Number Of Clinic Visits Research Articles

Immune-related adverse events, mood disorders, and the impact of social determinants of health among a national cohort of patients receiving immunotherapy.

364 Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancers such as lung, bladder, head and neck, colorectal cancers, and melanoma. Psychological distress may promote pro-inflammatory states which can exacerbate immune-related adverse events (irAEs) among ICI-treated cancer patients. This study assessed the impact of mood disorders (anxiety and depression diagnoses/medications before or during treatment) on the odds of irAEs among advanced cancer patients receiving ICIs, accounting for clinical characteristics and social determinants of health. Methods: This retrospective cohort study used data from a national sample of N=8,058 deceased adult patients diagnosed with advanced melanoma, lung, colorectal, head and neck, and bladder cancers from the nationwide Flatiron Health electronic health record (EHR) derived de-identified database. Diagnostic codes and medication orders were used to assess for mood disorders and auto-immune conditions documented within 2 years of receiving an ICI (irAEs). Bivariate tests and multivariable logistic regressions with interaction terms were conducted in R. Results: Accounting for age at advanced cancer diagnosis, ethnicity, socioeconomic status, baseline performance status, and number of clinic visits, female patients (aOR 1.25, 95% CI=1.07-1.46, p=0.005), patients seen in an academic practice setting only (aOR=2.16, 95% CI=1.80-2.60, p<0.001), and patients receiving combination CTLA-4 and PD-(L)1 inhibitors (aOR 1.47, 95% CI=1.11-1.95, p=0.008) had higher odds of irAEs compared with male patients, patients treated in community settings only, and patients receiving PD1/L1 inhibitors only. Non-White (aOR 0.61, 95% CI=0.49, 0.77, p<0.001), bladder (aOR 0.53, 95% CI= 0.37, 0.78, p=0.001) and colorectal cancer patients (aOR=0.55, 95% CI=0.32, 0.91, p=0.024) had lower odds of irAEs compared with White and melanoma patients. Insurance type moderated the relationship between mood disorders and IrAEs; commercially-insured ICI patients with mood disorders had higher odds of irAEs (aOR 1.65, 95% CI=1.16, 2.35, p=0.006) compared with Medicare-insured ICI patients with mood disorders. Conclusions: Social determinants of health such as insurance access may exacerbate the relationship between mood disorders and irAEs. These findings have implications for health equity and are an area warranting further study. Future analyses will also examine directionality of the associations between mood disorders and irAEs.

Impact of the COVID-19 Pandemic on People Newly Diagnosed with HIV and those Already in -care in Türkiye.

COVID-19 has inevitably influenced health systems. HIV testing rates have been reduced, and access to antiretroviral treatment has been scaled down. We evaluated the impact of COVID-19 on the management of people living with HIV (PLWH) in Türkiye. We conducted a cross-sectional study in three tertiary care hospitals. We compared the baseline characteristics at the first visit and viral suppression rates at the 24th week of new HIV diagnoses during the pandemic with those during the previous two years. To observe the effect of the pandemic on people living with HIV who were already in care, we compared the metabolic and clinical parameters like weight, blood pressure, blood lipid levels, fasting glucose levels, and liver and renal function tests, of the same people before and during the pandemic. The first group included 380 cases (127 diagnosed during the pandemic and 253 diagnosed during the previous year). The demographic characteristics were similar. The newly diagnosed PLWH during the pandemic had significantly higher baseline HIV RNA levels (p=0.005), a lower number of clinical visits (p=0.0005), and a lower number of cases with undetectable viral loads at 24 weeks of treatment (p=0.0005) than those diagnosed during the pre-pandemic period. The second group included 261 individuals with a mean follow-up duration of 24.7 (SD± 3.5; min- max 12-144) months. The comparison of laboratory parameters revealed that in the postpandemic period, virologic suppression was maintained at 90.1%, body mass index (p=0,0001), total cholesterol (p=0,0001), and LDL levels (p=0,0001) increased significantly, and creatinine levels decreased significantly (p=0,0001). Our study showed that COVID-19 deteriorated the HIV management of PLHIV. Strengthening the medical infrastructure of basic services for PLWH is critical for future crises.

Analysis of the Characteristics of Patients Visiting the Tokyo 2020 Olympics Polyclinic.

