99.1%, F1-score: 0.09) demonstrated inferior performance to RoBERTa NLP (sensitivity: 78.6%, specificity: 73.3%, F1-score: 0.79), Longformer NLP (sensitivity: 94.6%, specificity: 87.5%, F1-score: 0.93), and GPT-4 (sensitivity: 100%, specificity: 61.1%, F1-score: 0.86). Our advanced NLP models demonstrate a high degree of accuracy in identifying incarceration status from clinical notes. Further research is needed to explore their scaled implementation in population health initiatives and assess their potential to mitigate health disparities through tailored system interventions.

Adherence to Antiretroviral Therapy in People Living with HIV Accessing Care in a Secondary Healthcare Facility in Lagos State, Nigeria

Background: Achieving optimal adherence, referred to as ≥95%, is crucial for the success of antiretroviral therapy (ART) to maintain viral suppression among people living with HIV (PLHIV). Objectives: To assess level of adherence to ART in adult PLHIV in Ikorodu General Hospital, Lagos, Nigeria. Methods: A cross-sectional study in 340 PLHIV ≥18 years using questionnaires to assess knowledge of HIV, ART, adherence, and its barriers. Adherence measures were done with a 4-day self-reported AIDS clinical trial group (ACTG) tool and retrospective pharmacy refill record. Data were analysed using SPSS version 23.0. Good knowledge is a percentage score of ≥ 70. The level of significance was set at p &lt; 0.05. Results: A total of 227 (females 66.8%) with mean age of 42.3±11.3 years were assessed. Poor knowledge of HIV (66.8%), ART (64.9%), and adherence to ART (52.3%) was demonstrated by the respondents. Mean self-reported adherence was 92.78%, while pharmacy refill adherence was 90.91%. Overall, 84.1% achieved viral suppression, with a significant negative correlation between adherence to ART and viral load (R=-0.293, p= 0.035). Waiting time to see caregivers for treatment (Odds ratio (OR): 0.919; 95% confidence interval (CI): 0.745-1.135, p= 0.045), reasons for forgetting to take medicines (OR: 1.135; 95% CI: 0.985-1.308, p= 0.039), and how satisfied patients were with the current ARV regimen (OR: 1.868; 95% CI: 1.040-3.358, p= 0.037) were significant predictors to ART adherence. Conclusion: The sub-optimal self-reported and pharmacy refill adherence rates at the facility shows a need for adherence support interventions for PLHIV on ART.

Cemented femoral stem design and postoperative periprosthetic fracture risk following total hip arthroplasty.

Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented femoral stem design on the risk of PFF.