Hospital Authority Research Articles

A Study on Knowledge Attitude and Practice Towards Palliative Care among Nurses at Selected Hospitals in Bangladesh

Background: Palliative care refers to interdisciplinary, team-based care for individuals and families experiencing a life-threatening illness or injury, addressing physical, emotional, social and spiritual needs and managing illness, attempts to improve quality of life throughout the dying process. Palliative care has traditionally been viewed as providing intensive care to patients near death. In recent years, palliative care has come to include patients with end-stage organ failure and cancer who can live longer. To provide quality palliative care (PC), caregivers need not only knowledge and skills but also a positive attitude. Palliative care is new to the healthcare sector in the Patuakhali region and little is known about nurses' knowledge, attitudes and practices regarding palliative care. Many factors can influence nurses' knowledge, attitude, practice, and experience regarding palliative care. Objectives: To assess the Knowledge, Attitude and Practice regarding palliative care among nurses at selected hospitals in Bangladesh. Methods: A descriptive cross-sectional correlation study was conducted in Patuakhali District hospitals at one Medical College Hospital and six Upazila Health Complex to accomplish the purpose of this study. This study aims to assess the knowledge, attitude and practice towards palliative care among nurses at Hospitals.197 nurses were recruited as a sample from those hospitals. The instrument of this study consists of four parts including 1) a Socio-demographic characteristics, 2) Knowledge related questionnaire, 3) Attitude related questionnaire and 4) Practice related questionnaire toward palliative care for data analysis two-sample t-test, ANOVA and Pearson product-moment correlation coefficient (r) was used to examine the relationship between nurses’ knowledge, attitude and practice score. Result: The response rate was 89.5%. The average age of participants was 39.5 for her and ranged from 20 to 59 for him. 54.3% more men than 45.7% women. As a result, 56% had sufficient knowledge and 88.3% had a positive attitude towards palliative care. Regarding the practice of palliative care, 61.4% answered that they had experience with palliative care. Chi-square showed no significant association between PC and caregiver age, gender, and experience (P value > 0.05). There was a positive correlation between knowledge and attitudes towards palliative care (r = .268, p = 0.00). Conclusion: Based on the results, nurses working in palliative care units are trained in the care of dying patients. As a result, they have more knowledge, initiative and practice than nurses working in other departments. For this reason, training programs for nurses are recommended. Job satisfaction and work environment are highly related to nurses' Palliative care knowledge, attitudes, and practices. Therefore, hospital authorities should strive to create a working environment that is suitable for the care of dying patients. The majority of respondents expressed a positive attitude. Their knowledge and practice were inadequate. Continuing education and in-service training may be required to improve nurses' knowledge and build positive attitudes practice of palliative care.

Effectiveness of planned health education on knowledge regarding HIV-TB co-infection among HIV patients

Abstract: BACKGROUND: In various parts of the world, mainly in developing nations, co-infection with HIV and tuberculosis (TB) is a significant public health concern. Commonly HIV-TB co-infection is related to a lack of knowledge on TB among people surviving with HIV. Hence, the particular research study is done to know the effectiveness of planned health education on HIV-TB co-infection among HIV patients. MATERIALS AND METHODS: “Nonrandomized controlled trail design” (before and after trial) was used for the study. Written permission was granted from hospital authorities and written consent was obtained from HIV patients after explaining the study and its objectives. Data were collected from 80 HIV-positive patients using a purposive sampling technique. These patients were interviewed for their knowledge of HIV-TB co-infection, followed by health teaching was delivered. After 8 days of health education, a posttest was carried out using the same tool. RESULTS: It was showed that pretest mean knowledge scores were 4.18 with a 1.97 standard deviation (SD), whereas posttest mean knowledge scores were 7.58 with a 2.12 SD. The obtained paired t-value was 10.31, which at the 0.05 level was statistically significant and revealed that health education was effective in improving HIV patients’ knowledge scores. CONCLUSION: The present research study concluded that the health teaching program was effective in improving knowledge scores regarding HIV-TB co-infection among HIV patients. Hence, there is an urgent need to educate HIV patients on the prevention of HIV-TB co-infection.

