Follow-up Phone Research Articles

Abstract P190: Health Literacy And Cardiovascular Health: The Multi-Ethnic Study Of Atherosclerosis

Background: Limited health literacy (HL) is associated with individual cardiovascular risk factors and poor risk factor control. The association of HL to composite indices of cardiovascular health (CVH) has not been documented. Hypothesis: Limited HL is associated with suboptimal achievement of ideal CVH as identified by Life’s Simple 7 (LS7). Methods: Included in this analysis are 3766 participants of the Multi-Ethnic Study of Atherosclerosis who completed four HL questionnaire items via follow-up phone calls (2016-2018). Item scores were summed and dichotomized into adequate (≤10) or limited HL (>10). Clinical measures of BMI, total cholesterol, blood pressure, and fasting blood glucose, along with self-reported smoking status, physical activity, and healthy diet were measured at baseline (2000-2002) and categorized by LS7 achievement criteria (poor, inadequate, ideal). LS7 metrics were incorporated into overall CVH (low, medium, high). Poisson regression with robust variance estimation was used to compute prevalence risk ratios and 95% confidence intervals (PRR[95% CI]) of high/medium CVH as well as intermediate/ideal LS7 comparing limited HL to adequate HL. Results: Participants were on average(SD) 59.4(9.13) years old at baseline, 46.0% male, and 58.0% non-white. Prevalence of limited HL was 15.0%. Compared to adequate HL, participants with limited HL were less likely to have medium CVH (0.90[0.84-0.97]) and high CVH achievement (0.53[0.39-0.73]) after adjusting for age, sex, race/ethnicity and field center ( Table ). These associations attenuated with further adjustment for education and income, to 0.94[0.88-1.02] for medium and 0.68[0.50-0.94] for high CVH. Of individual LS7 metrics, limited HL was significantly associated with high glucose levels. Conclusion: Limited HL was associated with suboptimal overall CVH as well as elevated blood glucose levels independent of education. Clinical trials are needed to assess whether improving health literacy enhances CVH.

Delayed antibiotic prescribing to reduce antibiotic use: an urgent care practice change

BackgroundAntibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated with worse clinical outcomes and increased healthcare costs. Studies suggest...

Abstract EP24: Menu Calorie Label Use Is Associated With Healthier Diet Quality In Americans

Background: Unhealthy diet quality is a risk factor for cardiometabolic diseases. The Affordable Care Act mandated menu calorie labeling in many food service businesses to promote healthy food choices, but evidence is limited on whether label use affects dietary intake. Hypothesis: We studied the hypothesis that menu calorie label use is associated with healthier diet quality in a nationally representative dataset. Methods: We included individuals age≥16 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 who reported buying food from a fast food, sit-down, or buffet restaurant or coffee shop in the past year (n=3,823). The exposure, menu calorie label use, was dichotomized to participants who used labels vs. those who did not use labels at any of the mentioned food service sites using the Consumer Behavior Phone Follow-up Module survey data. The primary outcome was diet quality measured by the Healthy Eating Index 2015 (HEI-2015; range 0-100) using two days of 24-hour diet recall data (n=3,809). Secondary outcomes included certain HEI components (added sugars, saturated fats, fruits, vegetables) and total daily calories. We used multiple linear regression to measure the association between label use and outcomes, accounting for the complex survey design of NHANES and adjusting for demographic, socioeconomic, and comorbidity factors. Results: Of 3,806 participants (representing 224,305,985 Americans), 903 (26.9 weighted %) used menu calorie labels. Those who used menu calorie labels were more likely to be younger (μ=43.3 years, SE 0.58), female (60.8%), and with higher educational attainment (college degree or higher 44.6%), and less likely to be low-income (≤200% of federal poverty level 19.5%) compared to those who did not use them (age μ=47.1 years, SE 0.79; female 49.7%; college degree or higher 26.9%; ≤200% FPL 33.6%). Compared to participants who did not use calorie labels, those who used menu calorie labels had HEI-2015 scores that were 3.95 points (95% CI 2.28, 5.63) higher and consumed less calories (β=-240.4 kcal, 95% CI -384.3, -96.5). Of the HEI-2015 components, participants who used menu calorie labels ate more vegetables (β=0.41 points, 95% CI 0.20, 0.62) and less added sugars (β=0.74 points, 95% CI 0.24, 1.24). No differences were seen in saturated fat or fruit intake. Conclusions: Individuals who used menu calorie labels had significantly healthier dietary intake and consumed less calories compared to those who did not use labels, suggesting that providing caloric information may influence healthy food decisions. Those who did not use labels had lower education level and family income. Further research is needed to explore how people use label information to make food choices and why individuals may not use calorie labels to improve utility and effectiveness of point-of-purchase nutrition information without amplifying health disparities.

Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study.

BackgroundVital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD).ObjectiveThis study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology.MethodsIn total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ≥85% for HR and ≥80% for RR, based on the device’s proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls.ResultsIn total, 84% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76%, SD 26%). There was greater adherence in the stable group than in the post-AECOPD group (≥5 weeks wear: 71.4% vs 45.7%; P=.02). For all 84 participants, the median HR signal quality was 90% (IQR 80%-94%) and the median RR signal quality was 93% (IQR 92%-95%). The median HR data quality was 81% (IQR 58%-91%), and the median RR data quality was 85% (IQR 77%-91%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=–0.49, P=.009; rs=–0.44, P=.02). In total, 36 (74%) participants in the Stable group and 21 (60%) participants in the AECOPD group accepted the technology, but 10 participants (12%) expressed concerns with wearing a device around their chest.ConclusionsThis wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context.

The acceptability of two remote monitoring modalities for patients waiting for services in a physiotherapy outpatient clinic.

Access to public rehabilitation services for patients with non-urgent conditions - which suffer mainly from musculoskeletal disorders - is problematic around the world. Remote rehabilitation services are recognized as effective means to increase accessibility. Patient acceptability is an important element in the successful implementation of such clinical innovations and has not yet been studied thoroughly in this context. Thus, the aim of this study was to evaluate and compare the acceptability of two remote consultation modalities - phone and teleconsultation - for patients waiting for public outpatient non-urgent rehabilitation services. We conducted a qualitative descriptive study nested within a randomized clinical trial in which participants received either phone or teleconsultation follow-ups with a physiotherapist after a first systematic face-to-face evaluation. Semi-structured interviews were conducted with participants of both groups selected with purposive sampling. Sekhon's acceptability metaframework was used and interviews were transcribed and coded with thematic analysis. The research protocol was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS) (#2019-2919). Twenty participants were recruited. Results show both follow-up modalities have a good level of acceptability for participants; however, teleconsultation stands out because its visual dimension offers higher quality human contact and satisfactorily meets greater needs for support. Systematic in-person assessment and advice combined with telephone or teleconsultation follow-up can contribute to diversifying the services offered in physiotherapy outpatient clinics. Offering a range of service modalities with different resource requirements may shorten wait times. Such an approach seems to be well accepted by patients, especially with teleconsultation. gov ID: NCT03991858.

Predictors of maternal self-efficacy and the mediating role of postpartum fatigue for Jewish and Arab women in Northern Israel