To evaluate the characteristics of patients who visited the Polyclinic during the Tokyo 2020 Olympics and analyze geographical and economic correlations with the number of clinic visits. Cross-sectional study. Polyclinic during the Tokyo 2020 Olympics. Patients who visited the Polyclinic. Data from the electronic medical record system of the Polyclinic were extracted. The number of visits for each athlete or team official was calculated by country. Relationship between number of visits per patient and total number of team members, total health expenditure per capita, density of medical doctors, life expectancy at birth, and education expenditure per gross domestic product (GDP) were investigated. Independent variables related to medal tables were also investigated. The average number of visits per athlete was 0.67, and it was higher in athletes from non-high-income countries compared with high-income countries for both male and female athletes. Number of visits per athlete was higher in countries with low life expectancy at birth (95% CI, -0.16 to -0.02, P = 0.012) and education expenditure per GDP (95% CI, -0.17 to -0.04, P = 0.003). During the Tokyo 2020 Olympics, the number of visits to the Polyclinic per athlete was higher in countries with low life expectancy at birth and education expenditure per GDP.

The Efficacy of Multi-Layer Compression System and TIME-Concept for the Management of Leg Ulcers in Patients with Ambulatory Venous Hypertension – Truth and Myth

Introduction: Venous leg ulcers are late manifestations of chronic venous insufficiency that can cause disability and serious complications. The elderly are more commonly affected. This study was designed to test the effectiveness, healing rates, quality of life and costs of multi-layer compression system and TIME-concept (tissue management, infection control, moisture balance and wound edge optimization) for the management of leg ulcers in patients with ambulatory venous hypertension.Methods: A prospective clinical study on 50 outpatients with venous leg ulcers, treated three times weekly for 12 weeks or until healed, with all patients consenting and independently mobile associated with a multi-layer compression system along with the TIME-concept treatment.Results: The study revealed that, the cohort was predominantly female (66%) with a mean age of 61.7 years. Universal presence of varicose veins and secondary lymphedema was noted. Specific conditions included postthrombotic syndrome (24%), calf pump dysfunction (8%), and venectomy history (32%). All patients achieved complete epithelialization, with an average healing time of 8.5±8.3 weeks and a median of 5.5 weeks (P=0.0064), with 88% healing within 12 weeks. No significant complications were reported. The median number of clinic visits was 16.5, and the median treatment cost was UAH 11,240.00. Patients’ satisfaction with the treatment was 100% according to completed wound healing.Conclusions: The study demonstrates effective management of venous leg ulcers using a multi-layer compression system and the TIME concept, achieving high healing rates with minimal complications and manageable treatment costs.

P-388 The science of frozen embryo transfer, is modified natural cycle better?