Sociodemographic Association of Caregivers Burden with Schizophrenia Disorder

Objective: The aim of this study is to find out a relationship between life satisfaction and caregiver burden among patients who are suffering from psychiatric illness.
 Materials and methods: The sample size of this study was 170 psychiatric patients. Primarily consent was received from the higher authorities of the psychiatric hospitals and rehabilitation centers in Karachi. Zarit Burden Interview Scale (ZBIS) and Satisfaction with Life Scale (SWLS) were used. Psychiatric patients were divided into schizophrenia disorder (n = 85) and bipolar disorder (n = 85). Data were analyzed by statistics software (SPSS, version, 20.0). The sample was constituted with male 75 (44.1%) and females were 95 (55.9%). The average age range of caregivers was between 19 and 60 years with M = 44.74 and SD = 12.05 years.
 Results : The results indicated that caregiver burden was a significant predictor of satisfaction with life in patients with schizophrenia disorder [R2, .554; F (1.84) = 36.711, p<.000]. A significant difference was also observed between male and females caregivers of psychiatric patients on the variable of caregiver burden and satisfaction with life scale (i.e. t=-3.129; p=.<002; t=3.528; p=.<.001).
 Conclusion: It is concluded that caregiver burden significantly affects the level of mental health of the caregivers of patients with psychiatric disorders.
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 89-94

Patients’ Participation in Surgical Treatment Decision Making in General Government Hospital of Bharatpur

Background: Patient participation means involvement of the patient in decision making or expressing their opinions about different treatment methods, which includes sharing information, feelings and signs and accepting and rejecting health team instructions. The study aims to find out the level of patient participation in surgical treatment decision making of admitted patient in general government hospital of Chitwan.Methods: A descriptive cross –sectional research was carried out to assess the level of participation in surgical treatment decision making. Non-probability, purposive sampling technique was used. A set of valid instruments containing 16 item was used to assess the level of participation. Ethical clearance was taken from Institutional review Committee of Shree Medical and Technical College (SMTC-IRC 20221206-43). Data were collected and analyzed in statistical package for the social science version. Results: The result of the study shows that maximum respondents 51.8% belonged to age group less or equals to 40 years. Among 226 respondents 58.4% were female and 41.6% were male. Among them, more than half (62.8%) of the respondent had high level of participation and (37.2%) of the respondents had low level of participation.Conclusions: The findings of the study indicate the participation of patient in surgical treatment decision making. These findings may help hospital and concerned authorities to make appropriate policy and take corrective action to increase the level of patient participation in treatment decision making.

Vaccine Effectiveness of BNT162b2 and CoronaVac against SARS-CoV-2 Omicron BA.2 in CKD.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has posed increased risks of hospitalization and mortality in patients with underlying CKD. Current data on vaccine effectiveness of COVID-19 vaccines are limited to patients with CKD on dialysis and seroconversion in the non-dialysis population. A case-control study was conducted of adults with CKD using data extracted from the electronic health record database in Hong Kong. Adults with CKD and COVID-19 confirmed by PCR were included in the study. Each case was matched with up to ten controls attending Hospital Authority services without a diagnosis of COVID-19 on the basis of age, sex, and index date (within three calendar days). The vaccine effectiveness of BNT162b2 and CoronaVac in preventing COVID-19 infection, hospitalizations, and all-cause mortality was estimated using conditional logistic regression adjusted by patients' comorbidities and medication history during the outbreak from January to March 2022. A total of 20,570 COVID-19 cases, 6604 COVID-19-related hospitalizations, and 2267 all-cause mortality were matched to 81,092, 62,803, and 21,348 controls, respectively. Compared with the unvaccinated group, three doses of BNT162b2 or CoronaVac were associated with a reduced risk of infection (BNT162b2: 64% [95% confidence interval (CI), 60 to 67], CoronaVac: 42% [95% CI, 38 to 47]), hospitalization (BNT162b2: 82% [95% CI, 77 to 85], CoronaVac: 80% [95% CI, 76 to 84]), and mortality (BNT162b2: 94% [95% CI, 88 to 97], CoronaVac: 93% [95% CI, 88 to 96]). Vaccines were less effective in preventing infection and hospitalization in the eGFR <15 and 15-29 ml/min per 1.73 m 2 subgroups as compared with higher GFR subgroups. However, receipt of vaccine, even for one dose, was effective in preventing all-cause mortality, with estimates similar to the higher eGFR subgroups, as compared with unvaccinated. A dose-response relationship was observed between the number of BNT162b2 or CoronaVac doses and the effectiveness against COVID-19 infection and related comorbidity in the CKD population.