ObjectiveThe study aims to investigate positive and negative social interactions as predictors of maternal self-efficacy and to examine the mediating role of postpartum fatigue. DesignParticipants included 450 Arab and Jewish mothers of healthy one-month-old infants who visited 14 well-baby care clinics located in northern Israel. The study used a prospective longitudinal cohort design. Participants completed the first questionnaire and agreed to a follow-up phone interview three months later. Both ethnic groups had a response rate of 90% for the follow-up interview. The questionnaire included six scales that measured socioeconomic status and demographics, obstetric characteristics, social networks and support, negative social interactions, fatigue and maternal self-efficacy (MSE). The phone interview was a shorter version of the written questionnaire focusing on MSE and fatigue. Maternal self-efficacy four month after birth was examined with social support, negative interactions and fatigue, using multiple linear regressions within each ethnic group. FindingsIn both groups, negative social interactions decreased perceptions of maternal self-efficacy. Women who reported higher social support after birth experienced a greater sense of maternal self-efficacy four months after birth, though the association was stronger among Jewish women. Post-partum fatigue affects Arab and Jewish mothers differently. Among Arab mothers, fatigue at one month mediates MSE as well as the relationship between social support and negative interactions at four months. Among Jewish mothers, these factors are directly related to MSE, with no mediation effect. Implications for practiceThe correlations found between social interactions, fatigue and maternal self-efficacy can be useful in providing appropriate care that includes information and parental support. Health professionals working with postpartum women must assess degree of postpartum fatigue and negative postpartum social interactions as well as social support during the postpartum period.

Abstract TP28: Stroke Care Doesn't End At Hospital Discharge: What Patients Need After Hospital Discharge May Not Always Be Obvious

Introduction: Mood disorders after stroke are common, with up to one-third of patients developing depression and/or anxiety. Identifying those at greatest risk may be challenging in the acute care setting. We sought to better understand post-hospital barriers impacting emotional well-being for those who suffered a stroke and to evaluate needs for additional resources post hospital discharge. Methods: A Stroke Transitional Care Program (STCP) was initiated at a large two-campus hospital in Southern California in October 2020. All patients discharged home with acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA) received a follow-up phone within 3-7 days of hospital discharge from a community health worker familiar with the community and language. An initial needs assessment was completed over the phone to evaluate barriers for post-hospital care, address social and economic needs, and help patients navigate the healthcare system. Data from the initial needs assessment results were analyzed and 30-day readmission data reviewed. Results: A total of 145 patients with a stroke diagnosis were discharged home between October 2020 and June 2021. Of those, 68.3% were discharged with AIS, 21.4% with TIA, and 10.3% with HS. Initial assessments of the 100 patients accepting enrollment into the STCP were reviewed. Fifty-six patients required additional resources, of which 55% required counseling, emotional support, and/or mental health resources. Nine percent of patients were readmitted to the hospital within 30 days. Of these, 22% were admitted for isolated psychiatric issues. Conclusion: A large portion of the stroke patients in our analysis required additional resources post discharge to support emotional well-being, and 22% of patients who required hospital readmission were admitted for psychiatric issues. As a result of these findings, our STCP incorporated the PHQ-2 screening as a standard part of initial post-discharge assessment and implemented a referral process to mental health services. Our results suggest the need for stroke programs to consider implementing processes to assess emotional/psychiatric needs for stroke patients post discharge by incorporating community-based models of care.

Evaluation of a Diabetes Prevention Intervention for Korean American immigrants at Risk for Diabetes.

PurposeDespite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC).MethodsKorean Americans at risk for diabetes were recruited into a culturally adapted, community health worker (CHW) intervention in NYC. Treatment group participants received 6 group sessions and 10 follow-up phone calls from CHWs over the 6-month period. Control participants received only the first session. Study outcomes included changes in weight, body mass index (BMI), blood pressure, physical activity (PA) and PA behaviors, nutrition behaviors, and diabetes knowledge. Paired t-tests and chi-square tests assessed group differences for each group for each outcome measure.ResultsThe treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge.ConclusionsResults suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.