Abstract Study question Do live birth rate, obstetric outcomes and number of clinic visits differ between frozen embryo transfer in modified natural and artificial cycle? Summary answer Modified natural cycle yielded a higher live birth rate for the similar number of visits, less hypertension, but higher rate of gestational diabetes. What is known already A frozen embryo transfer in a modified natural cycle entails procedure timing such that it coincides with the woman’s ovulatory cycle. Conversely, a frozen embryo transfer in an artificial cycle involves controlled hormonal stimulation, with the subsequent scheduling of embryo transfer. Based on the current evidence, there is no difference in pregnancy rates between modified natural cycle and artificial cycle. Frozen embryo transfer during an artificial cycle allows for greater flexibility for the patient and physicians. However, it seems to be associated with higher risk of adverse obstetric and neonatal outcomes. Study design, size, duration 1206 frozen embryo transfer cycles between January 1st, 2022, and December 31st, 2022 were retrospectively studied. Patients older than 40, with recurrent implantation failure, and recurrent pregnancy loss were excluded. Patients were divided according to their age, BMI, AMH, and the type of embryo transfer protocol. Compared outcomes were endometrial thickness, biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, number of clinic visits prior to transfer, obstetric complications, livebirth rate, and livebirth weight. Participants/materials, setting, methods Patients in the modified natural cycle group were followed by ultrasound and when the endometrium reached a thickness ≥ 7mm, and a dominant follicle ≥ 15 mm, HCG trigger was given, and the embryo (blastocyst) transferred 7 days later. In the artificial cycle group, patients received estrogen supplementation either orally or by patches and when the endometrium reached a thickness ≥ 7 mm, embryo transfer was scheduled following intramuscular progesterone administration for 6 days. Main results and the role of chance Patients with modified natural cycle (n = 250) embryo transfers have better clinical pregnancy rate compared to the embryo transfers (n = 250) in artificial cycles (63,6% vs 55,2% p = 0,05), and significantly better live birth rate (57,2% vs 43,9% p = 0,003) despite similar biochemical pregnancy rate (64% vs 61% p = 0,48). The miscarriage rate was significantly lower in modified natural compared to artificial cycles (10,2 % vs 20,99%, p = 0,008). Similar results were found with the transfer of PGTA tested embryos. There was no difference in the endometrial thickness between the 2 groups. The number of visits was higher in the modified natural cycle group, but the difference was not clinically significant (1,57 days vs 1,2 days). When comparing the obstetric outcomes, patients with a modified natural cycle transfer had a lower risk of hypertension (6,6% vs 13,5 % p = 0,10), but a significantly higher risk of gestational diabetes (19% vs 8,3% p = 0,02). No difference was observed regarding the birth weight, percentage of preterm birth or mode of delivery. Regression analysis was performed to identify any cofounder that might have affected the clinical pregnancy rate, and the results showed that the type of transfer was the only factor affecting the outcomes (OR: 1,23 CI: 1,03- 1,46) Limitations, reasons for caution The main limitation of this study is its retrospective nature. A randomized controlled study should be performed to confirm these findings. Wider implications of the findings Modified natural embryo transfer could be used to improve pregnancy outcomes. With proper scheduling, embryo transfer could be done with a similar number of visits for modified natural cycles and artificial cycles. More studies are needed to assess the increased risk of gestational diabetes with natural cycle embryo transfer. Trial registration number NCT06053827

Trends of Buprenorphine Prescribing for Opioid Dependence Before, and During the Early and Later Part of the COVID-19: A Study from a Large Publicly-Funded Opioid Agonist Treatment Services in India.

The COVID-19 pandemic has affected the availability and access to medications for opioid dependence (OD). We examined the monthly trends in new buprenorphine/naloxone (BNX) treatment episodes, number of clinical visits for BNX, BNX dispensed per person, and BNX prescription over 56-month, which included pre-pandemic, during early, and later part of pandemic (Jan 2017 - Aug 2022). Research data were collected from the pharmacy database of a large publicly funded treatment center in India. A flexible, low-threshold service was adopted in April 2020 in response to the lockdown implemented on 25 March 2020. Change Point analyses were performed to examine monthly trends visually and statistically. We used Autoregressive integrated moving averages to forecast trends from April to Aug 2020 and March to August 2022, using Jan 2017 to March 2020 and March 2020 to February 2022 as training datasets. 993 patients were started on BNX treatment, 40452 BNX clinic attendances were made, 1401393 BNX tablets were dispensed, and 6795 new patients with OD were registered. The observed data for clinic attendance for BNX was significantly lower than the projected estimates in April -Aug 2020; however, observed new treatment episodes and monthly BNX prescriptions were within the 95% projected estimates; BNX dispensed per person was significantly more than the projected estimate. In contrast, observed BNX prescription trends surpassed the upper limit of 95% CI in March-Aug 2022. A low-threshold and flexible treatment service could mitigate the unintended consequences of pandemic-induced restrictions.

Intimate Partner Violence and Human Trafficking Screening and Services in Primary Care Across Underserved Communities in the United States-Initial Examination of Trends, 2020-2021.

