High-risk Adults Research Articles

Use of the electronic medical record to screen for high-risk geriatric patients in the emergency department.

Older adults with multimorbidities have the highest rate of emergency department (ED) usage. These patients are typically on numerous medications, may have underlying dementia, and often present with falls and delirium. Identifying these high-risk older adults for possible intervention is challenging in the ED setting since available screening methods are manual and resource-intensive. The objective is to study the electronic medical record (EMR) use for identifying high-risk older adults in ED. This feasibility study is conducted in an academic ED with 67 000 total and 24% geriatric (age ≥ 65 years) annual visits, American College of Emergency Physician (ACEP) accredited Level 1 Geriatric Emergency Department with an ED-based geriatric consultation program by incorporating criteria from existing manual geriatric screening instruments and the 4M framework into an automated EMR screen to identify high-risk geriatric patients. ED providers are then alerted by an EMR Best Practice Alert (BPA) if high-risk status is identified. Initial development and impact on geriatric ED consults are reported. During the study period, 7450 patient encounters occurred; 1836 (24.6%) encounters involved patients who were 65 years or older. A total of 1398 (76.1%) high-risk ED encounters resulted in BPA alerts using the EMR automated screen. BPA alerts resulted in 82 (5.9%) geriatric evaluations. We conclude that using the EMR to automate screening for older adults for high-risk geriatric conditions in the ED is feasible. An automated EMR screen with a BPA to ED providers identified a well-defined cohort of older patients appropriate for further ED geriatric evaluation.

Is There a Role for Alcohol Septal Ablation in Young Patients with Medically Refractory Hypertrophic Obstructive Cardiomyopathy?

Surgical myectomy is recommended for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) after optimal pharmacological therapy. Percutaneous transluminal septal myocardial ablation (PTSMA) is reserved for high-risk adults. Symptomatic patients below 25years underwent either surgery or PTSMA after heart-team discussion and informed consent. Echocardiography assessed gradients in surgical group. PTSMA group underwent invasive transseptal hemodynamic assessment, selective coronary angiography and super-selective cannulation of septal perforators using microcatheters. Contrast echocardiography through the microcatheter identified the myocardial target for PTSMA. Hemodynamic and electrocardiographic monitoring guided alcohol injection. Both groups were continued on beta-blockers. Symptoms, echocardiographic gradients and Brain natriuretic peptide (NTproBNP) measurements were assessed on follow-up. Twelve patients aged 5-23years (11-98kg) formed the study group. Indications for PTSMA in 8 patients included abnormal mitral valve anatomy warranting replacement (n = 3), Jehovah's witness (n = 2), severe neurodevelopmental and growth retardation (n = 1) and refusal of surgery (n = 2). PTSMA targeted first perforator (n = 5), second perforator (n = 2) and anomalous septal artery from left main trunk (n = 1). Outflow gradient reduced from 92.5 ± 19.7 to 33.1 ± 13.5mmHg. At a median follow-up of 38months (range 3-120weeks), the peak instantaneous echocardiographic gradient was 32 ± 16.5mmHg. Gradient reduced in four surgical patients from 86.5 ± 16.3mmHg to 42 ± 14.7mm Hg. All patients were in NYHA class I/II on follow-up. The mean NTproBNP in PTSMA group reduced from 6084 ± 3628pg/ml to 3081 ± 2019pg/ml; it was 1396 and 1795pg/ml in surgery. PTSMA may be considered in medically refractory high-risk young patients. It relieves symptoms and reduces gradient. Though surgery is preferred in young patients, PTSMA may have a role in selected patients.

Exposure to media with alcohol-related content across young adulthood: Associations with risky drinking and consequences among high-risk 2- and 4-year college students.