Knowledge and perceived barriers for care provision regarding COVID-19 among hospital nurses in Nepal

COVID-19 pandemic is significantly affecting the overall health and healthcare system globally. It has not shown mercy to Nepal either. All the health facilities are full of COVID-19 patients. Almost all death from COVID-19, has occurred in hospital. Adequate knowledge of nurses regarding the source, transmission, symptoms, and preventive measures of COVID-19 helps to provide effective care and prevent spreading infections from patients to patients, and nurses to patients. Therefore, this study aimed to identify the knowledge regarding COVID-19 and perceived barriers for care provision regarding COVID-19 patients among hospital nurses in Nepal. A cross-sectional descriptive study was conducted in different COVID-19 care designated hospitals of Nepal. Data were collected by using self-administered validated questionnaire through online survey. Descriptive analysis was done by using SPSS-16. More than 80% of nurses had adequate knowledge regarding symptoms, route of transmission, vulnerable population and preventive measures of COVID- 19 and only 15.0% had got training related to COVID-19 pandemic. Nurses perceived negligence of the patients and community people on COVID-19 prevention (84.6%), fear of being infected and carrier to family and community while contacting with patients (80.0%), long duty hour (75.0%), inadequately supply of personal protective equipment and insufficient institutional preparedness (74.0%) were the major barriers for providing care of COVID-19 patients. Thus, hospital authority, nursing administration and nursing professionals’ organizations should play an important role in organizing training to nurses and awareness program to community people. It is also essential in providing required supplies, and facilitates the motivating environment for effective care and prevention of COVID-19.

Clinical presentation, risk factors, and outcomes of stroke in Shabwah Governorate, Yemen

Background: There is a lack of reliable information on stroke risk factors, clinical presentation, and mortality. The aim of this study was to describe stroke risk factors, clinical presentations, and in-hospital mortality and to identify the independent predictors of mortality among stroke patients admitted to three hospitals in Shabwa Governorate, Yemen. Methods: This retrospective and cross-sectional study was conducted from July 1, 2022, to June 30, 2023, in three hospitals in Shabwah Governorate, namely, Shabwah General Hospital Authority, Al Shifa Specialized Hospital, and Afya Specialized Hospital. Results: We involved 124 stroke cases, of whom 92 (74.2%) were males and 32 (25.8%) were females. Their mean age was 64.98±16.22 years, and hypertension was the most common risk factor, accounting for 71.0% (n=88) of cases. Ischemic stroke was detected in 95 (76.6%) cases, intracerebral hemorrhage (ICH) was detected in 25 (20.2%) patients, and subarachnoid hemorrhage (SAH) was detected in 4 (3.2%) cases. The in-hospital mortality was 27(21.8%), and according to bivariate analysis, the in-hospital mortality was significantly associated with hypertension (p=0.015), diabetes mellitus (DM) (p&lt;0.0001), ischemic heart disease (p=0.002), rheumatic heart disease (p&lt;0, 0001), and cardiomyopathy (p=0.004). In addition, in-hospital mortality was significantly associated with coma (p&lt;0.0001), ischemic stroke (p&lt;0.0001), ICH (p=0.013), and SAH (p=0.032). However, in multivariate logistic regression analysis, only coma (adjusted odds ratio [OR]=11.21, 95% confidence interval [CI]=3.42–36.75, p&lt;0.0001) and DM (adjusted OR=5.8, 95% CI=1.79–18.85, p=0.003) were found to be independent risk factors for in-hospital mortality. Conclusion: In Shabwah Governorate, Yemen, ischemic strokes were more common than hemorrhagic strokes, with men more likely to have a stroke than women and the majority of cases being elderly. DM and coma were found to be independent risk factors for in-hospital mortality. Therefore, appropriate treatment of DM and other vascular risk factors is recommended to improve stroke outcomes.

Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative Population-Based Study.

In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.

Psycho-Social impact of Covid-2019 on Work-Life Balance of Health Care Workers in India:

Innumerable studies related to COVID-19 carried out across the globe have demonstrated that HCWs worked in stressful and difficult socio-economic environments and, therefore, had a disturbed work-life balance. However, negligible efforts have been made to analyze the factors that impacted it. In order to investigate this phenomenon, a cross-sectional study was undertaken utilizing data obtained directly from a sample of 799 healthcare workers (HCWs) employed in eight hospitals who were actively working throughout the period spanning from April 2020 to March 2022 within the COVID-19 pandemic. Five latent variables, namely, Psychological Stress (PS), Socio-Economic Impact (SEI), Interpersonal Relationships (IPRs), Government Intervention (GI) and Work-Life Balance (WLB), have been developed using a self-designed questionnaire with separate sections for each of them. A comprehensive structural model to determine the variables influencing WLB is estimated using PLS-SEM. The mediating role of IPR in the relationship between PS and WLB is investigated, and the moderating effect of two variables on WLB, 'Government intervention' and 'whether a worker is affected by COVID or not', has been examined. T-test and ANOVA techniques are also applied to examine the impact of these variables across different socio-demographic characteristics. Our findings indicate that variables PS and SEI negatively impact WLB whereas IPRs have positively impacted it. Government intervention, however, did not exhibit any significant impact on it. Further, IPRs partially mediated the relationship between PS and WLB. The role of government is completely non-significant in moderating the relationships of PS and SEI with WLB. A healthcare professional affected by COVID significantly moderated the mediating relationship between PS and IPR and the direct relationship between IPR and WLB. Subsequently, it favourably affected the WLB of HCWs. Our study recommends that the government and hospital authorities should strengthen the resilience-building interventions and expand their efforts to provide social support to HCWs at the hospital and community levels. Concerted actions must be taken to preserve HCWs' work-life balance amidst the challenging circumstances they face, especially during the pandemic.

