Individualized Management Plan Research Articles

EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital

Abstract Background Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital. Method This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25. Results Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134). Conclusion Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.

Synchronous bilateral typical pulmonary carcinoid tumours diagnosed by robotic navigation bronchoscopy: A unique case.

Pulmonary carcinoids are uncommon malignant neoplasms, believed to derive from specialized neuroendocrine cells known as Kulchitsky cells. We evaluated a 69-year-old female presenting symptoms consistent with carcinoid syndrome, such as intermittent flushing and diarrhoea, along with complaints of shortness of breath and cough. Imaging revealed bilateral lung nodules, confirmed by biopsy to be carcinoid tumours. The treatment of choice for carcinoid tumours is complete surgical resection. Nonetheless, individualized management plans are crafted based on the tumour's location and the patient's respiratory function as these present challenges to anatomical resection of tumours.

Worse Morning Energy Profiles Are Associated with Significant Levels of Stress and Decrements in Resilience in Patients Receiving Chemotherapy

ObjectivesEvidence suggests that lower levels of morning energy are associated with higher levels of stress and lower levels of resilience in patients receiving chemotherapy. Study purposes were to identify subgroups of patients with distinct morning energy profiles; evaluate for differences among the profiles in demographic and clinical characteristics, as well as measures of stress, resilience, and coping. MethodsA total of 1,343 outpatients receiving chemotherapy completed a demographic questionnaire and measures of global, cancer-related, and cumulative life stress, and resilience at study enrollment. Morning energy was assessed using the Lee Fatigue Scale at six time points over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning energy profiles. Differences among the subgroups were evaluated using parametric and nonparametric tests. ResultsThree morning energy profiles were identified (i.e., High (17.3%), Low (60.3%), Very Low (22.4%)). Compared to High class, the other two morning energy classes were less likely to be employed; had a lower functional status and a higher comorbidity burden; and were more likely to self-report depression and back pain. For all three types of stress, significant differences were found among the three classes with scores that demonstrated a dose response effect (i.e., High < Low < Very Low; as decrements in morning energy increased, stress scores increased). Compared to High class, Very Low class reported higher rates of physical and sexual abuse. The resilience scores exhibited a dose response effect as well (i.e., High > Low > Very Low). Patients with the two worst energy profiles reported a higher use of disengagement coping strategies. ConclusionsFindings highlight the complex relationships among decrements in morning energy, various types of stress, resilience, and coping in patients undergoing chemotherapy. Implications for Nursing PracticeClinicians need to assess for stress and adverse childhood experiences to develop individualized management plans to increase patients’ energy levels.

Comparative Analysis of Demographic Characteristics, Management, and Outcomes in Primary Versus Secondary Spontaneous Pneumothorax.

This study aimed to explore the differences between primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) in demographic and clinical features, management trends, and outcomes, alongside assessing recurrence risk factors in spontaneous pneumothorax (SP) patients. This retrospective cohort study at New Damietta Hospital, Al-Azhar University, examined data from adults diagnosed with SP, differentiating between PSP and SSP types based on clinical and radiological criteria, to analyze demographics, clinical characteristics, management strategies, and outcomes. In a study of 170 patients, 42.94% were diagnosed with PSP and 57.06% with SSP, showing significant differences in age distribution (P=0.042) and smoking habits (P<0.001 for both tobacco and cannabis). Management approaches varied, with conservative methods more common in PSP (15.07%) and surgical interventions following intercostal tube (ICT) drainage significantly higher in SSP (40.21%, P=0.001). Length of hospital stay (LOS) and recurrence rates were significantly higher in SSP than PSP (P<0.001 for LOS; P=0.001 for recurrence), with postoperative complications and in-hospital mortality occurring exclusively in SSP (P=0.054 for complications, P<0.001 for mortality). Risk factors for recurrence included older age, presence of blebs/bullae (P<0.001), and lower hemoglobin and hematocrit levels (P=0.009 and P=0.008, respectively), with thoracic drainage duration longer in recurrent cases (P=0.008). Smoking status significantly impacted recurrence risk, with current smokers showing a higher risk compared to never-smokers (P=0.012). This study highlights significant demographic, clinical, and management differences between primary and secondary spontaneous pneumothorax, underscoring the importance of tailored treatment strategies to improve patient outcomes. Key findings include the impact of smoking status on recurrence risk and the necessity for individualized management plans, especially in SSP patients who exhibit higher rates of recurrence, longer hospital stays, and greater morbidity.

