Higher Number Of Patients Research Articles

642. The Role of Electronic Medical Record Automation in Latent Tuberculosis Screening and Treatment in a Large Health System

Abstract Background Valley Medical Center is a tertiary county hospital in San Jose, California that also staffs 12 clinics. Our institution’s Mycobacterial and Refugee Health Clinic is the main referral center for latent tuberculosis (LTBI) and active TB cases in the county. The USPFTF recommends screening for LTBI in asymptomatic adults who are at higher risk. This is challenging in primary care settings where physicians often see a high number of patients within limited time frames. There are many points on the LTBI care cascade (Figure 1) where patients can fall off. In the age of automation, technological tools can be designed to help reduce clinician burden.Figure 1:Latent Tuberculosis Care CascadeSource: California Department of Public Health Tuberculosis Control Branch Methods An EMR tool was engineered to prompt physicians to order a QuantiFERON (QFN) if a patient meets certain criteria: 18 years or older, no prior QFN or TB skin test, and any of the following risk factors: HIV positive, in custody, drug use, homelessness, or non-English primary language (proxy for foreign birth). This EMR tool went live on 8/9/22. Using EMR data-collection tools, a retrospective analysis was done among patients who had a clinical encounter (office visit or telemedicine) between 8/9/21-8/9/22 and 8/9/22-8/9/23 (one year before and after implementation of the tool). We determined the number of patients who were eligible for screening, obtained a QFN, had a positive QFN, initiated, and completed treatment. A 2-sample Z-test was used to assess temporal trends.Table 1:LTBI Care Cascade for Patients Seen by a Primary Care Physician in 8/9/21-8/9/22 and 8/9/22-8/9/23 Results From 8/9/22-8/9/23, 34251 patients were marked eligible for LTBI screening based on the EMR tool (Table 1, Figure 2). The proportion of patients tested for LTBI increased from 45.3% to 81.2% (p-value < 2.2e-16). The proportion of positive LTBI results increased from 8.6% to 12.4% (p-value < 2.2e-16). The number of patients who initiated treatment increased from 545 (40.8%) to 1038 (30%). The number of patients who completed treatment increased from 417 (76.5%) to 770 (74.2%).Figure 2:LTBI Care Cascade for Patients Seen by a Primary Care Physician in 8/9/21-8/9/22 and 8/9/22-8/9/23 Conclusion This study highlights that a low-cost EMR intervention can lead to substantial increases in LTBI screening, and as a result higher treatment completion. EMR automation can also improve accuracy in screening, reflected by the increased proportion of positive QFN results. Future tools involving digital technology can be designed to reduce drop-offs at other points along the LTBI cascade as well. Disclosures All Authors: No reported disclosures

Comparison of algorithms of left ventricular diastole function assessment in hypertensive individuals with preserved ejection fraction

Abstract The aim of the study was to compare two echo-algorithms of the assessment of the left ventricular diastole function (2016 the American Society of Echocardiography/the European Association of Cardiovascular Imaging and the 2024 British Society of Echocardiography guidelines) in routine clinical practice. Methods We retrospectively enrolled 142 adult hypertensive patients with cardiovascular disease of different aetiologies who underwent transthoracic echocardiography examination (2D imaging, Doppler) for routine clinical indications. It was measured echocardiography parameters for diastolic function evaluation as transmitral Doppler E wave, mitral annular Tissue Doppler Imaging e`septal and e` lateral, average E/e`, left atrium volume index, the velocity of tricuspid regurgitation. Results Overall, a total of 90 subjects were finally included (mean age 61.8 years (95% CI 59.1 to 64.5), 44.4% women) who had preserved left ventricular (LV) ejection fraction (≥50%). By applying the 2024 recommendations, 11% of individuals fulfilled the criteria for impaired diastolic function with elevated filling pressure, 83 % of subjects were diagnosed with normal diastolic function, and only 4.4% had impaired diastolic function with normal filling pressures. Meanwhile, according to the 2016 recommendations, 12 % were diagnosed with diastolic dysfunction, 54% had a normal diastolic function and 34%subjects had indeterminate diastolic function, and required additional examination. Conclusions This study demonstrates that a low number of individuals with impaired diastolic function with normal filling pressures was classified based on British recommendation 2024, however, a high number of patients with indeterminate diastolic function was diagnosed through guideline 2016. The new echocardiographic approach for estimating the left ventricular diastole function presented in 2024 could have higher clinical utility, especially in resource-limited settings for routine examination of hypertensive patients.