Exploring the impact of patient internet usage on patient–physician interaction, satisfaction and revisit intention: a comprehensive study

PurposeThe ubiquity of the internet has extended immense informational power to patients around the world who previously had abysmal knowledge about the disease they are suffering from. With a large amount of information in their hands, these educated and well-informed patients are cultivating deeper relationships and engagement with their physicians through meaningful interactions. This study aims to investigate the influence of patients’ internet usage and their interactions on their intentions to revisit and foster relationships with their physicians.Design/methodology/approachA survey-based questionnaire was administered at four government hospitals in Pune, involving a sample size of 400. The study intends to use structural equation modelling (SEM) to examine the hypothesized relationships identified within the research analysis.FindingsThe findings of this study indicate that patients report higher levels of satisfaction and intention to revisit when they have a strong interaction with their physician.Research limitations/implicationsThis study provides valuable inputs to the hospital authorities and health-care-related policy makers. This study also contributes to the overall body of literature on health care information system, behavioural aspects of patients and doctors as well as other health-care-related staffs in hospitals.Originality/valueThe study adds values to the overall body of literature for both hospital information system, patient interaction and health care policy. To date, no research has examined the association between patient–physician interactions conducted through internet channels and subsequent behavioural intentions. Moreover, the study investigates the behavioural aspects of patients and health-care staffs, which adds value towards the body of knowledge in the extant literature.

Cost-Effectiveness Analysis of Myopia Progression Interventions in Children

Several interventions exist for treating myopia progression in children. While these interventions' efficacy has been studied, their cost-effectiveness remains unknown and has not been compared. To determine cost-effective options for controlling myopia progression in children. In this cost-effectiveness analysis, a Markov model was designed to compare the cost-effectiveness of interventions for controlling myopia progression over 5 years from a societal perspective in a simulated hypothetical cohort of patients aged 10 years with myopia. Myopia interventions considered included atropine eye drops, 0.05% and 0.01%, defocus incorporated multiple segment spectacles, outdoor activity, soft contact lenses (daily disposable and multifocal), rigid gas-permeable contact lenses, progressive addition lenses, bifocal spectacle lenses, orthokeratology, highly aspherical lenslets (HALs), and red light therapy; all interventions were compared with single-vision lenses. Deterministic and probabilistic sensitivity analysis determined the association of model uncertainties with the cost-effectiveness. Costs were obtained from the charges of the Hospital Authority of Hong Kong and The Chinese University of Hong Kong Eye Center. The mean costs (in US dollars) per child included the cost of hospital visits, medications, and optical lenses. The outcomes of effectiveness were the annual spherical equivalent refraction (SER) and axial length (AL) reductions. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy relative to single-vision lenses over a time horizon of 5 years. Outdoor activity, atropine (0.05%), red light therapy, HALs, and orthokeratology were cost-effective. The ICER of atropine, 0.05%, was US $220/SER reduction; red light therapy, US $846/SER reduction; and HALs, US $448/SER reduction. Outdoor activity yielded a savings of US $5/SER reduction and US $8/AL reduction. Orthokeratology resulted in an ICER of US $2376/AL reduction. These findings suggest that atropine eye drops, 0.05%, and outdoor activity are cost-effective for controlling myopia progression in children. Though more expensive, red light therapy, HALs, and orthokeratology may also be cost-effective. The use of these interventions may help to control myopia in a cost-effective way.

Abstract 18 — Standardized Mortality Ratio and Risk Factors for Mortality and Recurrence in Hong Kong Chinese Patients with Antiphospholipid Syndrome

