Patient Contact Research Articles

Quality of life assessment after minimally invasive operative treatment in children with pectus excavatum: A single-center study and literature review.

Most patients with chest wall deformities have a negative body image, which affects their self-esteem and quality of life (QoL). The aim of this study was to evaluate changes in patients' QoL after minimally invasive repair of pectus excavatum (MIRPE). A prospective, single-center study was conducted between 2019 and 2023. We included 20 pediatric patients at a median age of 15 years and 9 months who underwent MIRPE. Two QoL questionnaires were used: the KIDSCREEN-52 and the EQ-5D-Y. The data were statistically analyzed with the Wilcoxon and Mann-Whitney tests. All patients and their parents were asked to complete questionnaires preoperatively and 12 months after surgical treatment. All patients were followed up during the 12-month study period. The study group was comprised of 65% male patients. The median Haller index was 5.0 standard deviation (SD) = 1.58). The assessment of general health condition was higher among the boys (with postoperative improvement), though this finding was not statistically significant. Routine daily activities were easier for all patients after MIRPE (p = 0.048). The patients showed improved physical activity (p = 0.038) and psychological wellbeing (p = 0.013) after elevation of the anterior chest wall. There was no impact on relations with parents, free time or school environment, but we found better patient contact with peers in the postoperative period. A high correlation was confirmed between the parents' and the patients' responses in each questionnaire. Chest wall deformities can have a strong impact on the patient's wellbeing, which is a very important part of psychological development in adolescents. Our study showed that improved QoL should be always considered as an indication for surgical treatment of chest wall deformities in children.

Reproductive cancer cryopreservation services: Patient information, clinical advice, and support.

Fertility preservation services must offer information to patients, prior to their visit, so that they have time to read and digest the information, and also have the opportunity to write down any questions they wish to ask at the oncofertility consultation appointment. Appointments must be offered immediately, based on a specifically designed referral form. Each fertility service providing oncology cryopreservation should have a robust map of the patient's journey to include referral, counseling session, medical consultation, informed consent, treatment plan, and follow-up. Consent for fertility preservation should only be obtained after thorough assessment and discussion with the patient. It must contain basic aspects such as duration of storage, right to dispose or choose alternatives, wishes about stored material if death occurs, and need for patient contact on an annual basis. Appropriate legal advice should be sought in the process of establishing oncology cryopreservation services, most importantly related to patient consent. Ethical and legal aspects of fertility cryopreservation must be considered in the provision of care for cancer patients. Cancer patients attending for cryopreservation have significant concerns in relation to the success of the process, time frame to return for cancer treatment, and safety. Two major nonmedical aspects, coping ability and mortality, are best addressed by counselors and highlight the need to offer this type of psychological support to all cancer patients attending for fertility preservation. The role of genetic counseling is to discuss any potential risks of transmission of the disease to the resulting offspring and offer genetic testing when appropriate. A service based on availability of comprehensive information coupled with in-house implications counseling will have a positive impact and improve the overall care of patients attending for fertility cryopreservation and this should be standard care.

Medication reviews in hospitalised patients for reduced hospital readmission and mortality. Systematic review, meta-analysis and meta-regression of RCTs.

Efforts to reduce preventable medication-related harm through medication reviews have increased, but interventions often yield null-results regarding clinical outcomes. We conducted a systematic literature search in four data bases and summarised the available evidence from randomised controlled trials (RCTs) comparing medication reviews and usual care in hospitalised patients regarding hospital readmissions and all-cause mortality by random-effects meta-analyses. Effect size differences by methodological study differences were of special interest. The meta-analysis of all 24 trials on hospital readmissions, including 12,539 participants, showed a statistically significant 8% decrease in hospital readmissions (risk ratio (RR) [95% confidence interval]: (0.92 [0.88-0.97], p=0.002). The number of patient contacts was the most prominent effect modifier in meta-regression (p=0.003) and the effect of medication reviews was approximately twice as strong (15%) in 11 trials with 2 or more patient contacts (0.85 [0.78-0.92], p<0.001). No statistically significant reduction in all-cause mortality was observed in a meta-analysis of all 22 trials with data for this outcome (0.95 [0.86-1.04], p=0.24), including 12,350 participants. The method of mortality assessment was identified as an effect modifier by meta-regression (p=0.01). A meta-analysis of 10 trials with complete mortality ascertainment via registries or primary care data showed a significantly 19% reduced mortality (0.81 [0.70-0.94], p<0.01)). In conclusion, medication reviews reduce the risk of hospital readmission and might also reduce all-cause mortality. Comprehensive mortality assessment was essential for successful trials. Clinical guidelines should recommend medication reviews with multiple patient contacts, involving pharmacists, either for repeated medication reviews or to improve adherence.