P-809. Evaluating the Usage, Safety, and Accuracy of Vancomycin Dosing Practices at VA Eastern Colorado Health Care System (VA ECHCS)

Abstract Background Vancomycin is a glycopeptide antibiotic used as a mainstay of therapy for gram positive bacterial infections, including MRSA (methicillin-resistant staphylococcus aureus). Vancomycin requires pharmacokinetic calculations to determine dosing and close therapeutic drug monitoring to achieve goal trough between 15-20 mg/L (AUC/MIC goal between 400-600 mg ■h/L) and prevent nephrotoxicity. The purpose of this study is to assess our current vancomycin usage patterns, including empiric dosing accuracy & safety outcomes to help inform a decision whether a change to our current practice is indicated. Methods This retrospective, observational cohort study evaluated 117 vancomycin trough levels from 63 patients who received at least two doses of vancomycin between August 1, 2022 and July 31, 2023. Patients were excluded if they received hemodialysis or were dosed by random levels in the setting of severe renal dysfunction. Collected demographics included age, sex, weight, height, BMI, indication for vancomycin, dosing, trough levels, source of infection, MRSA nares, concomitant nephrotoxic medications, spinal cord injury diagnosis, serum creatinine, and cystatin C. Estimated AUC was calculated using VancoPK.com based on the reported trough using patient specific pharmacokinetic parameters. This study is exempt from IRB approval. Results A total of 58 trough levels from 49 patients were included. The majority of patients were male (87.7%) with an average age 61±13 years old. Out of the 58 trough levels evaluated, 20 (41%) were at goal. Of the levels not a goal 27 (71%) were subtherapeutic, and 11 (29%) were supratherapeutic. The estimated AUC was at goal for 35 (60%) of the 58 total troughs. Of the 27 patients who had a subtherapeutic trough 21 (77%) had an AUC at goal, and 14 of them increased the dose despite having a therapeutic AUC. Only 1 patient (2%) developed possible vancomycin associated AKI (acute kidney injury). Conclusion A higher number of patients were within therapeutic range when evaluating AUC compared to trough. The low incidence of vancomycin associated AKI was likely due to low frequency of supratherapeutic troughs in this study. Further analysis of these results will be used to identify opportunities for education and improvement of our current vancomycin dosing process. Disclosures All Authors: No reported disclosures

P-286. Prevalence of Pseudomonas aeruginosa in patients with ICU-related respiratory Infections: A secondary analysis of the European Network for ICU-Related Respiratory Infections (ENIRRIs)

Abstract Background Microorganisms causing healthcare-associated infections are usually difficult to treat Gram-negative bacteria, making the empiric antibiotic selection challenging. Pseudomonas aeruginosa (PA) is a microorganism associated with hospital-acquired infections, and its rate of antimicrobial resistance has increased in the last ten years. However, the international prevalence of P. aeruginosa in ICU-Related Respiratory Infections (ICU-RRI) is unknown. This study aims to bridge this gap in the literature using a multicenter cohort study.Figure 1:Prevalence of Pseudomonas aeruginosa infection by countries Figure 1: Prevalence of Pseudomonas aeruginosa infection by countries for participants in the entire cohort (A) and bacterial microbiological Identification (B) Europe is shown in detail because of the high number of patients enrolled and the large number of participating countries. Methods This prospective cohort was conducted in 12 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of VAP, VAT, ICU-HAP, HAP (i.e., patients transferred to the ICU without requiring invasive mechanical ventilation), and HAP that required invasive ventilation (VHAP) were collected. All patients were tested to find microbiological agents and their resistance phenotype. We assessed the prevalence of Pseudomonas aeruginosa ICU-RRI.Figure 2:Prevalence of Pseudomonas aeruginosa with antimicrobial resistance infection by countries Figure 2 Prevalence of Pseudomonas aeruginosa with antimicrobial resistance infection by countries for participants in the entire cohort (A) and bacterial microbiological Identification (B) Europe is shown in detail because of the high number of patients enrolled and the large number of participating countries. Results 1059 patients with ICU-RRI who underwent testing for microbiological diagnosis were included, and 710 (67.0%) had bacterial microbial identification. The overall prevalence of confirmed PA was 14.5% (n=153), and the overall prevalence of PA with at least one mechanism of antimicrobial resistance was 5,1% (n=55), with differing prevalence among the countries (Table 1/ Figure 1-2). 19.6 % (30/55) of the PA with at least one mechanism of antimicrobial resistance were catalogued as multidrug-resistant, and 11.1% (17/55) presented carbapenemase and beta-lactamase production (Table 2). Germany followed by Argentina and France were the countries with a major overall prevalence of PA. Turkey followed by Argentina and France were the countries with a major overall prevalence of PA with at least one mechanism of antimicrobial resistance (Figure 1-2).Table 1.Prevalence of positive testing for Pseudomonas aeruginosa, Pseudomonas aeruginosa without antimicrobial resistance mechanism and Pseudomonas aeruginosa with any antimicrobial resistance mechanism among 12 countries in LRTI diagnosed patients who were admitted to the ICU. Conclusion This multi-country study shows a high prevalence of PA and PA with at least one mechanism of antimicrobial resistance in ICU-RRI.Table 2.Description of antimicrobial resistance in LRTI-diagnosed patients who were admitted to the ICU. Disclosures All Authors: No reported disclosures