Preoperative bleeding risk assessment in cardiac surgery patients

Aim: To investigate the role of bleeding risk scores, personal and family medical history, and previous bleeding incidents in assessing the impact on the risk of all possible complications, including mortality, in adult patients following cardiac surgery.Methods. The search for publications was conducted using the PubMed, Transfusion Evidence Library, and eLibrary.ru databases, covering the period from 2019 to 2023. Search terms included: ‘bleeding risk assessment scales in adult cardiac surgery’, ‘preoperative anemia in adult cardiac surgery’, and ‘transfusion of red blood cell-containing components in cardiac surgery adults’. Duplicate articles were manually excluded. An additional search was performed among the reference lists of selected publications.Results. A total of 2,011 publications were found. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews, and regular reviews without language restrictions were considered based on the content of the abstract. In the second stage, for studies that passed the initial screening, decisions were made based on an assessment of the full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. Ultimately, 40 publications were included in the review.Conclusion. Preoperative bleeding risk assessment is a multimodal, interdisciplinary challenge that necessitates a patient-centered approach. It should commence at the preparatory stage and involve primary care physicians, cardiologists, surgeons, anesthesiologists, laboratory diagnostic specialists, and transfusiologists. The cornerstone of this process is the thorough collection of individual and family medical histories. Obtaining detailed information through patient involvement, utilizing bleeding risk rating scales, reviewing previous bleeding incidents, and supporting these findings with laboratory test data represent the most scientific approach to developing an individualized management plan for patients at risk of bleeding.

A rare case of polysplenia syndrome associated with atrioventricular canal defect and type four ileal atresia in a preterm neonate: A case report and literature review

Antenatal diagnosis of heterotaxy syndrome is only the tip of the iceberg. These neonates can have a myriad of multi-system anomalies, each of which requires anticipation and an individualized management plan. The spectrum of heterotaxy syndrome ranges from incidentally detected innocuous anomalies to major life-threatening congenital malformations such as atrioventricular canal defects and bowel atresia. Neonatal sepsis tends to be more fulminant and catastrophic in these neonates with complex anomalies and poor outcomes that necessitates better-informed antenatal counseling regarding the termination of such pregnancies.

The significance of cervical discopathy diagnosis in patients with mastalgia.

The primary aim of this study was to explore the involvement of cervical discopathy in the development of non-cyclic mastalgia by employing cervical magnetic resonance imaging (MRI). A total of 407 patients were included in the study. Individualized management plans were developed for each patient. Pathological findings in MRI results were assessed by specialists in physical therapy and neurosurgery, and appropriate treatment was administered. Visual assessments of patients were conducted. The Analog Scale (VAS) scoring system was used at the initial presentation, and patients were evaluated at 1 and 3 months following the treatment. In the MRI examinations of the patients included in the study, simultaneous cervical disc protrusion was observed in 29% (n: 124) of those with annular bulging. Comparing the VAS scores of patients before treatment, at the 1st and at the 3rd month showed a significant decrease in mastalgia pain (p < 0.001). The diagnosis of cervical discopathy holds significant importance in the treatment of mastalgia patients. Therefore, clinicians should keep the cervical spine in mind as a potential contributing factor to mastalgia.

Endometriosis and subfertility

Key content Medical management of endometriosis is often contraceptive. In contrast, surgical treatment may improve the chance of spontaneous conception. There is conflicting evidence as to whether surgery improves outcomes with assisted conception, and this should be discussed with a specialist in reproductive medicine. Surgery, particularly for ovarian endometriosis, can cause a decreased ovarian reserve and fertility preservation should be considered. There is no standard approach to managing endometriosis in the fertility setting. It is important to take a holistic approach to diagnosis and management of the subfertile couple where endometriosis may be a contributing factor. Learning objectives To understand the mechanisms by which endometriosis can contribute to subfertility. To understand the importance of a comprehensive assessment of the subfertile couple and the important factors that will inform an individualised management plan. To develop a framework for managing endometriosis in the context of subfertility including fertility preservation