The Health Resources and Services Administration (HRSA) began collecting data on intimate partner violence (IPV) and human trafficking (HT) in the 2020 Uniform Data System (UDS). We examined patients affected by IPV and HT served by HRSA-funded health centers in medically underserved US communities during the COVID-19 pandemic. We established a baseline and measured trends in patient care by analyzing data from the 2020 (N = 28 590 897) and 2021 (N = 30 193 278) UDS. We conducted longitudinal ordinal logistic regression analyses to assess the association of care trends and organization-level and patient characteristics using proportional odds ratios (PORs) and 95% CIs. The number of clinical visits for patients affected by IPV and HT decreased by 29.4% and 88.3%, respectively, from 2020 to 2021. Health centers serving a higher (vs lower) percentage of pediatric patients were more likely to continuously serve patients affected by IPV (POR = 2.58; 95% CI, 1.01-6.61) and HT (POR = 6.14; 95% CI, 2.06-18.29). Health centers serving (vs not serving) patients affected by IPV were associated with a higher percentage of patients who had limited English proficiency (POR = 1.77; 95% CI, 1.02-3.05) and Medicaid beneficiaries (POR = 2.88; 95% CI, 1.48-5.62), whereas health centers serving (vs not serving) patients affected by HT were associated with a higher percentage of female patients of reproductive age (POR = 15.89; 95% CI, 1.61-157.38) and urban settings (POR = 1.74; 95% CI, 1.26-2.37). The number of clinical visits for patients affected by IPV and HT during the COVID-19 pandemic declined. Delayed care will pose challenges for future health care needs of these populations.

Correction of Brassiere Strap Grooving with Injectable Poly-L-Lactic Acid in Plastic Surgery Resident Filler and Neuromodulator Clinic.

Poly-L-lactic acid (PLLA) is a biocompatible synthetic polymer that induces neocollagenesis by fibroblasts after placement into the reticular dermis and subcutaneous plane. We present an innovative use of this product to treat brassiere strap grooves. The size and weight of hypertrophied breasts can cause physical and psychological problems that can be corrected with reduction mammaplasty. However, bra strap grooving remains an unsightly consequence of brassiere use with large and heavy breasts. PLLA provides an innovative way to treat this deformity in a minimally invasive way, while maintaining relatively long-term results of two years or more. We studied 10 patients who presented to resident filler and neuromodulator clinic to help improve the bra strap groove deformity. The average number of clinic visits was 3.1. The average total number of vials injected was 2.58 on the right and 2.92 on the left. There were no complications or side effects, apart from one patient who reported injection site bruising. Patient surveys demonstrated 70% satisfied with the results and 30% very satisfied. We also discuss resident filler and neuromodulator clinic as an opportunity for resident research.

The Relationship between Fine Particle Matter (PM2.5) Exposure and Upper Respiratory Tract Diseases.

PM2.5 is one of the most harmful components of airborne pollution and includes particles with diameters of less than 2.5 μm. Almost 90% of the world's population lives in areas with poor air quality exceeding the norms established by the WHO. PM2.5 exposure affects various organs and systems of the human body including the upper respiratory tract which is one of the most prone to its adverse effects. PM2.5 can disrupt nasal epithelial cell metabolism, decrease the integrity of the epithelial barrier, affect mucociliary clearance, and alter the inflammatory process in the nasal mucosa. Those effects may increase the chance of developing upper respiratory tract diseases in areas with high PM2.5 pollution. PM2.5's contribution to allergic rhinitis (AR) and rhinosinusitis was recently thoroughly investigated. Numerous studies demonstrated various mechanisms that occur when subjects with AR or rhinosinusitis are exposed to PM2.5. Various immunological changes and alterations in the nasal and sinonasal epithelia were reported. These changes may contribute to the observations that exposure to higher PM2.5 concentrations may increase AR and rhinosinusitis symptoms in patients and the number of clinical visits. Thus, studying novel strategies against PM2.5 has recently become the focus of researchers' attention. In this review, we summarize the current knowledge on the effects of PM2.5 on healthy upper respiratory tract mucosa and PM2.5's contribution to AR and rhinosinusitis. Finally, we summarize the current advances in developing strategies against PM2.5 particles' effects on the upper respiratory tract.