Exposure to media with alcohol-related content is a known risk for alcohol use and related harms among young people. The present study used longitudinal self-report data on exposure to media with alcohol-related content to examine age trajectories across young adulthood and to estimate associations with heavy episodic drinking (HED) and negative consequences. Participants were 201 high-risk young adults enrolled in 2- and 4-year colleges (ages 18-25 at screening; 63.7% female). Repeated assessments occurred at four timepoints across a 12-month period. Self-reported exposure to both positively and negatively portrayed alcohol-related media content decreased with age. Between-persons, controlling for alcohol use frequency, exposure to positive alcohol-related media content was positively associated with HED, and exposure to negative alcohol-related media content was inversely associated with HED; no within-person effects on HED were significant. For negative consequences, controlling for alcohol quantity, exposure to positive media content was associated with more negative consequences both between- and within-persons. Unexpectedly, exposure to negatively portrayed media content was positively associated with negative consequences at the within-person level. Trajectories in exposure to media with alcohol-related content showed that relatively younger participants reported greater exposure, highlighting the need for policy and prevention efforts to protect this vulnerable demographic. Findings generally indicated that positive portrayals of alcohol use increase alcohol-related risks. Moreover, increased exposure to negative portrayals in a given assessment was associated with more negative consequences-potentially by normalising or glorifying high-risk drinking and consequences, though mechanistic/causal research is needed.

Multifactorial Exercise Intervention Decreases Falls Risk in High-risk and Low-risk Older Adults.

Each year, 1 in 4 people over the age of 65 years of age will experience a fall. It is important to identify and address modifiable risk factors that are associated with falls in adults at high and low risk for falls. Falls risk improves in both high-risk and low-risk participants with the implementation of Stay Active and Independent for Life (SAIL). Cohort study. Level 3. Seventy-eight older adults (age, 70.9 ± 5.1 years) were included in this study and categorized into high risk and low risk for falling based on the falls risk score from the Physiological Profile Assessment. High risk was defined as having a preintervention falls risk score >1, whereas low risk was defined as having a preintervention falls risk score <1. Both groups had the same 10-week intervention. A multivariate analysis of covariance was used to compare differences pre- and postintervention, using preintervention falls risk score as covariate. Results showed that regardless of preintervention falls risk, participants showed significant improvements in right and left knee extensor strength and sit-to-stand after participation in the 10-week SAIL program. Also, noteworthy is that 15 participants who were considered at high risk for falling preintervention were considered low risk for falling postintervention. The positive outcomes noted on modifiable risk factors suggest SAIL can be beneficial for decreasing falls risk in older adults, regardless of risk of falling, using a multifactorial exercise intervention. Our results also showed that it was possible for participants not only to improve falls risk but to improve to such a degree that they change from high risk to low risk of falling. Our results demonstrated that SAIL was effective in improving overall fall risk after a 10-week intervention. Targeted community-based interventions for the aging population can bring physical health benefits that can decrease falls risk.

A Strategy for Prevention of Type 2 Diabetes Mellitus in Guyana: The Guyana Diabetes Risk Score

Background: Type 2 Diabetes Mellitus (T2DM) imposes an enormous and mounting burden on global public health systems, especially in developing countries such as Guyana. However, primary prevention of type 2 diabetes can be achieved through organized lifestyle intervention programs for weight loss, increased physical activity and dietary restrictions. Therefore, there is a need to develop local risk stratification tools tailored to the local population to identify high-risk individuals who may benefit from these interventions. Objectives: This study proposes implementing a program for the primary prevention of T2DM in high-risk adults (18 – 55 years) in Guyana. The main objective is to identify adults at high-risk for developing type 2 diabetes mellitus using a Diabetic Risk Score and to enroll the participants in a lifestyle intervention program. Methods: The health belief model is a theoretical framework that guides health promotion programs by predicting health behaviours. A health promotion campaign will target high-risk adults at local healthcare facilities and across Guyana through television, radio and social media adverts. The health promotion adverts will inform and educate the target population to complete the Guyana Diabetic Risk Score questionnaire. If the score on the Guyana Diabetic Risk Score questionnaire exceeds 50, the participants will be enrolled in a lifestyle intervention program, 'Healthy Me'. Results and Discussion: Minor changes in lifestyle, such as a healthy diet, increased physical activity, and healthy body weight, can reduce diabetes in high-risk adults by over 50%. Conclusions: The Guyana Diabetes Risk Score is a low-cost, non-invasive, practical tool to identify individuals at high risk for T2DM in Guyana. Keywords: Type 2 Diabetes Mellitus, T2DM, Guyana Diabetes Risk Score.