Factors Influencing Choosing Diagnostic Radiology As a Specialty Among Medical Students.

Radiology plays a crucial role in modern healthcare as it facilitates the diagnosis and treatment of various medical conditions in different specialties. Therefore, this study aimed to gain insights into the factors that contribute to medical students choosing radiology as a future career. This cross-sectional study used an online, self-administered questionnaire. Data were collected exclusively from medical students at Imam Abdulrahman bin Faisal University in Saudi Arabia from August to September 2023. The chi-square test was used to assess the factors associated with medical students' choices as a future specialty. A total of 431 eligible respondents completed the survey; 267 (61.9%) were female, and their ages ranged from 18-36 years. When asked about their specialty of choice, 209 (48.5%) were interested in surgery and internal medicine, whereas only 81 (18.8%) chose radiology. Regarding the factors influencing the choice of radiology, the majority (85.6%) reported the importance of lifestyle in their choice, followed by the impact on patient care (83.5%), work environment (82.1%), intellectual challenge (79.8%), presence of procedures (76.6%), degree of patient contact (76.1%), and pre-existing experience of radiology (75.9%). Many factors influence medical students' choices of radiology as a future career. Predominantly, the working environment, current exposure, knowledge of the specialty, extent of patient contact, and work-life balance were chosen as the main factors affecting medical students' choices when considering radiology as a future specialty.

Nutrition Care in Cancer: An Overlooked Part of Patient-Centered Care.

Robust evidence highlights the crucial role of nutrition for people with cancer, and international organizations recognize it as a basic human right linked to health and food. Within this context, we aim to emphasize the critical role of nutrition care for cancer patients and to highlight the essential contributions of nurses in providing patient-centered nutrition care. This opinion paper synthesizes evidence and perspectives from peer-reviewed articles and position papers. Furthermore, insights were drawn from the European Commission's Health Policy Platform thematic network "Integrated Nutrition Cancer Care". Implementation of nutrition care is inconsistent, which can lead to inequalities in care. In oncology, nutrition care is vital as nutrition-related issues significantly impact clinical and patient outcomes. Studies show that cancer nurses can effectively integrate and manage nutrition care. Failure to address nutrition issues negatively impacts an array of patient outcomes and reduces quality of life. Thus, integrating nutrition care throughout routine cancer care is essential. Cancer nurses, as core multidisciplinary team members, are often the initial and consistent contact for cancer patients. They are ideally positioned to play a key role in securing nutrition care throughout the trajectory of cancer care. Cancer nurses should be empowered and enabled to manage all aspects of nutrition care in tandem with dietitians. This approach can improve patient outcomes, enhance quality of life, and ensure equitable access to essential nutrition care for all cancer patients.

Investigating the pre- and post-COVID-19 vaccination infection status of Iranian dental students: a cross-sectional study

BackgroundDental students face a potential risk of COVID-19 exposure due to close patient contact and aerosol-generating procedures. This study explores the frequency of COVID-19 infection among Iranian dental students in 2022 following different vaccination doses.MethodsA cross-sectional study was used to collect self-reported COVID-19 status. A total of 261 dental students volunteered to participate in the study. A total of 252 valid forms were gathered, with a response rate of 96.55%. Data analysis was performed using descriptive statistics, mean and standard deviation, and chi-square and Fisher exact tests by Spss17 (Chicago, USA) software.ResultsThe rate of COVID-19 infection significantly decreased after the first and third doses of vaccination. The rate of COVID-19 infection was not very different after the first, second, and third doses of the vaccine according to the type of vaccine. Despite no significant difference in COVID-19 infection rates between genders, study years, or vaccine types (excluding AstraZeneca), participants who received the AstraZeneca vaccine experienced more serious side effects compared to those who received other vaccines.ConclusionVaccination appeared to reduce the rate of COVID-19 infection among dental students and may have decreased the duration of infection following different vaccine doses. There was no significant difference in infection rates based on the type of vaccine received. Further research is needed to investigate the potential side effects and long-term effectiveness of COVID-19 vaccines.

