Frequency Of Consultations Research Articles

Telemonitoring program for genito-urinary cancer patients treated with oral anticancer agents.

e18731 Background: Oral anticancer agents (OAA) used has dramatically increased in treating genito-urinary (GU) cancer. Patients with metastatic prostate and kidney cancers, have advanced age, with comorbidities. The risks of OAA for this population with adverse effects, drug interactions and ambulatory administration must be detected, prevented and managed to decrease toxicity, improve compliance and efficacy. Here, we report the data of our comprehensive cancer center telemonitoring program named Outside the walls of the hospital (OWH), combining medical oncologist coordination, clinical pharmacist (CP) evaluations, and nurse follow-ups. Methods: Data from patients treated with OAA for advanced and metastatic prostate or kidney cancers in our center during year 2022 were retrospectively evaluated. At the start of OAA, the patients benefit from a consultation with the oncologist, clinical nurse (CN), and CP. For each drug, a standard telemonitoring program has been planned according to the patient's age and comorbidities. Results: The mean age of the patients was 68 years (44-90), 42% of the patients were over 70 years, 84% were men and 96% were in a metastatic setting. Out of 347 GU patients, 118 were included in the OWH telemonitoring program in 2022, representing 14% of the whole cancers patients enrolled in this program. Of these 118 new GU patients, 80% had a CP consultation, 76% for next generation hormonal therapy (NGHT) for advanced or metastatic prostate cancer and 24% for tyrosine kinase inhibitors (TKI) for kidney cancer. At least one drug interactions was detected for 54% of patients (61% of the NGHT and 35% of TKI). The associations was strongly discouraged for 18% because of an increase or decrease in drug concentration requiring a switch or an adaptation of dosage at the outset (statin (11 patients), oral anticoagulant (5 patients), analgesic (1 patient)). At least 1 complementary alternative medicine was used by 29% with 55% of them had an interaction with OAA. During follow-up, the frequency of consultations with CN or physician is reduced over time, in order to give priority to telemonitoring and visits to the oncologist for tumor assessment and if necessary at the request of the nurse or the patient. Conclusions: The OWH program makes it possible to limit medical visits by ensuring safe monitoring. It promotes patient empowerment and allows for medical visits when necessary, in the current context of declining medical demographic for an often elderly and fragile population.

Reproductive endocrinologist and infertility specialists’ knowledge, skills, behaviors, and attitudes regarding the care for transgender and gender-diverse individuals

To investigate associations between reproductive endocrinology and infertility (REI) providers' prior training and current knowledge, skills, attitudes, and behaviors regarding fertility preservation and family building for transgender and gender-diverse (T/GD) patients. The survey was distributed to members of the Society for Reproductive Endocrinology and Infertility, the REI-physician-focused professional body within the American Society for Reproductive Medicine, with additional participants recruited through snowball sampling. Participants (n = 206) reported on training in T/GD care; 51% endorsed prior training. Most participants (93%) believed T/GD individuals were as fit for parenthood as cisgender individuals. Prior training was associated with an increased likelihood of offering T/GD health resources and more frequent consultations with specialist colleagues.Common barriers to providing care indicated by respondents included cost, delays in gender-affirming care, and lack of knowledge of the potential impact of hormonal interventions. Common facilitators included education and training, prior experience, and affordability of services. Most REI providers believed T/GD individuals are fit for parenthood and agreed that prior training facilitates care for T/GD patients. The lack of provider knowledge emerged as a barrier to care. Although training helped facilitate some components of care, systemic barriers such as the cost and variability of patient population characteristics/experiences are important considerations when serving T/GD individuals.

Content of Telephone Consultations of Patients With Inflammatory Bowel Disease: A Single-Center Descriptive Study.

This study aimed to analyze the specific contents of telephone consultations of patients with inflammatory bowel disease. A medical record survey was conducted at a clinic in Japan for 1 year. Telephone consultation sheets recorded by nurses for calls with the patients or their relatives were reviewed. Content analysis was used to summarize the telephone consultation content. Consultations were categorized into 8 categories. Coding was conducted by 2 independent researchers. Concordance rates were evaluated using kappa coefficients. We analyzed 476 sheets. A total of 229 participants consulted the clinic at least once. The mean number of consultations per person was 2.1. Of these patients, 96 (40.9%) had ulcerative colitis. The kappa coefficient was 0.89. The most frequent consultation was "Consultation on worsening health: Inflammatory bowel disease is likely to have worsened" (42.0%). The second most frequent response was "Consultation or progress report on a worsening health condition: The disease is unlikely to have worsened" (19.8%). For consultations related to worsening the disease, it would be useful to assess symptoms over the phone using a disease activity index to ascertain the degree of worsening and to develop a screening tool for determining whether patients can continue remote support or require face-to-face consultation.