Abstract MP10: Healthy Diet Perception vs Actual Diet Quality for Cardiovascular Health: Prevalence and Predictors of Perceiving a Poor Diet as Healthy Among Adults

Objective: A healthy diet is key to preventing and managing CVD. Despite clear AHA guidelines, eating healthy can be difficult due to misinformation. We investigated perceived vs. actual diet quality and what contributes to perceiving a poor diet ‘healthy’. Methods: We identified adults aged &gt; 19 in 2005-2018 National Health and Nutrition Examination Survey. Healthy perceived diet was defined as answering “excellent” or “very good” to “how healthy is the diet?”. We assessed actual diet quality by calculating AHA Healthy Diet Score based on a 24-hour dietary recall and scaled the raw score to 0-100%; ‘poor diet’ was defined as AHA score &lt; 40%. We first estimated prevalence of poor actual diet and perceived healthy diet. Among those with poor diet (AHA score &lt; 40%), we fit modified-Poisson regression models to identify factors associated with perceiving a poor diet as ‘healthy’ and reported risk ratios with 95% confidence limits. Results: Among 31,621 adults (50% female, mean age 50, 43% non-Hispanic White, mean BMI 29), prevalence of ‘healthy’ perceived diet and actual ‘poor diet’ was 29% and 47%, respectively. Among adults with a ‘poor diet’ (n=14,951), 23% perceived their diet as ‘healthy’ and many sociodemographic and lifestyle factors and comorbidities were significantly associated with perceiving a poor diet as healthy in univariate analyses (Table). In multivariable analysis, increased age, male sex, White race (compared to Black and Hispanic race), MI history, smaller waist circumference, higher physical activity, and alcohol use were independently associated with perceiving their poor diet as ‘healthy’ (RR ranged from 0.77-1.48, Table). Conclusion: Nearly half of US adults had a poor diet based on dietary targets from AHA 2020 Strategic Impact Goals for CV health, yet nearly a quarter of them perceived their diet as ‘healthy’. Targeting high risk adults with focused educational interventions to calibrate their perception of a healthy diet can be effective in modifying their eating behavior and promoting CV health.

Abstract P367: Automated Outreach to Improve Statin Initiation and Follow-Up of Lipid Panels Among Patients With High LDL-C

Background: Despite their effectiveness in reducing low-density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) risk, high-intensity statins are underutilized among patients with LDL-C ≥ 190 mg/dL. We aimed to determine if a patient outreach program (KP Sure Net) automating high-intensity statin orders and lipid panels improved statin initiation and lab completions. Methods: Kaiser Permanente Southern California adults 20-60 years of age with LDL-C ≥ 190 mg/dL and no recent statin use were compared pre- (January 2016-September 2018, n=3,534) and post- (April 2019-July 2021, n=3,555) program implementation to examine statin prescriptions and fills, lab completions, and improved LDL-C (&lt;190 mg/dL) at 6 months. Using Poisson regression with robust variance, we calculated relative risks (RR) and 95% confidence intervals (CI) for the association of program implementation with statin prescriptions, fills, lab completions, and improved LDL-C, separately, adjusting for sociodemographics, insurance, comorbidity burden, and non-statin medication use. Results: Among adults identified during pre- and post-implementation, 759 (21.5%) and 976 (27.5%), respectively, received a statin prescription. Adults with a prescription post- versus pre-implementation were more likely to be younger, identify as Black or Asian ethnicity, be English-speaking and have higher income, but were similar by sex, education, insurance, and comorbidity burden. (Table) After multivariable adjustment, adults post- versus pre-implementation had a higher likelihood of receiving a statin prescription (RR 1.36, 95% CI 1.25, 1.48), filling their statin (RR 1.32, 95% CI 1.26, 1.38), completing their lipid panel (RR 1.60, 95% CI 1.44, 1.78), and improving LDL-C (RR 1.36, 95% CI 1.20, 1.53). Conclusion: Automating statin orders and lipid panels for high-risk adults improved prescription rates, fills and LDL-C. Understanding facilitators and barriers to adherence is an important next step in improving patients’ health.