청년층의 스트레스 군집유형에 따른 코로나19 전후 여가활동유형 차이

Purpose In addition to the recent economic downturn and employment difficulties caused by COVID-19, rapid inflation is increasing the psychological confusion and difficulties of young people. The purpose of this study is to understand the context of young people's lives and obtain implications for preparing individual and customized stress management plans by deriving stress types of young people showing different levels of stress according to their personal socio-economic situation through cluster analysis and verifying differences in leisure activity types before and after COVID-19.&#x0D; Methods To this end, 7,278 university students who responded to the main and supplementary surveys in the 3rd and 4th years of the Korea Education and Employment Panel Survey II (KEEP) were subjected to K-means cluster analysis, paired sample T-test, and χ2 test.&#x0D; Results As a result, it was divided into three groups, focusing on immediate tasks and interpersonal relationships, which are sub-factors of stress. In addition, due to COVID-19, the frequency of leisure activities that were highly utilized by an unspecified number of people or had high face-to-face contact was significantly reduced, and the frequency of leisure activities that could personally participate was significantly increased. In particular, it was found that participation in exercise increased significantly in cluster types with low stress levels. Finally, it was confirmed that the distribution of these three types was significantly different according to gender, employment status, monthly income, and current education.&#x0D; Conclusion Based on the research results, appropriate prescriptions were proposed for each type in providing individualized stress management measures.

How Can You Use Newer Therapies to Improve Clinical Decision-Making and Long-Term Health Outcomes for Patients with Chronic Lymphocytic Leukemia Acute Myeloid Leukemia?

The Catalyst initiative, developed by Med Learning Group in 2019 with continued grant support year-on year, is a comprehensive continuing medical education platform that provides innovative methods to increase HCPs' competence surrounding essential aspects of CLL and AML management, with a specific focus on molecular testing, therapy selection, and the combination of established and emerging treatments. By equipping healthcare professionals with up-to-date knowledge and skills, the Catalyst initiative empowers them to make informed decisions that lead to improved patient outcomes. The Catalyst website (www.Catalyst-HM.com) includes HCP- and patient-facing and serves as a validated platform for the latest guidelines and research on CLL and AML. There have been over 16500 views of the website since its launch in 2019. Learners also have access to a variety of accredited educational programs and tools, such as downloadable animations illustrating the value of molecular testing and how to use results to guide treatment choice and a Personalized Poster Portal where learners can choose a variety of images for a poster that is sent to their practice setting. In 2021/2022, these live and online programs have educated over 10000 HCPs Learners have particularly appreciated the innovative nature of the CATALYST Initiative, with 98% indicating the VR animations included in a variety of programming improved their learning experience and knowledge retention (N=2997). At the last two ASH annual meetings, learners could participate in the CATALYST VR Room, a digital version of which can be viewed here: https://catalyst-hm.com/virtualbooth/. Please view footage and attitudinal feedback from learners here. The proposed poster would review the gains in knowledge and competence among CATALYST learners longitudinally from 2019 - 2022, demonstrating the value of this community in helping to advance the translation of the latest science to practice behavior. As demonstrated in the figure below (Please see figure 1), in 2022 hematologists / oncologists increased their ability to apply treatment best practices in newly diagnosed and R/R AML by 28%, and their ability to individualize selection of therapies for treatment-naïve and R/R CLL based on disease- and patient-specific factors 31% (N=2953). While these are significant gains, baseline pre/posttest scores in the sixtieth percentile among specialists suggest these are important areas for continued focus. The CATALYST program has also had a significant impact on learners' practice, based on 60- and 90-day follow-on assessments (n=113). 87% of respondents indicate they now actively use strategies and tools to address adverse events in the treatment of CLL or AML with all or most of their patients. Additionally, 79% indicated increased incorporation of patient and disease-specific factors when treating newly diagnosed or relapsed/refractory AML patients. Over the last four years, the Catalyst initiative has helped the oncology/hematology multidisciplinary team increase their ability to utilize molecular and genetic features as well as patient characteristics to design individualized management plans to enhance patient outcomes. The proposed poster will describe CATALYST offerings and demonstrate its impact on HCPs' ability to translate the latest data and guidelines to practice for their patients with AML and CLL.