Background To report standardized mortality ratio (SMR) and assess risk factors for mortality and recurrence in Hong Kong Chinese patients with antiphospholipid syndrome (APS). Methods Patients followed up in 16 public hospitals in Hong Kong were identified by the Hospital Authority Clinical Data Retrieval System (CDARS) using the ICD-10 diagnostic code of APS. Their diagnoses were verified using the 2006 modified consensus criteria (1) for APS. The mortality, thrombosis recurrence rate and their associated risk factors were studied by Kaplan-Meier method and Cox Regression. Results Four hundred twenty-three Chinses APS patients were identified. Among them, 288 patients fulfilled the 2006 criteria for APS and were classified as definite APS, while 135 patients had probable APS. APS was primary in 204 patients and secondary in 219 patients. On presentation, 369 patients had thrombotic events. Arterial thrombosis occurred in 177 patients and venous thrombosis occurred in 189 patients. Obstetric morbidities occurred in 77 patients. Twenty three patients had both obstetric and thrombotic events. Over a mean follow-up of 9.7±7.2 years, 75 (17.7%) patients succumbed. The age and sex adjusted SMR relative to general population was 4.34[95% CI 3.44-5.41]. In thrombotic APS patients, mortality was associated with age [Formula: see text]60 years at diagnosis (HR 5.30 [95% CI 3.11-9.03]; p&lt;0.001), presence of arterial hypertension (HR 1.89 [95% CI 1.11-3.19]; p =0.018), and presence of arterial thrombosis (HR 1.81 [95% CI 1.06-3.10]; p=0.031). Recurrence of thrombosis occurred in 89 (21%) patients (15% arterial, 5.2% venous). Recurrence of thrombosis was found to be associated with triple positive antibodies (HR 2.71 [95% CI 1.15-6.42]; p=0.023) independent of other risk factors in a multivariate model. Conclusion Increased mortality rate was observed in Chinese APS patient, with older age at diagnosis, presence of arterial hypertension and arterial thrombosis being independent risk factors for mortality. Recurrence of thrombotic events was not uncommon and associated with the presence of triple positive aPL antibodies.

Dabrafenib plus trametinib versus anti-PD-1 monotherapy as adjuvant therapy in BRAF V600-mutant stage III melanoma after definitive surgery: a multicenter, retrospective cohort study

Both dabrafenib/trametinib (D/T) and anti-PD-1 monotherapy (PD-1) are approved adjuvant therapies for patients with stage III BRAF V600-mutant melanoma. However, there is still a lack of head-to-head comparative data. We aimed to describe efficacy and toxicity outcomes for these two standard therapies across melanoma centers. This multicenter, retrospective cohort study was conducted in 15 melanoma centers in Australia, China, Germany, Italy, Japan, UK, and US. We included adult patients with resected stage III BRAF V600-mutant melanoma who received either adjuvant D/T or PD-1 between Jul 2015 and Oct 2022. The primary endpoint was relapse-free survival (RFS). Secondary endpoints included overall survival (OS), recurrence pattern and toxicity. We included 598 patients with stage III BRAF V600-mutant melanoma who received either adjuvant D/T (n=393 [66%]) or PD-1 (n=205 [34%]) post definitive surgery between Jul 2015 and Oct 2022. At a median follow-up of 33 months (IQR 21-43), the median RFS was 51.0 months (95% CI 41.0-not reached [NR]) in the D/T group, significantly longer than PD-1 (44.8 months [95% CI 28.5-NR]) (univariate: HR 0.66, 95% CI 0.50-0.87, P=0.003; multivariate: HR 0.58, 95% CI 0.39-0.86, P=0.007), with comparable OS with PD-1 (multivariate, HR 0.90, 95% CI 0.48-1.70, P=0.75). Similar findings were observed using a restricted-mean-survival-time model. Among those who experienced recurrence, the proportion of distant metastases was higher in the D/T cohort. D/T had a higher incidence of treatment modification due to adverse events (AEs) than PD-1, but fewer persistent AEs. In patients with stage III BRAF V600-mutant melanoma post definitive surgery, D/T yielded better RFS than PD-1, with higher transient but lower persistent toxicity, and comparable OS. D/T seems to provide a better outcome compared with PD-1, but a longer follow-up and ideally a large prospective trial are needed. Dr. Xue Bai was supported by the Beijing Hospitals Authority Youth Programme (QMS20211101) for her efforts devoted to this study. Dr. Keith T. Flaherty was funded by Adelson Medical Research Foundation for the efforts devoted to this study.

Mediating role of nurse job enjoyment and participation in medical affairs on quality of patient care in Saudi hospitals