Association between sociodemographic factors and cholesterol-lowering medication use in U.S. adults post-myocardial infarction.

Cholesterol-lowering medications offer effective secondary prevention after myocardial infarction (MI). Our objective was to evaluate the association between sociodemographic factors and cholesterol-lowering medication use in high-risk adults. We conducted an analysis using weighted data from 31,408 participants in the 2017 and 2019 Behavioral Risk Factor Surveillance Systems cross-sectional surveys, who had a self-reported history of MI and high blood cholesterol. The sociodemographic factors evaluated were sex, age, race and ethnicity, annual household income, education level, relationship status, and reported healthcare coverage. We estimated the weighted prevalence of medication use, and weighted prevalence differences (with 95% confidence intervals) across categories, adjusting for sex, age group, healthcare coverage, smoking status, hypertension, and diabetes. Overall, 83% of survey participants with a self-reported history of both MI and high blood cholesterol reported currently using a cholesterol-lowering medication. The prevalence of use was only 61% in those without self-reported healthcare coverage, compared to 85% of those with healthcare coverage (adjusted prevalence difference of -20%; 95% CI: -25% to -14%). Use of cholesterol-lowering medication was relatively low in younger adults and higher in older adults, leveling off after age 65 years. The proportion of Native Hawaiian or Pacific Islanders who were using a cholesterol-lowering medication was relatively low, but otherwise there was little variation by race and ethnicity. Household income, education level, and relationship status were weakly or not associated with medication use. Knowledge of characteristics of persons who are relatively less likely to be adherent with cholesterol-lowering medications for secondary prevention may be useful to policymakers and healthcare providers involved in the long-term treatment of MI patients. Policy makers might consider a reduced cost prescription coverage for persons without current healthcare coverage who have sustained an MI to reduce future cardiovascular morbidity and mortality.

Lower serum FT3 within the reference range is associated with mortality for older adults over 80 years of age with sarcopenia

ObjectiveThyroid hormones stimulate myogenesis and muscle contraction and regulate skeletal muscle cell metabolism. However, the association between thyroid hormone levels and mortality in sarcopenic older adults remains elusive. The aim of this study was to investigate the relationship between thyroid hormones and all-cause mortality in people over 80 years of age with sarcopenia.MethodsThis study was performed on 264 sarcopenic patients aged 80 years and older. Serum levels of thyroid hormone, including free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were tested to evaluate thyroid status. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People. Mortality data were available for up to 38 months of follow-up. The correlation between FT3 and calf circumference (CC) or handgrip strength (HGS) was determined by Pearson correlation analysis. Kaplan-Meier analysis was used to compare the differences between FT3 tertile groups. Cox regression was used to analyze the mortality risk ratio of patients with different FT3 tertiles.ResultsDuring the follow-up period, 88 older adults died. Non-Survivors had lower serum FT3 levels (3.7 ± 0.5 vs. 3.9 ± 0.7, P = 0.001) than the Survivor. Serum FT3 was positively associated with CC and HGS (r = 0.29, P < 0.001, r = 0.21, P = 0.002, respectively). The Kaplan-Meier curve analysis demonstrated a difference in mortality among the FT3 tertile groups (log-rank test, χ2 = 11.83, P = 0.003). The high FT3 group had lower mortality compared with the low FT3 group (the adjusted HRs were 0.63 (95%CI: 0.41–0.96 P = 0.031).ConclusionLower FT3 within the reference range is associated with higher mortality in adults over 80 years with sarcopenia and euthyroid. Routine assessment of FT3 may be an easy way to identify high-risk older adults with sarcopenia.

Systematic literature review of the signs and symptoms of respiratory syncytial virus.

