GP Patients Research Articles

The 2022/23 flu vaccination season: a return to normality?

Practice NursingVol. 33, No. Sup4 ImmunisationThe 2022/23 flu vaccination season: a return to normality?Kelly NickallsKelly NickallsEditor, Practice NursingSearch for more papers by this authorKelly NickallsPublished Online:1 Apr 2022https://doi.org/10.12968/pnur.2022.33.Sup4.S4AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Joint Committee on Vaccination and Immunisation. Advice on influenza vaccines for 2022/23. 2021. https://app.box.com/s/t5ockz9bb6xw6t2mrrzb144njplimfo0/file/863135232161 (accessed 15 March 2022) Google ScholarMacDonald P. Another exceptional influenza season for 2021/22? Practice Nursing. 2021; 32(Sup6):S5–7. https://doi.org/10.12968/pnur.2021.32.Sup6.S5 Link, Google ScholarNHS England and NHS Improvement. Reimbursable vaccines and eligible cohorts for the 2022/23 NHS Seasonal Influenza (flu) Vaccination Programme. Version 1. 2022. https://www.england.nhs.uk/wp-content/uploads/2019/12/B1395-reimbursable-vaccines-and-eligible-cohorts-22-23-flu-vaccination-programme-guidance-march-2022.pdf (accessed 15 March 2022) Google ScholarUK Health Security Agency. Seasonal flu vaccine uptake in GP patients: monthly data, 2021 to 2022. 2022. https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-monthly-data-2021-to-2022 (accessed 17 March 2022) Google ScholarWorld Health Organization. Recommendations announced for influenza vaccine composition for the 2022-2023 northern hemisphere influenza season. 2022. https://www.who.int/news/item/25-02-2022-recommendations-announced-for-influenza-vaccine-composition-for-the-2022-2023-northern-hemisphere-influenza-season (accessed 15 March 2022) Google Scholar FiguresReferencesRelatedDetails 1 April 2022Volume 33Issue Sup4ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 1 April 2022 Published in print 1 April 2022 Information© MA Healthcare LimitedPDF download

The challenge of increasing uptake of flu and COVID-19 vaccinations in pregnancy

Practice NursingVol. 32, No. Sup12 ImmunisationThe challenge of increasing uptake of flu and COVID-19 vaccinations in pregnancyKelly NickallsKelly NickallsEditor, Practice NursingSearch for more papers by this authorKelly NickallsPublished Online:6 Dec 2021https://doi.org/10.12968/pnur.2021.32.Sup12.S4AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Kilich E, Dada S, Francis MR, et al. Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis. PLoS One. 2020;15(7):e0234827. Published 2020 Jul 9. doi: https://doi.org/10.1371/journal.pone.0234827 Crossref, Google ScholarNHS. The flu jab in pregnancy. 2021. https://www.nhs.uk/pregnancy/keeping-well/flu-jab/ (accessed 16 November 2021) Google ScholarPublic Health England. Seasonal influenza vaccine uptake in GP patients: winter season 2020 to 2021. Final data for 1 September 2020 to 28 February 2021. 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/996033/Annual-Report_SeasonalFlu-Vaccine_GPs_2020_to_2021.pdf (accessed 16 November 2021) Google Scholar FiguresReferencesRelatedDetailsCited byBarriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review2 March 2023 | PLOS ONE, Vol. 18, No. 3 1 December 2021Volume 32Issue Sup12ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 6 December 2021 Published in print 1 December 2021 Information© MA Healthcare LimitedPDF download

A cluster randomized controlled trial of a MedicineInsight Educational Quality Improvement Programme to improve the diagnosis and treatment of chronic hepatitis C in general practice (the EQUIP-HEPC trial).