Factors associated with the consultation of general practitioners among adults aged 16 and over: Analysis of data from health survey for England 2019.

Understanding of factors associated with demands for general practice (GP) care is crucial for policy decision makers to appropriately allocate health care resources. To investigate factors associated with the frequency of GP consultations. Data on 8086 adults aged ≥16 years was obtained from cross-sectional Health Survey for England 2019. The primary outcome was the frequency of consultations of a GP in the last 12 months. Multivariable ordered logistic regression analysis was used to evaluate associations between GP consultations and a range of sociodemographic and health-related factors. Frequency of GP consultations for all reasons was higher among females (odds ratio: 1.81, 95% confidence interval: 1.64-2.01), those aged 75 and over (1.48, 1.15-1.92), ethnic minority (Black 1.42, 1.09-1.84; Asian 1.53, 1.25-1.87), lowest household income (1.53, 1.29-1.83), adults with long-lasting illness (3.78, 3.38-4.22), former smokers (1.17, 1.04-1.22), overweight (1.14, 1.01-1.29) and obesity (1.32, 1.16-1.50). Predictors of consultations for physical health problems were similar to predictors of consultations for any health problems. However, younger age was associated with more consultations for mental health problems, or a combination of mental and physical health problems. The higher frequency of consultation of general practitioners is associated with female sex, older age, ethnic minority, socioeconomically disadvantaged, existence of lasting illnesses, smoking, overweight and obesity. Older age is associated with increased consultations for physical health problems, but associated with reduced consultations for mental health or a combination of mental and physical health problems.

Reasons for Emergency Consultations in the Paediatric Department of the Reference Health Centre in Commune II of the District of Bamako (MALI)

Introduction: The reason for consultation is the basis of medical reasoning, its understanding is fundamental to avoid diagnostic errors. The objective of this study was to determine the frequency of emergency consultations among children aged 2 months to 15 years in the paediatric department of the health centre of the commune II of Bamako. Patients and methods: This was a retrospective, descriptive study from 1 January to 31 December 2017. We included all children aged 2 months to 15 years who were consulted in emergency at the paediatric department. Data were collected from medical records and consultation registers on survey forms. Some variables (socio-demographic and clinical) were retained for analysis. Results: In our study, 254 patients aged 2 to 15 years were included. Children under 5 years of age were the most represented 82.67% and those aged 11-15 years the least represented 3.54%. Males were the most represented with 59.44% M/F sex ratio of 1.46. Parents of children residing in commune II at the time of the consultation were in the majority (74.81%). Parents came directly with their children in 83.85% and had a reference in 16.14%. The reasons for consultation were dominated by fever (50%), followed by respiratory difficulties (16.53%) and convulsions (14.17%). Consultations for fever, breathing difficulties and convulsions were more frequent in October with respectively: 23.62%; 26.19%; 22%.

Association between gout and epilepsy in adults – a retrospective cohort study with 244,964 primary care outpatients

BackgroundRecently there has been a rising interest in the identification of possible risk factors for epilepsies. In the present study, we investigated the potential association between gout and epilepsy in an outpatient cohort in Germany. MethodsUsing the IQVIA Disease Analyzer database, we identified 112,482 patients with gout treated in outpatient departments. These were matched 1:1 to non-gout patients based on sex, age, yearly consultation frequency during the follow-up period, and diagnoses associated with an increased epilepsy risk documented prior to or on the index date. Cox regression models were used to evaluate the association between gout and epilepsy. ResultsWithin 10 years after the index date, epilepsy had been diagnosed in 2.2% of gout and 1.6% of non-gout patients (log-rank p<0.001). In the regression analysis, we observed a significant association between gout and subsequent epilepsy (HR: 1.32; 95% CI: 1.21–1.44). The association was significant in all age groups, but strongest in the youngest age group (18–50) (HR: 1.86; 95% CI: 1.44–1.2.41). ConclusionOur study demonstrates that gout is associated with an increased incidence of epilepsy. This finding could help us to understand the mechanisms of epilepsy and better protect affected individuals in the future.