Five-Year Incidence Rate of Tuberculosis Disease Among Household Contacts of Extrapulmonary Tuberculosis Patients In South-West Karnataka – A Retrospective Cohort Study

Five-Year Incidence Rate of Tuberculosis Disease Among Household Contacts of Extrapulmonary Tuberculosis Patients In South-West Karnataka – A Retrospective Cohort Study

Manual handling and back pain among health care professionals in neurological inpatient and outpatient settings: a mixed methods study

Background: The number of patients with neurological disorders and severe disability is increasing globally. These patients often need help with positioning and the amount of support varies with their level of impairment. High rates of work-related musculoskeletal disorders are observed among healthcare professionals (HCP) with patient contact due to injuries during manual handling. There is insufficient research on manual handling by nurses and other HCP. Objectives: The primary aim of this study was to explore manual handling strategies by HCP in neurological inpatient and outpatient settings. A secondary aim was to explore pain during and post manual handling activities. Design: A convergent parallel mixed methods design. Methods: A quantitative survey was combined with qualitative semi-structured telephone interviews of HCP. The inclusion criteria were licensed allied HCP with at least seven years of experience with neurological patients in inpatient and/or outpatient settings and expertise in manual handling. Exclusion criteria included insufficient proficiency in German and pre-existing illness prior to start of professional education. The survey data were analysed using descriptive statistics and interviews were evaluated through inductive-reflexive thematic analysis. Results: Ten nurses, 10 occupational, 12 physiotherapists participated. Survey findings showed moderate time pressure, body strain, and low back and neck pain during patient transfers. HCPs spent an average of 7.3 (± 5.5) hours per week on personal endurance and strength training. They considered transfer aids moderately important and accessible, predominantly using the transfer board. Interdisciplinary collaboration in patient transfers was reported as crucial and usually available. We identified three themes from interviews: (1) individualised manual handling; (2) facilitating active patient participation during transfers; (3) maintaining personal physical fitness. Conclusions: Neurological symptoms, patient fears, and goal setting necessitated personalised transfer strategies. Patient characteristics, lack of space and time complicated transfers, prompting HCPs to use perception-oriented techniques, leverage, gravity, and momentum.

Occupational-related risk of testing SARS-CoV-2 positive for publicly employed medical doctors in Sweden: A nationwide cohort study.

Doctors have an increased risk of SARS-CoV-2 infection caused by exposure to contagious patients. We aimed to identify which clinical specialities among medical doctors had the highest occupation-related risk of testing positive for SARS-CoV-2, utilizing data for all publicly employed medical doctors in Sweden. Data regarding positive SARS-CoV-2 test results and employment for publicly employed doctors in Sweden were divided into three observation periods: 1) 1 February to 31 December 2020, 2) 1 January to 30 June 2021 and 3) 1 July 2021 to 31 March 2022. Individuals were stratified according to occupation clinic and compared with clinical occupations with little to no patient contact. The risk of testing positive for SARS-CoV-2 was estimated using Cox proportional hazards regression, with sex, age and vaccination status as covariates. The study cohort included all publicly employed doctors in Sweden: 35,028 individuals. In the first period, Infectious Disease doctors had the highest incidence of SARS-CoV-2 positive tests, with an incidence of 20.2 %, compared with 8.7 % in the reference group, and an adjusted hazard ratio of 2.5 (95% confidence interval 2.02-3.04), which decreased during period 2-3. Doctors in Geriatric Medicine had an elevated risk throughout the whole study period. Our study shows an association between working in a speciality that involves caring for contagious COVID-19 patients, which raises concerns about infection control measures and routines being insufficient to prevent occupational infection in future pandemics.

Association between emergency medical services' response times, low socioeconomic status, and poorer outcomes in out-of-hospital cardiac arrest: the MEDIC multicenter retrospective cohort study for disparities in access to prehospital critical care in the Paris metropolitan area.