The influence of exercise modality and intensity on ventricular arrhythmia burden and perception of effort in patients with Arrhythmogenic Right Ventricular Cardiomyopathy with plakophilin-2 variants

Introduction Intense endurance exercise is discouraged for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), as it can increase the risk for adverse cardiac events as well as accelerate disease progression. While a sedentary lifestyle is also not advisable, there is currently no prospective data on the safety of physical activity for ARVC patients. To describe ARVC patients' average and peak ventricular arrhythmia burden – estimated from the prevalence of premature ventricular contractions (PVC) – measured during and after different exercise modalities and intensities, in context with cardiac and physiological load. Methods Twenty ARVC patients (8 f/12 m, age 48 ± 15 years, BMI 24 ± 3 kg/m2, resting PVC burden 4 ± 4%) with a heterozygous pathogenic/likely pathogenic plakophilin-2 (PKP-2) variant prospectively performed different exercises while monitored via 12-lead ECG. The order of modalities was randomized and participants were instructed to stop when surpassing perceived exertion of 15 (6-20 Borg scale). Resistance exercises included 2-min two-legged squats and single arm biceps curls (20 repetitions each) while endurance exercise included 5-min treadmill walking at comfortable speed and 3-min cycling bouts at a heart rate (HR) of 80, 100 and 120 bpm. Each activity was followed by a 10-min recovery period. Blood lactate concentration [La-] was assessed at the end of each cycling bout, with 4 mmol/L defined as a threshold to describe high-intensity exercise. Results No adverse events (including sustained ventricular tachyarrhythmia) nor premature terminations occurred. Average PVC burden during activities (including 5 min recovery) was lower for biceps curls compared with all other activities (p < 0.046), despite having the second highest level of perceived effort (13.8 ± 1.7 units). Biceps curls elicited ~20 mmHg (p < 0.001) lower peak systolic blood pressure and ~40 bpm peak lower HR (p < 0.001) compared with cycling at 120 bpm, despite similar perception of effort (12.9 ± 1.7, p = 0.818). Peak PVC burden during the different activities (highest PVC count in 1 min) ranged between 0–57% among participants and it was lower during the activities (5 ± 8%) than the subsequent 5-min recovery (8 ± 8%, p = 0.006). but no differences were detected between activities. Five patients (25%) presented [La-] that exceeded 4.0 mmol/L when cycling at 120 bpm. Discussion/Conclusion PVC burden, a marker for arrhythmogenicity, was generally higher during recovery than during exercise, with the smallest burden found during the exercise with a small muscle mass, despite high perceived exertion. Thus, such exercises might be better suited for training in ARVC patients. Generalized recommendations for a maximum HR of 120 bpm during exercise likely predispose a high number of ARVC patients to inadvertently perform high-intensity exercise, risking accelerating disease progression. Therefore, individualized exercise prescription should be recommended.