PurposeThe study aims to investigate the nurse job enjoyment and their participation in medical affairs to enchance the quality of patient care in Saudi hospitals. In addition, this study also investigates the management team's role in patient care quality through the mediating effects of nurse job enjoyment and participation in medical affairs.Design/methodology/approachThe present study used a self-administered survey questionnaire to collect data from registered nurses in Saudi hospitals. In this study, 600 survey questionnaires were distributed online (Google Forms) and received 266 valid responses (44.33% response rate). In addition, SmartPLS-4.0 was applied to validate the research constructs and test the hypotheses via partial least squares structural equation modelling (PLS-SEM).FindingsThe study's findings indicate that the job enjoyment of the nurses and participation in medical affairs have positive and significant effects on the quality of patient care. In addition, the research findings also suggest that the management team of the hospitals has a significant indirect influence on the quality of patient care through the medicating effects of nurse job enjoyment and participation in medical affairs.Practical implicationsThe findings of this study also offer various practical implications. This study showed the direct impact of the management team on job enjoyment, medical affairs and patient care quality. Therefore, hospital authorities and policymakers may emphasise clear communication, collaboration, respect and trust for the effective management team in providing higher-quality patient care. The present study suggests that hospital policymakers should strive to create a positive work environment, provide adequate resources, foster team spirit, offer incentives and allow flexible scheduling to ensure higher job enjoyment and increase nurse participation in medical affairs.Originality/valueThis study adds to the growing body of knowledge by investigating the effects of the management team, job enjoyment and nurses' participation in medical affairs on patient care quality. This study also enhances the theoretical depth by exploring the mediating impact of job enjoyment in predicting the relationships between the management team and the quality of care provided to patients. The present study provides guidelines for healthcare service providers or practitioners to focus on the nurses' job enjoyment and their engagement in medical activities to continuously improve the quality of patient care in the hospitals.

FRI679 Risks Of Incident Major Osteoporotic Fractures Following SARS-CoV-2 Infection

Abstract Disclosure: D. Lui: None. X. Xiong: None. M. Chung: None. I. Au: None. F. Lai: None. E. Wan: None. C. Chui: None. X. Li: None. F. Cheng: None. C. Cheng: None. E. Chan: None. C. Lee: None. T. Ip: None. Y. Woo: None. K. Tan: None. C. Wong: None. I. Wong: None. Objectives: Pre-clinical and small cohort studies have suggested the potential deleterious effects of SARS-CoV-2 infection on bone health. We aimed to estimate the risks of incident fractures following SARS-CoV-2 infection in a population-based cohort. Methods: This was a retrospective, propensity-score matched, population-based cohort study of COVID-19 patients and non-COVID individuals identified from the electronic database of the Hong Kong Hospital Authority from January 2020 to March 2022. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus and wrist fractures), identified by the ICD-9-CM codes 805.x, 812.x, 813.x, 814.x, 820.x. Episodes of falls were identified by the ICD-9-CM codes 781.2, 781.3, 781.99, V15.88, E880-E888. COVID-19 patients were 1:1 matched to controls using propensity-score according to age, sex, comorbidities and medications. The cohort was followed up until the occurrence of outcomes, death, or 31 January 2023, whichever came first. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Results: 740,692 COVID-19 patients were included, 1:1 matched to non-COVID individuals. Upon median follow-up of 11 months, COVID-19 patients had higher risks of major osteoporotic fractures (0.35% vs 0.29%; HR 1.21, 95%CI 1.14-1.29, p&amp;lt;0.001), hip fractures (0.16% vs 0.11%; HR 1.34, 95%CI 1.23-1.47, p&amp;lt;0.001), and fall (0.89% vs 0.65%; HR 1.29, 95%CI 1.24-1.34, p&amp;lt;0.001). There was also statistically non-significant increased risk of clinical vertebral (0.03% vs 0.02%; HR 1.22, 95%CI 0.99-1.50, p=0.062) and upper limb (0.14% vs 0.12%; HR 1.08, 95%CI 0.99-1.18, p=0.081) fractures. Subgroup analyses revealed no significant interaction by age (&amp;lt;60 vs ≥60 years), presence of diabetes, fracture history, and the predominant SARS-CoV-2 variant. However, the impact of SARS-CoV-2 infection on fracture and fall risks was greater among men (p-interaction&amp;lt;0.001) and unvaccinated people (p-interaction=0.015). Among COVID-19 patients, hospitalised and dexamethasone-treated ones had higher subsequent fracture and fall risks. When dividing the follow-up period into the acute phase (within 30 days after SARS-CoV-2 infection) and the post-acute phase (beyond 30 days after SARS-CoV-2 infection), the risk of major osteoporotic fractures and falls was consistently increased in the whole cohort, particularly among the older individuals (≥60 years). Conclusions: Our study demonstrated increased risk of major osteoporotic fractures following SARS-CoV-2 infection, contributed by increased fall risk. Clinicians should be aware of musculoskeletal health of COVID-19 survivors, especially older individuals, and provide appropriate preventive actions. Presentation: Friday, June 16, 2023

THU338 Risks Of Stroke, Its Subtypes And Atrial Fibrillation Associated With Glucagon-like Peptide 1 Receptor Agonists Versus Sodium-glucose Cotransporter 2 Inhibitors: A Real-world Population-based Study In Hong Kong