Abstract TP33: Stroke Navigators: Closing Patient Educational Gaps

Background: A critical component in preventing Cerebral Vascular Accidents (CVA) and Transient Ischemic Attacks (TIAs) is knowledge of risk factors and, signs and symptoms of a stroke, and follow-up care with a neurologist and primary care provider. To prevent readmission to the hospital for a second CVA, a large hospital system outside the District of Columbia has implemented a Nurse-led Stroke Education program. Purpose: Introduction of a full-time Stroke Navigator will improve patient education for Ischemic and TIA patients, through a nurse-led Stroke Education program. Methods: Phase 1: The Stroke Navigator in conjunction with the bedside RN will provide personalized stroke education to patients who suffer from a CVA or TIA. Phase II: The Stroke Navigator will conduct a follow-up phone call of patients discharged with a diagnosis of stroke or TIA within seven days. The phone call will assess patient’s knowledge of their risk factors, the symptoms and symptoms associated with a stroke, medication compliance, and follow-up medical appointment compliance with a Primary Care Provider (PCP) and Neurologist. Results: Data was reviewed from January –May 2021(n=87) prior to the implementation of the stroke navigator role, and from June –July 2021(n=57) after integration of the role. Patients’ follow-up compliance with their PCP increased from 34% to 68%. Follow-up with a neurologist increased from 8% to 44%. Medication Compliance decreased from 99% to 89%. Patients’ knowledge of signs and symptoms of stroke increased from 8% to 18%. Patients’ knowledge of their personal risk factors for stroke decreased from 45% to 35%. Conclusion: Data surrounding implementation of a full time Stroke Navigator has made a positive impact on patient’s post-stroke knowledge and care surrounding follow-up with providers and knowledge of signs/symptoms of stroke. The Stroke Coordinator and Stroke Navigator will continue to measure quality outcomes over time to determine if the stroke education program is continuing to positively impact post-discharge patient care.

Abstract WMP45: Feasibility, Acceptability, And Accuracy Of A Text-messaging Program For Outcomes Data Collection In Patients After Stroke

Introduction: Robust outcome data collection is critical for stroke care and clinical trials. However, reaching patients after discharge from acute care is challenging. This study examined the feasibility, acceptability, and accuracy of collecting outcomes through a text message-based program after stroke. Methods: Patients discharged between June 8 th , 2020 and February 1 st , 2021 from Massachusetts General Hospital with an ICD-10 Code of stroke who consented to receiving messages, were enrolled in a message-based program upon acute stroke discharge. Participants received weekly brain health tips and assessments of the Modified Rankin Scale (mRS) and PROMIS Global-10 at 30, 60, and 90 days post-stroke via text message prompts. Participants were sent a satisfaction survey upon program conclusion. Data from routine 90-day follow-up phone calls were extracted from clinical charts of patients discharged during a representative 3 month period for comparison. Descriptive statistics, group comparisons, and inter-modal reliability (text message versus phone) were performed. Results: Of 530 patients with stroke discharged during the study period, 350 enrolled in the message program. Forty-one percent of the patients answered one or more of the assessment prompts. The 90-day mRS collected by messaging was 1[0-3] and the PROMIS Global Physical and Mental Health were 15[12.5-17] and 13[11-16], respectively. We reached 104/169 (61.54%) patients by phone. There were no statistically significant differences on 90-day outcome scores between those who responded via messages or phone. Inter-modal reliability (message versus phone) was moderate for mRS (κ=.521) but poor for PROMIS scores (κ<.1). Nearly all participants (90%) felt it was helpful to receive information about stroke via messages and found the program adequate (63%) and not burdensome (94%). Discussion: Post-stroke outcomes data collection via text-messaging is feasible, acceptable, and moderately accurate compared to phone-based methods. Inter-modal reliability was higher for functional outcomes as compared to PROMs. Further validation of specific measures is required; yet, these findings suggest that future programs could use messaging to identify patients at risk for poor outcome.

Strengthening therapeutic adherence and pharmacovigilance to antimalarial treatment in Manaus, Brazil: a multicomponent strategy using mHealth

