Follow-up Phone Calls Research Articles

Two-Year Clinical Outcomes of Patients Undergoing Synthetic Cartilage Arthroplasty for First Metatarsophalangeal Osteoarthritis.

Background Severe osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ) is usually treated by arthrodesis, which results in a loss of mobility in the joint.Cartiva (Stryker Corporation, Kalamazoo, USA) is a synthetic cartilage implant (SCI) designed to repair osteochondral defects in thetreatment of the first MTP OA. Treatment using the Cartiva SCI should relieve symptoms of OA whilst sparing motion in the first MTPJ and may provide a superior alternative to arthrodesis. Objectives The objective of this article is to assess the clinical outcomes of a novel SCI, Cartiva, for arthroplasty in the management of the first MTPJarthritis. Study design and methods We retrospectively reviewed 64 patients who had received a total of67 Cartiva implants between May 2016 and June 2020. The average age of these patients at the time of surgery was 54.3 years with a range from 19 to 77 years. Forty-fiveof the 67 implants were used in females and 22 were used in males. Radiological Grade 2 OA was present in 46 cases with Grade 3 in 21 (Hattrup and Johnson classification). Validated patient-reported outcomes measures (PROMs) were used to assess the functional efficacy of the implants. All cases were performed by a single surgeon. The PROMs data was collected via follow-up phone calls with the patients who were asked questions fromthe American Academy of Orthopaedic Surgeons' Foot and Ankle Measure (AAOS-FAM), the EQ-5D-3L survey and the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ). All data collected was anonymised to preserve confidentiality and local hospital ethics committee approval was sought. All statistical analysis was done using Microsoft Excel (Microsoft® Corp., Redmond, WA) and StatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 23.0, Armonk,NY). Results There was a significant improvement in all PROMs at three years, and one patient developed an implant-related infection. The average scores for the EQ-5D-3L survey significantly improved from 0.69 to 0.85 post-operative (post-op) (p<0.05). The mean MOXFQ scores improved from 42.5 to 15.4 post-op (p<0.05). The radiologic evaluation demonstrated satisfactory implant positioning in all cases at the last follow-up. Conclusions The data shows significant improvements between pre-op and post-op scores. The implication of this is that synthetic cartilage arthroplasty provides a viable alternative to arthrodesis in the treatment of OA affecting the first MTPJ. However, more studies may need to be done focusing on larger sample sizes and patients should be observed over a longer term, including a formal multi-centred clinical trial.

Development of a model predicting falls in older emergency department patients using smartphone-based mobility measures.

While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures. This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone. Participants completed baseline assessments, downloaded a custom app to track mobility measures from the iPhone, and were followed for 90 days post-discharge. Fall outcomes were self-reported via the app or follow-up phone calls. Logistic regression and the LASSO technique were employed to identify significant predictors. The discriminative ability of the models was assessed by comparing the C-statistics. Of the 149 participants enrolled, 76.5% (N = 114) provided at least 7 days of post-discharge iPhone sensor-based mobility data. The cohort had a mean age of 73 years, with 16.7% (N = 19) experiencing a fall. Participants who fell showed a significantly greater increase in daily steps over time compared with those who did not (p = 0.002). The extended logistic regression model, by incorporating mean gait asymmetry and change in step count, demonstrated a higher but nonsignificant improvement in discriminative ability (C-statistic = 0.84) compared with the base model (C-statistic = 0.79). This study demonstrates that iPhone mobility measures collected after ED discharge can enhance fall prediction relative to self-reported fall risk screening questions in older adults. The strongest mobility predictors were gait asymmetry and changes in step count. While the findings suggest that post-discharge mobility monitoring could improve fall prevention strategies, further validation in diverse populations is necessary.

What they did next: Using follow-up phone calls to investigate health care access patterns of patients who take their own leave.

The purpose of the present study was to use telephone follow-up (TFU) to investigate the actions taken by patients after they took their own leave (TOL) from an ED, with a focus on priority groups who are at risk of experiencing health inequity. These included people experiencing homelessness (EH), people with a low socioeconomic status by index of relative socioeconomic disadvantage (IRSD) and First Nations people. The primary outcome was being seen by a general practitioner (GP) within 2 days of the TOL event. The utility of the TFU was also examined. This was an observational study of data collected during a quality improvement intervention at an inner-city, tertiary, teaching hospital in Melbourne from January to December 2022. Descriptive results were obtained from a TFU survey that was administered 24-48 h after the TOL event. During the study period, 4209 patients TOL from the ED. Eight hundred forty-one of these were contacted and consented to the TFU survey. 97.7% of patients expressed gratitude at being followed up. Patients EH, compared to patients not EH, were less likely to have seen their GP within 2 days of TOL event (0.295 [0.132-0.661], P < 0.001). Both First Nations patients and those from low IRSD areas were as likely to have seen their GP within 2 days as other groups. Patients EH were less likely to receive GP care within 2 days of TOL. Improving the access and acceptability of health care in these priority groups is important for achieving health equity.