Respiratory syncytial virus (RSV) is responsible for over 30 million lower respiratory tract infections (LRTIs) and 3 million hospitalizations worldwide each year. Despite the risk RSV poses to young children, older adults, and individuals with comorbidities or suppressed immunity, there is limited understanding of RSV symptom presentation across these at-risk groups, and there is no vaccine for RSV. We conducted two systematic literature reviews (SLRs) of studies that document signs and symptoms (S&S) of RSV in (1) children aged ≤5years and (2) immunocompromised adolescents and adults, and adults at high risk for severe RSV due to age or comorbidities. Symptom duration and hospital length of stay (LOS) were explored. Electronic database searches were performed following PRISMA guidelines. Studies captured RSV S&S across community and hospital settings. Clinicians and caregivers reported (n = 25 studies) nasal discharge/congestion, cough, shortness of breath, feeding abnormalities, and fever in ≥40% of children across studies and settings. Median hospital stays for children ranged from 2days in the United States to 7.5days in China. High-risk adults with RSV (n = 6 studies) commonly (≥40% of adults) reported cough, sputum, dyspnea, and fever/feverishness. Median length of hospital stay in adults ranged from 6 to 15 days across studies. Caregivers and clinicians reported similar RSV S&S in young children, including upper and lower respiratory and systemic symptoms. In high-risk and immunocompromised adults, the most frequent (in multiple publications) and commonly reported RSV S&S were primarily LRTI symptoms. RSV symptoms could last for weeks and are variable based on geography.

Individual physical activity, neighbourhood active living environment and mental illness hospitalisation among adults with cardiometabolic disease: a Canadian population-based cohort analysis

ObjectivesThis population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition.Design and settingData...

Abstract WP74: Predictors Of Acute Ischemic Stroke In Young Adults With Cannabis Use Disorder: An Artificial Neural Network Analysis Using A Nationwide Cohort (2019)

Background: An increase in cannabis use disorder (CUD) has been associated with a rise in adverse cerebrovascular events in the United States. However, large-scale data on risk stratification of acute ischemic stroke (AIS) among young patients with CUD remains limited. We aim to determine predictors of AIS in the young CUD cohort using the Artificial Neural Network (ANN) model in a national cohort. Methods: We identified hospitalizations of young adults (18-44 years) with CUD (unweighted n=101094, weighted n=539125) using the National Inpatient Sample (2019). Later we grouped them into AIS and non-AIS cohorts. The neural network’s predictive factors were selected for AIS in CUD cohort. CUD admissions were randomly split between training (80%, n=80754) &amp; testing datasets (20%, n=20340). Training data was used to calibrate ANN, while testing data was used to evaluate the algorithm's accuracy. We compared the frequency of incorrect prediction between training and testing data and measured the area under the curve (AUC) to determine ANN’s efficacy in predicting AIS with CUD. Results: The 2019 cohort consisted of a total of 539125 admissions (56.1% male, 52.9% white, 28.7% blacks, 12.4% Hispanic, 6.0% Asian or Pacific Islander) in young adults with CUD with a median age of 30 (IQR 24-36) years. The rate of AIS admissions in young CUD cohort was 0.5% (n=2535). Training data showed improved predictions with a significantly low error rate (0.5%), thereby depicting better accuracy. The normalized importance of independent predictors of AIS in the CUD cohort is displayed in Fig. 1a . History of PVD, prior stroke/TIA, hypertension and hyperlipidemia had the highest normalized importance. The AUC was 0.811 (Fig. 1b) which shows an excellent ANN model for the prediction of AIS in young CUD cohort. Conclusion: The ANN model successfully revealed the order of prevalent independent predictors of AIS that can be utilized to screen high-risk young adults with CUD and improve outcomes.

Effectiveness of a two-stage strategy using the 16-item Prodromal Questionnaire (PQ16/fPQ16) and the Comprehensive Assessment of At Risk Mental States (CAARMS) in the early detection of Ultra High Risk (UHR) patients in Lebanon: a cross-sectional pilot study