Prolonged emergency medical services' response times (EMS-RT) are associated with poorer outcomes in out-of-hospital cardiac arrest (OHCA). The patient access time interval (PATI), from vehicle stop until contact with patient, may be increased in areas with low socioeconomic status (SES). The objective of this study is to identify predictors of prolonged EMS-RT intervals, and to evaluate associations with clinical outcomes in OHCAs occurring in the largest metropolitan area in France. Using the Utstein-style, prospectively implemented, population-based SDEC registry for OHCAs, we conducted a multicenter, region-wide, retrospective cohort study of EMS dispatches for OHCA cases occurring in the 124 cities of the Greater Paris area, France, between January 1, 2017 and December 31, 2018. Adult, nontraumatic, EMS-assessed, non-EMS witnessed OHCAs. Geographic location and scene-level SES. The primary outcome was the EMS-RT interval, from activation until arrival at patient's side. As secondary outcomes, we evaluated patient access outcomes of: (1) dispatch-to-patient contact interval ('EMS-RT'); and (2) vehicle scene arrival-to-patient contact interval (PATI); and patient clinical outcomes of: (1) death; and (2) unfavorable neurological status, both at 30 days. Area-level SES was assessed at census tract level using the European Deprivation Index (EDI; continuous, and divided into quintiles, Q5 = most deprived). We fitted multilevel mixed-effects regression models to identify predictors of patient access outcomes, and their association with clinical outcomes. We included 4082 cases; the median EMS-RT was 10.85 min (interquartile range [8.87-13.15]), and 138 (3.4%) survived to hospital discharge. Independent predictors of increased EMS-RT and PATI were age >65, female sex, residential location, occurrence at elevated floors, arrest unwitnessed by a bystander, and low EDI (all P < 0.018). After multivariable analysis, an overall EMS-RT interval >8 min was associated with higher mortality and poorer neurological status at hospital discharge (both P < 0.001). In OHCA cases occurring in the Greater Paris metropolitan area, after adjustment for scene characteristics, EMS delays until patient contact were longer in neighborhoods of low SES, and were associated with poorer clinical outcomes.

Assessing eye health knowledge and practices amongst primary health care nurses in a rural district, South Africa

Background The burden of visual impairment and avoidable blindness has been attributed to the shortage and poor distribution of adequately trained eye care personnel. In the district health system, primary health care (PHC) nurses are the first point of contact for eye care patients. To provide adequate eye care, the nurses in PHC clinics apply their knowledge on basic eye health to ensure best practices and management for patients that present at their clinics. Anecdotal evidence regarding the knowledge and practices of these PHC professionals is scarce. The purpose of this study was to evaluate PHC nurses’ knowledge and practices on eye health. Methods A quantitative, cross-sectional study was conducted in a rural district of the Eastern Cape Province in South Africa. Stratified random sampling was used to select 28 from the 74 PHC clinics in the district. A researcher-administered questionnaire using a 5-point likert scale with options strongly disagree, disagree, neutral, agree and strongly agree, was developed, piloted and finalised for this study. The tool had four sections: demographic information, knowledge of eye health, practices on evaluating visual function and identification and management of presenting eye conditions. Data were collected, captured onto MSXcel, cleaned, coded and analysed descriptively, and for Chi-squared significance at 95%, using R statistical software. Results From 200 responses, 86.4% (n=172) were females of the African race. Most (93.5%, n=187) had never undergone formal training in eye care. Only 28% (n=56) correctly identified a mature cataract while 28% (n=56) correctly identified signs of glaucoma; the global leading causes of preventable blindness. A total of 94% (n=188) failed to accurately measure visual acuity on a patient. Conclusions PHC nurses showed poor knowledge and practices of common eye conditions. There is an urgent need for eye health training for PHC nurses, and the clear management protocols on eye care.

Assessing the Effect of a Pandemic on Emergency Medical Service Response Times and Interventions for Out-of-Hospital Cardiac Arrest.