The availability of direct-acting antivirals (DAAs) sparked efforts to eliminate hepatitis C virus (HCV) in Australia. We evaluated whether an educational intervention of a 1-h discussion among staff using audit and feedback data from the MedicineInsight GP programme would improve DAA uptake. Of 296 eligible general practices in MedicineInsight, 11% opted out. Randomization stratified by practice caseload allocated 130 practices to the intervention arm and 129 to control. The primary outcome was the number of patients started on DAAs over 6months using the negative binomial regression model adjusted for DAA prescription history and clustering by practice. Data for analysis were available for 78% of practices, which included 101 practices and 2469 DAA-naive patients with confirmed/possible HCV in the intervention arm, and 100 practices and 2466 patients in the control arm. At baseline, 49.5% of practices had prescribed ≥1 DAA in the past year; 18.9% of HCV patients had already been treated with DAAs; the mean age of DAA-naive HCV patients was 43years old, and 57% were men. Over 6months, 43 patients in the intervention arm and 36 in the control arm started DAAs (adjusted IRR 1.19; 95% CI 0.67-2.11, p=0.55). In the first 3months, 27 vs 16 patients started DAAs (adjusted IRR 1.77, 0.88-3.58; p=0.111). Few patients were started on DAAs, and a facilitated discussion in HCV management did not lead to a significant increase. Alternative measures, such as incentivizing GP initiations or patients, are suggested to address remaining barriers to DAA uptake in Australian primary care. Australian New Zealand Clinical Trial Registry (ANZCTR) Registration Number: ACTRN12619000508178p.

An explorative study of factors associated with treatment in specialized mental health care centers among GP patients in Norway

BackgroundEffectiveness and efficiency are part of the quality of care for mental health problems, and treatment should thus be performed at the right level of care. Norwegian guidelines specify which patients should be given priority for treatment in specialized mental health care (SMHC) centers, but there is a lack of agreement on which patients should actually receive SMHC. In this study we wanted to examine what factors (patient and GP characteristics) were related to GP patients who received treatment in SMHC centers.MethodsIn this retrospective cohort study, we looked at 12 months of data from electronic health records from six GP and SMHC centers of hospitals in the catchment area. We included all patients who had been treated at any of the GP centers during the 12-month period (N=18032). We fit a generalized linear mixed model to explore which factors were related to patients receiving treatment in SMHC centers. Further exploration was performed to study the effects of gender and contact frequency.ResultsWe found that 4.6% of all GP patients and 18.4% of the GP patients with a mental health problems were treated in SMHC centers. There were more women than men among the GP-patients (56% vs 44%) and in SMHC centers (55% vs 45%), women with mental health problems were more severely ill than men. However, after adjusting for other factors men were more likely to be treated in SMHC centers (OR: 1.44). Patients with frequent GP contact were more likely to be treated in SMHC centers. The GP characteristics age, gender and specialization did not relate to patients receiving treatment in SMHC centers.ConclusionsMen were more likely to be treated in SMHC centers than women, which may imply that they have different thresholds for entering SMHC centers. GP characteristics were not related to receiving treatment in SMHC centers. More specific knowledge is needed to determine whether men and women currently receive treatment at the lowest possible level of care.

Bacterial agents in vulvovaginitis and vaginal discharge: a 10-year retrospective study in the Netherlands.

Vulvovaginitis is a common problem in the GP's practice. Causes are bacterial vaginosis (BV), Candida infection and sexually transmitted infections (STIs). Only if empirical treatment fails, a vaginal swab is sent in for culture and BV detection. However, without culture essential, bacterial pathogens may escape diagnosis. Many molecular BV assays have recently appeared on the marketplace, all quite differing in price and targets. However, for years, the Nugent score has been the gold standard for BV detection. We analysed retrospectively 10 years of microbiology results of vulvovaginal swabs, focusing on less frequently reported bacterial pathogens, and assessed the characteristics of BV diagnostics. Vulvovaginal swabs sent in between 2010 and 2020 from > 11,000 GP patients with vulvovaginitis associated symptoms, but negative STI tests, were analysed. First cultures and repeat cultures after at least 6 months were included in four age groups: < 12, 12-17, 18-51 and > 51 years. Candida species and BV were most frequently found, with the highest prevalence in premenopausal women. Haemophilus influenzae, beta-haemolytic streptococci, Streptococcus pneumoniae and Staphylococcus aureus were isolated in 5.6% of all cultures, with the highest percentages in children and postmenopausal women. If empirical treatment of vulvovaginitis fails, bacterial culture should be performed to detect all potentially pathogenic microorganisms to obtain a higher rate of successful diagnosis and treatment, avoiding unnecessary antimicrobial use and costs. For BV detection, molecular testing may seem attractive, but Nugent scoring still remains the low-cost gold standard. We recommend incorporating the above in the appropriate guidelines.