BackgroundPublic health initiatives for improving adherence to primaquine based regimens and enhancing effective pharmacovigilance are needed to support the efforts for malaria elimination in real world conditions.MethodsA multicomponent patient-oriented strategy using a Smart Safety Surveillance (3S) approach including: (1) educational materials for treatment counselling and identification of warning symptoms of haemolytic anaemia; (2) an mHealth component using Short Message Service (SMS) treatment reminders and (3) development and implementation of follow-up phone surveys three days after treatment completion, using a web-based platform linked to the local information system of malaria. Adherence was measured using the Morisky Medication Adherence Scale. Self-reported events were registered using a structured questionnaire and communicated to the Brazilian Health Regulatory Agency.ResultsEducational materials were disseminated to 5594 patients, of whom 1512 voluntarily entered the mHealth component through the local information system; 7323 SMS were sent, and 1062 participants completed a follow-up survey after treatment. The mean age of patients was 37.36 years (SD 13.65), 61.24% were male, 98.54% were infected with. Plasmodium vivax and 95.90% received a short regimen of chloroquine plus primaquine (CQ + PQ 7 days), as per malaria case management guidelines in Brazil. From the 1062 surveyed participants 93.31% were considered adherent to the treatment. Most of the patients (95.20%) reported at least one adverse event. Headache, lack of appetite and nausea/vomiting were the most frequently reported adverse events by 77.31%, 70.90% and 56.78% of the patients respectively. A quarter of the patients reported anxiety or depression symptoms; 57 (5.37%) patients reported 5 to 6 warning symptoms of haemolytic anaemia including jaundice and dark urine in 44 (4.14%). Overall, three patients presenting symptoms of haemolytic anaemia attended a hospital and were diagnosed with G6PD deficiency, and one had haemolysis. All of them recovered.ConclusionsUnder real world conditions, a multicomponent patient-oriented strategy using information and communication technologies allowed health care providers to reinforce treatment adherence and enhance safety surveillance of adverse events associated with regimens using primaquine. Active monitoring through phone surveys also reduced under-reporting of ADRs. This approach is low-cost, scalable and able to support prioritized activities of the national malaria programme.

Improving Guidance and Maternal Knowledge Retention After Well-Newborn Unit Discharge.

In 2015, the American Academy of Pediatrics published a policy statement to provide best practices on mother-infant discharge criteria, including the delivery of anticipatory guidance to mothers of healthy newborns. In our large health system with a mix of hospital types, no standard approach to or measurement of the effectiveness of newborn discharge guidance exists. At one community well-newborn unit, we aimed to increase maternal knowledge retention of newborn guidance from 69% to 90%. Data about newborn guidance effectiveness were collected by assessing maternal knowledge retention through phone follow-up quizzes. By using quality improvement methodology and informed by American Academy of Pediatrics guidelines and curricular and adult learning theory, we standardized a multidisciplinary approach to this education. Interventions included checklist, scripts, temperature-taking demonstration, gift thermometer, staff education, car seat infant mannequin, and car seat training video for staff. Over a 1-year period, 333 mothers were interviewed after discharge from the well-newborn unit. Baseline data over the first 3 months (n = 93) showed poor maternal knowledge retention (69% correct answers). Common incorrect answers were on newborn urination habits, car seat harness clip positioning, and fever recognition. After restructuring the educational process, special cause was achieved after 3 months, with a shift of the average of correct answers to 83% followed by a second shift to 86%. The implementation of interventions to standardize newborn discharge guidance resulted in marked and sustained improvement in maternal knowledge after well-newborn unit discharge. Our next step is to enhance the process by using videos with systemwide implementation.

Will the Public Engage with New Pharmacy Roles? Assessing Future Uptake of a Community Pharmacy Health Check Using a Discrete Choice Experiment.

BackgroundPharmacists are increasingly providing more clinically orientated services that focus on enhancing patient care and health promotion. However, little is known about how acceptable this is to the public. This study explored public preferences for a community pharmacy-based health check for cardiovascular disease (CVD).MethodsA convenience sample of 423 individuals was recruited (from a community pharmacy, a dental practice, a shopping centre, a university campus and a sports centre) to complete a discrete choice experiment (DCE) survey administered face to face on a tablet. The DCE included six attributes: day of the week (weekday or weekends); way of accessing the service (walk-in and wait or by appointment); provider of health check (trainee pharmacist, pharmacist or nurse); duration of health check (30 or 45 min); follow-up phone call (no, yes and within 3 months); and cost (included to estimate the monetary value of health checks). Experimental design methods were used to create 12 choice tasks describing different health check services. Mixed logit (MXL) was used to analyse response data.ResultsRespondents had a preference for a community pharmacy-based CVD health check over no health check. They preferred a service provided (i) at the weekend; (ii) by appointment; (iii) by a nurse; (iv) for 30 min and (v) with follow-up after 3 months. Respondents were willing to pay £50 for this health check.ConclusionFindings affirm the public’s acceptance and value of a pharmacy-led CVD health check. The findings can inform pharmacy-based screening services before they are introduced, guide new service design and support resource allocation decisions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40271-021-00566-4.