HLA-G Polymorphisms of The 3’-UTR Region Are Involved in Susceptibility to Non-Infectious Uveitis

ABSTRACT Purpose HLA-G is a non-classical HLA class I gene encoding a molecule endowed with immunomodulatory properties, playing important immunosuppressive and tolerogenic roles in immuno-privileged organs. Fluctuations in its expression levels have been correlated with the predisposition to autoinflammatory disorders, notably uveitis, characterized by inflammation of the uvea. In the present work, DNA was obtained from saliva samples of 147 Spanish patients with uveitis, with subsequent analysis focusing on the distribution of polymorphisms within the 3’UTR region of the HLA-G gene (a region known to modulate the expression of the HLA-G molecule). Methods Analysis techniques employed included PCR-RFLP or DNA sequencing. Comparative analysis was conducted against a control cohort comprising 117 healthy individuals. Results The frequency of the UTR-2 haplotype is increased in patients affected with anterior uveitis (OR (95% CI) 2.35 (1.06–5.21); p = 0.036). Additionally, a higher number of patients with posterior uveitis bearing in homozygosis the G allele of the 3142 C/G SNP (OR (95% CI) 2.67 (1.15–6.20); p = 0.023), was observed. Both markers are associated with diminished HLA-G expression. Conclusion These findings present the first evidence of the involvement of polymorphisms within the 3’UTR region of the HLA-G gene in susceptibility to uveitis.

A retrospective service evaluation of patient awareness and engagement, and medication compliance and adherence, in patients with opportunistically identified vertebral fragility fractures in a local fracture liaison service.

Fracture liaison services (FLS), often staffed by radiographers, identify and treat patients over the age of 50at high risk of future fractures by intervening after the first fracture. Vertebral fragility fractures (VFF) are particularly disabling and are highly predictive of future fracture but are underdiagnosed as they often do not come to clinical attention. To review the behaviour traits of patient with opportunistically identified VFF's (OIVFF), local FLS data can be used to compare outcomes of OIVFF's with acute VFF's (AVFF) and non-hip/spine fragility fractures (NHSFF). A retrospective service evaluation was completed using local FLS data from 1/1/22-31/12/22. A total of 1403 patients' data was included. Data was grouped by fracture cohort to evaluate patient engagement, fracture awareness, medication compliance and adherence. The OIVFF cohort had the highest proportion of men at 32.4%. There was little difference in engagement rates between cohorts but fracture awareness was low in the OIVFF cohort. Non-compliance to medication was highest in the NHSFF cohort. The OIVFF cohort had the highest number of patients no longer appropriate for treatment after 12 months (11.29%). Medication adherence at 12 months was similar across cohorts. Patients with OIVFF's do not appear to behave differently to other symptomatic fracture types within the FLS pathway in terms of engagement, compliance or adherence. Awareness of fracture was low for VFF's and future improvement of the patient diagnosis communication pathway is recommended. Further research into the increased number of men with OIVFF is recommended to ensure the pathway is efficient and to review potential barriers to diagnosis. Results suggest continued exploration of improving opportunistic identification of vertebral fractures is justified.

Breakthrough Psoriasis in Patients Receiving Biologicals.

Biological therapies, including TNF-alpha, IL12/23, IL17 and IL23 antagonists, adequately control a very high number of patients with moderate-to-severe psoriasis with an excellent long-term safety profile. However, on occasion, patients on biological therapy with stabilized disease or complete remission report episodes of sudden breakthrough psoriasis. To study prospectively in a monocentric tertiary setting, the clinical characteristics of patients presenting a sudden breakthrough psoriasis although completely stabilized (PASI 90-100) under biological therapy. Psoriasis patients treated by biological therapies achieving PASI 90-100 and with stabilized disease for at least 6 months were invited to enter the follow-up study for 5 years. The clinical features of patients presenting a breakthrough psoriasis were described as well as the rescue therapies and outcomes. From the total cohort of 1121 patients with psoriasis receiving biologicals, 985 patients responded to the inclusion criteria. After 5 years, 10/882 cases (1,13%) of breakthrough psoriasis were identified. Two cases were induced by the Köbner phenomenon and 8 cases by severe psychological stress. Rescue therapies included topical very potent corticosteroids or additional injections of the biological. Two patients recovered spontaneously when the stressful event was resolved. In none of the cases, there was a consistency between the breakthrough event and the next scheduled injection, nor the duration of the exposure to the treatment. No biological class or agent could be systematically incriminated. Breakthrough psoriasis is an exceptional event among patients with stabilized psoriasis using biologicals, either triggered by the Köbner phenomenon or by severe psychological stress. The pathogenesis of the breakthrough events could be linked to stress- or Köbner-related immunomodulation, permitting breakthrough psoriasis lesions to appear.

Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer.