A cluster randomised trial of a Needs Assessment Tool for adult Cancer patients and their carers (NAT-C) in primary care: A feasibility study.

People with cancer often have unidentified symptoms and social care needs. The Needs Assessment Tool-Cancer (NAT-C) is a validated, structured method of assessing patient/carer concerns and prompting action, to address unmet need. Assess feasibility and acceptability of a definitive two-armed cluster randomised trial of NAT-C in primary care by evaluating: recruitment of GP practices, patients and carers; most effective approach of ensuring NAT-C appointments, acceptability of study measures and follow-up. Non-blinded, feasibility study in four General Practices, with cluster randomisation to method of NAT-C appointment delivery, and process evaluation. Adults with active cancer were invited to participate with or without carer. Practices cluster randomised (1:1) to Arm I: promotion and use of NAT-C with a NAT-C trained clinician or Arm II: clinician of choice irrespective of training status. Participants completed study questionnaires at: baseline, 1, 3 and 6 months. Patients booked a 20 minute needs-assessment appointment post-baseline. Patients, carers and GP practice staff views regarding the study sought through interviews/focus groups. Quantitative data were analysed descriptively. Qualitative data were analysed thematically, informed by Normalisation Process Theory. Progression to a definitive trial was assessed against feasibility outcomes, relating to: recruitment rate, uptake and delivery of the NAT-C, data collection and quality. Five GP practices approached, four recruited and trained to use the NAT-C. Forty-seven participants and 17 carers recruited. At baseline, 34/47 (72%) participants reported at least one moderate-severe unmet need, confirming study rationale. 32/47 (68%) participants received a NAT-C-guided consultation, 19 of which on Arm I. Study attrition at one month (n = 44 (94%), n = 16 (94%)), three months (n = 38 (81%), n = 14 (82%)) and six months (n = 32 (68%), n = 10 (59%)). Fifteen patient interviews conducted across the whole study and one focus group at each GP practice. Participants supported a definitive study and found measures acceptable. The feasibility trial indicated that recruitment rate, intervention uptake and data collection were appropriate, with refinements, for a definitive multi-centre cluster randomised controlled trial. Feasibility outcomes informed the design of a 2-armed cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the NAT-C compared with usual care.

S1343 EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty

INTRODUCTION: Gastroparesis (Gp) patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation is an effective treatment strategy in these patients. We aimed to: 1) Assess if pyloric Through the Scope (TTS) balloon dilation results in symptom improvement in Gp patients with suboptimal response to pyloromyotomy/pyloroplasty; 2) Determine Endoscopic Functional Luminal Imaging Probe (EndoFLIP) characteristics of these patients before dilation. METHODS: Patients with severe Gp refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation to 18, 19 and 20 mm after assessing the pyloric characteristics at 30-, 40-, and 50-ml EndoFLIP distension volumes. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. RESULTS: Thirteen (10 females) patients (mean age 45.2 ± 5.1 years) with Gp and prior pyloric surgeries (laparoscopic pyloroplasty = 6, endoscopic pyloromyotomy = 5, laparoscopic pyloromyotomy = 1) presented with severe Gp symptoms (mean GCSI total score 3.4 ± 0.3, Table 1). TTS dilation was performed after assessing pyloric characteristics on EndoFLIP. Overall, there was improvement of symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, P = 0.04, Table 2; mean CPGAS score 1.6 ± 0.5, P < 0.01, Table 3), with 5 patients (38%) reporting symptom improvement (4 moderately better; 1 somewhat better), and 8 with little (n = 1) or no (n = 7) improvement. Patients with symptom improvement reported symptoms of nausea (3), vomiting (1), and loss of appetite (1) improving the most. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml (4.7 ± 0.8 vs 13.2 ± 2.9 mm2/mmHg, P = 0.04), 40 ml (7.2 ± 1.0 vs 13.9 ± 2.1 mm2/mmHg, P = 0.02) and 50 ml (4.9 ± 1.0 vs 10.2 ± 1.9 mm2/mmHg, P = 0.04) than patients with little/no improvement. CONCLUSION: In Gp patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility suggesting incomplete myotomy, pyloric muscle regeneration or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with Gp symptoms refractory to pyloromyotomy/pyloroplasty.Table 1Table 2Table 3

Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study

Abstract Background An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence. Methods We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time. Results Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430). Conclusions The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends. Key messages The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.