Abstract Disclosure: D. Lui: None. E. Tang: None. T. Wu: None. I. Au: None. C. Lee: None. Y. Woo: None. K.C. Tan: None. C. Wong: None. Objectives: There are limited data on head-to-head comparative risk of stroke between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA). Such a comparison may provide further insights in the selection of appropriate anti-diabetic agents. We compared risk of stroke with its subtypes and incident atrial fibrillation (AF) between them in a population-based cohort. Methods: A population-based cohort of adult patients (aged 18 years or above) with type 2 diabetes between 2008 and 2020 were identified from the electronic health records of Hong Kong Hospital Authority. Patients who received SGLT2i or GLP-1RA were matched pairwise by propensity score. The index date of each patient was set at the date of SGLT2i or GLP-1RA initiation. Patients with end-stage kidney disease or co-initiation of SGLT2i and GLP-1RA at the index date were excluded. The primary outcome was all events of stroke, consisting of hemorrhagic and ischemic stroke. Secondary outcomes included hemorrhagic stroke, ischemic stroke, incident AF, and cardioembolic stroke. Each patient was observed from the index date until the occurrence of events, death, treatment cross-over, or end-of-study (31 December 2020), whichever was earlier. Risks of stroke and AF were evaluated by hazard ratios (HRs) from the Cox proportional hazard regression models. Results: A total of 5,840 patients (2,920 SGLT2i users; 2,920 GLP-1RA users) were included (mean age 55.5 years, 56.1% men, mean HbA1c 8.9% and duration of diabetes 13.7 years). Upon median follow-up of 17 months (IQR: 8-34), there were 111 events of stroke. SGLT2i users had comparable risk of all stroke as GLP-1RA users (HR=1.46, 95%CI 0.99-2.17, p=0.058). SGLT2i users had higher risk of ischemic stroke (HR=1.53, 95%CI 1.01-2.33, p=0.044) but similar risk of hemorrhagic stroke (HR=1.29, 95%CI: 0.53-3.14, p=0.582) compared to GLP-1RA users. Although SGLT2i was associated with lower risk of incident AF (HR=0.43, 95%CI 0.23-0.79, p=0.006), risk of cardioembolic stroke was similar (HR=1.40, 95%CI: 0.62-3.17, p=0.414). Subgroup analyses showed no significant interaction between subgroups by age, sex, glycemic control and history of AF. However, patients with history of stroke appeared to benefit more from GLP-1RA use (p for interaction=0.043) than those without history of stroke. Patients with shorter duration of diabetes (&amp;lt;10 years) also appeared to benefit more from GLP-1RA use than those with longer duration of diabetes (p for interaction=0.017). Conclusions: Our real-world study demonstrated that GLP-1RA use was associated with lower risk of ischemic stroke, despite the association between SGLT2i use and lower risk of incident AF. There was no significant difference in hemorrhagic stroke risk. GLP-1RA may be the preferred agent for patients with type 2 diabetes at risk of ischemic stroke. Presentation: Thursday, June 15, 2023

A randomized controlled trial on the effectiveness of the abridged illness management and recovery program for people with schizophrenia spectrum disorders.

This study aimed to investigate the effectiveness of an abridged version of the Illness Management and Recovery Programme (AIMR) that was modified and developed in Hong Kong through a mult-centre randomized controlled trial for patients with schizophrenia spectrum disorders. This study was implemented in 10 occupational therapy departments, psychiatric day hospitals of 7 Hospital Authority clusters in Hong Kong. A total of 211 patients with schizophrenia or schizoaffective disorder was recruited and randomized into either the experimental or the control condition. In the control group, the subjects went through conventional occupational therapy programmes. In the experimental group, the subjects went through an additional 10-session programme of AIMR. were measured at baseline, completion of the AIMR, and 3-month after the AIMR programme. Measures include the expanded version of the Brief Psychiatric Rating Scale (BPRS-E), the client version of the Illness Management and Recovery Scale (IMRS), the Snyder Hope Scale, the Social and Occupational and Occupational Functioning Assessment Scale (SOFAS), the WHO Quality of Life Scale (WHOQOL-BREF), and the Chinese Version of the Short Warwick-Edinburgh Mental Well-Being Scale (C-SWEMWBS). Both the experimental and control cohorts had comparable clinical and socio-demographic characteristics except years of education and duration of illness. These two variables were entered as covariates in the linear mixed model which showed that the experimental group had significantly higher improvement than the control group in terms of illness management (F = 4.82; p = .03; Cohen's d = .45), functional (F = 10.65; p = .001; Cohen's d = .58), and hope (F = 5.52; p = .02; Cohen's d = .08) measures after the completion of treatment. The results supported the effectiveness of the AIMR programm which would be important in the recovery oriented practices in psychiatry.