Radical gastrectomy is generally prefered for gastric cancer but has postoperative complications. The objectives of the study are to evaluate the effectiveness of three different models of preoperative counseling and postoperative follow-up care in patients who underwent radical gastrectomy for gastric cancer. In retrospective medical record analyses, patients received nurse-led preoperative counseling and postoperative follow-up care (NC cohort, n = 105) or surgeon-led preoperative counseling and surgeon-led follow-up (SC cohort, n = 140), or did not receive counseling and aftercare (RC cohort, n = 160). Patients had a postoperative intensive care unit (PICU) stay of 24 (26-22) h/patient and postoperative pain of 6 (6-5)/ patient. The frequencies of nausea, vomiting, medical intensive care unit admission(s), dizziness, length of PICU stay, and intensity of postoperative pain were lower among patients in the NC cohort, followed by those in the SC and RC cohorts. A higher number of patients in the RC cohort died when compared to the NC (25 [16%) vs 2 [2%], p = 0.0458) and the SC (25 [16%] vs 11 [8%], p = 0.0001) cohorts in follow-up. Patients who undergo radical gastrectomy for gastric cancer require healthcare professional-led preoperative counseling and postoperative aftercare. Nurse-led preoperative counseling and postoperative aftercare, could improve outcome measures in patients who underwent radical gastrectomy for gastric cancer.

Efficacy of Auricular Therapy for Motor Impairment After Stroke: A Systematic Review and Meta-Analysis.

A high number of stroke patients cannot recover fully from motor impairment despite early rehabilitation. Auricular therapies, usually given by acupuncture doctors or nurses, have been widely used among these post-stroke patients. Potential benefits of auricular therapies were shown in recent clinical trials. The purpose of this review was to systematically evaluate the clinical effects of auricular therapy in the treatment of post-stroke motor impairment. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were searched from their inception to May 2023. Randomised controlled trials of auricular therapy for the treatment of post-stroke motor impairment met the screening criteria. The primary outcome was the Fugl-Meyer Assessment Scale (FMA). The secondary outcomes included the Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Chinese Stroke Scale (CSS), clinical efficacy and the Barthel Index Scale (BI). Meta-analysis was carried out using RevMan software 5.3. Twenty-eight RCTs with 1993 patients were included. The meta-analysis results suggested that compared with conventional treatment, auricular therapy combined with conventional treatment significantly improved the FMA score (MD: 15.07, 95% CI, 12.56 to 17.59), the FMA-UE score (MD: 6.49, 95% CI, 5.54 to 7.45), the clinical efficacy (RR: 1.20, 95% CI, 1.12 to 1.29) and the BI score (MD: 10.26, 95% CI, 9.11 to 11.40), while the combination treatment significantly decreased the CSS score (MD: -2.98, 95% CI, -4.38 to -1.59). Auricular therapy, as an adjunctive treatment to the conventional treatment, improved post-stroke motor impairment and self-care ability. Early auricular therapy of the patients in the early disease stage may lead to better improvement. Further well-designed, large-size clinical studies are needed. This study suggested that auricular therapy could be used as a complementary therapy with conventional treatment for improving motor impairment and self-care ability among post-stroke patients with motor impairment in hospitals, long-term care facilities and homes.

Clinical Presentation and Staging of Retinoblastoma Patients

IntroductionRetinoblastoma is the common curable primary intraocular malignancies of childhood occurring in approximately 1 in 18,000 live births. The burden of disease is of great importance because early detection and management will have a lifelong impact on other domains of development in these children. The purpose of this study is to determine the clinical presentation and staging of retinoblastoma patients. Methods This was a hospital-based descriptive study conducted at BP Koirala Lions Centre for Ophthalmic Studies. Children diagnosed with retinoblastoma were enrolled by purposive sampling method. After obtaining informed written consent, data was taken in semi-structured proforma. Data was analysed in the SPSS version 21.0. ResultsA total of 17 cases of retinoblastoma were enrolled in this study. Majority of the cases were male, belonging to low-class family, and from rural areas. Sixty four percent of participants had leukocoria, followed by proptosis (18%) and red eye (9%). One eye was affected in 12 (71%) cases and both eyes were affected in 5 (29%) cases. The highest number of patients was from Province 2 (35%) and they belonged to the upper caste (29%). Group D and group E lesions were seen in 37% and 50% of cases respectively whereas stage 1 disease was seen in 86%. ConclusionLeukocoria was the most common clinical presentation. More than 80% of tumours were in advanced Group D and Group E category. The study highlights the delayed presentation of cases to treatment because of lack of awareness, ignorance, poverty, illiteracy and limited access to health care facilities.