The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted emergency medical service (EMS) prehospital care for patients with out-of-hospital cardiac arrest (OHCA), necessitating a thorough assessment of its effects on prehospital time and emergency interventions. Therefore, we aimed to analyze the changes in EMS operations before and after the onset of the pandemic and their potential effects on patient care. We retrospectively reviewed OHCA cases between January 2017 and December 2022, categorizing them into pre-pandemic and pandemic phases. We examined the prehospital time from call intake to hospital arrival, analyzing time segments in detail (on-scene arrival, patient contact, loading, and departure) and procedural frequency/location. Changes in prehospital time, requests for hospital admission, laryngeal tube insertion, and venous line establishment were assessed using a multivariate analysis. Among the 925 OHCA cases, the pandemic phase (n = 467) experienced a 3-minute average prehospital delay compared with the pre-pandemic phase (n = 458) (P < 0.0001). Specifically, on-scene arrival time (adjusted odds ratio (aOR): 2.06; 95% confidence interval (CI): 1.36-3.11), laryngeal tube insertions (aOR: 3.2; 95% CI: 2.1-4.9), and post-transport venous access placements (aOR: 1.67; 95% CI: 1.06-2.63) increased. Hospital admission requests also increased significantly (aOR: 9.5; 95% CI: 2.78-32.7). These findings indicate that pandemic conditions delayed EMS responses and altered clinical practices, highlighting the urgent need for EMS system enhancements to improve on-site interventions. Therefore, addressing these challenges, particularly through strategies that expedite early adrenaline administration, is essential for optimizing patient outcomes.

Understanding Healthcare Barriers for Latino/a/e/x Families with Alzheimer's Disease: Insights from Primary Care Provider interviews.

Alzheimer's Disease and Related dementias (ADRD) are disproportionately underdiagnosed, misdiagnosed, and undertreated in Latino/a/e/x populations living in the U.S. Latino/a/e/x families also experience low access to ADRD caregiver support services and high levels of depression. Primary care providers (PCPs) are the first point of contact for patients and their families, and they are critical in understanding the factors associated with disparities in accessing services. This project aims to reflect on the barriers that Latino/a/e/x families experience in accessing and using healthcare services from the perspective of PCPs. The data was collected through structured interviews with 23 diverse PCPs across the US via videoconference or phone calls. Participants were recruited via snowball sampling. Two reviewers used an inductive coding approach to conduct qualitative thematic analysis. The Rigorous and Accelerated Data Reduction (RADaR) technique was used to extract relevant data and organize it into relevant categories. Some of the themes identified reflect the experiences of individuals in the diagnostic process and subsequent care: 1) Family members are usually the first ones to notice the symptoms, 2) Delays in seeking care might be partially influenced by denial from individuals and their families, 3) Language congruency promotes the disclosure of symptoms, 4) Care that is linguistically and literacy appropriate requires additional support of patients and families, and 5) Caregiving expectations and preferences by Latino/a/e/x families do not shield caregivers from feeling burnout. Overall, PCPs reflected that the experiences of individuals are highly influenced by socioeconomic factors, which also influence their care plans. Most Latino/a/e/x older adults with ADRD will be cared for by a PCP at some point during their disease, which means that they require additional support and resources at primary care appointments to address the barriers to accessing care services and enhance health equity in Latino/a/e/x communities.

Acceptance and Completion Rates of 3-Month Isoniazid-Rifampicin (3HR) Tuberculosis Preventive Treatment (TPT) Among Contacts of Bacteriologically Confirmed TB Patients-Patients' and Healthcare Workers' Perspectives.

Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs.

Is it worth it? A comparison study of medical students’ aspirations for gaining the Health Care Certificate following employment as Healthcare Assistants

Background Medical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students’ aspirations for this learning with the realities of employed work as HCAs. Methods This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis. Results The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses’ work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience. Conclusions HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner.

Women's healthcare providers' knowledge and practices surrounding fragile-X associated primary ovarian insufficiency (FXPOI).