Individualized medication card assists the elderly with medication understanding and adherence

Objective: In the outpatient setting, polypharmacy and poor communication among providers has left a gap in drug education involving the elderly population. Linking all of these providers with an accurate medication regimen may be the answer. Nurses can play a pivotal role in drug-related problems in the elderly population. The aim of this study is to use a liaison nurse to help educate the elderly population on the importance of adherence and understanding their medications by using an individualized medication card.Methods: This study used a descriptive study design. A convenience sample (n = 16) of patients, who were sixty-five years of age or older and were taking five prescription medications daily was employed. After collecting patient demographic information, a counseling session was performed with the patient on their medications using an individualized medication card. Data was then collected via two follow-up phone calls at two and four weeks after initial counseling session using a medication questionnaire and a set of five follow-up questions.Results: Sixteen participants received counseling on their medications and an individualized medication card to take home. Only thirteen participants were reached via phone call, two weeks after their initial counseling session. Of these thirteen, two had lost or forgotten their medication card. Eleven reported that the medication card had been helpful in understanding and adhering to their medications. Of the participants who kept their cards, all were satisfied with the counseling materials and methods used.Conclusions: The findings indicate that the elderly population who were taking five or more prescription medications showed benefit from counseling on their medications using an individualized medication card. Such a tool will help nurse practitioners guide elderly patients in medication education and adherence in future practice.

Design of the SPIROMICS Study of Early COPD Progression: SOURCE Study.

The biological mechanisms leading some tobacco-exposed individuals to develop early-stage chronic obstructive pulmonary disease (COPD) are poorly understood. This knowledge gap hampers development of disease-modifying agents for this prevalent condition. Accordingly, with National Heart, Lung and Blood Institute support, we initiated the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Study of Early COPD Progression (SOURCE), a multicenter observational cohort study of younger individuals with a history of cigarette smoking and thus at-risk for, or with, early-stage COPD. Our overall objectives are to identify those who will develop COPD earlier in life, characterize them thoroughly, and by contrasting them to those not developing COPD, define mechanisms of disease progression. SOURCE utilizes the established SPIROMICS clinical network. Its goal is to enroll n=649 participants, ages 30-55 years, all races/ethnicities, with ≥10 pack-years cigarette smoking, in either Global initiative for chronic Obstructive Lung Disease (GOLD) groups 0-2 or with preserved ratio-impaired spirometry; and an additional n=40 never-smoker controls. Participants undergo baseline and 3-year follow-up visits, each including high-resolution computed tomography, respiratory oscillometry and spirometry (pre- and postbronchodilator administration), exhaled breath condensate (baseline only), and extensive biospecimen collection, including sputum induction. Symptoms, interim health care utilization, and exacerbations are captured every 6 months via follow-up phone calls. An embedded bronchoscopy substudy involving n=100 participants (including all never-smokers) will allow collection of lower airway samples for genetic, epigenetic, genomic, immunological, microbiome, mucin analyses, and basal cell culture. SOURCE should provide novel insights into the natural history of lung disease in younger individuals with a smoking history, and its biological basis.

The impact of multidisciplinary geriatric follow-up on quality of life in older, non-surgical prefrail and frail patients with cancer [sbnd] A randomized controlled trial

IntroductionCancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and MethodsA single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. ResultsIn total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45–1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49–17.5]). DiscussionMultidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial RegistrationRegistered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

Does the Use of Potential Pancreatotoxic Drugs Increase the Risk of Post-Endoscopic Cholangiopancreatography Pancreatitis?