Approach to diagnosis and treatment to urologic emergencies

Acute urinary retention, which is an emergency presents a significant challenge, for healthcare providers especially among elderly men. This condition often leads to dysfunction and genital pain causing distress and anxiety for those affected. The likelihood of experiencing acute urinary retention increases with age, with men in their 70s facing a 10% risk that escalates to, over 30% in their 80s. Dealing with both dysfunction and acute pain adds complexity to the clinical management of these cases. This summary highlights the role played by emergency physicians in the management of this troubling urologic emergency. The initial approach involves conducting an evaluation that includes assessing medical history performing physical examinations and conducting relevant diagnostic tests. Promptly identifying the causes, which can range from prostatic hyperplasia and urethral strictures to infections or neurogenic conditions is crucial. Pain relief is an immediate concern, prompting the administration of analgesics to alleviate patient discomfort. Concurrently, urinary catheterization, skillfully performed by the emergency physician, effectively resolves the urinary obstruction, providing substantial relief. Referral to urologists ensures a comprehensive etiological assessment and the formulation of an individualized management plan. In summary, effectively managing retention, with associated erectile dysfunction and genital pain, requires a collaborative effort between emergency physicians and urological specialists. By identifying the cause, providing skilled pain management and expertly performing urinary catheterization emergency physicians play a crucial role in relieving patient discomfort.

Thread lifting as a modern method of non-radical face rejuvenation

Purpose of the study: The purpose of this review of scientific literature is to collect, systematize and update modern ideas about the types, methods and principles of thread lifting, taking into account the basic requirements for efficiency and safety.In this paper, we reviewed publications presented in scientific databases: Web of Science, Scopus, PubMed, Cochran library, Medline, and PubMed Central. The keywords for searching for materials were: thread lift, thread lift history, thread lift sutures, face thread lift, polylactic threads, polydioxanone threads.The earliest approach to the effective use of thread rejuvenation techniques was the use of non-absorbable threads based on polypropylene, which are still successfully used along with modern threads, among which a special place is occupied by absorbable threads and new modifications of non-absorbable ones, complemented by various fixing design features (notches, cones).A large selection of threads, techniques and principles of correction allows specialists to create an individual management plan for each patient, and continuity and synergy between the sequential use of different modifications of threads allows one to prolong the results obtained and delay or refuse more radical anti-aging surgeries on the face.At the same time, as a result of the review of the scientific literature, no published studies were found on the comparative analysis of thread and surgical methods of rejuvenation, which requires further study.

A STUDY TO ESTABLISH THE RELATIONSHIP BETWEEN DEPRESSION AND OSTEOARTHRITIS ACCORDING TO THE SEVERITY OF PAIN AND LOSS OF FUNCTION

Objective: To establish a relationship between depression and osteoarthritis according to the severity of pain and loss of function. &#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of study: Orthopedic and Rheumatology department of Combined Military Hospital, Lahore from October 2022 to March 2023&#x0D; Patients and Methods: All the patients reporting to the outpatient department of either gender aged more than 45 years with a diagnosis of OA based on X-ray findings and a consultant review were included in our study. Severity of OA was studied using the WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index. Depression was measured using the Personal Health Questionnaire (PHQ-9) scale in these patients simultaneously. (12) It was translated in Urdu for the ease of our participants.&#x0D; Results: Out of the 196 participants of our study, 71 (36.2%) were males while 125 (63.8%) were females. Mean age of the participants of our study was 55.49 Years + 8.98. Mean WOMAC index score was 61.02 + 19.11. 3 (1.5%) patients of OA had mild disease in our study and no depression was found in them. In the moderate disease group, 34 (17.3%) had no symptoms of depression, 62 (31.6%) had minimal depression, none had mild, moderate or severe depression while only 1 (0.5%) had moderately severe depression. Out of 96 (48.9%) of the OA patients with severe disease as per the WOMAC index, 3 (1.5%) had minimal depression, 47 (23.9%) had mild depression, 15 (7.6%) had moderate depression, 27 (13.8%) had moderately severe depression and 4 (2.0%) had severe depression.&#x0D; Conclusion: OA is a debilitating disease. Quality of life of patients is severely affected as the duration increases due to pain, stiffness and loss of function of joints. Long term disease leads to depression of variable degrees. . Thus early diagnosis and timely intervention in such patients with an individualized management plan can improve the outcome and quality of life of patients.&#x0D; &#x0D; Keywords: Osteoarthritis, Depression, Morbidity