RANDOMIZED, DOUBLE-BLIND, PLACEBO (PBO)-CONTROLLED, SINGLE- AND MULTIPLE-DOSE PHASE 1 STUDY OF VE202, A DEFINED BACTERIAL CONSORTIUM FOR TREATMENT OF IBD: SAFETY AND COLONIZATION DYNAMICS OF A NOVEL LIVE BIOTHERAPEUTIC PRODUCT (LBP) IN HEALTHY ADULTS

Abstract IBD patients can have reduced gut commensal abundance, relative expansion of pro-inflammatory taxa, and reduced microbial diversity and short-chain fatty acid production. FMT leads to clinical remission in some UC patients, but is a complex, nonscalable process with inconsistent composition/quality that has led to death from transmission of pathogens undetected in screening. VE202 is a rationally defined LBP of 16 beneficial Clostridia from clusters IV, XIVa, and XVIII, with properties including association with healthy human microbiomes, promotion of colonic Treg cells, production of beneficial and immunoregulatory metabolites, efficacy in mouse colitis models, and lack of overt pathogenic or toxigenic features. These properties could help restore a healthy microbiome in UC patients. Another rationally defined LBP, VE303, showed activity in a Phase 2 study for prevention of recurrentC. difficile. The goal of the current Phase 1 study was to evaluate safety and colonization of VE202, to inform planned Phase 2 trials in UC patients. METHODS: After 5 days of vancomycin pretreatment at 125mg po QID to decrease gut microbial burden, 31 healthy adults received 1 dose at 2 dosage levels (6 VE202, 3 PBO per dosage level) or a 14-day course (9 VE202, 4 PBO) of the lower dose. Each VE202 delayed-release enteric capsule contained ∼1x109 CFU of bacteria. Safety was monitored through Week 12, with phone follow-up at Week 24. Stool was collected for LBP strain detection and exploratory microbiome, metabolomic, and immune markers. RESULTS: VE202 was well tolerated with no dose-dependent pattern of AEs. The only MedDRA organ classes with ≥20% reported AEs in VE202 recipients were: —Single-dose cohorts (N=12): GI (n=6; 50%), nervous system (n=4; 33.3%), investigations and infections/infestations (n=3 each; 25%) —14-day cohort (N=9): GI (n=5; 55.6%), general/administration site, musculoskeletal/connective tissue and nervous system (n=3 each; 33.3%), and skin/subcutaneous tissue (n=2; 22.2%) In VE202 recipients (N=21), the only AEs seen in ≥10% of subjects were abdominal discomfort, diarrhea, headache (n=4 each; 19.0%), and fatigue (n=3; 14.3%). No severe AEs or clinically significant trends in lab values were seen. Two SAEs, neither treatment-related, occurred several weeks after completion of VE202 dosing: abdominal pain caused by a suspected passed bile duct stone (Day 71) and hip pain leading to hip replacement (Day 120). Sustained VE202 strain detection (Figure 1) and relative abundance (Figure 2) in the vancomycin-perturbed gut was seen as soon as Day 2, sustained through 2 weeks after dosing completion, then declined slowly but remained substantially above baseline through Week 24. A dose- and duration-dependent trend in colonization was seen. CONCLUSION: VE202 is well tolerated in healthy adults and provides robust, durable, abundant colonization of LBP strains.