Association of eGFR slope with all-cause mortality, macrovascular and microvascular outcomes in people with type 2 diabetes and early-stage chronic kidney disease

AimsThe association of estimated glomerular filtration rate (eGFR) slope with progression of complications in people with type 2 diabetes (T2D) and early-stage chronic kidney disease (CKD) is less clear. MethodsWe identified 115,139 T2D participants without decreased eGFR (>60 mL/min/1.73 m2) between 2008 and 2015 from the electronic database of the Hong Kong Hospital Authority. eGFR slope calculated by linear-mixed effects model using 3-year eGFR measurements was categorized into quintiles. With Quintile 3 of eGFR slope as the reference group, we used Cox proportional or cause-specific models to investigate the association between eGFR slope and all-cause mortality, macrovascular and microvascular complications, as appropriate. ResultsOver a median follow-up of 7.8 years, fastest eGFR declines (Quintile 1 with median eGFR slope: −4.32 mL/min/1.73 m2/year) were associated with increased risk of all adverse outcomes (adjusted hazard ratio [aHR] 1.36 to 2.97, all P < 0.0001), compared with less steep eGFR declines (Quintile 3: −1.08 mL/min/1.73 m2/year). Substantial eGFR increases (Quintile 5: 1.34 mL/min/1.73 m2/year) were associated with decreased risk of CKD and ≥ 40 % decline in eGFR (aHR [95 % CI] 0.65 [0.63, 0.67] and 0.85 [0.82, 0.89], respectively) and higher risk of death, CVD, DR and DN (aHR [95 % CI] 1.48 [1.40, 1.56], 1.19 [1.14, 1.25], 1.07 [1.004, 1.15] and 1.62 [1.37, 1.91], respectively). ConclusionsIn a cohort of T2D people without decreased eGFR, accelerated declines and increases in eGFR were associated with all-cause mortality, macrovascular and microvascular complications, supporting the potential prognostic utility of eGFR slope in T2D people with early-stage CKD.

Association between cumulative exposure periods of flupentixol or any antipsychotics and risk of lung cancer

BackgroundPreclinical evidence suggests that certain antipsychotic medications may inhibit the development of lung cancer. This study aims to investigate the association between incident lung cancer and different cumulative exposure periods of flupentixol or any antipsychotics.MethodsUsing electronic health records from the Hospital Authority in Hong Kong, this nested case-control study included case participants aged 18 years or older with newly diagnosed lung cancer after initiating antipsychotics between January 1, 2003, and August 31, 2022. Each case was matched to up to ten controls of the same sex and age, who were also antipsychotic users. Multivariable conditional logistic regression models were conducted to quantify the association between lung cancer and different cumulative exposure times of flupentixol (0–365 days [ref]; 366–1825 days; 1826+ days) and any antipsychotics (1–365 days [ref]; 366–1825 days; 1826+ days), separately.ResultsHere we show that among 6435 cases and 64,348 matched controls, 64.06% are males, and 52.98% are aged 65–84 years. Compared to patients with less than 365 days of exposure, those with 366–1825 days of exposure to flupentixol (OR = 0.65 [95% CI, 0.47–0.91]) and any antipsychotics (0.42 [0.38–0.45]) have a lower risk of lung cancer. A decreased risk is observed in patients who have 1826+ days of cumulative use of any antipsychotics (0.54 [0.47–0.60]).ConclusionsA reduced risk of lung cancer is observed in patients with more than one year of exposure to flupentixol or any antipsychotics. Further research on the association between lung cancer and other antipsychotic agents is warranted.

Closing the Treatment Gap: Implementing a Fracture Liaison Service in Public Healthcare A Case Study from Chile

Osteoporotic fractures, especially of the hip and spine, entail significant morbidity and mortality, with a 50% increased risk of hip fracture following a prior fracture. Globally - and in Chile, a low rate of post-fracture osteoporosis treatment persists. The International Osteoporosis Foundation's "Capture the Fracture" initiative advocates optimal practices, including Fracture Liaison Services (FLS); however, in Chile, there are only two FLS, both in the private healthcare system. This study aims to implement the first FLS in the public domain, specifically at the Dra. Eloísa Díaz Clinical Hospital, at Santiago. The methodology is based on the Logic Model, emphasizing the importance of human resources, especially a coordinating nurse. The findings identify the problem, necessary resources, key actions, and short, medium, and long-term goals. External factors such as the hospital environment and collaboration with existing programs are considered. A graphical representation of the Logic Model is presented, along with proposed evaluation indicators. Addressing fragility fractures as a public health issue is pertinent, and hospital authorities' acceptance of our project for implementation is highlighted. This initiative is anticipated to inspire other public health centers in Chile to implement similar services, contributing to closing the treatment gap and enhancing patients' quality of life.