Remote care through telehealth for people with inflammatory bowel disease.

Remote care through telehealth for people with inflammatory bowel disease.

Surgical aspects and early morbidity of patients undergoing open recurrent inguinal hernia repair.

This study aims to characterize the patterns of recurrence associated with specific types of primary inguinal hernia repair techniques used for and their respective correlations with early morbidity, in patients undergoing open repair for their first hernia recurrence. After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant. 1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques. Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.

Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds

BackgroundChest pain is a frequent consultation issue in primary care, with coronary artery disease (CAD) being a serious potential cause. Primary care physicians (PCPs) assess the probability for CAD and refer patients to secondary care if necessary. Our aim was to explore PCPs’ referral decisions, and to investigate determinants which influenced those decisions.MethodsPCPs working in Hesse, Germany, were interviewed in a qualitative study. We used ‘stimulated recall’ with participants to discuss patients with suspected CAD. With a sample size of 26 cases from nine practices we reached inductive thematic saturation. Interviews were audio-recorded, transcribed verbatim and analyzed by inductive-deductive thematic content analysis. For the final interpretation of the material, we used the concept of decision thresholds proposed by Pauker and Kassirer.ResultsPCPs reflected on their decisions for or against a referral. Aside from patient characteristics determining disease probability, we identified general factors which can be understood as influencing the referral threshold. These factors relate to the practice environment, to PCPs themselves and to non-diagnostic patient characteristics. Proximity of specialist practice, relationship with specialist colleagues, and trust played a role. PCPs sometimes felt that invasive procedures were performed too easily. They tried to steer their patients through the system with the intent to avoid over-treatment. Most PCPs were unaware of guidelines but relied on informal local consensus, largely influenced by specialists. As a result, PCPs gatekeeping role was limited.ConclusionsWe could identify a large number of factors that impact referral for suspected CAD. Several of these factors offer possibilities to improve care at the clinical and system level. The threshold model proposed by Pauker and Kassirer was a useful framework for this kind of data analysis.

Transcultural approach to psychiatric and somatic comorbidities in the context of humanitarian medicine in Africa

Introduction: Mental health is an essential component of human well-being. Nowadays there is a tendency to contrast the biological disorder with the mental disorder; which is hardly the case because the first would affect the body, the soma while the second would affect the psyche. Mental disorders described in different psychiatric taxonomies appear to be of multiple etiologies. Objective: The objective of the study was to determine the prevalence of psychiatric disorders and their co-morbidities during general medical consultations at the Mokassa Developmental Health Center. Method: A quantitative and diagnostic study, which took place in the context of a humanitarian mission to Mokassa in Congo-Brazzaville in May 2012. The target population consisted of children, adolescents, adults, and people from the third age. Sampling was carried out by taxonomic triage in two phases, one in Brazzaville for the management of cases and the second phase which concerned the search and evaluation of referred patients. The data was analyzed using content analysis during the interviews. The diagnostic process was carried out using the semi-structured interviews method according to DSM-5 and data collection (interview, diagnosis, anamnesis). The recruitment of participants took place according to the rules of the charter. Helsinki. Results: 50 patients were included during the study period, ie 27 (54%) men and 23 (46%) women, the most representative age group was that of] 35.45] years (34%); the reasons for frequent consultations were behavioral problems (20%) and headaches (24%). 30% of the patients suffered from depression, 4% suffered from psychosis and 2% from bipolar and schizophrenic disorder. The most represented comorbidity was the Nile with 44%. Conclusion: Psychiatry has its place in humanitarian medicine and the mental health of the population of this island of Mossaka in the republic of Congo must be included in the strategic plan for the overall health of the Congolese authorities.