557-P: Gastric Electrical Neurostimulation Combined with Pyloroplasty for Refractory Diabetic Gastroparesis Improves Subjective and Objective Outcomes

Background: Gastric electrical stimulation (GES) improves symptoms in diabetic gastroparesis (DM GP) refractory to medical therapies but does not increase gastric emptying (GE). This study investigates the clinical outcomes of GES combined with pyloroplasty (PP) to improve GE as well as the pathophysiological characteristics of the responding patients. Methods: Overall 39 DM (13 type I) GP patients with 16.6 (range 3-50) years of DM had GES with PP. Antral and pyloric biopsies were assessed for interstitial cells of Cajal (ICC) status. Depletion of ICC was defined as &amp;lt;10 cells/HPF. GE scintigraphy (normal &amp;lt;60% retention at 2h or &amp;lt;10% at 4 h) was performed, and GP total symptoms score (TTS) of vomiting, nausea, early satiety, bloating, fullness and epigastric pain was assessed with a 5-point Likert scale pre and post-surgery. Results: The 39 patients, (23F) mean age 45 (25-83) years, mean 5.2 years of GP symptoms, were enrolled. TSS improvement after mean follow up of 17 (1-42) months post-surgery was 62% (19.1±3.4) vs.(7.6±6.2), while almost 70% of patients improved TTS by ≥60%. GE at 2h improved from 77% to 45%, and from 55% to 20% at 4h while 47% completely normalized their GE. Both DM1 and DM2 patients responded with improved TSS and GE. Antral ICC were depleted in 28% of DM GP with a mean number of 12 (±5.2)/HPF, while 70% of patients had &amp;lt;10 pyloric ICC with mean 7.4(±5.0)/HPF. Patients with &amp;lt;10 pyloric ICC had a 64% improvement in TSS vs. 41% if pyloric ICC was ≥10/HPF. Conclusion: DM GP patients treated by combining GES and PP show significant symptomatic improvement with accelerated and often normalized GE. Patients with depleted pyloric ICC were the most improved, emphasizing the key role of the pylorus in GP, and explains why adding PP to GES addresses the specific pathophysiological challenges in severe diabetic GP. Disclosure T. Bright: None. I. Sarosiek: None. A. Shanker: None. B.R. Davis: None. O. Padilla: None. J.R. Diaz: None. K. Espino: None. R.M. McCallum: None.

Gastroparesis: New insights into an old disease.

Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported in the literature since the mid-1900s, only recently has there been renewed clinical and scientific interest in this disease, which has a potentially great impact on the quality of life. The aim of this review is to explore the pathophysiological, diagnostic and therapeutical aspects of Gp according to the most recent evidence. A comprehensive online search for Gp was carried out using MEDLINE and EMBASE. Gp is the result of neuromuscular abnormalities of the gastric motor function. There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes. As regards diagnostic approach, 99-Technetium scintigraphy is currently considered to be the gold standard for Gp. Its limits are a lack of standardization and a mild risk of radiation exposure. The C13 breath testing is a valid and safe alternative method. 13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits. The wireless motility capsule is a promising technique, but its use is limited by costs and scarce availability in many countries. Finally, therapeutic strategies are related to the clinical severity of Gp. In mild and moderate Gp, dietary modification and prokinetic agents are generally sufficient. Metoclopramide is the only drug approved by the Food and Drug Administration for Gp. However, other older and new prokinetics and antiemetics can be considered. As a second-line therapy, tricyclic antidepressants and cannabinoids have been proposed. In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed. In drug-unresponsive Gp patients some alternative strategies (endoscopic, electric stimulation or surgery) are available.

Reflux Symptoms in Gastroparesis: Correlation With Gastroparesis Symptoms, Gastric Emptying, and Esophageal Function Testing.