Demographics and clinical features associated with rates of electronic message utilization in the primary care setting

IntroductionElectronic messages are growing as an important form of patient-provider communication, particularly in the primary care setting. However, adoption of healthcare technology has been under-utilized by underserved patient populations. The purpose of this study was to describe how adoption and utilization of electronic messaging occurred within a large primary care urban-based patient population. MethodsIn this retrospective study, the frequency of electronic messages initiated by adult outpatient primary care patients was observed. Patients were classified as either non-portal adopters, non-message utilizers, low message utilizers, and high message utilizers. Logistic regression modeling was used to compare factors associated with message utilization rates to determine disparities in access. ResultsAmong a sample of 27,453 ethnically diverse adult patients from the Houston, Texas Metropolitan area, 33,497 unique messages were sent (1.22 messages/patient). Message burden was predominantly derived by a small number of high utilizers (individuals who sent 3 or more messages), who comprised 15.7 % of the study population (n = 4302) but accounted for 77 % of the message volume (n = 25,776). These high utilizers were typically older, White, English speaking, from middle to upper income zip codes, had higher number of comorbidities, and a higher number of clinical visits. ConclusionsMost inbox messages were generated by a small number of patients. While it was reassuring to see older and sicker individuals utilizing electronic messaging, patients from minority and/or lower income background utilized electronic messaging much less. This may propagate systematic bias and decrease the level of care for traditionally underserved patients.

The effectiveness of continuity of care in patients with inflammatory bowel disease: a systematic review

AimTo investigate the effectiveness of continuity of care in patients with inflammatory bowel disease.BackgroundThe prevalence of inflammatory bowel disease(IBD) is increasing by years, especially in China. Moreover, IBD is prolonged and difficult to heal, which seriously impairs the quality of life of patients. Some studies have identified that continuity of care could contribute to the improvement of the quality of life, but the results remains inconclusive in patients with IBD.MethodsPRISMA guidelines was the outline of this study. Review Manager Software (version 5.3) was used to carry out the data analysis. Outcome assessments included quality of life (QoL), remission rates, number of outpatient clinic visits, and medication adherence.ResultsUltimately, 12 studies involving 2415 patients were brought into this meta-analysis. The results indicated there was no significant difference for continuity of care to improve the QoL in intervention group (SMD = 0.02, 95% CI: -0.08, 0.12). Besides, the remission rates of disease had no difference with those patients in the two groups (OR = 1.07, 95% CI: 0.72, 1.60). However, continued care could contribute to the number of outpatient clinic visits (MD = -0.84, 95% CI: -1.19, -0.49) and patients’ adherence to medication significantly (OR = 2.40, 95% CI: 1.16, 4.95).ConclusionsIBD patients could benefited from continuity of care with reducing their number of clinic visits and improving medication adherence. Nonetheless, there was no evidence of continuity of care contribute to QoL and remission of disease for these patients.

Quality of life and burden of disease of vulvar lichen sclerosus: A single-center retrospective study in China.

This study examined the quality of life and burden of disease of vulvar lichen sclerosus (VLS) patients in three states of menstruation to better understand VLS. A total of 607 VLS patients were enrolled into this retrospective study. According to the ages of onset, menarche and menopause, the patients were divided into three groups: prepubertal group (n = 96), reproductive group (n = 400) and postmenopausal group (n = 111). Data were collected by direct interview and clinical examination. A total of 93% of patients had itching, with a median numerical rating scale score of five. In the prepubertal group, the median score was three. Nocturnal itching occurred in 49.6% patients. Nearly half of the patients (45.9%) thought the itching affected their sleep. However, this ratio was very different in the prepubertal group (20.7%). Some patients (12.8%) cleaned their vulva more than seven times per week. Only 17.2% of patients experienced no effect on their sex life. The median dermatology life quality index score in all patients was six, but it was only three in the prepubertal group. The median number of hospital visits was two times, and the number of clinic visits was three times. Previous expenses, in median, were 2000 RMB. For 84.3% patients, the gynecologic clinic was their first choice. VLS places great physical, mental and economic burdens on patients. Patients in the prepubertal group had milder symptoms and dermatology life quality index score. VLS should arouse the attention of patients and specialists.

Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients

Background Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH. Material and methods Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians’ decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery. Results Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment. Conclusion With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.

Comorbid asthma is associated with rhinitis severity in children exposed to air pollutants.