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure for pancreatobiliary disorders but carries significant risks, including post-ERCP pancreatitis (PEP). The exact cause of PEP is unclear, but mechanical and thermal injuries during the procedure and patient-related factors have been implicated. This study aims to investigate the possible contribution of potential pancreatotoxic drug (PPD) exposure to PEP risk. Methods: This was a retrospective, single-centre, cohort study conducted at Canberra Hospital, a tertiary university hospital. Consecutive ERCP performed with native papillae within a 4-year period from January 2019 to January 2023 were evaluated. Details of ERCP procedures, patient characteristics, and all medications were contemporaneously collected. All patients had follow-up phone calls or review within 24 h post procedure. The diagnosis of PEP was based on the Cotton consensus definition. Results: A total of 32 out of 444 patients (7.2%) developed PEP. There was no significant difference in the incidence of PEP between patients taking PPD compared to patients who were not (7.1% vs. 7.6%, p = 0.845). Three factors were independently associated with PEP in the multivariate analysis: the presence of a periampullary diverticulum (OR = 5.4, 95% CI 1.7–15.3, p = 0.002), the performance of pre-cut sphincterotomy (OR = 2.8, 95% CI 1.2–6.4, p = 0.017), and pancreatic duct cannulation (OR = 3, CI 1.3–7, p = 0.01). Conclusions: The overall incidence of pancreatitis in our selected group of ERCP patients with native papillae was 7.2%. Our study did not find the use of PPD to be a statistically significant risk factor for PEP.

Non-Invasive Ventilation for Children Affected by Duchenne Muscular Dystrophy in Ukraine

Background: Duchenne Muscular Dystrophy (DMD) poses significant challenges, especially in Low- and Middle-Income Countries (LMIC) with limited access to Non-Invasive Mechanical Ventilation (NIV), which prolongs life expectancy. Two years after Stage 1 of the successfull “1500 years of survival” NIV programme commenced with 8 DMD boys in Ukraine in 2021, this study further explores the Stage 2 of the programme in 2023. Method: DMD patients underwent a 5-day training program at the National Children’s Clinical Hospital “Okhmatdyt” in Kyiv, Ukraine, utilizing donated second-hand bilevel intermittent positive presure ventilators. Indications for NIV included: sleep-related symptoms, high Apnea-Hypopnea Index (AHI&gt;10 events/hour), decreased Forced Vital Capacity (FVC=50%), low minimum saturation during sleep (SpO2&lt;88%), or age above 17 years. Parallel Masterclass on NIV was conducted for Ukrainian healthcare professionals and patients’ parents. Findings: Thirteen DMD inpatients, aged (mean ± standard deviation) 14.8±2.6 years and FVC of 1.8±0.4L (65.5±22.8% predicted value) were enrolled. Criteria for NIV initiation were: age&gt;17 years (n: 4), FVC% =50% (n :6), AHI&gt;10 (n :2) and SpO2&lt;88% (n :5). Follow-up phone calls were conducted to monitor progress. Three months post-hospitalization, all 13 patients consistently adhered to nocturnal ventilator treatment with a mean use of 7.5 hours per night. Conclusions: Despite the lack of equipment and system of reimbursement, the implementation of the comprehensive Stage 2 training programme supplying NIV for DMD patients in an LMIC such as in Ukraine, was a successful experience. The next steps in the home NIV programme will take place in the coming years.

Exploring Perspectives on Stroke Standard Set Data Collection: A Qualitative Descriptive Study.

BACKGROUND: The International Consortium on Health Outcome Measurement developed a standard set for stroke (SSS) that includes patient-reported outcome measures to help capture patients' perspectives on their poststroke recovery. The objective of this study was to explore the experiences and perspectives of individuals who collected SSS data from patients who were admitted to hospital for a stroke. METHODS: A qualitative descriptive approach was taken. Semistructured, audio-recorded interviews were conducted with individuals employed at 2 acute neurological inpatient units in Southwestern Ontario, Canada. Interviews were transcribed verbatim and written text responses were analyzed directly. Transcripts were coded line by line and then organized into 5 overarching themes: adoption, acceptance, appropriateness, feasibility, and sustainability. RESULTS: Six interviews were conducted with participants from varying roles (eg, nurses, manager, web developer, social worker, medical clerk). Participants reported that patients were receptive to completing the SSS. Follow-up phone calls provided a significant opportunity to monitor patients' recovery postdischarge. Many patients requested medical guidance and help navigating health and social resources for unmet stroke-related needs. Barriers to consistent SSS assessment included high employee turnover and lack of time, space, or capacity for follow-up. To sustain data collection, a dedicated, financially supported neurological nursing role was suggested. CONCLUSION: Participants were supportive of SSS data collection that could provide monitoring, oversight, and follow-up of stroke patients after discharge from acute care. However, the utility of the dataset is heavily dependent on having the data collection process properly resourced.