346 The Bons effect—evaluation of the Frailty Service provision in Bons Secours, Galway

Abstract Background The Frailty Service in the Bons Secours Galway was created following the Covid pandemic. It is a 15-bed unit led by 2 consultant geriatricians and their team. NICE published guidelines in September 2016 for Clinical Assessment and management of multi-morbidity, where they advised on approaches to care of the older person. This included individualised management plan that incorporate non-pharmacological treatments. We aimed to evaluate the non-pharmacological intervention of the multi-disciplinary team input during the inpatient stay and assessed the result of same, using the outcome of discharge destination. Methods We reviewed the electronic records of all patients admitted to the Bons Secours Frailty service within November 2020 and January 2023, evaluating the input of the Occupational Therapist (OT) in their management plans. We assessed the core OT assessments (which included functional, cognitive, environmental/social assessments, and liaison with community services) and rehabilitation delivered in the frailty unit. Considering that the OT also covered the discharge planning of the patients, we therefore assessed the discharge destinations of the patients as a secondary outcome. Results Of the 434 total admissions, of which the average age was 84 years with 37% males and 63% females, OT reviews were performed in 100% of patients. The waiting time was &amp;lt;24 hours from admission. An average of 2.5 interventions were performed per patient, with Core OT assessments carried out in all cases. 82% required cognitive assessments. 10% required home visits. 61% of patients required equipment on discharge. Of the 434 patients, 78.1% returned home (of which 92% required a home care package), 5.06% transitioned to Respite, 9% required Long-Term Care placement and 1.6% were re-admitted to hospital. Conclusion Our findings of the Frailty service provision in Bons Secours reflect the importance of a specialist geriatric service and multi-disciplinary team in producing favourable outcomes for the older person who often have multi-morbidities and are vulnerable.

Nutritional assessment and nutritional status of centenarians (based on the materials of the study “Centenary citizen” in Moscow)

BACKGROUND: Malnutrition and micro- and macronutrient deficiencies are common in people aged 95 years and older. For timely detection of nutritional disorders, it is crucial to regularly examine centenarians and, if necessary, correct an individual patient management plan. A well-balanced diet is one of the fundamental factors for the normal functioning of the human body throughout its life. With age, for various reasons, the risk of malnutrition increases, however, the nutritional status of centenarians is currently not fully understood due to the difficulties of diagnosis.&#x0D; AIM: To evaluate nutritional status and its impact on life expectancy in patients aged 95 years and older, to identify the main determinants that affect the development of malnutrition, and to assess their impact on three-year survival of centenarians.&#x0D; MATERIALS AND METHODS: Analyzed the results of a Mini Nutritional Assessment, general and biochemical blood tests (including such parameters as hemoglobin levels, iron levels, total protein, albumin, vitamin B12, vitamin D, folic acid) in non-institutionalized people aged 95 and older living in Moscow. All studies were conducted at home in the presence of relatives and/or social workers after signing a voluntary informed consent.&#x0D; RESULTS: The study included 82 people, mean age (98.31.89) years; 87.8% were women. Of all the study participants, 56.1% (n=46) were at risk of developing malnutrition, and 11% (n=9) had malnutrition syndrome. Among the 64 participants who took the blood test, anemia was diagnosed in 71.9% (n=46), with macrocytic in 10.9% (n=5), normocytic in 84.8% (n=39), and microcytic in 4.3% (n=2) of patients. Hypoalbuminemia was identified in 16.9% (n=11 of 65) of participants. Of the 50 people who were screened for vitamin D levels, vitamin D deficiency was found in 98% (n=49 out of 50). The following factors influenced survival: a Mini Nutritional Assessment score of more than 24 reduces the risk of 3-year death by 72% (odds ratio (OR) 0.28, confidence interval (CI) 0.10.8), anemia increases the adverse risk by 3 times (OR=3.1, CI 1.18.9). The main clinical conditions associated with a higher risk of developing malnutrition were anemia (OR=3.1, CI 1.18.9) and chewing problems (OR=2.8, CI 0.97.8).&#x0D; CONCLUSIONS: Conducting a nutrition assessment and drawing up a program for the prevention of malnutrition syndrome in centenarians will improve the quality of life and increase life expectancy.

Creating a Self-management Mobile Application for People With Chronic Low Back Pain: A Focus Group Study of Unmet Needs and Strategies.

Mobile health can fulfill the unmet needs of patients with chronic low back pain by recommending individualized management plans. Limited mobile applications have been developed based on the needs, preferences, and values relative to self-management of patients with chronic low back pain. This study aimed to explore the experience of patients with chronic low back pain and the desired content, designs, and features of a self-management application. We conducted five focus groups (N = 24). Participants provided feedback on draft contents and they also discussed the desired designs and features of an application while reviewing a low-fidelity prototype. Data were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Three categories and eight subcategories emerged. Participants: (1) confronted difficulties of their pain experience along with vicious cycles of pain and unmet needs; (2) acknowledged the importance of self-management as they lived with chronic low back pain and realized how to self-manage their pain; and (3) suggested ways to fulfill needs and preferences among patients with chronic low back pain. The nature of chronic low back pain causes disruptions well-being and requires constant management. Developing user-centered strategies to enhance knowledge and promote self-management among chronic low back pain patients is required.