The goal of this study was to determine the relationship of reflux with gastroparesis (Gp), looking both at symptoms and objective testing. Gp patients often experience gastroesophageal reflux symptoms. How the severity of reflux correlates with the severity of Gp is not known. Patients referred to our academic center with symptoms of Gp completed the Patient Assessment of Upper Gastrointestinal Symptoms, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire (PHQ)-15. They underwent 4-hour gastric emptying scintigraphy; and, if indicated, high-resolution esophageal manometry and esophageal pH impedance (EpHI). Of 755 patients from July 2013 to May 2018, 432 had Gp with Gastroparesis Cardinal Symptom Index (GCSI) total score of 3.2±0.1 (mean±SEM) and heartburn/regurgitation subscore of 2.0±0.1. A fourth (27.1%) of all Gp patients had moderate to very severe heartburn/regurgitation symptoms. Heartburn/regurgitation subscore had strong correlation with GSCI total score (r=0.56, P<0.01), and weak correlation with 4-hour gastric retention (r=0.11, P=0.02). In total, 103 Gp patients underwent EpHI monitoring; time esophageal pH<4 had no correlation with heartburn/regurgitation subscore. Less than half (41.7%) of the patients undergoing EpHI had gastroesophageal reflux disease by EpHI. Gp patients with gastroesophageal reflux disease had more severe 4-hour gastric retention, and more frequently had decreased lower esophageal sphincter resting pressure and esophageal motility disorders. Heartburn/regurgitation subscore had moderate correlation with somatic symptoms, and weak correlations with anxiety and depression. The severity of reflux symptoms in Gp has strong correlation with GCSI total score, weak correlation with gastric retention, and no correlation with esophageal pH monitoring.

Clostridiodes difficile: Colonisation versus Infection - The importance of appropriate laboratory testing to minimise risk of overdiagnosis and overtreatment

Background Clostridiodes difficile (C. difficile) colonisation rates have been reported as ranging from 4-15% in healthy adults to 4-51% in long term care facilities. Inappropriate treatment for C. difficile colonisation alters gut microbiota and can consequently result in C. difficileInfection (CDI). Laboratory testing needs to aid diagnosis while at the same time minimising risk of overdiagnosis and overtreatment. Methods An audit was conducted of the number of patients with indeterminate and positive results between 01.09.16 and 31.08.18 to determine the impact of Scottish National C. difficile laboratory testing and CDI case definition Guidance re-inforcement in September/October 2017. A question was also added at sample requesting stage re Pseudomembranous colitis/Toxic megacolon to ensure appropriate testing. Results After Guidance re-inforcement, a rapid fall in number of indeterminate results (av. 34/month to 15/month) was observed. Decrease was most marked for GP patients (av. 12/month to 3/month). There was also a decrease in the number of patients with confirmed positive results (av. 9/month to 5/month). Conclusion Alignment with National Guidance resulted in significant reduction in patient indeterminate and positive results and assisted clinicians in the clinical diagnosis of CDI. There was also a reduction in the number of laboratory tests and repeat tests for indeterminate results. Therefore, this alignment with National Guidance resulted in Infection Prevention and Control Team, clinical and laboratory time and cost savings.

Code-switching between Arabic and English during Jordanian GP consultations

This study draws conceptually on communication accommodation theory (CAT) to describe and analyze conversations between doctors and patients to identify the psycholinguistic and social motivations for code-switching (CS) between English and Arabic languages during medical consultations in Jordan. The researchers employ a thematic qualitative approach to interpret the phenomena under study. GP doctors (n=9) and patients (n=18) were observed and video-recorded in real medical settings and subsequently interviewed. This generated a comprehensive audio and videotaped corpus of data, which revealed that doctors and patients used code-switching during the medical consultation for two main reasons: 1) filling lexical gaps and 2) accommodating the other party. Jordanian bilingual doctors code-switched from English to Arabic and from Arabic to English to bridge lexical gaps, while both doctors and patients adapted their speech styles for the purpose of convergence. This study is significant as it investigates and examines the phenomenon of code-switching among Jordanian doctors and patients from psycholinguistic and social perspectives to gain a clearly defined sociolinguistic explanation of code-switching phenomena during their clinical interaction.

Supermarket pharmacy delivers flu vaccines to GP patients as practices face shortages

Supermarket pharmacy delivers flu vaccines to GP patients as practices face shortages

Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study.

To examine the impact of determinants of incident dementia in three different old age groups (75-79, 80-84, 85+years) in Germany. Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals. Primary care medical record registry sample. General practitioners' (GPs) patients aged 75+years at baseline. Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset. Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups. This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.