Long‐term Outcomes of PRP Injections for Post‐viral Olfactory Loss: A Prospective Cohort Study

ABSTRACTBackgroundPlatelet‐rich plasma (PRP) injections have previously been shown to benefit coronavirus disease 2019 (COVID‐19)‐induced smell loss. It is unknown if that benefit is stable over time. The aim of this study was to assess outcomes at 1‐year post‐intervention.MethodsProspective cohort study. Sixteen patients (10 PRP and six placebo) from the original PRP randomized placebo‐controlled clinical trial, and a further 16 patients from smell clinic who were a year out from initial treatment (six PRP patients and 10 non‐PRP) were enrolled. University of Pennsylvania Smell Identification Tests (UPSITs) and visual analog scale (VAS) subjective scores were compared to initial scores.ResultsThere was no difference between groups with respect to age, gender, race, duration of smell loss prior to intervention, smoking or diabetes status, Charlson comorbidity index, presence of phantosmia or parosmia, or baseline UPSIT score. The PRP group had a significantly higher change in UPSIT score at 1 year (p = 0.001), a higher number of patients who met the minimal clinically important difference for the UPSIT (87.5% vs. 31.2%, p = 0.004), and a significantly greater change in VAS at 1 year (p = 0.001), compared to those who did not receive injections. On multivariate logistic regression analysis, no factors appeared to have a significant effect on these findings.ConclusionPRP injections into the olfactory cleft now have long‐term data suggesting benefit in both subjective and psychophysical measures of smell, and improvements in both realms at 1 year are significantly higher than in those who do not receive the injections.

Retrospective assessment of dental implant applications: cross-sectional study

Aims: The aim of this study was to retrospectively examine the demographic and clinical conditions of the patients operated between 2020 and 2023 and the characteristics of the implants placed and to evaluate them using descriptive statistics. Methods: In this study, 6990 implants were evaluated in a total of 1586 patients aged 17-80 years, whose implant treatments were performed between 2020 and 2023 in Atatürk University Faculty of Dentistry, Department of Periondotology and Department of Oral, Dental and Maxillofacial Surgery. The demographic data obtained were analyzed by descriptive statistical techniques to examine a series of characteristics such as age, gender, edentulous status, implanted sites, type of post-treatment restoration and implant locations, type of post-treatment restoration and the brand and model of implants used. Results: 52.1% (n=827) of the patients were female and 47.9% (n=759) were male. The highest number of patients (n=480) was in the 40-49 age group. The most commonly implanted tooth was the mandibular 1st molar, and the most commonly implanted area was the mandibular molar region. It was determined that 70.8% of the implants were performed in the periodontology clinic. When evaluated according to the type of prosthetic restoration, the highest proportion of patients was 49.4% (n=1366) with fixed partial edentulism terminated with teeth. The lowest number of patients was complete edentulism and overdenture restoration with 5.9% (n=162). Conclusion: In this study; demographic and clinical characteristics of dental implant applications and the results were explained with descriptive statistical analysis methods. Retrospective evaluation of the features of clinical applications and prosthetic rehabilitation of implants is very valuable in terms of guiding treatment planning processes.

Dynamics of Clinical Manifestations and Social Functioning in Schizophrenia: A Non-interventional Observational Study of Paliperidone Palmitat Dosage Forms

BACKGROUND: Over the past seven years, the use of long-acting forms of antipsychotic medication has significantly increased in Russia. Specifically, in Moscow, from 2016 to 2021, the proportion of prescribed injectable long-acting antipsychotics had increased more than sevenfold (from 3% to 23%). Studies have shown that the correct selection of target groups for such therapy can reduce the frequency of relapses requiring hospitalization, lower the costs of inpatient care, and shift the focus of therapy from multiple drug administrations to psychosocial work. AIM: This study was aimed at evaluating changes over time in psychosocial functioning, as well as clinical and psychopathological manifestations, in patients with schizophrenia during early remission and while on therapy with different forms of paliperidone: oral paliperidone (OP), paliperidone palmitate administered once monthly (PP1M), and paliperidone palmitate administered once every three months (PP3M). METHODS: The observational study included 155 patients: 54 patients who had been treated with another second-generation antipsychotic received OP, 50 patients who had been treated with another antipsychotic received PP1M injections, and 51 patients who had been in remission for four months after treatment with PP1M received PP3M. The duration of the follow-up period was 12 months. Assessment of personal and social functioning was conducted five times: before the start of treatment, and 3, 6, 9, and 12 months later. RESULTS: Treatment in all groups led to a statistically significant reduction in the severity of positive symptoms (p 0.001). Hallucinations proved more susceptible to therapy (p 0.001), while persistent delusions showed greater treatment resistance. Significantly more patients in the PP1M and PP3M groups had completed the entire program (n=24; 48.0%, and n=30; 58.8%, respectively) compared to the OP group (n=11; 20.4%). The PP3M group demonstrated the highest treatment adherence, with the largest number of patients completing the study, and a similar rate of exacerbations or inadequate efficacy compared to the other groups. CONCLUSION: Treatment with different forms of paliperidone provides a roughly equal pace reduction in the severity of schizophrenia, including positive and negative symptoms. The PP3M group had better adherence and the highest number of patients who fully completed the study.