Examining the Nexus Between Customer Engagement and Satisfaction: Evidence from A Selected Retail Bank in South Africa

In the current retail banking environment, effective customer engagement is crucial for the success of organizations, impacting customer satisfaction, loyalty, and overall business performance. Given the competitive landscape and evolving customer expectations, it is essential for banks, especially Absa bank in South Africa, to understand the dynamics of customer engagement. This study aims to investigate how customer engagement initiatives influence customer satisfaction at Absa bank in the Durban area to provide strategic insights for enhancing competitiveness. Using theoretical frameworks such as Sashi's customer engagement cycle and Gronroos' model of service quality, this research explores the relationship between communication strategies related to organizational change and customer satisfaction levels at Absa bank in Durban. A quantitative research approach was employed, utilizing a structured questionnaire survey and convenience sampling to gather data from walk-in clients at various Absa bank branches. Statistical analyses, including descriptive and inferential methods, were used to analyze the data and test hypotheses. The results of the study offer valuable insights into customer preferences and expectations in the retail banking sector. Customers appreciate consistent messaging across different engagement channels and value personalized communication from the bank. Personalized calls, follow-up phone calls, and nonverbal cues such as a firm handshake were found to significantly impact customer perceptions and satisfaction with Absa bank's services. Customers display a high level of trust, satisfaction, and engagement with Absa bank, indicating the success of its customer engagement initiatives. The study also emphasizes the importance of social media in enhancing positive word-of-mouth and shaping consumer perceptions. Based on these findings, it is recommended that Absa bank implements a proactive customer engagement strategy focused on providing positive and personalized experiences to its existing customers. Key strategies include tailoring customer interactions, soliciting feedback, introducing loyalty programs, and utilizing various engagement platforms.

2250 A mixed-method feasibility study of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥ 75 years

Abstract Introduction Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with negative health outcomes, reducing sedentary time may improve overall wellbeing. This single-arm mixed-method feasibility study explored the acceptability of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥75 years. Methods Participants were recruited from the Community Ageing Research 75+ Study (CARE75+) cohort, with factors such as age, frailty status, living arrangements and levels of sedentariness being considered. The intervention consisted of an educational booklet including advice on how to reduce sedentary behaviour, a smartwatch with a sedentary reminder function, educational group sessions and follow up phone calls. The 9-week intervention was conducted from June–August 2023. Reach, uptake, adherence, and adverse events were recorded, and the acceptability of the intervention was explored through semi-structured exit interviews. Results Of the 39 eligible participants, 10 consented (5 M:5F) and had a mean age 84.3 years. The intervention had an uptake and reach of 25.6%, and retention of 100%. No falls, hospitalisations or deaths occurred, and three cases of mild irritation were reported which resolved during the study. 100% adherence was observed for the group sessions and follow-up phone calls, and 65% for self-monitoring. Qualitative data suggests that participants were receptive of the intervention according to the domains of the Theoretical Framework of Acceptability, and suggestions were provided on refining the intervention components. Conclusion Strategies to reduce sedentary behaviour were tested on a diverse sample of community-dwelling older adults in the oldest old age group, with varying levels of sedentary behaviour and frailty status. The presented strategies appear to be acceptable, appropriate, safe, and high levels of adherence were observed. Participant feedback will be used to refine the intervention.

Dynamic Control of Service Systems with Returns: Application to Design of Postdischarge Hospital Readmission Prevention Programs

Dynamic Control of Service Systems with Returns Postdischarge interventions (e.g., follow-up phone calls, outpatient appointments) are commonly used to reduce unplanned hospital readmissions. Such interventions have been shown to be effective (to varying degrees) in reducing the probability of readmission (or return). The interventions are, however, costly, and hence, their benefits need to be carefully balanced with the costs. In “Dynamic Control of Service Systems with Returns: Application to Design of Postdischarge Hospital Readmission Prevention Programs,” Chan, Huang, and Sarhangian investigate how postservice interventions should be dynamically allocated, accounting for their costs as well as their benefits in terms of reducing returns and congestion costs. To this end, they study a transient queueing control problem and examine the structure of the optimal policy by analyzing associated fluid-control problems. The structural results motivate the design of intuitive surge protocols whereby different intensities of interventions are provided based on the congestion level of the system.