ObjectivesThis study aims to identify the prevalence of Ultra High Risk (UHR) adults in a sample of patients in Lebanon and to compare screening and diagnostic tools. MethodsThis is a cross-sectional pilot study which targeted patients aged 17–30 years willingly seeking psychiatric care in a university hospital in Beirut, Lebanon. Participants were invited to fill either the English or the French version of the Prodromal Questionnaire (respectively, PQ16 or fPQ16). The abbreviated version of the “Comprehensive Assessment of At-Risk Mental States” (CAARMS) was then administered to all participants. The latter were subsequently sorted into one of the three UHR groups – vulnerability group, attenuated psychosis (APS), intermittent psychosis (BLIPS) – or were diagnosed as suffering from a psychotic disorder. ResultsThirty-one patients participated in this study. The prevalence of positive screening on the PQ16/fPQ16 and positive diagnosis of UHR on the CAARMS were respectively of 61.29% and 45%. The APS group was the most prevalent (71.42%). A positive psychosis screening on PQ16/fPQ16 was statistically related to a UHR diagnosis on CAARMS (p-value: 0.011 on Chi2 test), OR=8.5 (95% CI: 1.4–50.9; p-value: 0.018). No relation was found between PQ16/fPQ16 results and risk stratification or between the number of “True” responses on PQ16/fPQ16 and the intensity of symptoms on CAARMS. PQ16/fPQ16 statements 5, 9, 11 and 16 predicted a UHR diagnosis on CAARMS (p-value of 0.045, 0.006, 0.045 and 0.045, respectively). ConclusionThis two-stage strategy for identifying UHR patients can be adopted in a tertiary health care center.

The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial

On the basis of low-quality evidence, international critical care nutrition guidelines recommend a wide range of protein doses. The effect of delivering high-dose protein during critical illness is unknown. We aimed to test the hypothesis that a higher dose of protein provided to critically ill patients would improve their clinical outcomes. This international, investigator-initiated, pragmatic, registry-based, single-blinded, randomised trial was undertaken in 85 intensive care units (ICUs) across 16 countries. We enrolled nutritionally high-risk adults (≥18 years) undergoing mechanical ventilation to compare prescribing high-dose protein (≥2·2 g/kg per day) with usual dose protein (≤1·2 g/kg per day) started within 96 h of ICU admission and continued for up to 28 days or death or transition to oral feeding. Participants were randomly allocated (1:1) to high-dose protein or usual dose protein, stratified by site. As site personnel were involved in both prescribing and delivering protein dose, it was not possible to blind clinicians, but patients were not made aware of the treatment assignment. The primary efficacy outcome was time-to-discharge-alive from hospital up to 60 days after ICU admission and the secondary outcome was 60-day morality. Patients were analysed in the group to which they were randomly assigned regardless of study compliance, although patients who dropped out of the study before receiving the study intervention were excluded. This study is registered with ClinicalTrials.gov, NCT03160547. Between Jan 17, 2018, and Dec 3, 2021, 1329 patients were randomised and 1301 (97·9%) were included in the analysis (645 in the high-dose protein group and 656 in usual dose group). By 60 days after randomisation, the cumulative incidence of alive hospital discharge was 46·1% (95 CI 42·0%-50·1%) in the high-dose compared with 50·2% (46·0%-54·3%) in the usual dose protein group (hazard ratio 0·91, 95% CI 0·77-1·07; p=0·27). The 60-day mortality rate was 34·6% (222 of 642) in the high dose protein group compared with 32·1% (208 of 648) in the usual dose protein group (relative risk 1·08, 95% CI 0·92-1·26). There appeared to be a subgroup effect with higher protein provision being particularly harmful in patients with acute kidney injury and higher organ failure scores at baseline. Delivery of higher doses of protein to mechanically ventilated critically ill patients did not improve the time-to-discharge-alive from hospital and might have worsened outcomes for patients with acute kidney injury and high organ failure scores. None.

A Comparison of Strategies to Improve Uptake of COVID-19 Vaccine among High-Risk Adults in Nairobi, Kenya in 2022.