Association between gout and subsequent breast cancer: a retrospective cohort study including 67,598 primary care patients in Germany

PurposeThe aim of this retrospective cohort study was to analyze the cumulative incidence of breast cancer following gout and to investigate the association between gout and subsequent breast cancer in 67,598 primary care patients in Germany.MethodsThis study included adult female patients (≥ 18 years) with an initial diagnosis of gout in 1284 general practices in Germany between January 2005 and December 2020. Individuals without gout were matched to gout patients using propensity score matching based on average yearly consultation frequency during the follow-up period, diabetes, obesity, chronic bronchitis/COPD diagnoses, and diuretic therapy. The 10-year cumulative incidence of breast cancer in the cohorts with and without gout was also studied using Kaplan–Meier curves, which were then compared using the log-rank test. Finally, a univariable Cox regression analysis was conducted to assess the association between gout and breast cancer.ResultsAfter up to 10 years of follow-up, 4.5% of gout and 3.7% of non-gout patients were diagnosed with breast cancer. A Cox regression analysis revealed a significant association between gout and subsequent breast cancer in the total population (HR: 1.17; 95% CI: 1.05–1.31). In the age-stratified analyses, gout was only strongly associated with subsequent breast cancer in the age group ≤ 50 (HR: 1.58; 95% CI: 1.10–2.27), but the association was not significant in women over 50 years old.ConclusionTaken together, the findings of our study provide evidence for the association between gout and subsequent breast cancer diagnosis, particularly in the youngest age group.

The impact of SARS-CoV-2 pandemic on patients who attend a pediatric emergency department for mental health issues

To compare the reasons for consultation, diagnoses at discharge, and admission and re-consultation rates of pediatric patients attending the Emergency Department due to mental health disorders before and after the SARS-CoV-2 pandemic lockdown. Retrospective, descriptive study. Patients under 16 years of age consulting due to mental health-related disorders during the pre- (07/01/2018-07/01/2019) and post-lockdown (07/01/2020-07/01/2021) periods were included. The frequency of mental health diagnoses, need for drug administration, hospitalization, and reconsultations were compared. 760 patients were included, 399 pre-lockdown and 361 postlockdown. After the lockdown, there was a 45.7% increase in the frequency of mental health-related consultations with respect to the total number of emergency consultations. Behavioral alterations were the most frequent reason for consultation in both groups (34.3% vs. 36.6%, p = 0.54). In the post-lockdown period, consultations related to self-harm attempts (16.3% vs. 24.4%, p < 0.01) and the diagnosis of depression (7.5% vs. 18.5%, p < 0.01) increased significantly. There was an increase of 58.8% in patients who were hospitalized with respect to the total number of ED patients (0.17% vs. 0.27%, p = 0.003) and in the number of re-consultations (12% vs. 17.8%, p = 0.026). No differences were observed in days of hospitalization (7 days [IQR 4-13] vs. 9 days [IQR 9-14], p0.45). In the post-lockdown period, the proportion of pediatric patients presenting to the ED with mental health disturbances increased.

Skin cancer-related conditions managed in general practice in Australia, 2000–2016: a nationally representative, cross-sectional survey

ObjectiveSkin cancer is Australia’s most common and costly cancer. We examined the frequency of Australian general practice consultations for skin cancer-related conditions, by patient and general practitioner (GP) characteristics and...

Just-in-Time Decision Making: Preliminary Findings of a Goals of Care Rapid Response Team.

The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care. Primary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation. We conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020-9/30/2020). Analysis was descriptive. Categorical variables were compared with Fisher's exact or Chi-Square tests and continuous variables with Mann-Whitney U tests. A total of 89 patients were referred. Eighty-five percent (76 of 89) underwent a total of 95 consultations. Median (range) patient age was 61 (49, 69) years, 54% (48 of 89) male, 19% (17 of 89) Hispanic, 48% (43/89) White, 73% (65 of 89) married/partnered and 66% (59 of 89) Christian. Hematologic malignancies and solid tumors were evenly balanced (53% [47/89] vs. 47% [42 of 89, P=0.199]). Most patients (82%, 73 of 89) had metastatic disease or relapsed leukemia. Seven percent (6 of 89) had confirmed COVID-19. Sixty-nine percent (61 of 89) died during the index hospitalization. There was no statistically significant difference in demographic or clinical characteristics among groups (no consultation, 1 consultation, >1 consultation). Core team members were present at 64% (61 of 95) of consultations. Care limitation occurred in 74% (56 of 76) of patients. GOC RRT consultations were feasible and associated with care limitation. Adherence to core team participation was fair.