Advancing ocular oncology care through teleophthalmology: a patient-centric perspective

ObjectiveAssessing patient satisfaction is an important component of understanding a program's efficacy and quality. The purpose of this study is to evaluate patient satisfaction with a teleophthalmology program tailored for ocular oncology that provides screening, remote assessment, care planning, and follow-up. Study designRetrospective survey. MethodsAn adapted version of the Telehealth Satisfaction Scale, consisting of the 8 questions plus 5 additional questions specific to the teleophthalmology program, was used to survey patients. The teleophthalmology program involves diagnostic imaging, remote physician assessments, and follow-up phone calls from health care team members to deliver results to patients. For reporting, the Consensus-Based Checklist for Reporting of Survey Studies was used. T-tests explored satisfaction differences across demographics and teleophthalmology visits. ResultsAmong the 95 patients contacted, 91 agreed to participate in the survey (96% response rate). Participants exhibited high overall satisfaction with the teleophthalmology program, reflected in a mean Telehealth Satisfaction Scale score of 28.88 (SD = 3.35 of 32). The median number of teleophthalmology visits completed was 4.0 (range of 1–8 appointments). No significant differences in satisfaction were found on the basis of age (P = 0.56), urban or rural residence (P = 0.17), or the number of telemedicine appointments (P = 0.51). ConclusionsThis analysis displays high satisfaction levels among patients within an ocular oncology clinic participating in the current telemedicine program, irrespective of age, geography, or number of teleophthalmology visits. Participants reported having their health care needs met with minimal clinical encounters due to remote consultations and telephone communications.

Association of maternal infection of SARS-CoV-2 and neonatal susceptibility: A retrospective cohort study

ObjectiveThis study aims to assess the risk of neonatal susceptibility to COVID-19 among pregnant women. MethodsWe conducted a retrospective cohort study involving 1089 pregnant women ≥28 weeks of gestational age, who were categorized into infected and uninfected groups. Data for all participants were collected through a comprehensive review of electronic medical records and follow-up phone calls. The primary outcome was neonatal infection with SARS-CoV-2, while secondary outcomes included delivery patterns and gestational age at delivery. ResultsMaternal vaccination (OR 95%CI:0.63[0.46, 0.85]) and maternal infection with SARS-CoV-2 (OR 95%CI: 0.45[0.34, 0.60]) were found to be associated with a decreased risk of neonatal infection. The infected group exhibited a lower neonatal SARS-CoV-2 infection rate (25.93%) compared to the uninfected group (45.15%). Logistic regression analysis identified several risk factors associated with an increased risk of neonatal infection, including pregnancy BMI (OR 95%CI: 1.04[1.01, 1.08]), age at first pregnancy (OR 95%CI: 1.05[1.01, 1.10]), age at menarche (OR 95%CI: 1.13[1.02, 1.26]), and parturition (Yes vs. No) (OR 95%CI:1.4 [1.04,1.88]). ConclusionMaternal vaccination and perinatal infection with SARS-CoV-2 play a protective role in preventing neonatal SARS-CoV-2 infection.

Epidemiology of Household Transmission of COVID-19 among Patients Attending Outpatient Clinics of Teaching Hospital in Cairo, Egypt

Abstract Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). People in closed settings with COVID-19 patients, such as household contacts, were more likely to become infected. Household studies can provide informative data for COVID-19 prevention and control. Aim to identify the epidemiological features of household transmission in a sample of patients attending the family medicine clinic of a tertiary hospital in Egypt, and to calculate the household COVID19 secondary clinical attack rate for the recruited patients. Materials and Methods An observational follow-up study was conducted among a sample of 180 primary probable COVID-19 cases attending a tertiary hospital in Cairo, Egypt and their 395 household contacts. The modified WHO case reporting form was used for follow-up of primary probable COVID-19 cases, and the modified WHO contact reporting form was used for their household contacts follow-up. Follow-up phone calls were conducted after 7, 10, and 14 days after attending to the hospital. Results The mean household Secondary clinical attack rate is 65.3 ± 29.9 (95 CI: 60.5% - 70.1%). There was a significant statistical association between reporting symptoms consistent with COVID-19 and sharing a room with the primary case, being not vaccinated, not using Personal protective equipment (PPE) as well as taking care of a primary case (p &amp;lt; 0.001). Conclusion and Recommendations Secondary clinical attack rate among the household contacts was high; more than the average reported rates globally. Vaccination and using PPE had important roles in lowering the risk of reporting symptoms consistent with COVID-19 among household contacts, yet the overall rate of using PPE was low and vaccination coverage was low compared to the rates reported globally. which necessitates more efforts to increase awareness of household transmission and how to safely care for a home-isolated COVID-19 case. The presence of co-morbidities increased the risk of hospitalization among symptomatic contacts This gives an alert to increase the awareness of cases with comorbidities about warning signs that necessitate early hospitalization for a better prognosis. about using PPE among household contacts with a COVID-19 case and also about the importance of vaccination against COVID- 19.