Prevalence of sleep apnea in patients with first diagnosis of hypertension

The risk of obstructive sleep apnea (OSA) is significantly increased in patients with hypertension. In addition, OSA appears to be an independent cardiovascular risk factor. So far, sleep apnea screening is only recommended for patients with refractory hypertension and history of OSA. Therefore, OSA often remains undiagnosed in hypertensive patients. The underlying prevalence data are mainly from outpatient hypertension clinics. Data on the prevalence of OSA in patients with hypertension in primary care are not yet available. Due to the cardiovascular risk, some experts recommend screening for OSA when high blood pressure is diagnosed. The study presented here describes for the first time the prevalence of OSA in GP patients immediately after the initial diagnosis of hypertension. 6 family practices participated in the study between December 2012 and April 2014. Cardiorespiratory polygraphy was performed on all patients diagnosed with hypertension during this period using a 24-hour blood pressure monitor (ABPM). A sleep physician evaluated the polygraphy data online. 50 patients were recruited, 6 patients did not meet the inclusion criteria. Thus, the data of 44 patients (19 women) were analyzed. An obstructive sleep apnea was diagnosed in 34% (n = 15) of the patients. 16% (n = 7) had a mild OSA, 16% (n = 7) a moderate OSA and 2% (n = 1) a severe OSA. In a relevant proportion of patients with newly diagnosed hypertension, an undiagnosed OSA was found. In order to estimate the possible effects of sleep apnea screening on hypertension patients, representative studies in the primary medical field are required.

Pilot study of the effect of hypercapnical-hypoxic respiratory trainings on decrease of neurological deficiency after ischemic stroke

To evaluate the effectiveness of hypoxic-hypercapnic respiratory training (GGRT) in restoring neurological functions after IS. We conducted a pilot blind, randomized, placebo-controlled study that was approved by the institutional review board. The study included 29 patients in the acute period of mild IS, which were divided into two groups: exposure (GE, n = 14) and placebo (GP, n = 15). Patients from GE underwent GGRT on a Carbonic ® simulator, and GP patients breathed through a false loop. The average number of workouts was 8. All patients were evaluated clinically before and after the course of GGRT on the NIHSS, Barthel, Rankin, Rivermead and Stange test. When carrying out early rehabilitation with the help of GGRT, a decrease in neurological deficit and degree of disability, an increase in daily activity and an improvement in cognitive functions were found in comparison with GP by days 11–14: NIHSS GE (1.1 ± 0.7) vs GP (3.8 ± 0.7), p = 0.0035, the difference was 15%. Rankin GE 1.3 ± 0.5 vs GP 2.1 ± 0.7 (p = 0.02), the difference was 10.5%. Rivermead GE 13.6 ± 1.1 vs GP 10.8 ± 2.3 (p = 0.01), the difference was 9.4%. The time of the Stange test in the GE increased 28.7 ± 17.8 → 40.7 ± 16.7 (p = 0.003), which did not occur in the GP (p = 0.8). GGRT can be an effective and safe way to rehabilitate patients after IS.

Caregiver Burden in Gastroparesis and GERD: Correlation with Disease Severity, Healthcare Utilization and Work Productivity.

Caregiver burden can be significant in chronic gastrointestinal diseases. No studies have been performed to evaluate caregiver burden in gastroparesis or gastroesophageal reflux disease (GERD). (1) Assess the caregiver burden in gastroparesis and GERD patients and healthy volunteers (HVs); (2) correlate the caregiver burden of these patients to the severity of patients' symptoms, healthcare utilization, and work productivity of the patients and the caregivers. Patients with gastroparesis and GERD, seen between June 2018 and November 2018, completed Patient Assessment of Gastrointestinal Symptoms, Work Productivity and Activity Impairment (WPAI) and healthcare utilization questionnaires. The caregivers of these patients completed Zarit Burden Interview (ZBI) and WPAI questionnaire. HVs and their potential caregivers also completed these questionnaires. Forty-seven patients (gastroparesis = 31, GERD = 17), 12 HVs, and their caregivers completed questionnaires. Caregivers of gastroparesis patients reported high burden on ZBI (27.7 ± 2.9), greater than the caregivers of GERD (14.9 ± 2.5) and HVs (5.5 ± 1.6, p < 0.01). Among all patients, the caregiver burden had a strong correlation with patients' Gastroparesis Cardinal Symptom Index (GCSI) total score (rs = 0.63, p < 0.01) and moderate correlations with the number of patients' physician office visits (rs = 0.46, p < 0.01) and the number of work hours missed by caregivers due to patients' symptoms (rs = 0.36, p = 0.04). Using multivariable regression, both presence of gastroparesis and other comorbidities significantly predicted caregiver burden, F(2, 33) = 15.94, p < 0.0001, R2 = 0.491. Caregivers of gastroparesis patients have high caregiver burden that strongly correlates with patients' GCSI total score. Interventions to reduce symptom severity of Gp patients may reduce the caregiver burden.