COVID-19 vaccine uptake in Kenya is still low compared to other countries, especially in Europe and North America. In most parts of the country, a large percentage of the Kenyan population remains unvaccinated. As of October 2022, the Ministry of Health (Kenya) estimates that only 36.2% of the adult population had been fully vaccinated. We conducted an experimental study in April 2022 targeting unvaccinated adults who had a history of hypertension and/or diabetes and those in the 60+ age group. We tested various messaging approaches using two different intervention channels. Although the overall rate of vaccinated individuals according to national records is low, responses from the study group collected through phone call conversations show that higher-risk adults such as those older than 60 or those with chronic illnesses have a remarkably high vaccination rate of 89%. After the study, four participants received a COVID-19 vaccine within 1 month of the intervention. These four participants all received a loss-messaging intervention approach during the study. This study supports a national approach to increasing COVID-19 vaccination rates using loss-messaging directed at unvaccinated, high-risk individuals.

What Is the Role of COVID-19 Monoclonal Antibody Programs in Promoting Posttreatment Vaccination?

Background In addition to highly efficacious mRNA vaccines, there are multiple therapeutic tools to prevent COVID-19, reduce the severity of illness, and prevent death among high-risk patients. Monoclonal antibodies (mAb) are vital to prevent and to manage acute illness, but subsequent vaccination is essential to mitigate risk of reinfection. The objective of our study was to assess vaccination status after mAb treatment. Methods We conducted a retrospective, observational cohort study of high-risk adults who were treated with bamlanivimab for mild-moderate COVID-19 between December 2020 and March 2021 at an ambulatory infusion center or 3 emergency departments in the Bronx, NY. Demographics, mAb treatment information, and vaccination status as of February 28, 2022, were collected from the electronic medical record. Patient outreach phone calls were made to obtain information missing in the electronic medical record. Results A total of 722 adults were included. Forty patients (6%) were vaccinated before mAb treatment. Of patients who were unvaccinated at time of treatment (n = 682), 569 (83%) were subsequently vaccinated, 35 (5%) remained unvaccinated, and 78 (11%) had an unknown vaccination status as of March 2022. The mean age of vaccinated patients was 59 years and unvaccinated patients was 54 years (P = 0.05). Median time to vaccination was 99 days (interquartile range, 90–142 days). As of March 2022, 307 patients (43%) had received at least 1 vaccine booster dose. Conclusions Most patients who were unvaccinated at time of treatment were subsequently vaccinated. Ambulatory COVID-19 encounters are valuable opportunities to provide vaccine education and counseling.

Teplizumab in Type 1 Diabetes Mellitus: An Updated Review.

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition characterized by the irreversible destruction of the β cells of the pancreas, which leads to a lifelong dependency on exogenous insulin. Despite the advancements in insulin delivery methods, the suboptimal outcomes of these methods have triggered the search for therapies that may prevent or reverse the disease. Given the autoimmune aetiology of T1DM, therapies counteracting the immune-mediated destruction of the β-cells are the obvious target. Although several treatment strategies have been attempted to target cellular, humoral and innate immunity, very few have had a clinically meaningful impact. Of all the available immunomodulatory agents, cluster of differentiation (CD) 3 antibodies have exhibited the most promising preclinical and clinical results. Muromonab-CD3, which also happened to be a murine CD3 antibody, was the first monoclonal antibody approved for clinical use and was primarily indicated for graft rejection. The adverse effects associated with muromonab-CD3 led to its withdrawal. Teplizumab, a newer CD3 antibody, has a better side-effect profile because of its humanized nature and non-Fc-receptor-binding domain. In November 2022, teplizumab became the first immunomodulatory agent to be licensed by the US Food and Drug Administration for delaying the onset of T1DM in high-risk adults and children over 8 years old. The mechanism seems to be enhancing regulatory T-cell activity and promoting immune tolerance. This article reviews the mechanism of action and the clinical trials of teplizumab in individuals with T1DM or at risk of developing the disease.

Changing Patterns of Mortality in Viral Hepatitis - China, 1987-2021.

Viral hepatitis continues to present a major global public health challenge, with China shouldering the heaviest burden of this disease worldwide. This study examined evolving trends and assessed the impacts of age, period, and cohort on viral hepatitis mortality from 1987 to 2021 in both urban and rural settings across China. This research provides critical insights, enabling policymakers to develop precise and effective intervention strategies that are specifically tailored to address the needs of high-risk older adults.