The impact of asthma on the severity of rhinitis when children with allergic rhinitis (AR) are exposed to air pollutants has not been studied. Children with AR (65 with asthma, 208 without asthma), aged 6-13 years, were recruited from a hospital in Taichung, Taiwan, between 2007 and 2011. Correlations between Pediatric-Rhinoconjunctivitis-Quality-of-Life score, nasal peak expiratory flow, and air pollutants were compared. With the same age, research time, and form the same city, children with AR (660 with asthma, 3174 without asthma) were selected from a database. Correlations between clinical visit times for AR and air pollutants were compared. In male children with AR and asthma, both clinical and database studies revealed a correlation between higher rhinitis discomfort (quality-of-life score), higher visit times for AR, and higher PM10, PM2.5, NO2, NMHC concentrations. Correlations between higher nasal inflammation/obstruction (lower expiratory flow) and higher air pollutant concentrations were observed in male children with AR and asthma. In children with AR, comorbid asthma was associated with increased rhinitis severity when they were exposed to air pollutants, and the association was only noted in males. Increased nasal obstruction/inflammation from exposure to air pollutants may be the mechanisms underlying this association. The influence of asthma on the severity of rhinitis when children with allergic rhinitis (AR) are exposed to air pollutants has not been studied. In children with AR, the correlation between higher rhinitis discomfort, higher number of clinical visits for AR, and higher PM10, PM2.5, NO2, NMHC concentrations were only noted in those who also had asthma. The correlation was only noted in male. Comorbid asthma was associated with higher rhinitis severity when children with AR are exposed to air pollutants The association was only noted in male.

Relationship Between Pain and LGBT Status Among Veterans in Care in a Retrospective Cross-Sectional Cohort.

Pain assessment is performed in many healthcare systems, such as the Veterans Health Administration, but prior studies have not assessed whether pain screening varies in sexual and gender minority populations that include individuals who identify as lesbian, gay, bisexual, and/or transgender (LGBT). The purpose of this study was to evaluate pain screening and reported pain of LGBT Veterans compared to non-LGBT Veterans. Using a retrospective cross-sectional cohort, data from the Corporate Data Warehouse, a national repository with clinical/administrative data, were analyzed. Veterans were classified as LGBT using natural language processing. We used a robust Poisson model to examine the association between LGBT status and binary outcomes of pain screening, any pain, and persistent pain within one year of entry in the cohort. All models were adjusted for demographics, mental health, substance use, musculoskeletal disorder(s), and number of clinic visits. There were 1,149,486 Veterans (218,154 (19%) classified as LGBT) in our study. Among LGBT Veterans, 94% were screened for pain compared to 89% among those not classified as LGBT (non-LGBT) Veterans. In adjusted models, LGBT Veterans' probability of being screened for pain compared to non-LGBT Veterans was 2.5% higher (95% CI 2.3%, 2.6%); risk of any pain was 2.1% lower (95% CI 1.6%, 2.6%); and there was no significant difference between LGBT and non-LGBT Veterans in persistent pain (RR = 1.00, 95% CI (0.99, 1.01), p = 0.88). In a nationwide sample, LGBT Veterans were more likely to be screened for pain but had lower self-reported pain scores, though adjusted differences were small. It was notable that transgender and Black Veterans reported the greatest pain. Reasons for these findings require further investigation.

Evaluating a systematic intensive therapy using continuous glucose monitoring and intermittent scanning glucose monitoring in clinical diabetes care: a protocol for a multi-center randomized clinical trial.

As many people with type 1 diabetes find it hard to reach the recommended glycemic goals, even with CGM, this study aims to determine if a closer, digitally supported collaboration on interpreting CGM data together with a diabetes nurse can improve glycemic control. A total of 120 individuals, 18 years and older and with HbA1c ≥ 58 mmol/mol will be included in the study at 8 different sites in Sweden and Norway. To be included, the participants must use a CGM or isCGM and be able to upload the data to the appropriate online service for their clinic and sensor. Both those with insulin pumps and insulin pens will be included in the study. Participants will be randomized into two different groups, that is, the intensive therapy group and the control group. The intensive therapy group will upload their glucose data weekly for the first 4 months and have telephone contact with their diabetes care team to receive support in interpreting CGM data and taking appropriate actions if their mean blood glucose level is above 8.4 mmol/L. After the 4-month-long intensive treatment phase, both randomized groups will have the same number of clinical visits and receive the same type of diabetes support. It is of great importance to find new ways to help people with type 1 diabetes manage their condition as well as they can to help them achieve better glycemic control so that hopefully more people can achieve the recommended glycemic goals, which are associated with fewer diabetes complications. If it is shown that people with type 1 diabetes achieve better glycemic control with intensive therapy, then this can be incorporated into clinical praxis as an option for those not currently reaching the recommended glycemic goals. https://clinicaltrials.gov/study/NCT03474393?locStr=Uddevalla,%20Sweden&country=Sweden&distance=50&cond=Diabetes&aggFilters=ages:adult%20older&state=V%C3%A4stra%20G%C3%B6taland%20County&city=Uddevalla&page=4&rank=34, identifier 03474393.