Characterizing Abdominal Pain in Patients With Gastroparesis Into Neuropathic and Nociceptive Components.

The cause of abdominal pain (AP) in gastroparesis (Gp) is often not known; hence, its treatment can be challenging. Preoccupation with or increased attention (hypervigilance) to pain is associated with perceived pain severity and psychosocial disability. The aims of this study were to (1) characterize AP in Gp patients into neuropathic and nociceptive pain components; (2) assess these patients for hypervigilance to pain. Gp patients with AP as an important symptom, seen from June 2017 to November 2017 were given validated questionnaires to characterize their AP. Carnett's sign (worsened AP/tenderness on head/shoulder lift and/or leg lift) was assessed on examination. Of 32 patients (87% females), 20 had idiopathic Gp, and 9 had diabetic Gp. AP severity using Patient Assessment of Gastrointestinal Symptoms averaged 4.3±0.2 (standard error of mean) for upper AP and 2.3±0.3 for lower AP. AP was typically located in epigastrium (53.1%), and described as sharp (75%). Eleven patients (35.5%) met criteria for neuropathic pain on Neuropathic Pain Questionnaire. Twenty patients (62.5%) had positive Carnett's sign suggesting somatic pain. Fifteen patients (48.4%) were hypervigilant to pain on Pain Vigilance and Awareness Questionnaire. Of Gp patients with AP, over one third have a neuropathic component to their pain whereas nearly two thirds have characteristics of somatic pain. Almost half of the Gp patients with AP are hypervigilant to pain. Determining the underlying cause of AP and hypervigilance to pain in Gp patients may assist in devising appropriate treatment strategies.

ADMINISTRATION OF SYSTEMIC PROPOLIS VERSUS MOXIFLOXACIN AS ADJUNCTIVE TREATMENT OF SEVERE GENERALIZED PERIODONTITIS

To-date, emerging bacterial resistance to the commonly prescribed antibiotics in the management of periodontitis has become a challenging problem making scientists continually seek for new agents. In the present study, propolis (PRO) (natural bee glue) and moxifloxacin (MXF) (new quinolone antibiotic) were evaluated in the treatment of severe generalized periodontitis (gP) as adjuncts to scaling and root planing (SRP). Fifty four subjects with severe gP were randomly assigned into three groups (3 subjects did not complete the study after participation). Group I in which SRP alone was performed to gP patients (SRP group; n=17); group II in which SRP was done to gP patients combined with orally administered propolis 400 mg once daily for 7 days (PRO group; n=16); and group III in which SRP was performed to gP patients combined with oral moxifloxacin 400 mg once daily for 7 days (MXF group; n=18). Pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque (PI) and gingival (GI) indices were recorded at baseline, after 6 and 12 weeks of SRP. Salivary interleukin-1 beta (IL-1β) was evaluated at the same time points for all groups. All three procedures led to significant reductions in PD, CAL, BOP, PI and GI after 6 and 12 weeks. PD reduction and CAL gain were significantly greater in the PRO and MXF groups compared to SRP group at 6 and 12 weeks after therapy (p 0.05). Likewise, in PRO and MXF groups, the salivary inflammatory marker (IL-1β) was significantly reduced in comparison to SRP group (p < 0.01). In all groups, salivary IL-1β levels were decreased at 6 and 12 weeks compared to baseline values. It was concluded that the adjunctive use of PRO and MXF to SRP had significantly improved the treatment outcomes in subjects with severe gP comparable to SRP alone. Thus, PRO and MXF showed promising results in the treatment of periodontal disease. KEYWORDS Propolis, Moxifloxacin, Adjunctive treatment, Periodontitis.