Opioid deprescribing in long-term care in Ontario: A comparison of resident and facility characteristics

Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care.

Using an individualized pain management plan for African American adults with sickle cell disease.

The increased lifespan of individuals having sickle cell disease (SCD) causes an overall increase in hospitalizations and more instances in which pain may not be well controlled. The mainstay treatment for severe pain is opioids and the underlying cause. Laws affecting opioid prescribing, implicit bias, racial inequity, poor research funding, and lack of knowledge contribute to poor patient outcomes. Data were collected retrospectively using electronic medical record data from before and after the intervention. The individualized pain management plan (IPMP) was initiated in collaboration with the patient, pain nurse practitioner (NP), and hematologist. The mean length of stay for the traditional pain management plan (TPMP) was 7.89 days compared with 5.66 days for the IPMP, with a mean difference of 2.23 days, t = 2.278, p = .024 ( p < .05). There was a decrease in the admission of the individuals with the IPMP, with 25% readmitted within 30 days of discharge, versus 59.0% who were readmitted using the TPMP. Chi-square showed statistical significance (χ 2 = 61.667, p = .000) in using nonpharmacological interventions with the IPMP group. The IPMP with a patient-centered approach did improve patient outcomes for African American adults living with SCD.

A retrospective study on the clinical use and owner perception of venlafaxine efficacy as part of a multimodal treatment for canine fear, anxiety, and aggression

The serotonin-norepinephrine reuptake inhibitor venlafaxine is labeled for use in the treatment of several emotional disorders in people and has been steadily growing in popularity for the treatment of aggression, anxiety, and fear-related behavior problems in canine patients. Current publications describing the clinical use of venlafaxine in dogs are limited to a narcolepsy-cataplexy case report and its suggested use for pain and narcolepsy. In this retrospective open-label clinical trial, the records for dogs administered venlafaxine for a minimum of 21 days in combination with an individual management and behavior modification plan for the treatment of fear, anxiety, and aggressive behaviors were reviewed. The following factors were considered: owner-reported efficacy, dose range, diagnosis, number of diagnoses, and previously trialed and concurrent medications. Of the 110 dogs included, 71.8% (N = 79) percent of owners reported venlafaxine as helpful during at least one follow-up and 39.1% (N = 43) found it helpful at all three follow-up points. For those who found it helpful, the median dose used was 1.65 mg/kg by mouth every 12 hours (range 0.63-5.91 mg/kg every 12 hours). Venlafaxine was not more helpful in treating any specific diagnosis or number of diagnoses. Due to the efficacy and low frequency of adverse effects (N = 20, 18.2%), venlafaxine might be a useful medication option in dogs showing clinical signs of aggression, anxiety, and fear.

‘Obesity and arthritis’ as the morbid duo: Designing and experimenting a novel strategy for weight reduction at a secondary care ayurveda –arthritis center

Obesity has been a critical confounding factor in arthritis. Its impacts are seemingly more apparent in conditions like knee osteoarthritis but it affects the net outcome in almost every type of arthritis. Reduction of weight is the obvious first advice by a treating physician in such cases. In the absence of a clear roadmap however to reach the goal, It remains an unmet advise for most arthritis patients. Obesity combined with arthritis, becomes a morbid combination where addition of weight adds to intensity of arthritis and arthritis induced limitation of movements adds to the weight. Weight reduction is much tougher in arthritis due to the physical limitations. Noticing this gap of knowledge between desired and achieved, Ayurveda –arthritis treatment and advanced research center at Lucknow has designed a strategic plan as a real help to such people and executed it through the activities focusing upon educating the obese arthritis patients for causes and concerns of obesity in general and individualized management plan through an interactive workshop. A workshop of its own kind was conducted on 24 April 2022. 28 obese arthritics as participants had offered to understand the real need and feasibility of doing these strategically focused activities aiming at weight reduction. This has come up as a new opportunity of help to the obese arthritis patients by empowering them with practical knowledge and tools to reduce weight suiting to their individual capacities and needs. The feedback of the participants provided at the end of the workshop was highly encouraging and has shown that strategically focused activities to bridge the gaps in clinical practice are highly desired and useful.