Factors associated with mobile medical clinic use: a retrospective cohort study

BackgroundMobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension.MethodsWe conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen’s Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors.ResultsOver the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36–1.92; 1.22, 95% CI, 1.02–1.45).ConclusionsMobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.

Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria.

To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases. Comparative cross-sectional study. Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria. Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited. Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases. Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Private:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm. Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use instalment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures. None declared.

Decentralization and Virtualization of INR-based Anticoagulation Control During the COVID-19 Pandemic.

To investigate the effectiveness of the decentralization and virtualization of anticoagulation clinics just before and during the coronavirus disease 2019 (COVID-19) pandemic. We conducted a cohort study investigation at Prince Sultan Cardiac Clinics PSCC Qassim region, Saudi Arabia. To evaluate the effectiveness of the virtual coagulation clinic, we calculated the time in therapeutic range (TTR), Morisky score for adherence, and satisfaction. Demographics of the patients were analyzed to group patients based on their regions or districts to facilitate the visits. Thirteen different PHCs/Hospitals were allocated for decentralization based on patient density in that region. Intensive courses were provided for all general practitioners (GPs) regarding warfarin anticoagulation and point of care testing (POCT) using iSTAT. All appointments were scheduled by WhatsApp, with no more actual visits to the main center. Among the included participants (n = 5616), 61.1% were females, 38.9% were males, and the mean age was 60.5 (18-85) years. The total number of clinic visits was 7303 per month, with an average of 1.3 visits per patient. Approximately 95% of the participants had a valvular indication to receive anticoagulation; of them, 55% underwent mitral valve replacement. Moreover, after the virtualization of the INR clinic, keeping INR levels within a therapeutic range was reported in 80% of patients. Regarding patient satisfaction, 90% of the total population was satisfied by the new experience. Decentralization and virtualization of the INR clinic have similar TTR results if conducted properly.

346. IMPACT OF VIRTUAL POST-OPERATIVE CARE ON ESOPHAGECTOMY PATIENTS DURING THE COVID-19 PANDEMIC

Abstract Background The SARS-CoV-2 pandemic has resulted in disruptions to oncology practices amongst healthcare institutions globally. To adapt, telehealth has been increasingly implemented into oncologic care, including that of esophageal cancer patients, which has been met with overall success. However, there remains a lack of evidence in the literature pertaining to the outcomes of virtual postoperative appointments for esophagectomy patients. Methods We conducted a retrospective cohort study to assess the clinical outcomes of esophageal cancer patients attending phone call follow-up (virtual) visits compared to standard in person care after esophagectomy. Demographic data, clinical and disease characteristics, and hospital visit data within 6 months of operation were collected. This included surgical clinic visits, endoscopies, and emergency room (ER) admissions. Results 168 esophagectomy patients underwent follow-up care between March 2020 to May 2022; 70 virtual and 98 in-person. Patients attending virtual appointments had significantly fewer ED admissions (−0.48, p = 0.005*, 95%CI [−0.80, −0.14]). Number of endoscopy visits (0.36, p = 0.110, 95%CI [−0.08, 0980]) and the number of clinic visits (0.42, p = 0.118, 95%CI [−0.11, 0.93]) were similar between the two cohorts. ER visits for virtual cohort included feeding tube complications (20.0%), dysphagia (20.0%), and abdominal pain (13.3%). For the in-person cohort, feeding tube complications (12.8%) and chest pain or cardiac features (9.3%) were the most common reasons. Conclusion The results of this study provide evidence for the increased use of telehealth following esophagectomy. The reduction in emergency admissions in the virtual cohort may be due to increased comfort with phone call appointments or increased fear of hospital visitation during the pandemic.