This study investigates the knowledge gaps about fragile X-associated primary ovarian insufficiency (FXPOI) among women's healthcare providers. Previous research highlighted a lack of awareness regarding FXPOI as a cause of primary ovarian insufficiency (POI) and its diagnosis. The objective of this study was to describe these gaps and explore demographic factors influencing FXPOI knowledge in women's healthcare practitioners. A survey assessed familiarity with primary ovarian insufficiency and FXPOI knowledge among 107 women's healthcare providers and 14 medical students in the USA. Knowledge Scores, ranging from 0 to 16, were assigned, and demographic data, including healthcare provider type, specialty, and genetics exposure in education or training, were collected. Participants scored an average of 6.92 (± 2.19) out of 16 (42%) despite 88% of participants reporting genetics exposure in training. Maternal fetal medicine (MFM) and reproductive endocrinology (REI) providers significantly outperformed general obstetrics and gynecology (OBGYN) practitioners (p = 0.0186 and 0.0125, respectively). Participants with a genetic counselor in their clinic scored 8% higher (p = 0.0083) than those without. Additionally, medical school graduation year was a significant predictor for knowledge score (p = 0.0397). This study underscores limited FXPOI knowledge among women's healthcare providers, aligning with patient reports. Notably, medical specialty and the presence of a genetic counselor impacted knowledge, emphasizing the urgency for broader education in women's healthcare, particularly among OBGYNs, the initial point of contact for patients with POI symptoms.

Ecological preferences and patient autonomy

Healthcare systems contribute considerably to worldwide carbon emissions and therefore reinforce the negative health impacts of climate change. Significant attempts to reduce emissions have been made on the macro level...

Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic.

During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.

Predictive metabolite signatures for risk of progression to active TB from QuantiFERON supernatants of Household Contacts of TB patients

The identification of individuals with the greatest risk of progression to active tuberculosis (TB) disease from the huge reservoir of Mycobacterium tuberculosis (Mtb) infected individuals continues to remain an arduous ascent in the global effort to control TB. In a two-year prospective study, we analysed metabolic profiles in the unstimulated and TB antigen stimulated QuantiFERON supernatants of 14 household contacts (HHCs) who progressed to TB (Progressors) and 14 HHCs who remained healthy (Non-Progressors). We identified 21 significantly dysregulated metabolites in the TB antigen-stimulated QuantiFERON supernatants of Progressors, of which the combination of Malic acid and N-Arachidonoylglycine had maximum AUC of 0.99. Eighteen significantly dysregulated metabolites were identified in the unstimulated QuantiFERON supernatants of Progressors, among which the combination of Orotic acid and the phosphatidylcholines PC (O-34:1), PC (O-18:1(9Z)/16:0), PC (O-18:1(11Z)/16:0) had the maximum AUC of 0.98. Most of the dysregulated metabolites belonged to the pathways of fatty acid metabolism, lipid metabolism and nitric oxide metabolism. Validation of these metabolic signatures in large, diverse cohorts would pave way for targetted intervention of TB disease.

The Use of Telemedicine in an Interdisciplinary Pain Center in the Years 2020 and 2021 in Germany: Effects of the COVID-19 Pandemic.

Introduction: COVID-19 changed the management of patients with chronic pain. The increased utilization of telemedicine was recommended as a solution. Telemedicine provides medical services by overcoming the geographical distance between practitioner and patient and makes it possible to continue treating the patients with a high level of safety for patients and staff. The aim of our study is to investigate the data on the use of telemedicine in an interdisciplinary pain center in the years 2020 and 2021. Methods: Every patient contact in 2020 and 2021 with the interdisciplinary pain center was registered. Dataset consists of 4,156 patient contacts (N = 1,996 in the year 2020; N = 2,160 in the year 2021). For each patient contact, we collected data on age, sex, place of residence, and the reason or type of the contact. In addition, the incidence rates were used as a data source for the COVID-19 development. Results: In 2020, there was a significant decrease in face-to-face contacts (85.0% to 59.4%) and a significant increase in telemedicine use (especially video calls 0.6% to 20.0%). The use of telemedicine had a temporary peak at the beginning of 2021 (first quarter of 2021: 41.2%). The trend generally reversed during 2021: face-to-face contacts increased again (25.5% to 58.9%) and telemedicine decreased (mainly video calls 41.2% to 25.9%). Conclusion: The results show that telemedicine was successfully implemented in an interdisciplinary pain center during 2020 and 2021. In addition to the software requirements and the data protection, the aspect of digital literacy appears to be relevant. There seems to be a need for an implementation plan in pain centers that includes guidelines for the use of telemedicine.