Post-discharge phone follow-up: a collaboration for optimizing medications management upon transition of care

Background: Clinical Pharmacists (CPs) have a vital role in the patient transition of care (TOC), including medication reconciliation and counseling upon admission, transfer, and discharge.1 The Clinical Pharmacy Department at Al Wakra Hospital, Qatar, Hamad Medical Corporation (HMC), established a collaborative practice agreement with the Internal Medicine Department.2 The post-discharge phone follow-up (PDPF) telehealth service aimed to maintain patient continuity of care post-discharge and ensure the safety and effectiveness of discharge medication therapy. This audit describes the implementation of a new TOC initiative. Methods: Criteria for PDPF service were developed and documented into a protocol. Patients discharged from medical wards with complex medication therapy or discharged without discharge medications counseling were contacted within 3 to 7 days from discharge. CPs provided phone medication reconciliation, counseling, lifestyle modification education, assessed medication adherence, and communicated identified medication errors to the primary physicians. Data collected from documented pharmacy interventions and PDPF service forms were used for descriptive analysis. Results: From December 2020 to March 2021, 429 patients met the inclusion criteria out of 1,117 discharged patients. CPs conducted more than 613 phone calls with an average of 15 minutes per patient. CPs reviewed 2,471 medications, found 638 pharmacy clinical interventions (Table 1), and approached more than 77 physicians. Out of the 276 patients who completed PDPF service (Figure 1), the average patients’ age was 52 years, 151 (51%) were females, and 85 (31%) were Qataris. Medication assessment by CPs revealed that 87% (n = 235) of the patients were adherent to medications, 20% (n = 56) were confused about discharge medication indications, and 13% (n = 30) experienced adverse drug reactions. Conclusion: There is no standardized or established TOC service utilizing telepharmacy; however, PDPF service expanded the clinical pharmacy role beyond the in-patient services.3 Our plan includes monitoring outcome-based parameters, including post-phone call readmissions rate, 60 days emergency visits, and patients’ satisfaction.

What Practice Issues Over 25 Years Most Interest Registered Dietitians? Survey and Interview Results.

Dietetics has changed substantially; a mixed-methods project was undertaken to: (i) gauge interest in the profession history since 1993, (ii) identify preferred format(s), (iii) identify possible topics, and (iv) identify possible key informants. An online bilingual survey was conducted in 2018, with follow-up phone interviews among interested respondents. Survey content was organised as 12 major topics. Respondents were invited via a Dietitians of Canada (DC) newsletter, Facebook groups, and at the DC national conference. Survey data, including respondent-generated topics of interest and interview content, were descriptively analyzed. The online survey garnered 360 responses; 332 (92%) completed more than 10% of the survey and were interested in history. Detailed responses were analyzed (296 English; 36 French); 51 were interviewed. An online timeline was the most preferred format (79%). Review of the rise in technology and obesity, aging, supermarket registered dietitians (RDs), the local/organic movement, Practice-based Evidence in Nutrition (PEN), the changes in training models and scope of practice, public awareness of the profession, and advocacy and unique career paths were of most interest (≥ 50% of respondents). These results confirm interest in the recent history of the profession among RDs and provide guidance on preferred format and topics for further work.

One surgeon’s experience with r-TAPP: a retrospective analysis of 150 consecutive robotic inguinal hernia cases

There is a tremendous paucity of literatures regarding the long-term surgical outcomes of the r-TAPP procedure for inguinal hernia repair. Additionally, much of the existing literatures regarding this procedure have limited follow-up of to 12 months. This article presents the outcomes of 150 consecutive r-TAPP inguinal hernia repairs performed on 111 patients using Progrip mesh without fixation, with up to 24 months of follow-up. The initial 150 consecutive r-TAPP inguinal hernia repairs were performed from February 2017 to April 2018 using Progrip without fixation. All patients were seen at 2 weeks, followed by phone follow-up at 6 months, 1 year, and 2 years. Of the 111 patients, 39 had bilateral hernias (35%) and 72 had unilateral hernias (65%). The age range was 18–93 years. The BMI range was 20.7–50.2, with a mean of 26.4 and median of 25.8. Total operative time ranged from 28 to 138 min with a mean of 62.4 min and median of 56 min. ASA classification ranged from 1 to 4, with a mean of 2.1. No significant blood loss was observed in any of the cases. There were no conversions to open surgery. All patients were discharged the same day of the operation. We were able to follow up with 100% of the hernias at 2 weeks, 88% at 6 months, 87% at 1 year, and 80% at 2 years. No recurrences were recorded at 2 weeks, 3 months, 6 months, 1 year, or 2 years. There were no reports of chronic pain up to 2 years in any of the patients. These results indicate that r-TAPP inguinal hernia repair using Progrip without further fixation is safe, effective, and can be performed with minimal recurrences or chronic pain.