Outcomes in Cardiac Transthyretin Amyloidosis and Association With New York Heart Association Class: Real-World Data.

Results from ATTR-ACT (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy)indicate that tafamidis prolongs survival and reduces cardiovascular hospitalizations in cardiac transthyretin amyloidosis (ATTR-CA). However, real-world data supporting these findings are scarce. Thus, we sought to characterize the clinical outcome of patients with ATTR-CA treated with tafamidis in a real-world setting and assess the prognostic role of the New York Heart Association (NYHA) classification. We conducted a retrospective observational study, enrolling a consecutive sample of patients with ATTR-CA (wild-type or variant) treated with tafamidis. Clinical outcome was tracked through follow-up visits or phone calls. Primary outcomes were death and major adverse cardiac events (MACE), a composite end point of death and hospitalizations for acute cardiac decompensation, myocardial infarction, severe arrythmias, or stroke. Kaplan-Meier analysis estimated overall and MACE-free survival including NYHA subgroups (NYHA I/II versus NYHA III). One hundred sixty-seven patients with ATTR-CA (94.6% wild-type) were enrolled and followed for a median of 539 [323-869] days. Median overall survival was not reached. Estimated 1-year, 2-year, and 5-year overall survival among the whole cohort was 93.5%, 85.9%, and 70.2%, respectively. Overall survival was higher in the NYHA I/II subgroup (P=0.002). Median MACE-free survival time was 1082 (95% CI, 962-1202) days. MACE-free survival was higher in the NYHA I/II subgroup (P<0.001). With respective hazard ratios of 5.85 (95% CI, 1.48-23.18; P=0.012) and 3.95 (95% CI, 1.99-7.84; P<0.001), NYHA III was an independent predictor of death and MACE. Treatment of ATTR-CA with tafamidis led to substantial improvements of clinical outcome. NYHA classification at treatment initiation is a reliable tool to provide patients with individualized prognostic information.

Effectiveness of methylene blue as a local anesthetic and analgesic in perianal operations: A prospective double-blind randomized control trial

BackgroundPerianal operations often result in significant postoperative pain, which negatively affects patient comfort and recovery. The search for effective pain relief options has led to the investigation of methylene blue, a biological stain with potential analgesic properties. AimsThis study aimed to evaluate the analgesic and anaesthetic effects of a mixture of methylene blue and lidocaine compared to plain lidocaine in the management of postoperative pain after perianal operations. MethodsA prospective, double-blinded, randomized controlled trial was conducted at a single center between 2015 and 2023. A total of 727 adult patients undergoing perianal surgical operations were randomly assigned to two groups: the experimental group received a solution of methylene blue and lidocaine, while the control group received plain lidocaine. Pain levels were assessed using the Visual Analog Scale (VAS), and follow-up visits and phone calls were conducted. The analysis included 727 participants who underwent operations for perianal abscess, fistula, fissure, and haemorrhoid. The participants were divided into the experimental group (N=329) and the control group (N=398). The data were analyzed using SPSS version 28, applying descriptive and inferential statistical methods. ResultsThe study included a total of 727 patients, with a mean age of 47 years (ranging from 18 to 90 years). Among the patients, 56.5% were males and 43.5% were females. The two groups showed significant differences in terms of postoperative analgesic use and pain-free days (p<0.001). Specifically, the methylene blue group had lower Visual Analog Scale (VAS) scores compared to the control group (p<0.05, p<0.001), respectively. No significant differences in immediate complications were observed between the two groups. ConclusionMethylene blue is an effective intervention for reducing postoperative pain after perianal operations, potentially decreasing the need for additional pain medication. The findings of this study suggest that methylene blue has a promising role in pain management without an increase in complications.