A community-based study on willingness and predictors to receive precautionary dose of COVID-19 vaccine in Puducherry

Introduction: World Health Organization has proposed yearly boosters for high-risk adults and biannual boosters for the general population. Research on the acceptance of current COVID-19 immunization has been done, but only a little information is available on booster dose acceptance in India. The objectives of this study were to assess the willingness to receive precautionary doses of the vaccine among adults and to identify the sociodemographic predictors to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 in Puducherry. Methods: A community-based, cross-sectional study was conducted for 2 months in the field practice area of a private medical college in Puducherry. Individuals, ≥18 years residing for &gt;6 months in the selected villages/wards and willing to give consent were included in the study. Individuals with absolute/relative contraindications for COVID-19 vaccination were excluded from the study. The sample size was 632, and a multistage sampling technique was employed. A semi-structured questionnaire was utilized for face-to-face interviews. Results: Among 632, 86.4% were vaccinated with two doses of COVID-19 vaccines. Out of 609 adults who have been fully vaccinated against COVID-19, 83.6% exhibited willingness to receive precautionary doses of the vaccine. Common factors influencing willingness to receive precautionary doses of the vaccine among adults who have been fully vaccinated against COVID-19 which were fear of postvaccine complications in 37%, less awareness about the precautionary dose among 14%, waiting for others to get vaccinated first in 7%, and 2% expressed as their personal desire for not being vaccinated. Education and socioeconomic status of the individuals were found to be significantly associated (P &lt; 0.05) with the willingness to receive precautionary doses. Gender, marital status, and residence of the study population were significantly associated with higher odds for willingness to receive precautionary doses. Conclusion: Most of the adult population in this study completed the second dose of the COVID-19 vaccine and were willing to receive a third dose. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Systems-based practice, Medical knowledge, Interpersonal and communication skills, and Professionalism.

Pre-operative kidney biomarkers and risks for death, cardiovascular and chronic kidney disease events after cardiac surgery: the TRIBE-AKI study

BackgroundSoluble tumor necrosis factor receptor (sTNFR)1, sTNFR2, and plasma kidney injury molecule-1 (KIM-1) are associated with kidney events in patients with and without diabetes. However, their associations with clinical outcomes when obtained pre-operatively have not been explored.MethodsThe TRIBE-AKI cohort study is a prospective, multicenter, cohort study of high-risk adults undergoing cardiac surgery. We assessed the associations between pre-operative concentrations of plasma sTNFR1, sTNFR2, and KIM-1 and post-operative long-term outcomes including mortality, cardiovascular events, and chronic kidney disease (CKD) incidence or progression after discharge.ResultsAmong 1378 participants included in the analysis with a median follow-up period of 6.7 (IQR 4.0–7.9) years, 434 (31%) patients died, 256 (19%) experienced cardiovascular events and out of 837 with available long-term kidney function data, 30% developed CKD. After adjustment for clinical covariates, each log increase in biomarker concentration was independently associated with mortality with 95% CI adjusted hazard ratios (aHRs) of 3.0 (2.3–4.0), 2.3 (1.8–2.9), and 2.0 (1.6–2.4) for sTNFR1, sTNFR2, and KIM-1, respectively. For cardiovascular events, the 95% CI aHRs were 2.1 (1.5–3.1), 1.9 (1.4–2.6) and 1.6 (1.2–2.1) for sTNFR1, sTNFR2 and KIM-1, respectively. For CKD events, the aHRs were 2.2 (1.5–3.1) for sTNFR1, 1.9 (1.3–2.7) for sTNFR2, and 1.7 (1.3–2.3) for KIM-1. Despite the associations, each of the biomarkers alone or in combination failed to result in robust discrimination on an absolute basis or compared to a clinical model.ConclusionsTNFR1, sTNFR2, and KIM-1 were independently associated with longitudinal outcomes after discharge from a cardiac surgery hospitalization including death, cardiovascular, and CKD events when obtained pre-operatively in high-risk individuals. Pre-operative plasma biomarkers could serve to assist during the evaluation of patients in whom cardiac surgery is planned.