Медико-социальная характеристика медицинской активности пациентов с болезнями системы кровообращения

INTRODUCTION: The course and outcomes of the disease, including diseases of the circulatory system, are greatly influenced not only by the quality of medical care, but also by the attitude of patients to their health, as well as their medical activity. AIM: To study the age characteristics of the medical activity of patients with diseases of the circulatory system, taking into account gender and marital status. MATERIALS AND METHODS: On the basis of the Vinogradov City Clinical Hospital, Moscow, using a specially designed questionnaire, 582 patients hospitalized in the cardiological and neurological departments of the hospital for diseases of the circulatory system were interviewed. In the mathematical processing of the obtained data, the methods of variation statistics were used. RESULTS: Only 28.9% of the respondents answered that they regularly see a doctor for diseases of the circulatory system. Women were more active than men in terms of compliance with the dispensary observation schedule and the frequency of consultations with doctors of other specialties. According to the data obtained, 62.4% of the respondents considered it necessary to establish schools for the chronically ill and their family members, but only 17.4% of the respondents attended a school for a patient with diseases of the circulatory system. It was found that 86.1% of the surveyed patients with diseases of the circulatory system kept self-monitoring diaries: 68.7 per 100 respondents monitored blood pressure, 46 — blood sugar level and 33.6 — body weight. At the same time, married men are more likely to keep self-monitoring diaries for blood pressure, blood sugar levels and body weight. The timeliness of seeking medical care is the most important criterion that characterizes the medical activity of patients and largely determines the outcome of treatment and the cost of it. The conducted sociological study revealed a rather high medical activity of patients with diseases of the circulatory system, as well as its significant differences in a number of positions in age, gender, and marriage and family aspects. CONCLUSION: The identified features of the self-preserving behavior of patients with diseases of the circulatory system should be taken into account when providing them with therapeutic and preventive care.

PENDAMPINGAN LITERASI KEUANGAN BAGI UMKM DI RUKUN WARGA (RW) 003 KELURAHAN KALISARI

More than 90 percent of business activities in Kalisari Village can be categorized as Micro, Small and Medium Enterprises (MSMEs). MSME actors in the Kalisari Village generally experience problems in terms of financial management (financial literacy), even though MSME actors must be able to manage their finances well so that their business activities are successful. efforts regarding financial literacy with the aim of increasing knowledge and being able to overcome financial problems faced. Partners in the activity are 3 business actors in the Rukun Warga area (RW 003 Kelurahan Kalisari, Pasar Rebo District, East Jakarta. Partners are very enthusiastic in participating in business assistance and consulting which is marked by frequent regular consultations. The result of community service activities is partner knowledge regarding literacy financial literacy has increased by 33.81 percent, and problems faced by partners regarding literacy or financial management can be overcome. Assistance activities for partners still need to be continued with material adapted to the problems faced by partners.

Bacteriological study of nasopharyngeal carriage of the child with nasopharyngitis

Background: Nasopharyngitis is a public health problem due to the high frequency of medical consultations involving this condition, the significant economic cost of drug prescriptions. The etiologies are diverse, its management, first medicinal (whose contribution of bacteriology among many others), may require for some palpating indications a surgical cure. The objective was to identify the main bacteria responsible for nasopharyngitis in children within the ENT department of the District Hospital CIV Bamako. Methods: This was a prospective cross-sectional study, over a period of 4 months, from 1 December 2018 to 31 March 2019 involving children with nasopharyngitis seen in consultation. The samples were taken by swabbing the nasopharynx using a sterile swab in accordance with the rules of asepsis and sterility and in the absence of antibiotic intake. Results: A total of 51 nasopharyngeal swabs were taken and analyzed using usual laboratory methods, 26 strains were isolated from 24 children. The age group of 1 to 4 years was mainly concerned. Main germs identified were Kocuria rosea 30.8%, Staphylococcus aureus 15.4%, Kocuria varians 11.5% Staphylococcus pneumoniae 7.7%. We observed a low percentage of resistance to penicillin G and tetracyclins. The majority of our strains were sensitive to macrolids. Conclusions: Nasopharyngitis of the child initial viral pathology, but whose clinical course may involve superinfection germs promoting complications. The bacteriological study of nasopharyngeal carriage rightly allows antibiotic therapy adapted to the germs in question, in this multivariate management of the nasopharyngeal disease of the child within our department.