Automatic urine cultures from catheter-obtained samples—time to implement a practice change to improve value

Abstract Objectives Urine cultures are often automatically obtained after urinary catheterization in young children, even in the absence of pyuria, to test for urinary tract infections (UTIs). Although this practice conflicts with some newer guidelines, it is frequently followed in busy emergency departments (EDs) to minimize the need for a repeat invasive procedure. To assess the implications of this longstanding practice, we aimed to describe the frequency and characteristics of children with normal urinalysis (UA) and positive urine culture obtained via catheterization, and to describe their clinical course. Methods A single center, retrospective cohort study was performed for otherwise healthy children aged 6 to 24 months, presenting to a Pediatric ED between January and June 2019 who underwent UTI testing via a urine catheterization. The point-of-care (POC) UA and urine culture results along with any follow-up phone call documentation were reviewed and analyzed using descriptive statistics. Results Of the 818 urine cultures obtained via catheterization during the 6-month study period, 131 (16%) cultures were reported as positive. Of these positive cultures, 14 (10.7%) of the patients meeting inclusion criteria had a normal POC UA. In follow-up phone calls after the ED visit, the majority of these 14 patients were asymptomatic without any antibiotic treatment and 3 (2.3%) patients were still febrile and classified as a potentially missed UTI. Conclusions The routine practice of sending urine cultures from all catheterized urine samples in children 6 to 24 months, regardless of POC UA results, rarely detect missed UTIs. In alignment with more recent practice guidelines, this practice should be reconsidered in low-risk children seen in EDs to improve overall care quality and resource utilization.

Assessment of Discomfort and Analgesic Usage Following Pediatric Dental Procedures in India: A Cross-Sectional Study.

Pain management in pediatric dentistry is crucial for ensuring positive treatment outcomes and reducing patient suffering. This study aimed to evaluate postoperative discomfort and analgesic usage among pediatric dental patients undergoing various procedures in India. A cross-sectional study was conducted at a tertiary care dental hospital in India from June 2023 to December 2023. A total of 150 pediatric patients aged 2-18 years who underwent different dental procedures were included. Data on postoperative discomfort and analgesic usage were collected immediately following the procedure and during follow-up phone calls. Significant differences were found in immediate postoperative discomfort following pulpotomy (P = 0.03). Patients receiving primary stainless steel crowns (SSCs) alone or in combination with pulpotomy were significantly more likely to report discomfort (P < 0.001 and P < 0.05, respectively). No significant associations were observed between discomfort and sealants, preventive resin restorations, 1- or 2-surface restorations, or extractions. Over-the-counter analgesic usage was prevalent, particularly following SSC placement. This study highlights the variability in postoperative discomfort among pediatric dental patients undergoing different procedures in India. Tailored pain management strategies based on specific procedures are essential to minimize discomfort and improve patient outcomes in pediatric dentistry.

Impact of a Mental Health Screening Process in a Pediatric Emergency Department.

The aim of this study was to describe how specific mental health-trained social workers can assist in the evaluations and follow-up of patients presenting with mental health concerns in the pediatric emergency department (ED). Work was performed at a quaternary children's hospital ED with 95,000 annual ED visits across 2 locations. Patients requiring mental health services identified based on presenting complaint or from universal suicide screen were included. Emergency department team first evaluates the patients for medical screening and then consults a team of social workers specialized in acute mental health screening (AMHS). The team evaluates and provides recommendation for disposition and assists in plan completion. For patients not admitted, AMHS team makes 24- and 48-hour calls to ensure safety. We collected and analyzed the data on all eligible patients from September 2015 through June 2019 for (1) demographic information, (2) trends in number of consults to AMHS, (3) disposition plans and trends by year, and (4) frequency of follow-up phone calls. A total of 5950 patient visits were reviewed, for 4454 distinct patients. Most patients were 12 to 17 years of age, female, and White, with Medicaid being the predominant insurance. The most common chief complaint was suicidal ideation/plan/attempt. Self-referrals were the majority of assessments, and 59% of patients were already receiving mental health services. Median team response time was 19 minutes. There was an upward trend in consults. Psychiatric hospitalization was the most common disposition; more than 95% of the other visits had timely follow-up phone calls. Despite an increasing number of patients presenting to the ED with mental health crisis, safe and efficient management is possible with ED staff-social worker partnership. This approach can ensure that eligible patients receive consistent and evidence-based evaluations and can allow ED clinicians to respond to medical emergencies that require their attention.