Early observations from the HIV self-testing program among key populations and sexual partners of pregnant mothers in Kampala, Uganda: A cross sectional study.

HIV self-testing (HIVST) was adopted for key populations (KPs) and sexual partners of pregnant and lactating women (mothers) in Uganda in October 2018. We report early observations during HIVST implementation in Kampala, Uganda. HIVST was rolled out to reach those with unknown HIV status at 38 public health facilities, using peer-to-peer community-based distribution for female sex workers (FSW) and men who have sex with men (MSM) and secondary distribution for mothers, who gave HIVST kits to their partners. Self-testers were asked to report results within 2 days; those who did not report received a follow-up phone call from a trained health worker. Those with HIV-positive results were offered confirmatory testing at the facility using the standard HIV-testing algorithm. Data on kits distributed, testing yield, and linkage to care were analysed. We distributed 9,378 HIVST kits. Mothers received 5,212 (56%) for their sexual partners while KPs received 4,166 (44%) (MSM, 2192 [53%]; FSW1, 974, [47%]). Of all kits distributed, 252 (3%) individuals had HIV-positive results; 126 (6.5%) FSW, 52 (2.3%) MSM and 74 (1.4%) partners of mothers. Out of 252 individuals who had HIV-positive results, 170 (67%) were confirmed HIV-positive; 36 (2%) were partners of mothers, 99 (58%) were FSW, and 35 (21%) were MSM. Linkage to treatment (126) was 74%. HIVST efficiently reached, tested, identified and modestly linked to care HIV positive FSW, MSM, and partners of mothers. However, further barriers to confirmatory testing and linkage to care for HIV-positive self-testers remain unexplored.

Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

Professional Master's Athletic Training Students' Career Influences Part I: Perceptions of Athletic Training

ContextAs athletic training education transitions to a professional master's degree, understanding the perceptions professional master's athletic training students have of athletic training is important.ObjectiveTo examine second-year professional master's students' perceptions of the athletic training profession, a career in the profession, and identify the factors that influence their perceptions.DesignConvergent mixed methods.SettingOnline surveys and individual phone interviews.Patients or Other ParticipantsA total of 80 second-year professional master's students (63 female, 13 male, 4 no response, age = 24.63 ± 2.29 years), who were enrolled in the final semester of their program in the spring of 2019, completed the online survey. Ten survey respondents completed the follow-up phone interviews.Data Collection and AnalysisA survey instrument and a semistructured interview guide were developed to answer the research questions. Both were validated externally by 3 independent researchers using a content-validity indexing tool. The data from the survey and interviews were woven together and merged to provide 1 comprehensive results section. Trustworthiness was established using triangulation, member checks, memos, and peer debriefing.ResultsThree higher-order themes emerged from the data: (1) perceptions of the athletic training profession: lack of appreciation and awareness for the profession from others, rewarding profession, and dynamic profession; (2) perceptions of a career in athletic training: low pay, long hours and inconsistent schedules, and inability to have work-life balance; (3) factors influencing perceptions: clinical experiences and interactions with athletic trainers.ConclusionsSecond-year professional master's athletic training students developed positive and negative perceptions about the profession and a career in the profession during their professional education experiences. The factors identified were professional socializing agents and should be considered when designing clinical education experiences.