Weather Patterns and the Frequency of Ophthalmology Consultations in the Emergency Setting

ABSTRACT Purpose To determine if weather patterns are associated with the frequency of ophthalmology consultations in the Emergency Room (ER) and trauma settings. Methods Hospital-based ophthalmology consultations between January 1, 2015 and December 31, 2020 at the University of Maryland Medical Center (UMMC) were included in the BALCITE (BALtimore Consultation, Inpatient, and Trauma of the Eye) database. Encounters were filtered to the general ER, the R. Crowley Adams Shock Trauma Center, and consultations within 24 h of admission where a delay was attributed to bed assignment. Weather data from the National Climatic Data Center (NCDC) for Baltimore, Maryland, was matched to the day of the initial encounter. Results A total of 3,877 patients were included. Overall, there was a significant association between increasing daily average temperature (R 2 = .152, p = 0.0003) and daily maximum temperature (R 2 = .243, p < 0.001) with incidence of ophthalmology consultations. There was no significant decrease in consultations with increasing precipitation (R 2 = −.007, p = 0.7477). For trauma-related consultations, there was not a significant association between consultation incidence and average daily temperature (R 2 = .011, p = 0.2013), maximum daily temperature (R 2 = −0.012, p = 0.6529), or precipitation levels (R 2 = .075, p = 0.24). The months with the highest consultation volume were September, August, and July, and the lowest numbers in April, March, and February. Conclusions Emergency ophthalmology consultations increased with increasing daily temperature. Trauma-specific consultations did not show a significant association with weather patterns. This information may prove useful to ER providers and ophthalmologists in order to help predict frequency of consultations and better deploy personnel and resources.

ELECTROCONVULSIVE THERAPY FOR AGITATION IN LEWY BODIES DEMENTIA

IntroductionDementia with Lewy Bodies (DLB) is a primary degenerative dementing syndrome characterized by visual hallucinations, fluctuation in cognition, depressive symptoms and parkinsonism. Literature has shown the utility of electroconvulsive therapy (ECT) in demented patients regarding depressive symptoms and agitation. Nevertheless, the majority of cases described include patients with vascular dementia and Alzheimer’s disease. There are no cases informed concerning ECT in DLB patients with agitation and aggressive behaviors.ObjectivesEvaluate the impact of electroconvulsive therapy (ECT) for agitation in a patient with diagnosis of Lewy Bodies Dementia (DLB).MethodsCase report. 68-year-old male, with no prior neuropsychiatric history, was present for psychiatric evaluation for 5 year history of progressive dementia with fluctuations in cognition, complex visual hallucinations, delusional beliefs, depressive mood, anhedonia, irritability, associated to parkinsonism and increasing autoaggressive behaviors and agitation.An extensive neurologic workup including neuroimaging, EEG and laboratory studies failed to reveal a specific etiology. Neuropsychological testing reveals frontal, attentional, and visuospatial dysfunction. A presumptive diagnosis of DLB was made.Medication trials including donepezil, memantine, lamotrigine, sertraline, quetiapine, risperidone and melatonin failed to manage his depressive, psychotic and behavioral disturbances.ResultsConsidering past medication failures and prominent behavioral disturbances family consented for an acute course of ECT.Initial acute phase consisted of 6 sessions of right unilateral, brief pulse width (0.3 ms) ECT tri-weekly utilizing Mecta Spectrum. Anesthesia was induced with propofol, and received succinylcholine for muscle relaxation. Initial charge was 115 mC (6x seizure threshold), then raised to 192 mC. Seizure duration averaged in 22 seconds. No adverse reactions reported.Clinical outcomes were measured with the CGI-Efficacy Index. Pre-ECT CGI-SI score was 6 (severely ill) and post-ECT CGI-I was 3 (minimally improved).ConclusionsMood and behavioral disturbances are a frequent primary motive consultations in DLB patients. The treatment is challenging due to the sensitivity to antidopaminergic medications evidenced in this type of patients. This case suggests that ECT has an impact in the treatment of agitation and aggression in DLB patients, although further investigation is needed.Disclosure of InterestNone Declared

Primary Care Consultations Among UK Police Officers and Staff: Links With Adverse Mental Health and Job Strain.

The current study examined links between adverse mental health, job strain, and likelihood and frequency of primary care consultations among police employees. We conducted secondary data analysis on the Airwave Health Monitoring Study data ( n = 33,730). Measures included self-report data on mental health, job strain, job support, and primary care consultations in the past 12 months. Data were analyzed using a zero-inflated Poisson regression framework. Findings showed that overall, help seeking was low based on mental health status and job strain. Adverse mental health was associated with more primary care consultations. Police employees with high, active, or passive job strain reported more primary care consultation compared with police employees with low strain. Findings suggest that more work to reduce stigma of taking the initial step of help seeking would be beneficial.