Evaluation of the Epidemiological Disease Burden and Nationwide Cost of Endometriosis in Hungary.

Endometriosis is one of the most common gynecological diseases that can lead to infertility. The aim of this quantitative, descriptive, and cross-sectional study was to analyze the prevalence and the annual nationwide health insurance treatment cost of endometriosis in Hungary in 2010 and 2019. The data used in this study were sourced from publicly funded, national, real-world datasets administered by the National Health Insurance Administration (NHIFA). The total number of cases of endometriosis in the Hungarian population was determined by ICD codes and all types of care. The total prevalence, age-specific prevalence, and annual health insurance expenditure by age group were evaluated. The highest numbers of patients and prevalence (2010: 101.9/100,000 women; 2019: 197.3/100,000 women) were found in outpatient care. Endometriosis, regardless of its type, mainly affects patients in the 30-39-year age group (number of patients-2010: 6852; 2019: 11,821). The NHIFA spent a total of EUR 1,639,612 on endometriosis treatment in 2010 and EUR 1,905,476 in 2019. The average annual health insurance expenditure per capita was EUR 574 in 2010 and EUR 426 in 2019. There was a significant correlation between length of stay and mean age of patients in both years (2010 r = 0.856, p < 0.001; 2019 r = 0.877, p < 0.001). The number endometriosis cases is increasing. Early diagnosis and targeted treatment would reduce endometriosis symptoms and therefore improve patients' quality of life and reduce health insurance costs. This would be helped by the establishment of endometriosis centers.

Geriatric traumatology-Principles of orthogeriatrics

The number of patients with fragility fractures will continue to increase in the future. The multimorbidity of these patients places high demands on the treatment. The treatment of this complex group of patients in specialized centers is therefore recommended. The collaborative treatment of patients by trauma surgeons and geriatricians improves the results. The treatment is carried out according to a standardized protocol and includes rapid surgical stabilization of the fracture and an interdisciplinary care of the patients. During hospitalization many patients develop delirium. Due to the high rate of complications endangered patients should already be identified in the emergency department to enable a timely initiation of preventive measures. Due to the high number of patients requiring treatment and the complexity of the patients, the legislation has established specific requirements for the treatment of proximal femoral fractures. The treatment of fragility fractures in trauma surgery goes beyond the surgical stabilization alone and incorporates the pharmaceutical treatment of the osteoporosis.

THE COST OF SMS REMINDER TO IMPROVE ARV ADHERENCE AMONG KEY POPULATIONS

Background: HATI is an implementation trial aimed at improving HIV care and treatment, including through SMS reminders. Aims: This study aimed to estimate the cost and analyze the outcomes of providing SMS Reminders within the HATI program in different settings. Methods: Data were analyzed using a micro-costing approach from providers' and health systems' perspectives. Subjects were divided into intervention and control groups for outcome analysis, with adherence as the outcome indicator. Results: From a provider's perspective, the highest cost was incurred in primary health care (PHC) clinics, while the lowest was in hospital clinics, most likely due to a much higher volume of SMS sent from hospitals. Costs from the health system perspective were more than two times higher than those from the provider perspective, as they included costs borne by HATI management and intervention setup. In one year, the number of patients with &gt;95% adherent visits was higher in the intervention group than the control group, although visits decreased over time in both groups. The highest number of patients with &gt;95% adherent visits was found in PHC clinics, while the lowest was in hospital clinics. Conclusion: SMS reminders can be expensive initially due to setup and program costs. However, they become cheaper once they are embedded into the existing system. Further studies are necessary to determine better site options for scaling up SMS reminder intervention and to study the declining adherence rate in all clinics. Keywords: Adherence, cost analysis, HIV, Indonesia, SMS reminder

Experience of urologists, oncologists and nurse practitioners with mainstream genetic testing in metastatic prostate cancer.

International guidelines recommend germline genetic testing for men with metastatic prostate cancer. If offered to all patients by genetic healthcare professionals, there will be insufficient capacity to cope with the high patient numbers. In a mainstreaming pathway, non-genetic healthcare professionals (ngHCPs) discuss and order germline genetic testing instead of referring patients to genetic healthcare professionals. We aimed to evaluate the experience of ngHCPs with pre-test genetic counselling and to explore the feasibility from the ngHCPs' perspective. We carried out a prospective cohort study in 15 hospitals in the Netherlands. All participating ngHCPs (i.e. urologists, medical oncologists, specialist nurses and nurse practitioners) completed an online training module of 45 min. The ngHCPs completed a questionnaire both before the training and at three and nine months after it. Paired analyses were used to compare the first with the last questionnaires on attitude, confidence in the ability to discuss and order germline genetic testing, and perceived and actual knowledge of genetics and genetic testing. 167 ngHCPs were invited to participate of whom 69 completed the first questionnaire and started or completed the last one. They had a positive attitude towards offering genetic testing themselves. After nine months of providing pre-test genetic counselling, significantly more ngHCPs considered mainstreaming helpful (94% after versus 81% before, p = 0.01). Both perceived and actual knowledge increased significantly. Pre-test genetic counselling took less than 10 minutes for 82% of ngHCPs and the majority (88%) were in favour of continuing the mainstream pathway. Only six participating ngHCPs considered mainstreaming possible without completing a training module beforehand. After completing a short online training module, ngHCPs feel well-prepared to discuss germline genetic testing with metastatic prostate cancer patients.

Study of Blunt trauma to abdomen and associated mortality after admission in a tertiary care hospital in Moradabad District.

Introduction:- The abdomen area is the 3rd most common area which is injured and surgery required in almost about 25% of civilian cases(1). Blunt abdominal trauma (BAT) is one of the most important causes of mortality among trauma victims. It is the main cause of death in people under 35 years of age in worldwide. (2) Most common cause of blunt trauma abdomen in our country (India) is road traffic accident which is followed by abdominal blows and fall from heights. This ever-expanding out break targeting the youth and useful generations is likely to take a serious burden on theirsocioeconomic growth and quality of life. Material &amp; Method: - All the cases admitted in the Casualty of T.M.M.C &amp; R.C from district Moradabad and its adjoining area from 1stJanuary 2014 to 30thDecember 2015 with history of blunt trauma to the abdomen were included in the study. All data were compared to similar studies. Result: - Highest number of patients i.e. 36 (32.7%) belonged to 21-30 years age group. There were 91 (82.7%) male patients and 19 (17.3%) female patients. There were 82 (74.5%) accidental deaths and 23 (20.9%) homicidal deaths while only 5 (4.5%) suicidal deaths. In present study, majority of patients in accidental victims in males belongs to rural community 50 (61%) followed by urban community 12 (14.6%)

Association of Triglycerides and HbA1c Levels with Stages of Invasive Ductal Breast Cancer: A Prospective Study

ABSTRACT Background: This prospective study investigates the association between triglyceride (TG) levels and HbA1c values with different stages of invasive ductal breast cancer (IDC) in female patients. Metabolic alterations, including dyslipidemia and hyperglycemia, are increasingly recognized as potential factors associated with cancer progression. Methods: A total of 150 female patients diagnosed with IDC were included in the study, categorized into four stages of the disease. Triglyceride levels were measured using colorimetry, and HbA1c values were determined using the ion exchange resin method. Descriptive statistics and distributions of TG and HbA1c values were analyzed across the cancer stages. Results: In Stage 1, patients had a mean TG level of 347.5 mg/dL and a mean HbA1c of 10.2%. These values declined in subsequent stages, with Stage 4 patients showing a mean TG level of 208.6 mg/dL and a mean HbA1c of 6.9%. A majority of Stage 1 patients (n = 35) had TG levels between 200 and 499 mg/dL, while Stage 4 had the highest number of patients with TG levels below 150 mg/dL (n = 6). Additionally, a significant proportion of Stage 1 patients had HbA1c values ≥10% (n = 17), indicating poor glycemic control. As the disease progressed, this proportion decreased, with only two patients in Stage 4 having HbA1c levels ≥10%. Conclusion: This study suggests a correlation between lower TG and HbA1c levels and more advanced stages of IDC. These findings highlight the importance of metabolic factors in IDC progression and may inform future research on potential therapeutic targets.